Improving Outcomes with HIT

1. Improving Outcomes with HIT Kevin Larsen MD Medical Director, Meaningful Use Office of the National Coordinator of Health IT Virginia HIMSS November 7, 2013

4. Change is not ComingChange is here already

5. Change is here • 80% of all Minnesotans in value based purchasing contract for health care • State articulated goal, already at 50% • Medicare and Medicaid with real money on the line for quality outcomes • Phased in to nearly 10% potential loss by 2018 • Arkansas- doubling primary care salaries at from specialist payments

6. Stage 3 Stage 2 Stage 1

7. Hospitals attesting to Meaningful Use, through September 2013 Note: Large = 400+ staffed beds; Medium = 100-399 staffed beds; Small = <100 staffed beds. Rural = non-metropolitan; Urban = metropolitan. See Data Sources and Definitions slides for more details.

8. Hospitals attested to stage 1 MU by 2014 edition certification status of primary vendor 84% (16 vendors) 84% of EHs that have attested to Stage 1 used a primary vendor that had any 2014 Edition product as of 10/21/13 81% (9 vendors) Note: Primary EHR vendors are the vendors whose products are certified to the most 2011 Edition certification criteria in the provider’s EHR system (in cases where a provider used certified products from multiple vendors to attest). Sources: ONC Certified HIT Products List (CHPL) (10/21/2013), CMS Attestation Data (9/30/2013).

9. Professionals attesting to Meaningful Use, through September 2013

10. Professionals attested to stage 1 MU by 2014 edition certification status of primary vendor 69% of EPs that have attested to Stage 1 used a primary vendor that had any 2014 Edition product as of 10/21/13 69% (33 vendors) 58% (21 vendors) Note: Primary EHR vendors are the vendors whose products are certified to the most 2011 Edition certification criteria in the provider’s EHR system (in cases where a provider used certified products from multiple vendors to attest). Sources: ONC Certified HIT Products List (CHPL) (10/21/2013), CMS Attestation Data (9/30/2013).

11. Only those who provide care can improve care

12. The only way you can achieve the triple aim is not to do one thing but to do everything. Don Berwick

13. Office of the National Coordinator for Health Information Technology

14. Office of the National Coordinator for Health Information Technology

15. Office of the National Coordinator for Health Information Technology

16. Computer assisted flying as CDS It is winter, sometimes there is snow. Be careful. Press here to document you read this. Scheduled maintenance due in 2 months, mark here to accept Bathroom water pressure is low

17. “I am the expert about me.”

18. Hurricane Sandy

19. INTEROPERABILITY

20. Complex Adaptive System

21. Quality

22. Quality Ecosystem Local EHR Registry or data intermediary Benchmarking Coaching Technical support Office of the National Coordinator for Health Information Technology

23. HIT enable practice of the future

24. Vision for the Future • Measures Drive Improvement • Real-time • Local ownership with benchmarking • Linked to decision support and patient dashboards • Measures Drive Value-Based Purchasing • Reliable • Accurate • Outcomes-based • Measures Inform Consumers • Meaningful • Transparent

25. Small Data is our Short Term Focus. Dr. Joe Kimura “Small Data is our short term focus” Dr. Joe Kimura

26. Quality Measurement Alignment

27. Three Categories of CMS Programs • Pay-for-Reporting • Provider incentives to report information • Pay-for-Performance • Provider incentives to achieve targeted threshold or clinical performance • Pay-for-Value • Incentives linked to both quality and efficiency improvements

28. CMS’ Vision for Quality Measurement • Align measures with the National Quality Strategy and Six Measure Domains/Priorities • Implement measures that fill critical gaps within the 6 domains • Align measures across CMS programs whenever possible • Core sets of measures • Removal of measures that are no longer appropriate (e.g., topped out) • Align measures with external stakeholders, including private payers and boards and specialty societies • Major aim of measurement is improvement over time

29. CMS has a variety of quality reporting and performance programs * Denotes that the program did not meet the statutory inclusion criteria for pre-rulemaking, but was included to foster alignment of program measures.

30. Medicare Data Sharing for Performance Measurement NOW FUTURE INSURANCE COMPANIES INSURANCE COMPANIES MEDICARE? MEDICARE? Qualified Entity COMPREHENSIVE CONSISTENT FAIRACTIONABLE

31. Future State: HIT Enabled QI Toolkit Stakeholders Unambiguous human readable Value Set Authority Center Public Domain Unambiguous machine readable Population Health Tool EHR Certification Tools Electronic Health Records Clinical Registries Clinical Decision Support CMS Quality Reporting Other HIT Tools

32. Health eDecisions http://wiki.siframework.org/Health+eDecisions+Homepage Office of the National Coordinator for Health Information Technology

33. “I wouldn’t give a fig for simplicity on this side of complexity but I’d give my right arm for simplicity on the other side of complexity.” Oliver Wendell Holmes

34. Questions? Kevin.larsen@hhs.gov For more information about ONC visit: healthIT.gov Office of the National Coordinator for Health Information Technology