Beacon Community Program Build and Strengthen – Improve – Test innovation

1. Beacon Community ProgramBuild and Strengthen – Improve – Test innovation Beacon-EHR Vendor Full Affinity Group August 16, 2013

2. Today’s Goals • Full AG Roll call – Lynda Rowe • Meaningful Use Stage 2 Numerator/Denominator Discussion – Lynda Rowe • HealtheWay Question and Answer Discussion – Lynda Rowe/Chuck Tryon/Adele Allison • ONC White Paper Discussion “Key Considerations For Health Information Organizations Supporting Meaningful Use Stage 2 Patient Electronic Access Measures” – Lynda Rowe • Wrap up/Next Steps – Adele Allison/Chuck Tryon

3. MU 2 Numerator Denominator Discussion - Questions • How do you plan to distinguish a CCD that is tied to the ONC definition of a TOC. For those of you who trigger a CCD to the local exchange based on some trigger event, how will you know that a CCD is part of the TOC denominator vs. other reasons (lab data, update registry, immunization, etc.) • How do you plan to “count” the denominator based on the TOC definition as well as the time frame for reporting the measure • Option 1 – HIE will calculate numerator and denominator (you are passing the denominator) • Do you have a way to export to an HIE the patient, sending provider, intended recipient, and date stamp for referral (or DOS) to an HIE? • What format would you provide that to the HIE? • Could you time bound this based on the providers preference for their 90 day reporting period? • The assumption is that if you provide this to the HIE they could then match to “receipt” of TOC which would count as the numerator • Option 2 – HIE will send you the numerator, you will calculate the measure and will have the denominator • If an HIE/HIO sends you a numerator file, what will you need at a minimum to count the numerator – how will you do patient and provider matching. • If more than one provider views the TOC as a recipient do you have a mechanism to account for that? • What do you need for date/time stamp to match to the denominator reporting window? • How will you determine if an EP/EH TOC denominator counts toward more than one sending provider (i.e. in a multi speciality practice both the PCP and a specialist contributed to the CCD that will be sent to the receiver)

4. Beacon Pilot Progress • Tulsa – In Progress • Working on developing pilot option 9+ as well as the details behind numerator denominator calculations • Mississippi – Not able to run pilots at this time • South East Michigan – In Progress • Went online with one Allscripts practice this week using XDS.b as the transport mechanism in an effort to work toward eHealth exchange • Looking to add an additional Allscripts practice in the next week as well • In reference to User Story 2b, SE Michigan is working with Success EHS to pilot PIX and XDS.b Query & Retrieve, with automatic triggers to query our MPI and XDS.brepository to retrieve a longitudinal CDA • Keystone – In Progress • Developed Technical Script this week • RIQI – In Progress • Pilot: ToC: CEHRT to an HIO/HIE/HISP - Query by Provider B • Currently: data is being sent from Provider A, Blackstone Valley, and it is being stored within the HIE (discrete data and the document itself). • To be completed as soon as next week: Quantifying view of the data by Provider B. • WNY – In Progress • Direct accounts have been established for Elmwood and staff training has commenced on the use of Direct email. • Mirth is working on the automation process, in the meantime Neva will send files to Elmwood. • Go live is planned for 07/23 with Direct function to be implemented shortly there after.

5. Possible Pilot Scenarios 1 - 5

6. Possible Pilot Scenarios 6 - 10

7. Vendor Pilot Options

8. Vendor Pilot Options

9. VDT Objective Measure 1 for EPs and EHs

10. VDT Objective Measure 2 for EPs and EHs

11. Secure Messaging Objective Measure 1

12. HIO Online Portal Certification Requirements • HIOs that intend to support EP’s/EH’s patient electronic access measures by offering an online portal must use a certified portal with the following capabilities : • View: display the common MU dataset, EPs (provider’s name/office contact information), EHs (Admission & discharge dates & locations; discharge instructions; & reason(s) for hospitalization). • 2. Download: ability for patients (or authorized caregiver) to download the data listed in item number one above in human readable or consolidated clinical data architecture (CCDA) format. • 3. Transmit: ability to send the data listed in item number one above to a third party in human readable or CCDA format, via the Direct SMTP standard. • 4. Utilize Web Content Accessibility Guidelines (WCAG) 2.0, Level A Conformance for the online site. • 5. Utilize any encryption and hashing algorithm identified by the National Institute of Standards and Technology (NIST) as an approved security function in Annex A of the FIPS Publication 140-2. • 6. Depending on the type of certification, modular or complete, perform one or both of the following: • a. Create a report or file that enables a user to review the patients or actions that would make the patient or action eligible to be included in the measure’s numerator. The information in the report or file created must be of sufficient detail such that it enables a user to match those patients or actions to meet the measure's denominator limitations when necessary to generate an accurate percentage; and/or • b. Electronically record the numerator and denominator and create a report including the numerator, denominator, and resulting percentage associated with each applicable meaningful use measure.

13. Other Considerations for HIOs Providing VDT Functionality • Single Sign-on to Multiple Patient Records • HIO may provide users with access to not only their own records, but also those for whom they are an authorized representative (a spouse’s, children’s, and elderly parents’ records through a single sign-on to the patient portal. • Each individual’s record that is viewed through the single sign-on can be counted in an EP/EH’s numerator provided each individual is in their denominator • HIO providing single sign-on must have the capability to ascertain which records were viewed and provide the right EP/EH with either a numerator/denominator calculation or a report of the patients whose records were viewed. • Adolescent Patient Records • HIOs supporting the patient engagement Stage 2 measures must carefully craft policies for providing access to adolescent patient records. HIPAA protects adolescent health information from parental access under specific circumstances • HIOs must account differing state and federal laws through policies and technological solutions. • Meaningful use regulations also give EPs considerable discretion in deciding what information to make available to adolescents. • EPs must be careful not to make policy decisions which differ from their HIOs because it may hamper their ability to attest to VDT Measure 2 • Providing Audit Documentation • EPs/EHs may need a list of the patients that are counted in the numerator (including those whose records were accessed by an authorized representative for VDT Measure 2) • VDT Measure 2: The list may need to include the date patients or their representatives accessed the online system, which will help EPs/EHs demonstrate that it transpired during the reporting period • Any information used to determine the meaningful use performance of the EP should be kept in such a way that it can be provided during a desk audit in the future.

14. Wrap Up/Next Steps • Final comments • All attendees • Co-Chairs: Chuck Tryon/Adele Allison • Next steps – Adele Allison • Conclusion