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Meaningful Use Panel: Stage 3 Update Arthur Davidson, MD, MSPH Denver Public Health Council of State and Territorial Epidemiologists Annual Conference Pasadena, CA June 10, 2013. Agenda. Overview of Stage 3 policy perspectives Review of HIT Policy Committee progress

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Presentation Transcript
slide1

Meaningful Use Panel: Stage 3 Update

Arthur Davidson, MD, MSPH

Denver Public Health

Council of State and Territorial Epidemiologists

Annual Conference

Pasadena, CA

June 10, 2013

agenda
Agenda
  • Overview of Stage 3 policy perspectives
    • Review of HIT Policy Committee progress
      • Consolidation and Deeming
  • Public health agency opportunities: on-boarding
  • CSTE and member role during this phase
stages of meaningful use mu improving outcomes
Stages of Meaningful Use (MU)Improving Outcomes

Stage 3

2016-17

Stage 2

2014-15

Stage 1

2011-13

original principles for stage 3 recommendations
Original Principles for Stage 3 Recommendations
  • New model of care:support team-based, outcomes-oriented, population management
  • National health priorities: address National Prevention/Quality Strategies, Partnerships for Patients, and Million Hearts Campaign
  • Broad applicability(since MU is a floor)
    • Provider specialties (e.g., primary care, specialty care)
    • Patient health needs
    • Areas of the country
  • Not "topped out" or not already driven by market forces
  • Mature standardswidely adopted or could be widely adopted by 2016 (for stage 3)
additional goals for stage 3
Additional 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 field
    • to create network effects
    • to fulfill need for a public good
  • Consolidation: combine MU objectives where higher level objective implies compliance with subsumed process objectives
  • Deeming: consider alternative pathways to meet performance and/or improvement thresholds; satisfaction of subset of relevant MU functionality implicitly required to achieve performance/improvement
proposed stage 3 population and public health mu objectives criteria
Proposed Stage 3 Population and Public Health MU Objectives/Criteria

*EH= eligible hospital; EP=eligible Provider

consolidation summary
Consolidation Summary
  • 43 MU Workgroup objectives proposed in stage 3 Request for Comment (RFC)
  • Consolidated to 25 objectives
  • Assumptions
    • Full MU Workgroup will consider RFC feedback and update criteria
    • All criteria will be included in certification
      • Focus on advanced uses
        • e.g., recording data vs. use data
      • Give credit for MU objectives that should be standard of practice once passed stages 1 and 2
      • Identify what needs to be “used” and certified
types of consolidation
Types of Consolidation
  • Advanced within concept of another objective
    • (no current PH example)
  • Duplicative concepts -objective becomes certification only
    • immunization forecasting -> clinical decision support
  • Demonstrated use and can trust that it will continue
    • patient lists, population management, ACO and quality reporting
consolidation overview
Consolidation Overview

Quality, safety, reducing health disparities

Engaging patients & families

Improving care coordination

Population & public health

VDT

ToC – Care summary

Immunization registry

eRx – formulary

EH: Lab results EP

Amendment

CPOE - meds

CPOE - referrals

Syndromic Surveillance

Test tracking

Family Hx

Amendment

Prob, med, allg list

CPOE - lab

Electronic Lab Reproting

Advanced directive

Family Hx

Structured lab

Prob, med, allg list

CDS

Electronic notes

Vitals

Structured lab

CDS for immun

Smoking status

Registries

Pt list/dashboard

Vitals

Demographics

Cancer registry

Smoking status

Reminders

eRx transmission

Specialty registry

Demographics

Comm preference

Patient education

HAI reports

Comm preference

Reconciliation

EH: eMAR

Case reports to PHA

Inter prob list*

Clinical summary

Imaging results

RxHx PDMP*

Adverse event*

Comm preference

CPOE - rad

CPOE - meds

Secure Messaging

Notify of health event

Key:

PGHD

Care plan*

Maintained Objective

Identify clinical trials

Referral loop

Certification Criteria

* Proposed for future stage of MU

deemed mu objectives
Deemed MU Objectives

Deemed in Satisfaction of:

  • Clinical decision support
  • e-Prescribing – formulary, generic subs
  • Reminders
  • Electronic notes
  • Test tracking
  • Clinical summary
  • Patient education
  • Reconcile 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 uptake

Remaining Items:

  • Advance directive
  • E- medication administration record
  • Imaging results
  • EH: provide lab results
  • Patient generated data
  • *View/download/transfer
  • *Secure patient messaging
  • Care summary
  • Care plan
  • Referral loop
  • Notification of health event
  • Immunization registry
  • Electronic laboratory reporting
  • Case reports to public health agency
  • Syndromic surveillance
  • Reporting to 2 registries
  • Adverse event reporting
stage 2 mu on boarding
Stage 2 MU: On-Boarding

EP/EH passes:

Letter for attestation

  • Provider must:
  • register intent by the deadline
  • participate in on-boarding process
  • respond to PHA written requests for action within 30 days on two separate occasions.

EP/EH

Registration of intent

Yes

MU objective met?

PH capable?

No

No

EP/EH exclusion

Yes

Yes

Provider acts?

PH requests provider action

PH on-boards EP/EH

Yes

No

1st Time Failure?

Yes

No

EP/EH fails

CMS Final Rule:

http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-21050.pdf

slide13

Stage 2 MU Public Health Reporting Requirements Task Force

  • Formed to discuss and develop consensus around standardization of the new processes across domains and across jurisdictions
  • Representatives from:
  • ASTHO, NACCHO, AIRA, ISDS, CSTE, JPHIT, NAACCR, state PHAs, ONC, CDC, PHII, others
registries
Registries

Eligible Provider

Eligible Hospital

  • BMI
  • CVD risk
  • Tobacco
  • Mental health

Standard Data

Warehouse

Secure

federated

query

Query Service

Eligible Provider

Eligible Hospital

Secure

federated

query

Secure

Portal

Standard Data

Warehouse

query health pilots
Query Health Pilots

http://wiki.siframework.org/Query+Health+Pilots+Team

slide17

Conclusions

  • Stage 3 MU will push for improved outcomes with greater emphasis on health information exchange
  • Public health agencies will demonstrate their capacity/desire to participate through on-boarding in Stage 2
  • CSTE can provide new data regarding functionality and standards to influence policy decisions
  • CSTE and its members have a unique opportunity to be more strategic, with cross-cutting approaches to informatics investments
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