HITPC – Meaningful Use Workgroup Care Coordination – Subgroup 3

1. HITPC – Meaningful Use WorkgroupCare Coordination – Subgroup 3 Stage 3 Planning July 27, 2012

2. SGRP 303 Stage 3 Care Coordination Objective (Revised Summary of Care) EP/ EH / CAH Objective: EP/EH/CAH who transitions their patient to another setting of care or refers their patient to another provider of care • Provide a summary care record for each transition of care or referral when transition or referral occurs with available information and • Provide updates with supplemental information when such information becomes available. • Measure: The EP, eligible hospital, or CAH that transitions or refers their patient to another setting of care (including home) or provider of care provides a summary of care record* for 65% of transitions of care** and referrals. At least 30% of all patients need to receive a summary of care record electronically.*** • *Must include the following information: • Concise narrative in support of care transition (free text) • Setting-specific goals* • Instructions for care during transition and for 48 hours afterwards* • Care team members, including primary care provider and caregiver name, role and contact info (using DECAF)* • **Need definition for “Transition of Care” that EHR system can recognize and use in calculating the measure, such as the existence of an order. • ***HIT Policy Committee Question: By stage 3, will there be a new context in which to measure based on the penetration of EHRs and health exchange infrastructure? For example, if providers are exchanging data with other providers who have attested to meaningful use, could a higher threshold be expected? I split this into 2 bullets

3. SGRP 304Stage 3 Care Coordination Objective (New, CORE – Care Plan) • EP/ EH / CAH Objective: EP/ EH/CAH who transitions their patient to another setting or care or refers their patient to another provider of care • For each transition of care, provide the care plan information, including the following elements* as applicable: • Medical diagnoses and stages • Functional status, including ADLs* • Relevant social and financial information (free text) • Relevant environmental factors impacting patient’s health (free text) • Most likely course of illness or condition, in broad terms (free text) • Cross-setting care team member list, including the primary contact from each active provider setting, including primary care, relevant specialists, and caregiver • The patient’s long-term goal(s) for care, including time frame (not specific to setting) and initial steps toward meeting these goals • Specific advance care plan (POLST) and the care setting in which it was executed • For each referral, provide a care plan if one exists • Measure: The EP, eligible hospital, or CAH that transitions or refers their patient to another setting of care or provider of care provides the electronic care plan information for 10% of transitions of care to receiving provider and patient/caregiver. • = aligned with PE View/Download/Transmit and Report objective • Standards Input: We have consolidated CDA which enables templates for problems, medications, allergies, notes, labs, and care plans. There are no standards to support the structured recording of anything else you’ve listed.

4. I changed the name SGRP 305Stage 3 Care Coordination Objective (New, Menu – Collaborative Care) • EP / EH / CAH Objective (new): “Closed Loop” Information Exchange –Must include (but not limited to): • Referral Results (for example, consult report, patient seen, etc. in response to a Consult Request, sent to the requesting provider) • In a transfer of care, acknowledgement of receipt of a Care Summary by the subsequent care provider (sent to the originating provider) • Measure: 2 Part measure: • Provider acknowledges receiving referral results and summary of care, including summary of care updates after transition/referral, for 10% of patients referred or transitioned during the reporting period. (automation is OK; to be sent to origin of referral and patient/caregiver) • Provider acknowledges receipt of referral results and summary of care received after transition/referral for 10% of patients referred or transitioned during the reporting period. (automation not OK) Reduced to 2 items Not clear to me what we are measuring. Who is responsible for “closing the loop”? Seems like it should be the provider who receives the Consult Request or the Care Summary as part of a Transition of Care

5. SGRP 302Stage 3 Care Coordination Objective (Revised – Med Rec) • EP / EH / CAH Objective: The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform reconciliation for: • medications • contraindications* and medication allergies and intolerances • problems • EP / EH / CAH Measure: The EP, eligible hospital or CAH performs reconciliation for medications for more than 50% of transitions of care, and it performs reconciliation for contraindications, medication allergies, and problems for more than 10% of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23). *A contraindication is defined as any medical reason for not performing a particular therapy; any condition, clinical symptom or circumstance indicating that the use of an otherwise advisable intervention in some particular line of treatment is improper, undesirable, or inappropriate. This must include specification of the particular contraindicated therapy, reason for contraindication, and severity of contraindication. Input from Standards: No accepted standard for reconciling medication lists or contraindications other than existing allergy vocabularies. #3 Contraindications objective that could include: allergies, adverse reactions, procedural intolerance

6. Referral from Subgroup 1 • Medication reconciliation: create ability to accept data feed from PBM (Retrieve external medication fill history for medication adherence monitoring) • Vendors need an approach for identifying important signals such as: identify data that patient is not taking a drug, patient is taking two kinds of the same drug (including detection of abuse) or multiple drugs that overlap. SGRP125 • Ability to maintain an up-to-date interdisciplinary problem list inclusive of versioning in support of collaborative care - SGRP127 • Functionality to make patient information reconciliation possible for problems

7. Referral Clarification • Ability to self-refer. Note from Subgroup 2 to 3: More information needed here.