Meaningful Use Panel: Stage 3 Update Arthur Davidson, MD, MSPH Denver Public Health

1. 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

2. 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

3. Stages of Meaningful Use (MU)Improving Outcomes Stage 3 2016-17 Stage 2 2014-15 Stage 1 2011-13

4. 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)

5. Lessons from Stages 1Implications for Stage 3

6. 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

7. Proposed Stage 3 Population and Public Health MU Objectives/Criteria *EH= eligible hospital; EP=eligible Provider

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

16. CSTE Position Statements

17. 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