AMIA 2013 Hill Day Orientation

1. AMIA 2013 Hill Day Orientation Meryl Bloomrosen, Margo Edmunds, and Doug Peddicord April 25, 2013/May 1, 2013

2. Today’s Discussion Topics • Purpose of Hill Day • Hill Day Schedule • 2013 AMIA’s Public Policy Priorities • 2013 Talking Points (asks/tells) • Tips for Congressional Visits • Hill Day Logistics • 2014 Federal Budget • Congressional Committees • Selected Resources

3. Purpose of AMIA Hill Day • Represent AMIA and build valuable relationships in Congress • Present AMIA and yourself as a resource to Members of Congress • Offer availability of AMIA for informatics expertise, advice, and assistance • Spread awareness about AMIA, health information technology and informatics • Make a difference for the biomedical and health informatics community

4. 2013 Hill Day • Educate Congressional Members and staff regarding the importance of biomedical and health informatics practice, research, and training • Highlight informatics research and innovation projects undertaken by AMIA members and funded by NIH (NLM and other institutes), AHRQ and other Federal agencies • Promote what’s important to AMIA and its members • Help Congressional Members understand the impact of AMIA’s issues on their constituents/Districts

5. Hill Day Schedule – May 1 7:45 am Arrive at 122 Cannon House Office Building (Independence Avenue and 1st Street, SE - Breakfast provided 8:15 am Welcome, Introductions, and Opening Remarks – Gil Kuperman, BOD Chair; Kevin Fickenscher, AMIA President and CEO; Margo Edmunds, AMIA PPC Chair 8:45 am Review: Agenda; Logistics; AMIA Public Policy Priorities/ Talking Points; Overview of Congressional Offices, Staff, and Committees - Margo Edmunds, Meryl Bloomrosen and Doug Peddicord 9:15 am Ericka Appel (Rep. Van Hollen’s Health LA – Van Hollen is sponsoring the meeting room) 9:45 am Proceed to Group Appointments (lunch on your own) 5:00 pm Optional Debrief at Bullfeathers (meet after last appointment)

6. AMIA’s 2013 Public Policy Priorities INFORMATICS RESEARCH, PRACTICE, AND EDUCATION/TRAINING • Research: Advocate for ongoing funding for informatics researchand innovation (AHRQ, NIST, NIH, NLM) • Practice: Advocate for ongoing focus on the impact of Health IT on workflow, patient safety, and improving quality of care, including EHRs, HIEs, and national infrastructure (AHRQ, CDC, CMS, DoD, HRSA, ONC, VA) • Workforce: Advocate for ongoing support for informatics scientists, and Health IT workforce education and training (researchers, practitioners, and scientists) (AHRQ, NLM, ONC) • Proactive Issue Monitoring and Tracking: • HIT and Patient Safety • Mobile Medical Applications

7. AMIA’s 2013 Talking Points Biomedical and Health Informatics Research • Maintain sustained levels of funding for research (no decrease/cuts) supported by key Federal agencies, especially AHRQ, ONC, and NIH/NLM (note: NLM budget has a proposed increase) • Develop a National Strategy for Health Information Research by convening a public-private sector consensus conference (of academic, government, and industry experts)

8. AMIA’s 2013 Talking Points cont’d Practice: Health Information Technology Usability, and Patient Safety • AMIA’s Usability Task Force recommends that HHS establish an adverse event reporting system for Health IT to improve patient safety •  AMIA participated in and supports the Bipartisan Policy Center (BPC) oversight framework for patient safety and Health IT, which emphasizes adherence to standards and guidelines, broad participation in guideline development, and creation of a learning environment to enhance innovation

9. AMIA’s 2013 Talking Points cont’d Ongoing Need for Training the Health Informatics Workforce • ONC: 50,000 workers are needed by 2015 to meet health IT demands • 67 percent of healthcare CIOs reported IT staff shortages in 2012 , compared with 59 percent in 2010 (CHIME survey) • AMIA is developing a clinical informatics subspecialty certification for physicians, which will recognize formal training in informatics • A comparable Advanced Inter-professional certification is in development

10. Tips on Congressional Visits • AMIA’s designated leads keep track of your timing and will open/close the discussions • Be aware of the office you are visiting: Republican or Democrat, personal or Committee; make a note of which Committee(s) the Member is on • Introduce yourself and your organization; be descriptive - how many patients you serve, how many employees, how much research funding, etc. • Make a personal connection -- around geography, education, sports, anything -- if you are a constituent, say so

11. Tips on Congressional Visits cont’d Talk about Research, Practice and Workforce in your organization • Research you have been involved in/conducted or currently being conducted within your organization • Practice: pros and cons of your EHR system, usability and interoperability issues, patient engagement efforts; patient safety issues; health information exchange efforts • Workforce training and staffing shortages and issues in your organization. 

12. Tips on Congressional Visits con’t • Tell real stories and make the stories memorable (no jargon allowed, not even the word "interoperability", until one of you defines it) • Get to your Asks/Tells if and when that makes sense - from the first 5 minutes to the last 5 minutes, or not at all (though we would like you to deliver at least one of the Asks, if possible) • Ask (listen for) what you, your organization, AMIA can do to be of assistance - would the Member like to visit your hospital, university, or office or know more about a particular program? Make sure AMIA staff knows about the request and either you or staff gets back to them

13. Tips on Congressional Visits con’t • Like most people, Congressional/committee staff can only hold only a few pieces of information in their heads – don’t overload them • We suggest focusing on no more than two “Asks/Tells” across AMIA’s three topic areas: Research, Practice, Workforce NOTE: AMIA and its members have expertise across many areas and you can talk about many things related to your Research, Practice and Workforce interests, but our leave-behinds will contain only a few Asks/Tells.

14. Hill Day Logistics • If you are running late please call (see phone numbers at end of slides) • Allow enough time; security is tight • Leave bags/luggage elsewhere • Any bag larger than 14" wide x 13" high x 4" deep is prohibited. All bags are subject to a lengthy search and security screening. • Take Metro or taxi (maps at end of slides ) • Dress for the weather (bring umbrella if raining) • Wear COMFORTABLE shoes • Groups of participants (usually based on geography) will visit Congressional offices. • Each group will have a designated AMIA lead • AMIA will provide packets containing AMIA leave behinds and talking points for you to use during your visits • Please familiarize yourself with AMIA talking points and materials • The Senate and House office buildings have cafeterias located on the ground or basement floors- you are on your own for lunch

15. President’s FY 2014 Budget Proposal (In millions) AHRQ 2013: $432 2014: $434 CDC 2013: $5,068 2014: $6,600 HRSA 2013: $6,088 2014: $6,021 FDA 2013: $4,486 2014: $4,654 NLM 2013: $384 2014: $390 NIST 2013: $857 2014: $928 NIH 2013: $30,702 2014: $31,331 ONC 2013: $66 2014: $78

16. Selected Happenings • Energy and Commerce Committee Hearings on Mobile Applications: The Committee’s Subcommittees on Communications and Technology, Health, and Oversight and Investigations held hearings on March 19-21 to discuss role of technology in the health care industry and how federal regulations could threaten patient safety and innovation and increase costs for consumers. http://energycommerce.house.gov/press-release/fda-goes-on-record-with-pledge-not-to-tax-consumers-smartphones-and-tablets • New ONC FACA Workgroup: New workgroup (Food and Drug Administration Safety Innovation Act (FDASIA)) Workgroup will focus on identifying key considerations to improve patient safety and promote innovation including mobile medical applications--will report to the Health IT Policy. http://www.healthit.gov/policy-researchers-implementers/federal-advisory-committees-facas/fdasia • Senate Report Critical of MU: Six Republican members of the U.S. Senate published a report critical of the progress of the electronic health records meaningful use program and calling for a pause to the program and re-examination of its strategies. http://www.thune.senate.gov/public/index.cfm/files/serve?File_id=0cf0490e-76af-4934-b534-83f5613c7370

17. Overview of Congress: Who’s Who in the US Senate Leadership • Majority Leader: Harry Reid (D-NV) Minority Leader: Mitch McConnell (R-KY) • Majority Whip: Richard Durbin (D-IL) Minority Whip: John Cornyn (R-TX) Key Committees FinanceHealth, Education, Labor, Pension Chairman: Max Baucus (D-MT) Chairman: Tom Harkin (D-IA) Ranking: Orrin Hatch (R-UT) Ranking: Lamar Alexander (R-TN) Budget Appropriations Chairman: Patty Murray (D-WA) Chairman: Barbara Mikulski (D-MD) Ranking: Jeff Sessions (R-AL) Ranking: Richard Shelby (R-AL) Source: KaiserEDU.org

18. Overview of Congress: Who’s Who in the US House Leadership Speaker: John Boehner (R-OH) Majority Leader: Eric Cantor (R-VA) Minority Leader: Nancy Pelosi (D-CA) Majority Whip: Kevin McCarthy (R-CA) Minority Whip: Steny Hoyer (D-MD) Key Committees Energy and Commerce Ways and Means Chairman: Fred Upton(R-MI) Chairman: Dave Camp (R-MI) Ranking: Henry Waxman (D-CA) Ranking: Sander Levin (D-MI) Budget Appropriations Chairman: Paul Ryan (R-WI) Chairman: Harold Rogers (R-KY) Ranking: Chris Van Hollen (D-MD) Ranking: Nita Lowey (D-NY)

19. Overview of Congress: Senate Committee on Finance Chief Health Responsibilities: • Health programs under the Social Security Act and including: • Medicaid - including ACA expansions, Center for Consumer Information, and Insurance Oversight • Medicare • CHIP • Welfare (TANF) • Maternal and Child Health block grant • Supplemental Security Income (SSI) • ERISA (w/HELP Committee) • Revenue measures Source: KaiserEDU.org

20. Overview of Congress: Senate Committee on Health, Education, Labor, and Pensions (HELP) • Public Health • Employee Retirement Income Security Act (ERISA), (shared with Finance Committee) • Individuals with disabilities • Occupational safety and health • Biomedical research and development • Aging Source: KaiserEDU.org

21. Overview of Congress: House Committee on Energy and Commerce • Medicaid and Children’s Health Insurance Program • Medicare (Part B, Parts C and D shared with Ways & Means) • Centers for Medicare and Medicaid Services (CMS), including the Center for Consumer Information and Insurance Oversight • Aging policy, individuals with disabilities • National Institutes of Health (NIH) • Domestic activities of the American National Red Cross • Occupational safety and health, including the welfare of miners • Public Health Source: KaiserEDU.org

22. Overview of Congress: House Committee on Ways and Means • Government payments for programs in Social Security Act: • Medicare (Part A, Parts B, D joint with E&C) • Welfare, Temporary Assistance for Needy Families (TANF) • Supplemental Security Income (SSI) • Social Services (Title XX) • Tax credits and related matters in tax code dealing with health insurance premiums Source: KaiserEDU.org

23. Overview of Congress: Senate and House Committees on Appropriations • Allocates discretionary funding to federal agencies, departments, and programs • Sub-committees prepares funding allocations for programs within jurisdiction • Subject to spending levels established in budget resolution • Major authority over discretionary, non-entitlement programs Source: KaiserEDU.org

24. Overview of Congress: Senate and House Committees On Budget • Review and evaluate President’s budget proposal • Formulate budget resolution establishing Congressional spending and revenue levels • Submit resolution to full chambers for vote and negotiations in conference • Monitoring budget “reconciliation” process • Oversight of Congressional Budget Office (CBO) Source: KaiserEDU.org

25. Other Supporting Materials and Resources Biomedical and Health Informatics Research • President’s Council of Advisors on Science and Technology (PCAST). “Designing a Digital Future: Federally Funded Research and Development Networking and Information Technology." December 16, 2010. • President’s Council of Advisors on Science and Technology (PCAST). “Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward.” December 8, 2010. • AMIA Response to Request for Information (RFI): Training Needs in Response to Big Data to Knowledge (BD2K) Initiative (NOT-HG-13-003)

26. Other Supporting Materials and Resources Workforce and Informatics Training • Defining the Medical Subspecialty of Clinical Informatics. Don E Detmer, John R Lumpkin, Jeffrey J Williamson. JAMIA 2009;16:167-168 • AMIA Board White Paper: Core Content for the Subspecialty of Clinical Informatics. JAMIA 2009;16:153-157 • AMIA Board White Paper: Program Requirements for Fellowship Education in the Subspecialty of Clinical Informatics.. JAMIA 2009;16:158-166 • National Institutes of Health BIOMEDICAL RESEARCH WORKFORCE WORKING GROUP REPORT A Working Group of the Advisory Committee to the Director June 14, 2012 • Bipartisan Policy Center. The Complexities of National Health Care Workforce Planning: A review of current data and methodologies and recommendations for future studies Feb. 5, 2013

27. Other Supporting Materials and Resources Health Information Technology, Usability, and Patient Safety • AMIA Usability Task Force Report: Enhancing Patient Safety and the Quality of Care by Improving the Usability of Electronic Health Records: Recommendations from AMIA • Bipartisan Policy Center. An Oversight Framework for Assuring Patient Safety in Health Information Technology Feb. 13, 2013

28. AMIA- Who We Are • AMIA and its multidisciplinary members advance the use of health information technology (HIT) in clinical care, research, public and population health, personal health management, and translational science • Our more than 4000 members are health professionals, researchers, teachers, and thought leaders who work in academic, government, private health care delivery, research, and commercial settings • AMIA is regarded as an authoritative and objective source within the informatics community, the policy community, and the health care industry • AMIA members’ expertise spans a wide range of disciplines including biomedical and health sciences, computer and communications technology. organizational behavior, cognitive science, biomedical and health sciences library and information science, and consumer health

29. AMIA’s Mission With others, create health information technology and systems that transform health care and measurably improve health status Strengthen the ability to create and manage the science and knowledge base of health and health care, including its timely access Actively participate in global health information policy, technology, and informatics with particular emphasis on needs of underserved populations

30. What is Informatics? • A general term used to refer to biomedical informatics and its many areas of application and practice (e.g., bioinformatics, clinical informatics, public health informatics) • Biomedical informatics (BMI) is the interdisciplinary, scientific field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving and decision making, motivated by efforts to improve human health and health care delivery http://www.amia.org/about-amia/science-informatics

31. 2006:Toward a national framework for the secondary use of health data: an American Medical Informatics Association White Paper. 2007: Advancing the framework: use of health data--a report of a working conference of the American Medical Informatics Association 2008: Informatics, evidence-based care, and research; implications for national policy: a report of an American Medical Informatics Association health policy conference 2009: Anticipating and Addressing Unintended Consequences of HIT and Policy 2010: The Future of Health IT Innovation and Informatics 2011: Future State of Clinical Documentation and Data Capture 2012: Health Data Use, Stewardship and Governance AMIA’s Invitational Health Policy Meetings

32. Cannon Office Building Cannon House Office Building Address: Independence Avenue and 1st Street, SE Washington, DC 20003

33. Map of Capitol Buildings

34. Nearby Metro Stations

35. Need More Information Between Now and Hill Day? Meryl Bloomrosen 301 657-1291 (office) meryl@amia.org

36. Discussion

37. After Our Hill Visits 5:00 pm Optional/Informal Debriefing (after your last appointment) Bull Feathers (http://bullfeathersdc.com/) 410 1st St SE Washington, DC 20003 (202) 484-0228