HIT Policy Committee

1. HIT Policy Committee Review of Meaningful Use Core Objectives and Existing Measures – Relevance to Specialty and Small Practices and Small Hospitals Paul Tang Palo Alto Medical Foundation George Hripcsak Columbia University October 27, 2009

2. Workgroup Members Co-Chairs: • Paul Tang, Palo Alto Medical Foundation • George Hripcsak, Columbia University Members: • David Bates, Brigham & Women’s Hospital • Christine Bechtel, National Partnership for Women & Families • Neil Calman, The Institute for Family Health • Art Davidson, Denver Public Health Department • David Lansky, Pacific Business Group on Health • Deven McGraw, Center for Democracy & Technology • Latanya Sweeney, Carnegie Mellon University • Charlene Underwood, Siemens ONC Lead: • John Glaser

3. Approximate Timeline 4Q09/1Q10: Conduct informational hearings to inform 2013 and 2015 criteria development 2Q10: Work with HIT Standards Committee to ascertain availability of relevant standards Mid-2010: Refine 2013 meaningful use criteria 4Q10: Assess industry preparedness for meeting 2011 and initial 2013 meaningful use criteria

4. Rationale Not all objectives and measures appropriate for all eligible professionals How to decide, specify, and maintain mapping Groups of measures Groups of professionals Eligible professionals Objectives & measures

5. Organizing Principles Eligible Professionals Profession: MD, DO, DDS, DMD, nurse mid-wife, NP, PA, etc. (Medicare vs Medicaid) Role: Primary Care, Specialty Objectives and Measures Process, Quality, Efficiency Prevention, etc.

6. Process Early MU Emphasis on Primary Care Key role of primary care Fewer specialty measures available Number and complexity of specialties Begin with a Simple Framework

7. Framework Core measures – all providers use CPOE for all orders (process) avoid use of high-risk medications in the elderly (quality) percent of patient encounters with insurance eligibility confirmed (efficiency) Adult primary care measures report percent of diabetics with A1c under control Pediatric primary care measures report up-to-date status for childhood immunizations Specialty measures cross all specialties: closing the loop on referrals specialty-specific measures

8. Who is Primary Care? • Family medicine • All or some of internal medicine • Other professions • Specialties like obstetrics and gynecology? • Serve as many patients’ sole provider • Preventive care versus treatment • Role: specific to profession, professional, or patient?

9. Issues in Grouping Measures • Adult & pediatric, Male & female, Cancer survivor, … • Stay simple, use denominator to differentiate • Self-Selected Quality Measures • Select and track a quality measure for your specialty • Use of Registries

10. Hospitals • At present, all hospitals responsible for all objectives and measures

11. Plan • Edit the framework based on upcoming testimony • Create a matrix that maps objectives and measures to professionals • Circulate back for feedback

12. QUESTIONS AND DISCUSSION