Meaningful Use Workgroup

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Meaningful Use Workgroup . Paul Tang, Palo Alto Medical Foundation, Chair George Hripcsak, Columbia University, Co-Chair July 27, 2012. Workgroup Membership. Co-Chairs: Paul TangPalo Alto Medical Foundation George Hripcsak Columbia University Members: - PowerPoint PPT Presentation

Text of Meaningful Use Workgroup

Meaningful Use Workgroup Recommendations for Response to Stage 2 Notice of Proposed Rule Making on EHR Incentive Program

Meaningful Use Workgroup

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

July 27, 2012Workgroup MembershipCo-Chairs:Paul TangPalo Alto Medical FoundationGeorge Hripcsak Columbia University

Members:David BatesBrigham & Womens HospitalMichael BarrAmerican College of PhysiciansChristine BechtelNational Partnership/Women & FamiliesNeil CalmanInstitute for Family HealthTim Cromwell Department of Veterans AffairsArt DavidsonDenver Public HealthMarty FattigNemaha County HospitalJames FiggeNY State Dept. of HealthJoe FrancisVeterans AdministrationLeslie Kelly HallHealthwiseYael HarrisHRSADavid LanskyPacific Business Group/HealthDeven McGrawCenter/Democracy & TechnologyLatanya SweeneyCarnegie Mellon UniversityGreg PaceSocial Security AdministrationRobert Tagalicod CMS/HHSKaren TrudelCMSCharlene UnderwoodSiemensAmy ZimmermanRhode Island Department of Health and Human Services2MU Workgroup Recommended Response to Stage 3 NPRMAgendaUpdates from each subgroup*Continue review of comments from previous meeting

*Slides do not reflect referrals from each subgroups3MU Workgroup Recommended Response to Stage 3 NPRMSubgroup 1:Improve Quality Safety, Efficiency and Reducing Health DisparitiesIs enough being done to reach domain goals, especially related to efficiencies? There seems to be little in the rule around disparities.MU Workgroup Recommended Response to Stage 3 NPRM4Improve Quality Safety, Efficiency and Reducing Health DisparitiesMU Workgroup Recommended Response to Stage 3 NPRM5Stage 1 Final RuleStage 2 NPRMStage 3 RecommendationsMedication only: More than 30% of unique patients seen during the reporting period with at least one medication in their medication list have at least one medication order entered using CPOEObjective: Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per State, local and professional guidelines to create the first record of the order.

Measure: More than 60% of medication, laboratory, and radiology orders created by the EP or authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOEDefine % after Stage 2 final

Objective: Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per State, local and professional guidelines to create the first record of the order.

Measure: More than 60% of medication, laboratory, and radiology orders created by the EP or authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOENew for stage 3New for stage 3Objective: Use computerized provider order entry for referrals/transition of care orders directly entered by any licensed healthcare professional who can enter orders into the medical record per State, local and professional guidelines to create the first record of the order.

Measure: More than 20% of referrals/transition of care orders created by the EP or authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded.SGRP101 SGRP130 5Improve Quality Safety, Efficiency and Reducing Health DisparitiesMU Workgroup Recommended Response to Stage 3 NPRM6Stage 1 Final RuleStage 2 NPRMStage 3 RecommendationsImplement drug-drug and drug-allergy interaction checks Consolidated ConsolidatedCertification: EHRs need to be able to consume external lists of DDIs (e.g., never combinations).

Would need SNOMED-CT, Structured Product Labeling, and RxNorm (no current standards to represent DDIs).EP only: Generate and transmit more than 40% of all permissible prescriptions electronicallyEP Objective: Generate and transmit permissible prescriptions electronically (eRx)

EP Measure: More than 65 % of all permissible prescriptions written by the EP are compared to at least one drug formulary and transmitted electronically using Certified EHR Technology.

EH Objective: Generate and transmit permissible discharge prescriptions electronically (eRx)

EH Measure: More than 10% of hospital discharge medication orders for permissible prescriptions (for new or changed prescriptions) are compared to at least one drug formulary and transmitted electronically using Certified EHR TechnologyEP Objective: Generate and transmit permissible prescriptions electronically (eRx)

EP Measure: More than 50% of all permissible prescriptions written by the EP are compared to at least one drug formulary (reviewed for generic substitutions) transmitted electronically using Certified EHR Technology.

EH Objective: Generate and transmit permissible discharge prescriptions electronically (eRx)

EH Measure: More than 30% of hospital discharge medication orders for permissible prescriptions (for new or changed prescriptions) are compared to at least one drug formulary and transmitted electronically using Certified EHR TechnologySGRP102 SGRP103 6Improve Quality Safety, Efficiency and Reducing Health Disparities7Stage 1 Final RuleStage 2 NPRMStage 3 RecommendationsRecord demographics as structured data for more than 50% of all unique patients: Preferred language Gender Race Ethnicity Date of birth

(Hospital Only) date and preliminary cause of death in the event of mortality in the eligible hospital or CAHObjective: Record the following demographics: Preferred language Gender Race Ethnicity Date of birth

Measure: More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data (Hospital Only) date and preliminary cause of death in the event of mortality in the eligible hospital or CAHObjective: Record the following in structured data:Demographics: Preferred language Gender Race Ethnicity Date of birthClinical: SOGI Disability status

Measure: More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data (Hospital Only) date and preliminary cause of death in the event of mortality in the eligible hospital or CAH

Referral from subgroup 2: Record 1) disability status, 2) sexual orientation and gender identity status, and 3) more granular race/ethnicity and language per IOM.Notes: Need to give thought to how EHRs display this, because often demographic data shows up at the top of every EHR screen, so SOGI data may not be part of demographics but should be a clinical field.

NOTE: In order to define disability status, subgroup 2 will use the 6 questions set forth in the American Community Survey (ACS). Subgroup 2 needs to see follow up work on the granular standards of race/ethnicity & language. MU Workgroup Recommended Response to Stage 3 NPRMSGRP104 78Improve Quality Safety, Efficiency and Reducing Health Disparities8Stage 1 Final RuleStage 2 NPRMStage 3 RecommendationsMaintain an up-to-date problem list of current and active diagnoses for more than 80% of all unique patients: have at least one entry or an indication that no problems are known for patient recorded as structured dataConsolidated with summary of careConsolidateDiscussion: EHR systems need to be capable of computer assisted problems, meds, and med allergies. o Problem reconciliation? o Reconciliation from discharge, experience says that it is important for a human to review. Select high priority conditions (such as HTN, under diagnosed and under treated). Assess whether properly identifying all patients with high blood pressure:o Have HTN on problem list?o Lab tests, drugs, vitals, diagnoses usedo Davids study identify diseases, DM, HTN, renal insufficiency (asthma and COPD are too hard).

Functionality to make patient information reconciliation possible for problems - subgroup 3Defining high priority conditions.Maintain active medication list: more than 80% of all unique patients have at least one entry recorded as structured data (or indication that the patient is on no meds)Consolidated with summary of careN/AMU Workgroup Recommended Response to Stage 3 NPRMSGRP105 SGRP106 89Stage 1 Final RuleStage 2 NPRMStage 3 RecommendationsMaintain active medication allergy list: More than 80% of all unique patients seen during the reporting period have at least one entry (or indication that the patient has no known medication allergies) recorded as structured dataConsolidated with summary of care Consolidated

Discussion: Coding of med allergies to support better drug-allergy interactions. Algorithms to identify a strongly predictive interaction. What is the reaction? Has this person been on this and had no problem? Contraindication objective (meds or procedures).

HITSC: Are there mature standards for drug intolerance or allergic reaction value sets? Also standard value sets for overriding an allergy alert?Record and chart changes in vital signs: more than 50% of all unique patients age 2 and over have vital signs recorded as structured data Height Weight Blood pressure Calculate and display BMI Plot and display growth charts for children 2-20 years, including BMIObjective: Record and chart changes in vital signs: Height/Length Weight Blood pressure (age 3 and over) Calculate and display BMI Plot and display growth charts for patients 0-20 years, inc