Overview of CMS E-Health Initiatives

1. Overview of CMS E-Health Initiatives Tony Trenkle Director, Office of E-Health Standards and Services April 4, 2006

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3. 3 Areas of Focus Promote key CMS initiatives Support ONC/AHIC initiatives Promote collaboration

4. 4 Promote Key CMS Initiatives E-prescribing Personal Health Records (PHRs) Quality HIT (e.g., P4P, evidence development) HIPAA

5. 5 Support ONC/AHIC Initiatives AHIC Workgroups Consumer Empowerment Electronic Health Record Chronic Care Bio-Surveillance Standards Harmonization HIT Policy Council Federal Health Architecture

6. 6 Key CMS E-Health Initiatives Support for Personal Health Records E-Prescribing Standards Implementation

7. 7 Personal Health Records (PHRs) Short-term Objective-Define CMS role(s) to meet our beneficiary needs for PHRs Potential CMS Roles Make Medicare data available to PHRs Support standards for PHRs Support interoperability between PHRs and between PHRs and EHRs �Certify� PHRs as meeting certain functionality, security and privacy requirements Educate beneficiaries on the uses and benefits of PHRs

8. 8 CMS PHR Activities To-Date Solicit input on CMS� potential role Open Door Forum-Complete Request for Information-Complete Develop action plan and issues paper-Internal review Begin feasibility testing-Award in May Coordinate CMS operational requirements with the overall ONC strategy-On-Going

9. 9 Personal Health Records - RFI In July 2005, CMS released a Request for Information soliciting public feedback on CMS� role with regard to PHRs CMS received over 50 responses from groups such as: Large and small PHR vendors National associations Health plans Provider groups

10. 10 RFI Responses What do beneficiaries need? Summary of claims -diagnoses, procedures Benefit information � what they are entitled to Health screening and immunization reminders What should CMS make available? All data � demographics, claims, benefits, coverage Real-time data, if feasible Only provide data to PHR vendors meeting criteria for functionality, privacy and security

11. 11 PHR-Future Activities Build infrastructure to support wide-spread dissemination of CMS data to PHRs (technical, policy) Work with partners on standards and certification Promote education and outreach

12. 12 E-Prescribing Under the MMA Foundation standards final rule � November 2005 Pilots began � January 2006 Report to Congress on pilots � April 2007 Final standards final rule � April 2008

13. 13 E-Prescribing under the MMA MMA creates an ambulatory electronic prescribing program under Part D Voluntary for physicians and pharmacies Part D plans must support e-prescribing, should their physicians and pharmacies desire to do it If e-prescribing is done, must use standards promulgated now and in the future Only includes non-controlled substances.

14. 14 Foundation Standards NCPDP SCRIPT � for prescriptions ASC X12 270/271 � for eligibility and benefits inquiries and responses between prescribers and Part D sponsors NCPDP Telecommunications Standard � for eligibility and benefits inquiries and responses between dispensers and Part D sponsors

15. 15 Pilot Testing Required to pilot test standards for which there is not adequate industry experience Voluntary participation via agreements with the Secretary Conducted during CY 2006 Pilot testing results will be used to develop final e-prescribing standards to be adopted in 2008

16. 16 Additional Standards to be Tested Formulary and benefit information - NCPDP standard using RxHub protocol Exchange of medication history �NCPDP standard medication history message using RxHub protocol Structured and Codified Sig � Test structured and codified SIGs (patient instructions) developed through standards development organization efforts Clinical drug terminology � Determine whether RxNorm terminology translates to NDC for new prescriptions, renewals and changes Prior authorization messages - New version of ANSI ASC X12 278

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18. 18 Southeastern Michigan Electronic Prescribing Initiative Awarded grant to MedCo to evaluate the impact of SEMI Complementary to the pilot project Will provide short-term lessons learned from one of the nation�s largest electronic prescribing programs

19. 19 HIPAA Update Electronic Health Care Claims Attachments � Proposed Rule This is one of the last transaction standards to be adopted under HIPAA. Over 100 individual comment submissions and thousands of comments being reviewed by CMS and SDOs. Extended comment period closed January 23, 2006. Technical: X12 version; HL7 specifications; LOINC� codes; CDA version (1.0 vs. 2.0) Policy: solicited vs. unsolicited; number of requests for an individual claim; privacy and minimum necessary issues.

20. 20 HIPAA Update Proposed rule affects all covered entities under HIPAA (health plans, health care clearinghouses and certain health care providers). Health plans required to be able to accept or send the transactions. Providers have the option of using the transaction. Health care clearinghouses, if contracted to provide the transaction on behalf of the health plan or health care provider, must conduct the standard transaction Standards proposed: Six types of claims attachments - emergency department; ambulance; rehabilitation (9 disciplines); medications; laboratory results; clinical reports. Two new X12 transactions - the request (277) and the response (275) � version 4050. Clinical Document Architecture (HL7 CDA Release 1.0) to carry the information.

21. 21 HIPAA Update 2nd round of modifications to Transactions and Code Sets � proposed rule under development ICD-10 � CMS considering NCVHS recommendation to move from ICD-9 to ICD-10

22. 22 QUESTIONS?