meaningful use workgroup meaningful use stage 3 recommendations

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Meaningful Use Workgroup Meaningful Use Stage 3 Recommendations. Paul Tang, chair George Hripcsak , co-chair. Meaningful Use Workgroup Membership. Paul Tang, Chair, Palo Alto Medical Center George Hripcsak , Co-Chair, Columbia University David Bates , Brigham & Women’s Hospital * - PowerPoint PPT Presentation

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Meaningful Use Workgroup Meaningful Use Stage 3 Recommendations

Paul Tang, chairGeorge Hripcsak, co-chair1Meaningful Use Workgroup MembershipPaul Tang, Chair, Palo Alto Medical CenterGeorge Hripcsak, Co-Chair, Columbia UniversityDavid Bates, Brigham & Womens Hospital*Christine Bechtel, National Partnership for Women & Families *Neil Calman, The Institute for Family HealthTim Cromwell, Department of Veterans AffairsArt Davidson , Denver Public Health Department *Paul Egerman , Software EntrepreneurMarty Fattig, Nemaha County Hospital (NCHNET)Joe Francis, MD, Veterans AdministrationLeslie Kelly Hall, HealthwiseDavid Lansky, Pacific Business Group on HealthDeven McGraw, Center for Democracy & TechnologyMarc Overhage, Siemens HealthcareGreg Pace, Social Security AdministrationMarty Rice, HRSARobert Tagalicod, CMS/HHSCharlene Underwood, Siemens *Michael H. Zaroukian, Sparrow Health SystemAmy Zimmerman, Rhode Island Department of Health and Human Services

2* Subgroup LeadsStages of Meaningful UseImproving OutcomesStage 12011-13Stage 22014-15Stage 32016-173Original Principles for Stage 3 RecommendationsSupports new model of care (e.g., team-based, outcomes-oriented, population management)Addresses national health priorities (e.g., NQS, prevention, Partnerships for Patients, Million Hearts)Broad applicability (since MU is a floor)Provider specialties (e.g., primary care, specialty care)Patient health needsAreas of the countryNot "topped out" or not already driven by market forcesMature standards widely adopted or could be widely adopted by 2016 (for stage 3)

4Lessons from Stages 1Implications for Stage 3Stage 1 ExperienceSubstantial increase in adoption rates and effective useMandatory floor creating network effectsThresholds consistently exceeded

Consistent use across the years

Reporting requirements have considerable costs and burdenPrescriptive, forced march impacts available resources for innovation or to address local priorities

Implications for Stage 3Creating critical mass of users and data in electronic formRising tide is floating boats (e.g., setup for patient engagement, HIE)Once MU functionality is implemented, it is usedGains from stage 1 (and 2) will persistStage 3: Simplify and reduce reporting requirementsStage 3: Rely more heavily on market pull (e.g., new payment incentives); promote innovative approaches i.e., reward good behavior5Additional Goals for Stage 3 Address key gaps (e.g., interoperability, patient engagement, reducing disparities) in EHR functionality that the market will not drive alone, but are essential for all providers:to create level playing fieldto create network effectsto fulfill need for a public goodConsider alternative pathway where meeting performance and/or improvement thresholds deems satisfaction of subset of relevant MU functionality implicitly required to achieve performance/improvementConsolidate MU objectives where higher level objective implies compliance with subsumed process objectives6Deeming Pathway7Deeming AssumptionsCannot reliably achieve good performance (or significantly improve) without effective use of HITTherefore: in order to promote innovation, reduce burden, and reward good performance, deem high performers (or significant improvers) in satisfaction of a subset of MU objectives as an optional pathway to qualifying for MU

88Example Criteria for Deeming for EPsDemonstrate high (top 30 %ile) or improved performance (20% reduction of gap between last year's performance and top quartile). Select two items from each of the categories below: Prevention of high priority diseases (pick 2 from)Breast cancer (mammography screening)Colon cancer (colonoscopy screening)Influenza (flu vax)Pneumonia (pneumococcal vaccine)Obesity (BMI screening and follow up)Cardiovascular disease (LDL screen)HTN (BP screen and follow up)Control of high priority chronic health conditions (pick 2 from)HTN (BP control or improvement)Diabetes (A1c control)Heart attack (LDL control)Asthma (controller med)CHF (ACEI or ARB meds)MI (beta blocker)9Example Criteria for Deeming for EHsDemonstrate high (top 30 %ile) or improved performance (20% reduction of gap between last year's performance and top quartile) for all of the below:Patient safety (pick 2 from)Clostridium difficile Infection (outcome measure)Catheter-Associated Urinary Tract Infection (outcome measure)Central Line-Associated Blood Stream Infection (outcome measure)MRSA (outcome measure)Specific Surgical Site Infection (SSI) Outcome MeasureSevere sepsis and septic shock: Management bundleLate sepsis or meningitis in very low birth weight (VLBW) neonates (risk-adjusted)Measure of pressure ulcersCare coordination (pick 2 from)Experience of care (from HCAHPS)?Hospital-wide-all-cause unplanned readmission measure (HWR)CTM-3, 3-item care transition10Additional RequirementDisparitiesStratify all four population reports by disparity variables

11Deemed MU ObjectivesDeemed in Satisfaction of:CDSRemindersElectronic notesTest trackingClinical summaryPatient educationReconcile problems, meds, allergies

*View, download, transmit (VDT), consider adding if stage 2 reports good uptake*Secure patient messaging, consider adding if stage 2 reports good uptakeRemaining Items:Advance directiveeMARImaging resultsEH: provide lab resultsPatient generated data*VDT*Secure patient messagingCare summary Notification of health eventImmunization registryElectronic lab reportingSyndromic surveillanceReporting to registries12Additional ConsiderationsPropose performance reporting period to be 6 months vs. 1-year MU reporting period to give providers a chance to deem yet still have time to resort to functional objectives if not meeting deeming thresholdsSpecialists may have fewer options for deeming as determined by available NQF QMs. If not able to report on at least 4 performance measures, then may not be eligible for the deeming pathway

13Consolidation Work14Consolidation Summary43 objectives, consolidated to 25AssumptionsThe full WG will consider RFC feedback and update criteriaAll criteria will be included in certificationFocus on advanced uses (e.g. recording data vs. use data)Give credit for objectives that should be standard of practice after stages 1 and 2

15Types of ConsolidationAdvanced within concept of another objectiveDuplicative conceptsobjective becomes certification onlyDemonstrated use and can trust that it will continue16Advanced within Concept of Another ObjectivePatient preferred means of communication (SGRP208)

DemographicsAdded as an additional element

Patient education, per patient preference

Clinical Summary, per patient preference

Certification CriteriaMaintained ObjectiveKey:Reminders, per patient preference

17Duplicative ConceptsImmunization intervention (SGRP401B)

CDS (113)Interventions include preventative care for immunizations

Certification CriteriaMaintained ObjectiveKey:18Structured lab results (SGRP114)

Included in care summary (303)

Included in view, download, transmit (204A)

Demonstrated UsePatient lists and dashboards (SGRP115)Needed for population management and quality measurementHow to measure use?Existing external drivers that will drive use (new models of care)19CPOE - Advanced within concept of another objective, duplicative concept, demonstrated use20

CPOE for Medication Orders

Needed to provide meds within care summary (303)Needed to provide meds within VDT (204A)Certification CriteriaMaintained ObjectiveKey:Consolidation OverviewReconciliationCDS

Pt list/dashboardReminders

EH: eMAREH: Lab results EPPGHDClinical summary

Patient education

Secure MessagingNotify of health eventCare plan

Immunization registryAdverse eventCase reports to PHAVDT

ToC Care summary

Advanced directiveRegistries

Synd SurveillanceELRClinical trialsQuality, safety, reducing health disparitiesReferral loopOrder trackingImaging resultsElectronic notesEngaging patients & familiesImproving care coordinationPopulation & public healtheRxCertification CriteriaMaintained ObjectiveKey:21CDS for immunComm preferenceCPOEAmendmentFamily HxComm preferenceComm preferenceCancer registrySpecialty registryHAI reportsCPOE - referralsInter prob listRxHx PDMPFuture StageDemographicsSmokingVitalsABBICDS for listsChanged after consolidation workFamily history was consolidated with VDT, but was moved back to a use case based upon public commentInteroperable problem lists were consolidated in the review process with the care plan both of these are future stage items21Subgroup 1: Improving quality, safety, efficiency and reducing health disparitiesDavid Bates, Subgroup LeadGeorge Hripcsak, MU WG Co-Chair

22SGRP112: Advance DirectiveStage 2 Final RuleStage 3 RecommendationsProposed for Future StageQuestions / CommentsEH MENU Objective: Record whether a patient 65 years old or older has an advance directive

EH MENU Measure: More than 50 percent of all unique patients 65 years old or older admitted to the eligible hospital's or CAH's inpatient department (POS 21) during the EHR reporting period have an indication of an advance directive status recorded as structured data.Ensure standards support in CDA by 2016EP MENU/EH Core Objective: Record whether a patient 65 years old or older has an advance directiveEP MENU/EH Core Measure: More than 50 percent of all unique patients 65 years old or older admitted to the eligible hospital's or CAH's inpatient department (POS 21) during the EHR reporting period have an indication of an advance directive status recorded as structured data. 23Certification and Adoption WG are planning a listening session waiting for feedback from this session.23SGRP113: Clinical Decision Support Stage 2 Final RuleStage 3 RecommendationsEP/EH Objecti

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