What Did I Work on in Washington?

John Glaser

April 16, 2010

Electronic Health Records as a Foundation

TIMETIME

Transformational Change in Health Care Delivery & Population Health

Technology Adoption

20042004 2012?2012?

100

80

60

40

20

0

9%

50%

Size of Practice

> 50 physicians

Per

cent

age

1 - 3physicians

DesRoches CM et al., N Engl J Med 2008;359:50-60.

25

20

15

10

5

0

4%

13%

Level of EHR Function

Fully Functional

Basic System

Per

cent

age

EHR Adoption in Physician Office Practices

American Recovery and Reinvestment Act (ARRA)

Title XIII $2B to the Office of the

National Coordinator for Health IT to develop the foundation necessary for broad adoption of EHRs

Title IV $23B in Medicare and

Medicaid financial incentives to providers who are Meaningful Users of certified, interoperable EHRs (first payment year FY 2011)

The Core Idea

Adoption

Meaningful Use

Outcomes

Examples of Meaningful Use

Maintain an up-to-date problem list of current and active diagnoses

At least 80% of patients seen or admitted have at least one entry

Record smoking status for patients 13 and older

At least 80% of patients seen or admitted have “smoking status” recorded

Send reminders to patients per patient preference for preventive/follow-up care

Reminders sent to 50% of all patients seen that are over 50 years old

Provide patients with an electronic copy of their health information

At least 80% of patients who request an electronic copy are provided it within 48 hours

Provide summary of care record for each transition of care or referral

Summary provided for at least 80% of all transitions of care or referrals

Capability to provide electronic syndromic surveillance data to public health agencies

Perform at least one test of capacity to provide such data

Providers Must Submit Quality Measures

Physicians -Core quality measures-Smoking status-Blood pressure-Drugs to be avoided by the elderly

-Set of 3-5 specialty-specific measures

Hospitals -Thirty-five measures (currently submitting nine for PQRI)

EHRs Must Support Standards

Problem List (ICD-9-CM or SNOMED)

Patient summary (HL7 CDA R2 CCD)

Lab orders and results (LOINC)

Prescriptions (NCPDP SCRIPT 10.6)

Units of measure (UCUM) Quality reporting (CMS PQRI 2008 Registry XML)

Medication List (RxNorm) Submission to public health agencies (HL7 2.3.1)

FY 11 Privacy and Security Standards Must be Implemented

To Receive Payments and Avoid Penalties Providers Must

Implement applications needed to support meaningful use

Certify their electronic health record Support required data, transaction and

quality measure reporting standards Meet privacy and security standards Achieve meaningful use goals

Status of Strategy

Meaningful Use NPRM has been released and comments are being reviewed

Standards and certification criteria IFR has been released and comments are being reviewed

Certification process NPRM was released in February and comments are being received

To Support the Achievement of Meaningful Use Several Grant Programs have been Developed

Extension centers to provide EHR assistance to: Public or not for profit hospitals or critical access hospitals Federally qualified health centers Entities in rural and other areas that serve uninsured,

underinsured, and medically underserved individuals Individual and small group primary care practices

State health information exchanges (HIE) to: Develop and implement HIE privacy and security requirements Develop interoperability directories and technical services Coordinate with Medicaid and state public health programs Ensure effective HIE governance and accountability

To Support the Achievement of Meaningful Use Several Grant Programs have been Developed

Workforce development grants to: Establish electronic health record curriculum Provide training through community colleges

and universities Develop competency-based exams

Beacon communities Identify 15 communities that will address a

community health concern using interoperable electronic health records

To Support the Achievement of Meaningful Use Several Grant Programs have been Developed

Advanced research centers (SHARP) to fund breakthrough research in:

Security of health information technology Patient-centered cognitive support Healthcare application and network platform

architectures Secondary use of EHR data

Status of Strategy

Grants/contracts have been awarded for: Regional extension centers State health information exchanges Workforce development Research centers

Beacon community grants will be announced shortly

CMS Estimates of the Number of Providers who will be Meaningful Users in 2011

Scenario 2011 2012 2013

Eligible Professionals Low 10% 13% 15%

High 36% 40% 44%

Hospitals Low 30% 35% 46%

High 43% 58% 73%

Baselines considerations (2008):

29% of hospitals have some level of medication CPOE (AHA)

4% of eligible professionals have a full function electronic health record

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