Meaningful Use Workgroup

1. Meaningful Use Workgroup Stage 3 Update Paul Tang, Chair George Hripcsak, Co-Chair August 29, 2013

2. Agenda • Review what we heard last month • Re-confirm our focus on outcomes • Outline the outcomes-oriented framework • Connect the dots • Seek approval of outcomes-oriented framework to flesh out details

3. What We Heard • Stage 3 focuses on outcomes; how do the functional objective recommendations link to outcomes? • How does MU3 link to HHS initiatives (e.g. NQS, Million Hearts) and future payment models (e.g., ACO, MSSP, PCMH)? • Deeming pathway is a good direction • Emphasizes outcomes • Reduces burden • Aligns with other federal programs • BUT, need appropriate QMs

4. Updated Recommendations Based Upon Feedback from HITPC • Focus on improving care outcomes • Useof quality measures to assess identifiedoutcomes • Incorporatefunctional deeming as an option for stage 3 compliance • Align with CMS and future payment priorities

5. Harmonizing Meaningful Use and National Quality Strategy: National Priorities Partnership – Common Roots National Quality Strategy: Serves as a catalyst and compass for a nationwide focus on quality improvement efforts and a national approach to measuring quality. The NQS concurrently pursues three aims to provide better, more affordable care for the individual and the community. To advance these aims, the NQS focuses on six priorities for health and health care quality that have an impact on most Americans. National Priorities Partnership: Convened by NQF, is composed of 28 organizations and is focused on a core list of priorities that will yield change in the form of improved care, equity, safety, and efficiency. NPP provides input on goals, measure concepts and strategic opportunities to achieve the NQS aims. Initially published in March 2011. 4

6. Importance of an Outcomes-Based Framework • Placeholder for Scenario

7. Recommendation 1: Focus on improving care outcomes

8. Revised Care Outcomes Aligned with NQS Equitable Care for All

9. Improving Quality of Care and Safety:Linking Outcomes with Stage 3 Functions Stage 1 + 2 Stage 3 Outcome Goals • Structured data • Problem, Meds, Allergy lists • Vitals, smoking status • Lab results, Hospital labs • Imaging • CPOE • CDS • Progress notes • Safety • eRx, drug-allergy checks • Medication reconciliation • Population management • Patient lists • Patient reminders • CDS++ • Order tracking (e.g., closing the loop) • Real-time dynamic dashboards (for clinical and population health management) • Medication adherence • Patient safety • Common Format for registry reports (e.g. healthcare associated infections) • Sharing radiation dosing information • Capture FDA Unique Device Identifier (UDI) • Quality of care • Better control of chronic diseases • Improved efficiencies to prevent inappropriate care (overuse, underuse, and misuse) • Reduce preventable hospital admissions and readmissions • Improved population management • Patient safety • Reduced incidence of adverse events

10. Engaging patients and families in their care:Linking Outcomes with Stage 3 Functions Stage 1 + 2 Stage 3 Outcome Goals • Clinical summary • Online access • Patient education • View, download, transmit • Secure messaging • Patient education, clinical summary, & reminders provided to patients in their preferred means of communication • Patient generated health data • Communication preferences • Amendments • Improved access/sharing of information for the patient and caregiver • Patients and caregivers recognized as partners • Shared decision-making, care planning/goals • Improved patient and caregiver experience 9

11. Improving care coordination:Linking Outcomes with Stage 3 Functions Stage 1 + 2 Stage 3 Outcome Goals • CDS+ • Cancer registry • Family history • Electronic lab reporting • Summary of care • Health event notification (e.g., ED visit, admission to hospital) • Close the referral loop • Improved communication across care settings  • Improved coordination of care across the continuum • Improved accountability across settings and reduction in health disparities 10

12. Disease Prevention:Linking Outcomes with Stage 3 Functions Stage 1 + 2 Stage 3 Outcome Goals • CDS+ • Cancer registry • Family history • Electronic lab reporting • CDS • Immunization • Patient education • PH reporting • Cancer registry • Family history • Electronic lab reporting • CDS+ interventions to manage chronic conditions • Increased adherence with preventive health recommendations 11

13. Improving Population and Public Health:Linking Outcomes with Stage 3 Functions Stage 1 + 2 Stage 3 Outcome Goals • CDS+ • Cancer registry • Family history • Electronic lab reporting • Immunization • PH reporting • Cancer registry • Electronic lab reporting • Submission of electronic syndromic surveillance data • Common Format for registry reports (e.g. healthcare associated infections) • Case reports submitted to the state/local jurisdiction • Improved population health 12

14. Affordable CareLinking Outcomes with Stage 3 Functions Stage 1 + 2 Stage 3 Outcome Goals • CDS+ • Cancer registry • Family history • Electronic lab reporting • Formulary checks • Generics • Imaging results • Improved efficiencies to prevent inappropriate care (overuse, underuse, and misuse) 13

15. Equitable Care for AllLinking Outcomes with Stage 3 Functions Stage 1 + 2 Stage 3 Outcome Goals • Race • Ethnicity • Language • Occupation • Sexual orientation and gender identity • Veteran status • Patient education in a language other than English • Equitable care for all by reducing health disparities 14

16. Recommendation 2: Use of quality measures to assess identified outcomes

17. Recommendation 2: Use of quality measuresto assess identified outcomes (I) Care Outcomes Proposed CQMs

18. Recommendation 2: Use of quality measuresto assess identified outcomes (II) Care Outcomes Proposed CQMs

19. Recommendation 3: Incorporate functional deeming as an option for stage 3 compliance

20. 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

21. Accountable Care Clinical Quality Measures Subgroup Tasks • Develop recommendations for ‘HIT-sensitive’ eCQM concepts and specific measures that could be used to deem” EPs and EHs as meaningful users through their ability to perform on quality outcomes • HIT-sensitive outcome measures are ideal for deeming • Which measures that currently exist in CMS programs are appropriate to use for deeming? (charge to QM WG) • Which measures in the pipeline for MU3 time frame are appropriate to use for deeming? What measure gaps exist, that could be filled in time for MU3, that are exemplars of HIT sensitive measures for deeming? • Eligible professionals and group reporting • What parameters should be used for a group reporting option for MU overall (including deeming) • If there is a group reporting option, how do you attribute a provider's membership in a group and his/her ability to receive incentives (or avoid penalties)?

22. Recommendation 4: Align with CMS and future payment priorities

23. Alignment Across National Initiatives

24. Questions?