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HIT Policy Committee Meaningful Use Workgroup

HIT Policy Committee Meaningful Use Workgroup. Paul Tang, Palo Alto Medical Foundation, Chair George Hripcsak, Columbia University, Co-Chair October 20, 2010. Workgroup Membership. Co-Chairs: Paul Tang Palo Alto Medical Foundation George Hripcsak Columbia University Members:

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HIT Policy Committee Meaningful Use Workgroup

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  1. HIT Policy CommitteeMeaningful Use Workgroup Paul Tang, Palo Alto Medical Foundation, Chair George Hripcsak, Columbia University, Co-Chair October 20, 2010

  2. Workgroup Membership Co-Chairs: Paul Tang Palo Alto Medical Foundation George Hripcsak Columbia University Members: • David Bates Brigham & Women’s Hospital • Michael Barr American College of Physicians • Christine Bechtel National Partnership/Women & Families • Neil Calman Institute/Family Health • Art Davidson Denver Public Health • James Figge NY State Dept. of Health • Linda Fischetti Department of Veterans Affairs • David Lansky Pacific Business Group/Health • Deven McGraw Center/Democracy & Technology • Latanya Sweeney Carnegie Mellon University • Charlene Underwood Siemens

  3. Agenda • Recap of stage 1 recommendation process • Process for development of stage 2 recommendations • Directional strategies for discussion

  4. Recap of Stage 1 Recommendation Process • Apr 29, 2009: NCVHS Meaningful Use hearing • May 11, 2009: First HIT Policy committee meeting • May 28, 2009: First Meaningful Use (MU) workgroup meeting • Jun 16, 2009: First Draft “Meaningful Use matrix” presented at HITPC for feedback • Draft released for public comment • Jul 16, 2009: HITPC approved MU recommendations • Jan 13, 2010: MU NPRM • Jul 13, 2010: MU Final Rule

  5. Developing Recommendations for Stage 2 (and 3)Deliberative Process • Hearings over past year: • Specialists; smaller practices and hospitals • State issues • Health care disparities • Patient and family engagement • Population and public health • Care coordination • CMS Final Rule on Meaningful Use • ONC Final Rule on EHR certification • MU WG deliberations on stage 2/3 criteria

  6. Discussion of Philosophical Approaches to Stages 2 and 3 Recommendations • Positioning of stage 2 • Incremental change over stage 1 • Stepping stone to stage 3 • Migration to outcomes • Stage 3 outcomes based • Stage 2 introduction of outcomes orientation • Patient engagement information sharing • Access vs. copy vs. “clinical summaries” • Deeming of external criteria • Accrediting groups • Professional accrediting boards • Other CMS programs

  7. Positioning of Stage 2Discussion • Incremental change over stage 1 • Pro: Extends current implementation plans • Con: Continues uncertainty for market for stage 3 • Stepping stone to stage 3 • Pro: Establishes a roadmap (and timeline) • Con:

  8. Migration to OutcomesDiscussion • Set Stage 3 outcomes-based measures • Setting performance thresholds • Direct measure of benefits of HIT • Deem satisfaction of process measures by achieving threshold performance measure • Supports value-based purchasing • Reduce dependence on process measures • Reduce emphasis on “how” (in favor of “what”); allows for innovation • Reduce burden of measuring structure and process • Introduce outcomes orientation in Stage 2 (merely examples) • Apply clinical decision support to achieve outcome (vs. use specific type of CDS) • Reduce prescribed major drug interactions (for prescribed drug categories) by x% • Reduce 30-day readmission rate by 10%

  9. Patient Engagement Information SharingDiscussion • Move towards innovative patient use of data • Re: “access” vs. “copy” vs. “clinical summaries” vs. “discharge instructions” • Setting differences and information purposes • Ambulatory care [ongoing care] • Hospitals [episodic major event] • Types of information sharing • “Access”: real-time, on-demand availability of shared EHR content [could replace “copy” in the future] • “Copy” / “Download”: point-in-time copy of existing electronically available information [transitional stage from paper] • Specific-use documents (examples) • Hospital: discharge instructions • Ambulatory care: visit summaries

  10. Explore Deeming of External CertificationDiscussion • Use external certification to deem satisfaction of specific MU criteria (hypothetical examples) • E.g., Does satisfaction of MU care-coordination criteria satisfy HIT component of PCMH OR does PCMH accreditation  deemed to satisfy care coordination criteria? • E.g., Does satisfaction of MU category 1 criteria (quality, safety, efficiency) satisfy HIT component of professional maintenance of certification (MOC) for medical boards OR does MOC  deemed to satisfy a subset of MU criteria? • MU deeming of HIT infrastructure for ACO qualification?

  11. MU Work Plan Timeline • Oct 20, 2010: directional guidance from HITPC • Nov 19, 2010: present draft MU stages 2/3 criteria • Dec, 2010: refine draft MU criteria, prepare for RFC • Jan, 2011: release draft MU criteria RFC • Feb, 2011: analyze RFC submissions and revise MU draft criteria • Mar, 2011: present revised draft MU criteria to HITPC • 2Q11: CMS report on initial MU submissions • 3Q11: Final HITPC recommendations on stage 2 MU • ~4Q11: CMS MU NPRM

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