Meaningful Use Workgroup

1. Meaningful Use Workgroup Paul Tang, Chair George Hripcsak, Co-Chair January 6, 2014

2. Meaningful Use Workgroup Members J. Marc Overhage, Siemens Healthcare Patricia Sengstack, Bon Secours Health Systems Charlene Underwood, Siemens Michael Zaroukian, Sparrow Health System Amy Zimmerman, Rhode Island Office of Health & Human Services Federal Ex officios Tim Cromwell, Department of Veterans Affairs Joe Francis , Veterans Administration Greg Pace, Social Security Administration Martin Rice, HRSA Robert Tagalicod, Centers for Medicare & Medicaid Services, HHS Chairs • Paul Tang , Palo Alto Medical Foundation • George Hripcsak, Columbia University Members • David Bates , Brigham and Women’s Hospital • Christine Bechtel , National Partnership for Women & Families • Neil Calman, The Institute for Family Health • Arthur Davidson, Denver Public Health Department • Paul Egerman, Businessman/Entrepreneur • Marty Fattig, Nemaha County Hospital Auburn, Nebraska • Leslie Kelly Hall, Healthwise • David Lansky, Pacific Business Group on Health • Deven McGraw , Center for Democracy & Technology

3. Workplan 2

4. Feedback from HITSC - PGHD

5. Engaging patients and families in their care: Patient Generated Health Data Stage 3 Functionality Goals Functionality Needed to Achieve Goals • Enabling active participation by patients and families to improve health and care • Provide ability to contribute information in the record, including patient reported outcomes (PRO) • Patient preferences recorded and used • Eligible Providers and Hospitals provide the capability for patients to electronically submit patient-generated health information through structured or semi-structured questionnaires (e.g., screening questionnaires, intake forms, risk assessment, functional status), secure messaging or provider-selected devices using CEHRT. (Provider-selected devices pending consideration by HITSC) • Recommended as a Menu item • Low threshold 4

6. Standards Recommendations • ONC should consider the Direct transport standard for secure messaging and data from devices • ONC should consider the HL7 Care Team Roster standard • ONC should consider the HL7-CCDA for structured and unstructured questionnaires • ONC should consider the Continua standard for data from devices • We encourage standards that support mobile access to patient data and PGHD given the proliferation of mobile devices. However, we do not recommend mandating a specific standard at this time given that might stifle innovation.

7. HITSC Discussion • The key discussion was an evaluation of the standards maturity and the level of adoption of the standards suggested for patient generated data.  Recommendations included Direct for data transport, CCDA for content capture, LOINC/SNOMED for vocabulary capture, and Continua implementation guides for devices.   • As a followup the Consumer Technology Workgroup will list examples of CCDA templates that can be used to support patient generated data use cases.   • Continua will provide a list of the named standards so that we can validate the maturity and adoption of Continua's recommendation.   • We will also ensure that the CCDA templates include the appropriate vocabularies that will  enable incorporation of patient generated data into EHRs. • http://geekdoctor.blogspot.com/2013/12/the-december-hit-standards-committee.html

8. Medication AdherenceHITSC Clinical Quality Workgroup Marjorie Rallins, Co-Chair Danny Rosenthal, Co-Chair

9. Questions presented to CQWG from MUWG

10. CQWG: Recommendations/Comments for Medication Adherence (I) • Suggest further clarification on the goals of MU for medication adherence and prescription drug monitoring. Once clarified, prioritize goals • The following standards could be recommended for medication adherence. Note, original intent of the standards were for administrative analysis. Clinical use may require further cleaning of the data • NCPDP SCRIPT Standard • NCPDP Structured and Codified Sig Format (component to be used with NCPDP SCRIPT Standard) • RxNorm. EHR should be able to accept RxNorm codes • NDF-RT considered but limited to drug class identification

11. Recommendations/Comments (II) CQWG: Recommendations/Comments for Medication Adherence (II) Other comments and recommendations • Signals can be identified but are not necessarily computable; • Actions on signals are out of scope for this question • C-CDA medication list; reconciliation should be considered in the context of medication adherence • Various states accumulate data on controlled substances and make that data available to providers that have no data integration with other systems • Alignment of goals medication adherence and prescription drug monitoring with other regulatory activity and other agencies (e.g., FDA is crucial) • MUWG should have direct communication with an NCPDP expert(e.g., Lynn Gilbertson, Vice President, Standards Development, NCPDP)

12. CQWG: Recommendations/Comments for PDMP • Many issues remain under consideration for prescription drug monitoring standards. • As such, CQWG cannot recommendations at this time

13. Open Notes

14. Follow-up from clinical documentation hearing • To improve accuracy, to improve patient engagement, and to guard against fraud, EHRs should have the functionality to provide progress notes as part of MU objective for View, Download, and Transmit • OpenNotes • http://www.myopennotes.org/ • Recent NEJM article

15. Affordable Care

16. Affordable care:Stage 3 Priorities MU Outcome Goals Stage 3 Functionality Goals MU Outcome Goals Stage 1 + 2 Functional Objectives • CDS support to avoid duplicative care • CDS support to avoid unnecessary or inappropriate care • Eliminate duplicative testing • Use cost-effective diagnostic testing and treatment • Minimize inappropriate care (overuse, underuse, and misuse) • Formulary checks • Generics 15

17. Affordable care:Clinical Decision Support Examples of Functionality Needed to Achieve Goals Stage 3 Functionality Goals • Demonstrate use of multiple CDS interventions that apply to quality measures in each of the six NQS domains. Recommended interventions include: • Preventive care • Chronic disease management (e.g., diabetes, coronary artery disease) • Appropriateness of lab and radiology orders • Advanced medication-related decision support (e.g., renal drug dosing) • Improving the accuracy/completeness of the problem list • Drug-drug and drug-allergy interaction checks • CEHRT should provide tools that enable the ability to provide these interventions • Related work that can inform: S&I HealtheDecisions, HITSC Clinical Quality WG • CDS support to avoid duplicative care • CDS support to avoid unnecessary or inappropriate care 16

18. Reducing Health Disparities

19. Reducing health disparities:Stage 3 Priorities MU Outcome Goals Stage 3 Functionality Goals MU Outcome Goals Stage 1 + 2 Functional Objectives • Patient conditions are treated appropriately (e.g. age, race, education, LGBT) • Eliminate gaps in quality of health and health care across race, ethnicity, and sexual orientation • Language • Gender • Race • Ethnicity 18

20. Reducing health disparities:Additional Patient Information Functionality Needed to Achieve Goals Stage 3 Functionality Goals • CEHRT provides the ability to capture • Patient preferred method of communication* • occupation and industry codes • Sexual orientation, gender identity (optional fields) • Disability status • Differentiate between patient reported & medically determined • Communication preferences will be applied to the clinical summary, reminders, and patient education objectives • Providers should have the ability to select options that are technically feasible for them, these could include: Email, text, patient portal, telephone, regular mail • Recommended as certification criteria only • Patient conditions are treated appropriately (e.g. age, race, education, LGBT) 19

21. Reduction of Disparities – previous deeming recommendations • Reduction of disparities in gap area • Identify areas where attesters should be required to demonstrate they have reduced health care disparities in high-risk populations