HIT Standards Committee Meaningful Use Workgroup Update

1. HIT Standards CommitteeMeaningful Use Workgroup Update Paul Tang, Palo Alto Medical Foundation, Chair George Hripcsak, Columbia University, Co-Chair April 20, 2011 1

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 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 • Overview of MU WG’s work plan • High-level summary of comments • Review HITECH statutory constraints • Discussion of timing options

4. MU Stage 2 Recommendations Work Plan • Hearings on stage 2 in 2010: • Specialists; smaller practices and hospitals • State issues • Health care disparities • Patient and family engagement • Population and public health • Care coordination • Dec, 2010 HITPC feedback on initial stage 2 draft criteria • Jan, 2011 Request for Comment (due Feb 25, 2011) • Mar, 2011 ONC summarizes 422 organizational comments • Apr/May: MU WG revises draft recommendations in response to RFC input, other WG recs (e.g., IE, P&S, PCAST, QM) • May 11, 2011: Present revised set of stage 2 MU recommendations to HITPC • May 13: Hearing on specialists and feedback from field • June 8, 2011: Final stage 2 MU recommendations for HITPC approval

5. High-Level Summary of Comments -- 1 • 422 organizations submitted comments • Changes to existing objectives generally supported • Some question as to degree (such as increasing threshold and broadening the definition, e.g., CPOE) • Strong support for these new objectives: • eRx for discharge prescriptions • Electronic clinical progress notes • Electronic medication administration record • Patient-provider secure messaging • Recording patient preferences for communications • Mixed support for these new objectives: • Advanced directives for EPs • View & download longitudinal record • List of care team members • Longitudinal care plan

6. High-Level Summary of Comments -- 2 • Concerns about new objectives often related to: • Clarity of definitions/expectations • Timeline for developing and implementing new functionality • Request for recording structured family health history data

7. HITECH Statutory ConstraintsImpact on Meaningful Use Stages Timeline • Medicare incentives are front-loaded (max for EP: 2011-12; Hospitals: 2011-13) and diminish over time; In Medicaid, can receive full payment as long as 6 qualifying years of payment by 2021 • No incentives if not meaningful user by 2014 for Medicare • Final payments in 2016 for Medicare, 2021 for Medicaid • Medicare penalties for failing to qualify as meaningful user begins in 2015 for Medicare; no penalties under Medicaid • Criteria for qualifying as meaningful user can be raised by HHS beyond 2015 •  Incentive policy lever is front-loaded; Medicare penalties persist

8. Timing of Stage 2 • Some support current timeline (e.g., consumers /purchaser, health plans, disease management organizations) • Some propose lengthening timeline (e.g., hospitals, physicians, EHR vendors) • Timing issues: • EHR vendor development time (e.g., specification, development, testing, deployment) • Provider implementation and training time • HIE governance time (e.g., trust-building, policy development, standards implementation) • For new functionality: • Final Rule/Certification criteria  vendor development  provider implementation  reporting period  MU qualification for incentives • For existing functionality (already certified): • Final Rule  provider implement increment  reporting period  MU qualification for incentives

9. Illustrative Timing Options for Stage 2 • Maintain current timeline and one-year reporting period; or • Maintain current timeline and permit 90-day reporting period (gain up to 9 months delay); or • Delay transition from stage 1 to stage 2 by one year (providers could get third-year payment for meeting stage 1 expectations); or • Phase-in approach that separates existing from new functionalities • 2013: Stage 2a using existing certified EHR functions with all-core objectives, increased performance thresholds and new quality measures • 2014: Stage 2b objectives requiring new EHR functionalities take effect • Other?

10. Summary • General support for stage 2 recommendations • Some new requirements need further clarification and attention to some detailed questions • Significant concern about time required for development and implementation of new functionality • MU WG is working on reconciliation of comments and addressing details of new requirements • Will present full draft recommendations at May 11 HITPC meeting for feedback prior to final recommendations on June 8