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HIT Policy Committee Meaningful Use Workgroup Presentation to HIT Policy Committee. Paul Tang, Palo Alto Medical Foundation, Chair George Hripcsak, Columbia University, Co-Chair June 8, 2011. Workgroup Membership. Co-Chairs: Paul TangPalo Alto Medical Foundation - PowerPoint PPT Presentation

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HIT Policy Committee Meaningful Use Workgroup

HIT Policy CommitteeMeaningful Use WorkgroupPresentation to HIT Policy CommitteePaul Tang, Palo Alto Medical Foundation, ChairGeorge Hripcsak, Columbia University, Co-Chair

June 8, 2011Workgroup MembershipCo-Chairs:Paul TangPalo Alto Medical FoundationGeorge Hripcsak Columbia University

Members:David BatesBrigham & Womens HospitalMichael BarrAmerican College of PhysiciansChristine BechtelNational Partnership/Women & FamiliesNeil CalmanInstitute for Family HealthArt DavidsonDenver Public HealthMarty FattigNemaha County HospitalJames FiggeNY State Dept. of HealthJoe FrancisVeterans AdministrationDavid LanskyPacific Business Group/HealthDeven McGrawCenter/Democracy & TechnologyJudy MurphyAurora Health CareLatanya SweeneyCarnegie Mellon UniversityKaren TrudelCMSCharlene UnderwoodSiemens2AgendaContextAlignment with National Quality StrategyTiming proposalRevised recommendations to HITPCincorporating:May 11 HITPC feedbackAdditional public hearingSpecialists issuesEarly experience from the fieldNext stepsRecommendations to ONCRequests for HIT Standards Committee (HITSC)3Key Principles Driving Stage 2 RecommendationsAlign Meaningful Use (MU) objectives with National Quality Strategy prioritiesEnsure MU lays adequate HIT infrastructure to achieve delivery system changes required for Affordable Care Act (ACA) reformsEnsure technical and implementation feasibilityEncourage and reward early adopters

4Escalator Principle: Slope = Rise/Run Data Capture & SharingAdd in key elements of NQS/delivery system reforms5EHR Core Functionalities

EHR Core Functionalities Lay Foundation for Better OutcomesNational Quality Strategy Priorities (1 of 3)National Quality Strategy PrioritiesFuture MU RequirementItalicized objectives indicate only change in threshold from stage 1Making care safer by reducing harm caused in the delivery of care. Electronic medication administration recordCPOE (broaden definition/raise thresholds)Medication reconciliationCDSSafety-related CQMsDrug-drug, drug-allergy checksMedication allergy listeRxEnsuring that each person and family are engaged as partners in their care. New CQMs in development Stage 3:Secure messaging Report experience of careView & download Incorporate patient dataRecording patient preferencesRecord advanced directivesRecord demographics (raise threshold 5080%Discharge instructions in common primary languagesPatient reminders Patient-specific education resources Clinical summaries 7National Quality Strategy Priorities (2 of 3)National Quality Strategy PrioritiesFuture MU RequirementItalicized objectives indicate only change in threshold from stage 1Promoting effective communication and coordination of care. HIEList of care team membersLongitudinal care planMedication reconciliationShare summary care recordElectronic clinical lab results Send electronic lab results to outpatient providerElectronic progress notes that are searchableCare coordination CQMsActive med and problem list Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease. Registries/generate patient lists for specific conditions Patient-specific education resources Record and chart vital signsRecord smoking statusStage 3: Self-management tools; family historyRecord demographics (use IOM categories)

8National Quality Strategy Priorities (3 of 3)National Quality Strategy PrioritiesFuture MU RequirementItalicized objectives indicate only change in threshold from stage 1Working with communities to promote wide use of best practices to enable healthy living. Public health objectives Stage 3: Public health button & patient-reported dataMaking quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models. CPOE (extend to radiology)CDS (to prevent repetitive testing)Drug formulary checks 9Reminder of Stage 2 Timing IssueTiming of EHR Certification and MU Stage Objectives

10Draft Timing OptionsRelative Impact on Program AttributesMaintain current timeline and one-year EHR reporting period; orMaintain current timeline and permit 90-day EHR reporting period; orDelay transition from stage 1 to stage 2 by one year only for providers who qualify for MU in 2011Impact of Timing Option on:Option 1Option 2Option 3Establishment of infrastructure for delivery system reform+ ++0Vendor development timeline (new functionality)- -- + +Provider implementation timeline- -0+ +ICD-10 synergy--+CMS & states program operational complexity0-0CQM measurement & reporting0-0Probability of recommendations standing in Final Rule-++ +Optimize overall MU momentum-0+ +++ = implementing this option strongly supports this attribute; + = implementing this option supports this attribute0 = implementing this option has relatively no impact on this attribute; - = implementing this option negatively impacts this attribute; -- = implementing this option has a significant negative impact on this attribute

11Draft Stage 2 MU ObjectivesImproving Quality, Safety, Efficiency & Reducing DisparitiesStage 1 Final RuleHITPC Proposed Stage 2Key: Red indicates proposed change based on HITPC 5/11 commentsImproving Quality, Safety, Efficiency & Reducing Health Disparities>30% of unique patients with at least one med order have at least one med order entered using CPOE

Raise threshold to >60% for medication orders and include at least one lab order using CPOE for >60% of unique patients who have at least one lab test result; at least one radiology test is ordered using CPOE (unless no radiology orders)Implement drug-drug and drug-allergy interaction checks (enabled functionality)Employ drug interaction (drug-drug, drug-allergy) checking; Providers have the ability to refine DDI rules. [In stage 3, goal is to have nationally endorsed lists of DDI with higher positive predictive value and ability to record reason for overriding alert]EP: Generate and transmit permissible prescriptions electronically for >40% of prescriptions50% of outpatient medication orders and 10% of hospital discharge medication orders transmitted as eRx>50% of all unique patients have demographics recorded as structured data. (preferred language, gender race ethnicity, DOB, date and preliminary COD- EH ONLY). 80% of patients have demographics recorded and can use them to produce stratified quality reports; for stage 3, use more granular demographic categories per IOM report (HITSC needs to work on standards for granular demographics)

Report CQM as per CMS attestation

Report CQM electronically as per CMS

Maintain an up-to-date problem list for >80% of all unique patientsMaintain problem list (80%)12Stage 1 Final RuleHITPC Proposed Stage 2Key: Red indicates proposed change based on HITPC 5/11 commentsMaintain active med list for >80% of all unique patientsMaintain active med list (80%)Maintain active med allergy list for >80% of all unique patientsMaintain active med-allergy list (80%)

Record and chart vital signs for >50% of all unique patients age 2 and over80% of patients have vital signs recorded during the reporting year; change age for peds BP from 2 yrs to 3 yrsRecord smoking status for >50% of all unique patients 13 years or older80% of patients have smoking status recorded [stage 3 add new field in certification for secondhand smoke]Implement 1 clinical decision support rule relevant to specialty or high clinical priority along with ability to track complianceUse CDS; HITSC: Suggest changing certification criteria definition as indicated on comment summaryMenu: Implement drug-formulary checks with access to at least one drug formulary Move to Core: Implement drug formulary checks according to local needs (e.g., may use internal or external formularies, which may include generic substitution as a formulary check)Menu: Record AD for 50% of all unique patients 65 years and olderMove to Core: For hospitals (inpatient), 50% of patients 65 years and older have recorded whether an advance directive exists (with date and timestamp of recording) and access to a copy of the directive itself if it exists; for EPs, >25 unique patients have recorded whether an advance directive exists (with date and timestamp of recording) and access to a copy of the directive itself if it; (signal ability to store and retrieve AD for Stage 3)Draft Stage 2 MU ObjectivesImproving Quality, Safety, Efficiency & Reducing Disparities, II13Stage 1 Final RuleHITPC Proposed Stage 2Key: Red indicates proposed change based on HITPC 5/11 commentsMenu: Incorporate clinical lab-tests results as structured data for more than 40% of all lab tests results orderedMove to Core: Incorporate lab results as structured data (40%); HITSC: Use LOINC where availableNewEHs: Hospital labs send (directly or indirectly) structured electronic clinical lab results to outpatient providers for 40% of electronic orders received; HITSC: Use LOINC where available; (note challenge to small hospitals; may require exclusions)Menu: Generate at least one report listing patients by specific conditionsMove to Core: Generate patient lists for multiple patient-specific parametersMenu: Send an appropriate reminder for preventive/follow up care to more than 20% of all unique patients 65 years or older or 5 years or younger Move to Core: EPs:10% of all active patients are sent a clinical reminder (reminder for existing appointment does not count)New30% of EP visits have at least one electronic EP note and 30% of EH patient days have at least one electronic note by a physician, NP, or PA; non-searchable, scanned notes do not qualify [use broad definition of qualifying note types]NewEH medication orders automatically tracked via electronic medication admin