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HIT Policy Committee: Meaningful Use Workgroup Stage 3 – Preliminary Recommendations Debrief. Paul Tang, Palo Alto Medical Foundation, Chair George Hripcsak, Columbia University, Co-Chair August 1, 2012 Washington Marriott, 1221 22nd Street, NW, DC 20037. Workgroup Membership. Co-Chairs:

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hit policy committee meaningful use workgroup stage 3 preliminary recommendations debrief

HIT Policy Committee: Meaningful Use Workgroup Stage 3 – Preliminary RecommendationsDebrief

Paul Tang, Palo Alto Medical Foundation, Chair

George Hripcsak, Columbia University, Co-Chair

August 1, 2012

Washington Marriott, 1221 22nd Street, NW, DC 20037

workgroup membership
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
  • Tim Cromwell Department of Veterans Affairs
  • Art Davidson Denver Public Health
  • Marty Fattig Nemaha County Hospital
  • James Figge NY State Dept. of Health
  • Joe Francis Veterans Administration
  • Leslie Kelly Hall Healthwise
  • Yael Harris HRSA
  • David Lansky Pacific Business Group/Health
  • Deven McGraw Center/Democracy & Technology
  • Latanya SweeneyCarnegie Mellon University
  • Greg Pace Social Security Administration
  • Robert Tagalicod CMS/HHS
  • Karen Trudel CMS
  • Charlene Underwood Siemens
  • Amy Zimmerman Rhode Island Department of Health and Human Services

HITPC: MU Workgroup Stage 3 Recommendations

hitpc stage 3 mu timeline
HITPC Stage 3 MU Timeline
  • Aug, 2012 – present draft preliminary stage 3 recs
  • Oct, 2012 – present pre-RFC preliminary stage 3 recs
  • Nov, 2012 – RFC distributed
  • Dec 21, 2012 – RFC deadline
  • Jan, 2013 – ONC synthesizes RFC comments for WGs review
  • Feb, 2013 – WGs reconcile RFC comments
  • Mar, 2013 – present revised draft stage 3 recs
  • Apr, 2013 – approve final stage 3 recs
  • May, 2013 – transmit final stage 3 recommendations to HHS

HITPC: MU Workgroup Stage 3 Recommendations

guiding principles mu objectives
Guiding PrinciplesMU Objectives
  • Supports new model of care (e.g., team-based, outcomes-oriented, population management)
  • Addresses national health priorities (e.g., NQS, Million Hearts)
  • Broad applicability (since MU is a floor)
    • Provider specialties (e.g., primary care, specialty care)
    • Patient health needs
    • Areas of the country
  • Promotes advancement -- Not "topped out" or not already driven by market forces
  • Achievable-- mature standards widely adopted or could be widely adopted by 2016
  • Add guideline about reasonableness (feasibility)
    • Reapply principles to get to the next stage of objectives

HITPC: MU Workgroup Stage 3 Recommendations

subgroup 1 improve quality safety efficiency and reducing health disparities
Subgroup 1:Improve Quality Safety, Efficiency and Reducing Health Disparities

HITPC: MU Workgroup Stage 3 Recommendations

slide6

General Comment: Subgroup 1 & Overall

  • Which objectives address health disparities?
    • Answer: Demographic collection & patient dashboard (with near real time results) provide the capability to record better demographic data and thus better reporting tools to help us focus our attention to populations that need it
    • Is there more that can be done?
  • Have you explored objectives that would be helpful to organizations that are specifically addressing health disparities and similar populations?
    • Answer: We have not focused on any specific organizations. We are interested in demographic conditions and bettering our reporting
  • Has patient safety been explored within the institution setting?
  • Will there ever be 100% adherence to an objective?
    • Answer: Setting the bar at 80% allows providers to maintain exclusions for why they do not have data on 100% of patients. There are legitimate reasons for omitted information and we do not want to penalize providers for those reasons. 80% is the highest we want to push as a policy initiative. We do not want to force providers to explain why they are missing some data for a few patients. We consider measures that are at 80% ‘topped out’ because if you are achieving 80% you have the capability to achieve 100%.
  • Many items are not "e" ready. Are there ways to accelerate this work to share with the industry in an open source fashion.
    • Need to take advantage of HHS resources.
  • Concern about timing, already behind for stage 2.
  • The stages should be driving each other, but we haven't had the time to learn from stage 1 which is concerning. There are 4/5 things that could be identified that would dramatically improve things.
    • P&S as well interoperability and functions

HITPC: MU Workgroup Stage 3 Recommendations

improve quality safety efficiency and reducing health disparities
Improve Quality Safety, Efficiency and Reducing Health Disparities

HITPC: MU Workgroup Stage 3 Recommendations

improve quality safety efficiency and reducing health disparities1
Improve Quality Safety, Efficiency and Reducing Health Disparities

HITPC: MU Workgroup Stage 3 Recommendations

improve quality safety efficiency and reducing health disparities2
Improve Quality Safety, Efficiency and Reducing Health Disparities

HITPC: MU Workgroup Stage 3 Recommendations

improve quality safety efficiency and reducing health disparities3
Improve Quality Safety, Efficiency and Reducing Health Disparities

HITPC: MU Workgroup Stage 3 Recommendations

slide11

Improve Quality Safety, Efficiency and Reducing Health Disparities

HITPC: MU Workgroup Stage 3 Recommendations

slide12

Improve Quality Safety, Efficiency and Reducing Health Disparities

HITPC: MU Workgroup Stage 3 Recommendations

slide13

Improve Quality Safety, Efficiency and Reducing Health Disparities

HITPC: MU Workgroup Stage 3 Recommendations

improve quality safety efficiency and reducing health disparities4
Improve Quality Safety, Efficiency and Reducing Health Disparities

HITPC: MU Workgroup Stage 3 Recommendations

slide15

Improve Quality Safety, Efficiency and Reducing Health Disparities

HITPC: MU Workgroup Stage 3 Recommendations

slide16

Improve Quality Safety, Efficiency and Reducing Health Disparities

HITPC: MU Workgroup Stage 3 Recommendations

slide17

Objective Not Included in Stage 2 NPRM - Improve Quality Safety, Efficiency and Reducing Health Disparities

HITPC: MU Workgroup Stage 3 Recommendations

slide18

Improve Quality Safety, Efficiency and Reducing Health Disparities

HITPC: MU Workgroup Stage 3 Recommendations

18

subgroup 2 engage patients and families
Subgroup 2: Engage Patients and Families

HITPC: MU Workgroup Stage 3 Recommendations

slide20

Engage Patients and Families

HITPC: MU Workgroup Stage 3 Recommendations

slide21

Engage Patients and Families

HITPC: MU Workgroup Stage 3 Recommendations

slide22

Engage Patients and Families

HITPC: MU Workgroup Stage 3 Recommendations

slide23

Engage Patients and Families

HITPC: MU Workgroup Stage 3 Recommendations

engage patients and families
Engage Patients and Families

HITPC: MU Workgroup Stage 3 Recommendations

slide25

Objective not included - Engage Patients and Families

HITPC: MU Workgroup Stage 3 Recommendations

slide26

Subgroup 3:

Improve Care Coordination

HITPC: MU Workgroup Stage 3 Recommendations

general comments subgroup 3
General Comments: Subgroup 3
  • True care coordination depends upon exchanging data - long way from making it happen.
  • Want a public hearing from people having trouble with this.
    • What are the issues?
  • Remove percentages the are distracting and takes away from the policy that we are trying to accomplish.
  • We need to figure out where the market is and where it will be in 2 years in order to understand the best infrastructure to transmit the data.

HITPC: MU Workgroup Stage 3 Recommendations

slide28

Improve Care Coordination

HITPC: MU Workgroup Stage 3 Recommendations

slide29

Improve Care Coordination

HITPC: MU Workgroup Stage 3 Recommendations

slide30

Improve Care Coordination

HITPC: MU Workgroup Stage 3 Recommendations

slide31

Improve Care Coordination

HITPC: MU Workgroup Stage 3 Recommendations

slide32

Objectives Not Included - Improve Care Coordination

HITPC: MU Workgroup Stage 3 Recommendations

subgroup 4 improve population and public health
Subgroup 4: Improve Population and Public Health

HITPC: MU Workgroup Stage 3 Recommendations

general comments subgroup 4
General comments: Subgroup 4
  • (Judy F) – Does this objective keep in mind those who move from immunization system to another (I.e. moved from North Dakota to Utah). There is no national standard established – each state has different standards for how the data is stored, how it is formatted, how it is viewed/transferred There is an assumption that we are driving the market to come up with standards? HL7?
  • But how do we drive the public health area (HIE in particular)? And how do we decide when to drive and when to follow the market?
  • (Terry) – Again, it comes back to what is the state of readiness in the states? We don’t want to have unintended adverse consequence by putting out all this different stuff out there as objectives. Can we relook at this issue to drive capacity?
  • Have to consider the receiver of this information and the sender of this information in these objectives.
  • Goal may be to drive states to adopt common standards.

HITPC: MU Workgroup Stage 3 Recommendations

slide35

Improve Population and Public Health

HITPC: MU Workgroup Stage 3 Recommendations

improve population and public health
Improve Population and Public Health

HITPC: MU Workgroup Stage 3 Recommendations

slide37

Improve Population and Public Health

HITPC: MU Workgroup Stage 3 Recommendations

improve population and public health1
Improve Population and Public Health

HITPC: MU Workgroup Stage 3 Recommendations

slide39

Improve Population and Public Health

HITPC: MU Workgroup Stage 3 Recommendations

improve population and public health2
Improve Population and Public Health

HITPC: MU Workgroup Stage 3 Recommendations

slide41

Improve Population and Public Health

HITPC: MU Workgroup Stage 3 Recommendations

improve population and public health3
Improve Population and Public Health

HITPC: MU Workgroup Stage 3 Recommendations

improve population and public health4
Improve Population and Public Health

HITPC: MU Workgroup Stage 3 Recommendations

hitpc final comments
HITPC Final Comments
  • HITPC policy recommendations
  • Immunizations & other objectives that do not have the most mature standards:
  • HITPC considering making a policy statement regarding national standards for immunization data (so states can transmit immunization data)
  • The recommendation would join in with CDC (who has the authority to do this)
  • Hearings
  • HIE
  • Area in HIT riddled with problems
  • Need to hear problems and proposed/implemented solutions
  • Include P& S
  • Consider state-perspective (Gayle)
  • Consider specialists? (their records need interoperability as well)
  • Setting Direction CDS
  • Essential to a learning health care system
  • Fear of CDS that tries to look at how providers respond to it [filter alerts CDS example]
  • Start directing decisions and limiting them, becomes a difficult path. Concern that payers and others are making decisions about how to limit care.
  • .
  • General
  • Requirements creep. Need core capabilities and an architecture that establishes it.
  • Concern about time, money, will power, and consensus to do all of this?
  • Are we in danger of diluting what we are trying to do with too many objectives.
  • Stage 3 time to drive truly different care delivery.
  • Broad things that we need to focus on.
  • MU has laid a tremendous foundation. We are seeing systems deployed by those who probably would not before MU.
  • There is a lack of evidence that we are achieving goals of MU & EHR.
  • We need to lay down clear tracks to lower costs and save lives.
  • Concerns about number of requirements
  • Prioritizing: 56 objectives is too many

HITPC: MU Workgroup Stage 3 Recommendations

public comment
Public Comment

Larry Wolf Need to look carefully at the minimum necessary to achieve policy goals. Darryl Roberts - P&S Tiger Team [nursing]LOA3 doesn't do what is intended - just by association. Interferes with patient care, takes away time and takes away from relationship with the patient. Committee did not discuss the use of biometrics. Thumb print reduces helpdesk calls too.Julie Cantor-Weinberg [pathologist]

A lot of pressure on labs. Pathologists are not included in objectives for stage 1 and 2, as they don't fit in. Urge the committee to revisit, as they are considered eligible providers. Move slowly on items related to lab data, need to make sure that the data can move in the appropriate format and can cause problems with patient safety.

Tom Larry - HIMSSGood dialogue around P&S. National HIT week September 14th.Seth Foldy- wants the group to know that considerable work has been done with the lessons from stage 1 to find ways to tighten implementation and certification. Each of the implementation guides used in stage 1 have conformance statements. Working on harmonizing data elements across PH reports - stage 3 will have ramifications for future PH reporting.

HITPC: MU Workgroup Stage 3 Recommendations