Meaningful Use Workgroup

1. Meaningful Use Workgroup Stage 3 Update Paul Tang, Chair George Hripcsak, Co-Chair August 16, 2013

2. August 7 HITPC Meeting High-level summary of feedback received from HITPC:

3. Functional Objective Feedback • Stage 3 should clearly signal outcomes • Tie MU3 objectives to outcomes measures • Link to HHS quality strategy (e.g., NQS, Million Hearts) • Link to future payment models (e.g., accountable care organizations) • Consider shifting structure of recommendations to focus on outcomes • The use of certification-only criteria should be strategically limited

4. Deeming Feedback • Deeming concept focuses on achieving good outcomes • Appreciate the flexibility of this alternative pathway • Need outcomes-oriented eCQMs • Must all the data measures come from the EHR? What about claims data?

5. Next Steps • Address HITPC concerns • Provide framework recommendations • Present high level outcomes-driven framework to HITPC at September Meeting • Follow up in Oct or Nov with more detailed recommendations (QM/ACO TT in Oct)

6. Recommendations for Presentation to HITPC in September 2013

7. Core Recommendations • Focuson health and care outcomes • UseeCQMs to measure identifiedcare outcomes • Incorporatefunctional deeming as an option for MU3 compliance

8. Recommendation 1: Focus on initiatives that help improve care outcomes

9. Moving towards outcomes for MU3

10. MU Categories Derived from National Priorities Partnership Goals National Priorities Partnership Goals MU3 Care Outcomes Align with NPP

11. Care Outcome: Improved Quality of Care Stage One Stage Two Stage Three Recommendation • CPOE • Initial CDS • Patient lists • Problem lists • Meds lists • Medication allergies • Drug-allergy checks • Vitals • Lab results • Smoking • eRx • Patient reminders • CPOE+ • CDS+ • Patient lists+ • Imaging • Hospital labs • Progress notes • CDS++ • Real-time dynamic dashboards (for clinical and population health management) • Advanced CDS interventions (e.g., chronic disease management, test ordering, prevention, accuracy of lists) • Medication adherence • Order tracking (e.g., closing the loop)

12. Care Outcome: Healthier Living & Disease Prevention Stage One Stage Two Stage Three Recommendation • Immunization • PH reporting • Patient education • CDS+ • Cancer registry • Family history • Electronic lab reporting • CDS interventions that use family history • CDS interventions to manage chronic conditions

13. Care Outcome: Increased Patient Engagement Stage One Stage Two Stage Three Recommendation • Clinical summary • Online access • Patient education • View, download, transmit • Secure messaging • Patient generated health data • Communication preferences • Amendments

14. Care Outcome: Improved Safety Stage One Stage Two Stage Three Recommendation • CPOE • CDS • eRx • Medication allergies • Medication reconciliation • CPOE+ • CDS+ • eMAR • CDS++ • Use of Common Formats (e.g., adverse event reports, healthcare associated infections)

15. Care Outcome: Improved Care Coordination Stage One Stage Two Stage Three Recommendation • Summary of care • Health event notification (e.g., ED visit, admission to hospital) • Close the referral loop

16. Care Outcome: Accessible and Affordable Care for All Stage One Stage Two Stage Three Recommendation • Race • Ethnicity • Language • Formulary checks • Capture of additional information • Occupation • Sexual orientation and gender identity • Veteran status • Capture FDA Unique Device Identifier (UDI)

17. Recommendation 2: Use eCQMs to Measure Identified Care Outcomes

18. Core Recommendation 2Use CQMs to Measure Outcomes Outcomes Proposed eCQMs

19. Core Recommendation 2Use CQMs to Measure Outcomes Health Improvement Outcomes Proposed eCQMs

20. Recommendation 3: Implement Deeming Pathway

21. Recommendations on Functional Deeming • Providers who have already met all functional objectives in stages 1 and 2 should be allowed to “deem” • Deeming allows high MU performers (or significant improvers) to attest for MU by satisfying a subset of MU objectives; this would be an optionalpathwayto achieve MU • “Deeming” promotes innovation, reduces burden, and rewards good performance • CMS should survey the landscape for available eCQMs that are outcomes-oriented and consider their use as deeming measures; in addition, new development of eCQMs may be necessary

22. Next Steps • Approve outcomes framework for MU stage 3 • MU WG to review objectives for alignment with outcomes framework • Receive input on eCQMs from QM/ACO TT (Oct) • Present additional recommendations to HITPC in Nov