Meaningful Use Workgroup

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Meaningful Use Workgroup. Paul Tang, Chair George Hripcsak, Co-Chair. January 6, 2014. Meaningful Use Workgroup Members. J . Marc Overhage , Siemens Healthcare Patricia Sengstack , Bon Secours Health Systems Charlene Underwood, Siemens Michael Zaroukian, Sparrow Health System - PowerPoint PPT Presentation

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Paul Tang, ChairGeorge Hripcsak, Co-Chair

Meaningful Use WorkgroupJanuary 6, 2014Meaningful Use Workgroup MembersChairsPaul Tang , Palo Alto Medical FoundationGeorge Hripcsak, Columbia UniversityMembersDavid Bates , Brigham and Womens HospitalChristine Bechtel , National Partnership for Women & FamiliesNeil Calman , The Institute for Family HealthArthur Davidson, Denver Public Health DepartmentPaul Egerman, Businessman/EntrepreneurMarty Fattig, Nemaha County Hospital Auburn, Nebraska Leslie Kelly Hall, HealthwiseDavid Lansky, Pacific Business Group on HealthDeven McGraw , Center for Democracy & Technology

J. Marc Overhage, Siemens HealthcarePatricia Sengstack, Bon Secours Health SystemsCharlene Underwood, SiemensMichael Zaroukian, Sparrow Health SystemAmy Zimmerman, Rhode Island Office of Health & Human ServicesFederal Ex officiosTim Cromwell, Department of Veterans AffairsJoe Francis , Veterans AdministrationGreg Pace, Social Security AdministrationMartin Rice, HRSARobert Tagalicod, Centers for Medicare & Medicaid Services, HHS

1WorkplanDateMeeting Tasks1/6/20149:30-11:30 ETStandards feedbackPGHDMedication AdherenceOpen NotesAffordable care Health disparities1/17/1411:00-1:00 ETFollow-up itemsReview of recommendations1/28/141:00-3:00 ETFollow-up itemsReview of recommendations2/4/14

Present to HITPC22Feedback from HITSC - PGHD3Engaging patients and families in their care: Patient Generated Health Data4Stage 3 Functionality GoalsEnabling active participation by patients and families to improve health and care Provide ability to contribute information in the record, including patient reported outcomes (PRO)Patient preferences recorded and usedFunctionality Needed to Achieve GoalsEligible Providers and Hospitals provide the capability for patients to electronically submit patient-generated health information through structured or semi-structured questionnaires (e.g., screening questionnaires, intake forms, risk assessment, functional status), secure messaging or provider-selected devices using CEHRT. (Provider-selected devices pending consideration by HITSC)Recommended as a Menu itemLow threshold 4Standards RecommendationsONC should consider the Direct transport standard for secure messaging and data from devices

ONC should consider the HL7 Care Team Roster standard

ONC should consider the HL7-CCDA for structured and unstructured questionnaires

ONC should consider the Continua standard for data from devices

We encourage standards that support mobile access to patient data and PGHD given the proliferation of mobile devices. However, we do not recommend mandating a specific standard at this time given that might stifle innovation. 5HITSC DiscussionThe key discussion was an evaluation of the standards maturity and the level of adoption of the standards suggested for patient generated data. Recommendations included Direct for data transport, CCDA for content capture, LOINC/SNOMED for vocabulary capture, and Continua implementation guides for devices. As a followup the Consumer Technology Workgroup will list examples of CCDA templates that can be used to support patient generated data use cases. Continua will provide a list of the named standards so that we can validate the maturity and adoption of Continua's recommendation. We will also ensure that the CCDA templates include the appropriate vocabularies that will enable incorporation of patient generated data into EHRs. AdherenceHITSC Clinical Quality WorkgroupMarjorie Rallins, Co-ChairDanny Rosenthal, Co-Chair7Questions presented to CQWG from MUWGUpdated Stage 3 ObjectiveQuestionMedication adherence certification criteria: Ability to accept data feed from PBM (Retrieve external medication fill history for medication adherence monitoring)Ability to identify important signals such as: identify data that patient is not taking a drugpatient is taking two kinds of the same drug (including detection of abuse) or multiple drugs that overlap

Certification criteria: EHR technology supports streamlined access to prescription drug monitoring programs (PDMP) data.For example:Via a hyperlink or single sign-on for accessing the PDMP dataVia automated integration into the patients medication history Leveraging things like single sign on or functionality that could enable the linkage between PDMPs and prescribers and EDs?Clinical Quality: feedback on the readiness of standards will help determine whether this could be a certification criteria item for stage 3 or should be pushed out to a future stage.8CQWG: Recommendations/Comments for Medication Adherence (I)Suggest further clarification on the goals of MU for medication adherence and prescription drug monitoring. Once clarified, prioritize goalsThe following standards could be recommended for medication adherence. Note, original intent of the standards were for administrative analysis. Clinical use may require further cleaning of the dataNCPDP SCRIPT StandardNCPDP Structured and Codified Sig Format (component to be used with NCPDP SCRIPT Standard)RxNorm. EHR should be able to accept RxNorm codesNDF-RT considered but limited to drug class identification9Recommendations/Comments (II)Other comments and recommendationsSignals can be identified but are not necessarily computable; Actions on signals are out of scope for this questionC-CDA medication list; reconciliation should be considered in the context of medication adherenceVarious states accumulate data on controlled substances and make that data available to providers that have no data integration with other systemsAlignment of goals medication adherence and prescription drug monitoring with other regulatory activity and other agencies (e.g., FDA is crucial)MUWG should have direct communication with an NCPDP expert (e.g., Lynn Gilbertson, Vice President, Standards Development, NCPDP)CQWG: Recommendations/Comments for Medication Adherence (II)10CQWG: Recommendations/Comments for PDMPMany issues remain under consideration for prescription drug monitoring standards. As such, CQWG cannot recommendations at this time

11Open Notes12Follow-up from clinical documentation hearingTo improve accuracy, to improve patient engagement, and to guard against fraud, EHRs should have the functionality to provide progress notes as part of MU objective for View, Download, and TransmitOpenNotes NEJM article

13Affordable Care14Affordable care:Stage 3 Priorities15CDS support to avoid duplicative careCDS support to avoid unnecessary or inappropriate careMU Outcome GoalsEliminate duplicative testingUse cost-effective diagnostic testing and treatmentMinimize inappropriate care (overuse, underuse, and misuse)Formulary checksGenerics

Stage 3 Functionality GoalsMU Outcome GoalsStage 1 + 2 Functional Objectives15Affordable care:Clinical Decision Support16Examples of Functionality Needed to Achieve GoalsDemonstrate use of multiple CDS interventions that apply to quality measures in each of the six NQS domains. Recommended interventions include: Preventive careChronic disease management (e.g., diabetes, coronary artery disease) Appropriateness of lab and radiology orders Advanced medication-related decision support (e.g., renal drug dosing) Improving the accuracy/completeness of the problem listDrug-drug and drug-allergy interaction checksCEHRT should provide tools that enable the ability to provide these interventionsRelated work that can inform: S&I HealtheDecisions, HITSC Clinical Quality WGStage 3 Functionality GoalsCDS support to avoid duplicative careCDS support to avoid unnecessary or inappropriate care16Reducing Health Disparities17Reducing health disparities:Stage 3 Priorities18Patient conditions are treated appropriately (e.g. age, race, education, LGBT) MU Outcome GoalsEliminate gaps in quality of health and health care across race, ethnicity, and sexual orientationLanguageGender RaceEthnicity

Stage 3 Functionality GoalsMU Outcome GoalsStage 1 + 2 Functional Objectives18Reducing health disparities:Additional Patient Information19Functionality Needed to Achieve GoalsCEHRT provides the ability to capturePatient preferred method of communication*occupation and industry codesSexual orientation, gender identity (optional fields) Disability status Differentiate between patient reported & medically determined Communication preferences will be applied to the clinical summary, reminders, and patient education objectives Providers should have the ability to select options that are technically feasible for them, these could include: Email, text, patient portal, telephone, regular mailRecommended as certification criteria onlyStage 3 Functionality GoalsPatient conditions are treated appropriately (e.g. age, race, education, LGBT) 19Reduction of Disparities previous deeming recommendationsReduction of disparities in gap areaIdentify areas where attesters should be required to demonstrate they have reduced health care disparities in high-risk populations20