Stage 3 Recommendations for Meaningful Use Workgroup Members

1. Meaningful Use Workgroup Stage 3 Recommendations Paul Tang, Palo Alto Medical Foundation, Chair George Hripcsak, Columbia University, Co-Chair

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 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

3. HITPC Stage 3 MU Timeline • 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

4. Guiding Principles • 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 • Reasonableness/feasibility of products or organizational capacity • Prefer to have standards available if not widely adopted • Don’t want standards to be an excuse for not moving forward MU Workgroup Stage 3 Recommendations

5. Key to reviewing items • Red items - changes from Stage 1 to Stage 2 • Blue items - changes from Stage 2 to Stage 3 recommendations • Green items - updates made following the August 1, 2012 HITPC MU Workgroup Stage 3 Recommendations

6. Improve Quality Safety, Efficiency and Reducing Health Disparities - Subgroup 1 Progress notes for stage 3 – Farzad’s push to eliminate coding issues. Marc: think about the amount of work to do this, matrix to quantify better MU Workgroup Stage 3 Recommendations

7. Improve Quality Safety, Efficiency and Reducing Health Disparities MU Workgroup Stage 3 Recommendations

8. Improve Quality Safety, Efficiency and Reducing Health Disparities MU Workgroup Stage 3 Recommendations

9. Improve Quality Safety, Efficiency and Reducing Health Disparities Gayle: incorporate into stage 3. Every state has a formulary list for Medicaid and should be incorporated into stage 3 as certification requirement. Making PDMP data available (ONC doing work). MU Workgroup Stage 3 Recommendations

10. Improve Quality Safety, Efficiency and Reducing Health Disparities MU Workgroup Stage 3 Recommendations

11. Improve Quality Safety, Efficiency and Reducing Health Disparities Query whether something was done or missing? Looking for discrepancies, clarify? MU Workgroup Stage 3 Recommendations

12. Improve Quality Safety, Efficiency and Reducing Health Disparities Improve MU Workgroup Stage 3 Recommendations

13. Improve Quality Safety, Efficiency and Reducing Health Disparities Improve MU Workgroup Stage 3 Recommendations

14. Improve Quality Safety, Efficiency and Reducing Health Disparities Improve Judy didn’t like the word interventions. Interventions or guidance?

15. Improve Quality Safety, Efficiency and Reducing Health Disparities MU Workgroup Stage 3 Recommendations 15

16. Improve Quality Safety, Efficiency and Reducing Health Disparities Improve MU Workgroup Stage 3 Recommendations

17. Improve Quality Safety, Efficiency and Reducing Health Disparities Improve MU Workgroup Stage 3 Recommendations

18. Improve Quality Safety, Efficiency and Reducing Health Disparities Improve MU Workgroup Stage 3 Recommendations

19. Improve Quality Safety, Efficiency and Reducing Health Disparities Improve MU Workgroup Stage 3 Recommendations 19

20. Engaging Patients and Families – Subgroup 2 MU Workgroup Stage 3 Recommendations

21. Engage Patients and Families Engage Liability issues and breach issues – lay out questions in the RFC. Consent management issues – P&S Tiger team MU Workgroup Stage 3 Recommendations

22. Engage Patients and Families Engage MU Workgroup Stage 2 Final Rule

23. Engage Patients and Families Engage MU Workgroup Stage 3 Recommendations

24. Engage Patients and Families Engage MU Workgroup Stage 3 Recommendations

25. Engage Patients and Families MU Workgroup Stage 3 Recommendations

26. Engage Patients and Families Engage MU Workgroup Stage 3 Recommendations

27. Improving Care Coordination – Subgroup 3 MU Workgroup Stage 3 Recommendations

28. Improve Care Coordination Improve MU Workgroup Stage 3 Recommendations

29. Improve Care Coordination Improve MU Workgroup Stage 3 Recommendations

30. Improve Care Coordination Improve Care Coordination MU Workgroup Stage 3 Recommendations

31. Improve Care Coordination Improve MU Workgroup Stage 3 Recommendations

32. Improve Care Coordination Objectives not included MU Workgroup Stage 3 Recommendations

33. Population and Public Health – Subgroup 4 MU Workgroup Stage 3 Recommendations

34. Improve Population and Public Health Improve MU Workgroup Stage 3 Recommendations

35. Improve Population and Public Health MU Workgroup Stage 3 Recommendations

36. Improve Population and Public Health Improve MU Workgroup Stage 3 Recommendations

37. Improve Population and Public Health Ability to receive a general public health messages – pilot done in Maryland (Josh S). Look for ways that it can be patient specific within the EHR? PHA tells which patient to look at. Not available in a general form. MU Workgroup Stage 3 Recommendations

38. Improve Population and Public Health Improve MU Workgroup Stage 3 Recommendations

39. Improve Population and Public Health MU Workgroup Stage 3 Recommendations

40. Improve Population and Public Health Improve MU Workgroup Stage 3 Recommendations

41. Improve Population and Public Health MU Workgroup Stage 3 Recommendations

42. Improve Population and Public Health MU Workgroup Stage 3 Recommendations

43. Public Comment Public Comment Eldercare: Why was care plan moved to future stages? This is the most important piece of mobilizing services for the serious ill. Advanced directive – listening session, why not have a PDF for the care plan? Nothing more central to patient centered care than the care plan. AMA: Engage patients and families – error in the record? Fix language? HIPAA allows for a process to do this if you think there is problem. AMA: Miss measures by small % - have failed, is there ability to meet ¾ of the measures that you have made a change Judy: single national standard for immunizations, Stage 4 – is there money? MU Workgroup Stage 3 Recommendations