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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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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)


Lessons from stages 1 implications for stage 3
Lessons from Stages 1Implications 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 Objectives/Criteria

  • 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 Objectives/Criteria

  • 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 Objectives/Criteria

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 Objectives/Criteria

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 Objectives/Criteria

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


Stage 2 MU Public Health Reporting Requirements Task Force Objectives/Criteria

  • 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 Objectives/Criteria

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 Objectives/Criteria

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


Cste position statements
CSTE Position Statements Objectives/Criteria


Conclusions Objectives/Criteria

  • 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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