HIT Policy Committee Meaningful Use Workgroup Presentation to HIT Policy Committee

1. HIT Policy CommitteeMeaningful Use WorkgroupPresentation to HIT Policy Committee Paul Tang, Palo Alto Medical Foundation, Chair George Hripcsak, Columbia University, Co-Chair June 8, 2011

2. Workgroup Membership Co-Chairs: Paul Tang Palo Alto Medical Foundation George Hripcsak Columbia University Members: • David Bates Brigham & Women’s Hospital • Michael Barr American College of Physicians • Christine Bechtel National Partnership/Women & Families • Neil Calman Institute for Family Health • Art Davidson Denver Public Health • Marty Fattig Nemaha County Hospital • James Figge NY State Dept. of Health • Joe Francis Veterans Administration • David Lansky Pacific Business Group/Health • Deven McGraw Center/Democracy & Technology • Judy Murphy Aurora Health Care • Latanya Sweeney Carnegie Mellon University • Karen Trudel CMS • Charlene Underwood Siemens

3. Agenda • Context • Alignment with National Quality Strategy • Timing proposal • Revised recommendations to HITPC—incorporating: • May 11 HITPC feedback • Additional public hearing • Specialists issues • Early experience from the field • Next steps • Recommendations to ONC • Requests for HIT Standards Committee (HITSC)

4. Key Principles Driving Stage 2 Recommendations • Align Meaningful Use (MU) objectives with National Quality Strategy priorities • Ensure MU lays adequate HIT infrastructure to achieve delivery system changes required for Affordable Care Act (ACA) reforms • Ensure technical and implementation feasibility • Encourage and reward early adopters

5. Escalator Principle: Slope = Rise/Run Data Capture & Sharing Add in key elements of NQS/delivery system reforms

6. EHR Core Functionalities Lay Foundation for Better Outcomes EHR Core Functionalities

7. National Quality Strategy Priorities (1 of 3)

8. National Quality Strategy Priorities (2 of 3)

9. National Quality Strategy Priorities (3 of 3)

10. Reminder of Stage 2 Timing IssueTiming of EHR Certification and MU Stage Objectives

11. Draft Timing OptionsRelative Impact on Program Attributes • Maintain current timeline and one-year EHR reporting period; or • Maintain current timeline and permit 90-day EHR reporting period; or • Delay transition from stage 1 to stage 2 by one year only for providers who qualify for MU in 2011 ++ = implementing this option strongly supports this attribute; + = implementing this option supports this attribute 0 = 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

12. Draft Stage 2 MU ObjectivesImproving Quality, Safety, Efficiency & Reducing Disparities

13. Draft Stage 2 MU ObjectivesImproving Quality, Safety, Efficiency & Reducing Disparities, II

14. Draft Stage 2 MU ObjectivesImproving Quality, Safety, Efficiency & Reducing Disparities

15. Draft Stage 2 MU ObjectivesEngaging Patients and Families

16. Draft Stage 2 MU ObjectivesImprove Care Coordination

17. Draft Stage 2 MU ObjectivesImproving Population and Public Health

18. Draft Stage 2 MU ObjectivesEnsure Privacy and Security Protections

19. Priorities for the Health IT Standards Committee • Demographics--Stage 3 includes expansion of existing fields • CDS attributes for certification • Display source/citation of CDS • Configurable based on patient context (e.g., problems, meds, allergies, lab results) • Presented at a relevant point in clinical workflow • Alerts presented to users who can act • Integrated with EHR (ie., not standalone) • eMAR attributes for certification • 1) Check for right patient • 2) Check right medication • 3) Check right dose • 4) Check right route • 5) Record time medication administered • View and capability to download information • 1) Track number of views • 2) Track number of downloads • 3) Electronically counted for compliance and measurement • Summary of care record/plan: Stage 2 includes additional data elements • to be included in the record/plan

20. Priorities for the Health IT Standards Committee • Hospital labs provide structured electronic lab results in LOINC, where available • PH objectives: consider a single standard to be used for the submission of all public health data • PH objective of submitting reportable cancer conditions: Possible use of IHE cancer reporting implementation guide • Timely Electronic Access: P&S Tiger Team consider including a warning message before downloading personal health information

21. Priorities for the Health IT Standards Committee for • Privacy and Security • Standards for recording family history • Patient-generated data submitted to public health agencies • Add new fields in demographics per IOM report • Capability to retrieve AD from EHR • Mechanism for patient entered data • Single factor authentication (user and password) for patient online account • Audit trails for access to patient online account • Provisions for data provenance • View and download function should be secure • Compliance with NWHIN governance policies should be included in Stage 3 certification criteria. Stage 3

22. Summary Recommendations • Delay transition from stage 1 to stage 2 by one year only for providers who qualify for MU in 2011 • Approve recommendations for stage 2 Meaningful Use objectives • Refer stage 2 objectives to HITSC for recommendations on applicable standards