HIT Policy CommitteeHIT Policy CommitteeMeaningful Use WorkgroupMeaningful Use Workgroup

Paul Tang, Palo Alto Medical Foundation, ChairGeorge Hripcsak, Columbia University, Co-Chair

October 20, 2010

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

Agenda

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

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

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

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

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:

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%

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

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?

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