1315 Keynote Halamka

8/3/2019 1315 Keynote Halamka

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The ONC Strategy:

cceleration, Standards,and Meaningful UseJohn D. Halamka MD


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The ONC Strategy

Grants - Accelerating Adoption

Standards - Interim Final Rule Meaningful Use - Notice of ProposedRulemaking

Certification - Notice of ProposedRulemaking


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Grants Regional extension centers (RECs) $643

million

Health Information Exchange $564 million

Workforce Training Programs $118 million Beacon Communities $235 million

Strategic Health Advanced Research Project(SHARP) $60 million

Nationwide Health InformationNetwork/Standards and Certification $64.3


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Interim Final Rule

Content

Vocabulary

Transmission

Privacy/Security


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Record Content - CCD or CCR, Convergence to onestandard Vocabulary Problem List - ICD9/SNOMED, ICD10/SNOMED

Medications - RxNorm mapping to existingcommercial products, RxNorm

Allergies - None, UNII (Universal IngredientIdentifier)

Vital Signs - None, CDA Template

Unit of Measure - None, UCUM (Unified Code for


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e-Prescribing

Drug Formulary Check - NCPDPFormulary & Benefits Standard 1.0,Medicare Part D as it evolves

Content - NCPDP Script 8.1 or 10.6,NCPDP Script 10.6

Vocabulary - RxNorm mapping toexisting commercial products , RxNorm


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Transactions

Those required by HIPAA X12 4010 now, X12 5010 in 2013

CAQH Core I implementation guidance

Q li


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Quality

NQF Health Information TechnologyExpert Panel Definitions

PQRI XML, Next generation whichcould be QRDA

P bli H lth L b


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Public Health Labs

Content - HL7 2.5.1 Vocabulary - LOINC interpretation,LOINC, UCUM, SNOMED-CT


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Surveillance Content - HL7 2.31 or 2.51, Newerversions Vocabulary - According to Applicable

Public Health Agency Requirements,Geocoded Interoperable PopulationSummary Exchange (GIPSE)


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Immunizations

Content - HL7 2.31 or 2.51, Newerversions

Vocabulary - CVX (CDC maintainedHL7 standard list of immunizations)

T i i


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Transmission

SOAP 1.2

REST

P i /S it


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Privacy/Security General Encryption and Decryption of Electronic Health

Information - AES

Encryption and Decryption of Electronic Health Informationfor Exchange - TLS, IPv6, IPv4 with IPsec

Record Actions Related to Electronic Health Information -Policy Verification that Electronic Health Information has not been

Altered in Transit - SHA-1 or higher

Cross-Enterprise Authentication - Policy

Record Treatment, Payment, and Health Care OperationsDisclosures - Policy

M i f l U


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Meaningful Use Use CPOE

Ambulatory - 80% of medications,laboratory, radiology/imaging, andreferrals

Inpatient - 10% of medications, laboratorradiology/imaging, blood bank, physicaltherapy, occupational therapy, respiratorytherapy, rehabilitation therapy, dialysis,

provider consultants, anddischar e/transfers.

M i f l U


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Meaningful Use

Implement drug-drug, drug-allergy,drug-formulary checks

Maintain an up to date problem list ofcurrent and active diagnoses (at leastone coded entry or "No Problemsexist") in ICD9-CM or SNOMED-CT for

at least 80% of all patients

M i f l U


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Meaningful Use Generate and transmit permissible

prescriptions electronically (the DEAdoes not yet allow controlled

substances to be e-prescribed) for 75%of all ambulatory prescriptions

Maintain an active medication list (atleast one coded entry or "NoMedications taken") for at least 80% ofall patients

M i f l U


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Meaningful Use

Maintain an active allergy list (at leastone entry or "No Allergies reported") foat least 80% of all patients.

Record demographics includingpreferred language, insurance type,gender, race, ethnicity, date of birth,and date of death/cause in the event of

inpatient mortality for 80% of patients.

M i f l U


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Meaningful Use Record vital signs including height,

weight, blood pressure, Body MassIndex (calculated) and growth charts fochildren 2-20 years for 80% of patients.

Record smoking status for 80% ofpatients 13 years or older

Incorporate 50% of clinical lab testresults as structured data using LOINCcodes

Meaningf l Use


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Meaningful Use Generate a least one report listing

patients with a specific condition. Theconcept is that such reporting can be

used for quality improvement, reductionof disparities, and outreach.

Report aggregate numerator anddenominator quality data to CMS in2011 and exchange it using PQRI XMLby 2012

Meaningful Use


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Meaningful Use Send reminders to at least 50% of allpatients who are 50 years and over for

preventative care/followup. The intent is toallow the patient to choose between postcard, email, phone reminder, or PHRreminder.

Implement 5 clinical decision support rulesrelevant to the clinical quality metrics.

Check insurance eligibility and submitclaims electronically for at least 80% of

Meaningful Use


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Meaningful Use Provide 80% of patients who request a

electronic copy of their healthinformation in the CCD or CCR formatwithin 48 hours of their request

Provide 10% of patients with onlineaccess to their problem list, medicationlists, allergies, lab results within 96

hours of the information being availableto the clinician.

Meaningful Use


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Meaningful Use Provide a clinical summary for 80% ofall office visits (problem lists,

medication lists, allergies,immunizations, and diagnostic testresults) in paper or CCD/CCR format

At least one test of health informationexchange among providers of care andpatient authorized entities.

Perform Medication reconciliation for atleast 80% of relevant encounters and

Meaningful Use


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Meaningful Use Provide a summary of care record for aleast 80% of transitions of care and

referrals. This also implies the ability toreceive a record and display it in humareadable format

Perform at least one test of the EHRcapacity to submit electronic data toimmunization registries.

Perform at least one test of the EHR'scapacity to submit electronic lab results

Meaningful Use


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Meaningful Use

Perform at least one test of the EHR'scapacity to submit syndromicsurveillance data to public healthagencies.

Conduct or review a security riskanalysis and implement updates asnecessary

Summary


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Summary 2011 standards set a floor and will evolve to

more specificity in 2013

Certification organizations are yet to be named

There are approximately 25 required projects tachieve meaningful use - a major organizationcommitment

Divide your projects into discrete doable steps

Leverage the HIE, RHITEC, and BeaconCommunities grants to support meaningful use

Documents

1315 Keynote Halamka