Certification / Adoption Workgroup

1. Certification / Adoption Workgroup Larry Wolf May 13th, 2014

2. Agenda • Update from May HITPC Meeting • Update from Certification Hearing • Proposed LTPAC Patient Assessment Recommendation • Next Steps: • LTPAC / BH Voluntary Certification Blog • Listening Session – Thursday, 05/22/2014

3. Workplan

4. Update from May HITPC • TOC & Privacy Recommendations Approved by HITPC w/ the following clarifications: • Alignment with MU: TOC certification criteria and standards should align with ONC’s Meaningful Use criteria and standards to ensure interoperability across systems and to encourage exchange. • Updated with MU: Starting with the 2014 Edition of CEHRT, criteria and standards for other settings should be updated when MU criteria and standards are updated. • Data Segmentation/Consent Management • Provider Workflow: HITPC requested that the Privacy & Security Tiger Team (P&S TT) conduct additional outreach to stakeholders to determine the workflow impact of data segmentation and consent management of documents. The P&S TT will engage in this outreach in May • Definition of Disclosure: P&S TT also will work with SAMHSA to determine the definition of disclosure used for purposes of 42 CFR part 2 • Report Back to HITPC: P&S TT anticipates reporting back to HITPC in June with updated recommendations

5. Update from May HITPC HITPC Feedback on Draft Quality Measurement Recommendations for LTPAC / BH Voluntary Certification • Noted that the proposed behavioral health quality measures are process focused, and should be more focused on outcomes. • Consider how data already collected from LTPAC/BH providers (e.g., by CMS) could provide a foundation for quality measurement in the setting • Interested in additional vendor feedback on the proposed quality measure recommendations • Consider international examples of ways to integrate behavioral health, maternal health, social care programs, etc. to render a holistic view of the patient 2015 NPRM Feedback • HITPC to provide ONC with 2015 NPRM discussion ‘sentiments’ • Certification should be ‘lean and mean’ • Balance between maturity of standards and infrastructure needed to support policy (e.g., Meaningful Use, Advanced Care Models)

6. Feedback from Certification Hearing • The certification process is overwhelming for some (timeframes, complexity) • Certification of immature criteria/standards are concerning • The certification schedule involves tight timelines and cycles that vendors must work within • Certification regulations lack clarity • Feedback mechanisms beyond the NPRM process are needed • Certification can stifle innovation

7. Certification Hearing Outcomes Key Points: • ONC should organize a Certification Kaizen • Need for active collaboration with all stakeholders, including CMS • Kaizen process is more effective than responding to NPRMs • Certification efforts should focus on interoperability, privacy and security, and quality measures

8. Voluntary Certification for LTPAC and BH Proposed LTPAC Setting Specific Recommendation

9. LTPAC Patient Assessments Policy Opportunity:   • Alignment among federal programs around data and standards • Patient assessments can be key drivers of interoperability • Previous standards mapping work has been done (e.g., mapping assessment content to vocabulary standards, CCDA) • Responsive to certification hearing concerns regarding the lack of interoperability

10. LTPAC Setting Specific Recommendations Interoperability of LTPAC Patient Assessment Data • NEWSupport the ability to create, maintain, and transmit (in accordance with CMS requirements) assessment instruments and data sets for LTPAC in, for example, MDS 3.0 (Nursing Homes), OASIC-C (Home Health), IRF-PAI (Inpatient Rehabilitation Facility), CARE subset (for Long Term Care Hospital), and a Hospice Item Set. • NEW Support the use of accepted vocabulary standards to enable the reuse of assessment data for: • various clinical purposes; and • administrative purposes. • NEW Support the ability of the provider or a designated third party to create and exchange interoperable LTPAC Assessment Summary CDA documents. FUTURE WORK • Harmonization of federal content and format for patient assessments with ONC specified EHR standards (e.g. consistent standards on demographics). • Make the data element library publically available and link content to nationally accepted standards.