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HIT Standards Committee. Clinical Operations Workgroup Report Jamie Ferguson, Chair Kaiser Permanente John Halamka, Co-chair Harvard Medical School 21 July, 2009. Clinical Operations Workgroup Members. Christopher Chute, Mayo Linda Dillman, Wal-Mart Martin Harris, Cleveland Clinic

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HIT Standards Committee

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Hit standards committee

HIT Standards Committee

Clinical Operations Workgroup Report

Jamie Ferguson, Chair

Kaiser Permanente

John Halamka, Co-chair

Harvard Medical School

21 July, 2009


Clinical operations workgroup members

Clinical Operations Workgroup Members

Christopher Chute, Mayo

Linda Dillman, Wal-Mart

Martin Harris, Cleveland Clinic

Stan Huff, Intermountain Healthcare

Kevin Hutchinson, Prematics

Liz Johnson, Tenet Healthcare

John Klimek, National Council of Prescription Drug Plans

Wes Rishel, Gartner

Nancy Orvis, Department of Defense

Don Bechtel, Siemens

Joyce Sensmeier, HIMSS

John Halamka, Harvard Medical School

Jamie Ferguson, Kaiser Permanente

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Summary

Summary

The workgroup used a two-phase process first to identify EHR standards, then to assess feasibility for widespread implementation

Almost all of the current 2011 MU measures were addressed

Applicable HHS-adopted, recognized or accepted standards are recommended for 2013 and for 2011

Gaps were identified that may affect 2011 MU measures

Unstructured documents, local and proprietary codes generally are recommended as allowable alternatives for 2011 but not for 2013 reporting of MU measures

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Clinical operations workgroup process

Clinical Operations Workgroup Process

Review proposed MU objectives and measures

Initial focus on proposed MU quality measures

Identify existing EHR standards for MU measures

Existing HHS adopted, recognized and accepted standards

Other widely accepted and widely deployed standards

Gaps in standards for the measure

Identify the feasibility of widespread implementation of the identified national EHR standards by 2011 or 2013 or beyond

“Reality check” notes on requirements and next steps

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Example of clinical operations process

Example of Clinical Operations Process

Pre-decisional Draft Example For Discussion

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Workgroup discussions during process

Workgroup Discussions During Process

  • Concerns were discussed regarding those have not yet implemented, as well as those who have implemented legacy alternatives to HHS adopted standards for MU

  • Main concerns for new implementers included ICD-10

  • The longer the legacy systems are in place, the more is built up around them and the greater the upgrade cost

  • The workgroup agreed not to let these concerns stand in the way of progress, and found interim solutions to ease the path of implementing or upgrading to the standards


Recommendations summary

Recommendations: Summary

Meaningful use based on the standards in recognized and accepted HITSP capabilities is recommended for 2013 and 2011 implementation of the 2011 measures

Includes many uses of CCD, LOINC, RxNorm and other standards referenced in HITSP capabilities

Specific additional alternatives are recommended for interim periods such as specified allowable uses of unstructured documents, local/proprietary codes, and current quality measures for meaningful use in 2011 and 2012

Most alternatives are not recommended for 2013 and beyond

See descriptions and details of HITSP Capabilities in the attached documents

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Recommendations detailed example

Recommendations: Detailed Example

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Clinical operations recommendations

Clinical Operations Recommendations

The workgroup requests Committee approval of the attached detailed recommendations for 2011 measures of meaningful use to be forwarded to ONC

The workgroup requests Committee approval to proceed and to recommend to ONC if adopted standards may apply to the 2011 MU measures not yet addressed

% encounters where med reconciliation was performed

% reportable lab results submitted electronically

30-day readmission rate

The workgroup recommends that ONC determine how to address gaps in standards via HITSP, or direct requests to standards organizations, or other means

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