Meaningful Use Workgroup New Pathways for Meaningful Use Stage 3

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Meaningful Use Workgroup New Pathways for Meaningful Use Stage 3. April 9, 2013 Paul Tang, MD George Hripcsak , MD Christine Bechtel. Agenda. Review of HITPC presentation and feedback Consolidation and Deeming Clinical Documentation - PowerPoint PPT Presentation

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Meaningful Use Workgroup New Pathways for Meaningful Use Stage 3

April 9, 2013Paul Tang, MDGeorge Hripcsak, MDChristine Bechtel

1AgendaReview of HITPC presentation and feedbackConsolidation and DeemingClinical DocumentationComments/discussion of direction from HITPC and directional decisions (to be fleshed out in subgroupsWork plan reviewReconcile RFC comments where divergent public comments2Presentation to HITPC Meaningful Use WorkgroupApril 3, 20133Stages of Meaningful UseImproving OutcomesStage 12011-13Stage 22014-15Stage 32016-174Stages of Meaningful UseImproving OutcomesStage 12011-13Stage 22014-15Stage 32016-175Original Principles for Stage 3 RecommendationsSupports new model of care (e.g., team-based, outcomes-oriented, population management)Addresses national health priorities (e.g., NQS, prevention, Partnerships for Patients, Million Hearts)Broad applicability (since MU is a floor)Provider specialties (e.g., primary care, specialty care)Patient health needsAreas of the countryNot "topped out" or not already driven by market forcesMature standards widely adopted or could be widely adopted by 2016 (for stage 3)

6Lessons from Stages 1Implications for Stage 3Stage 1 ExperienceSubstantial increase in adoption rates and effective useMandatory floor creating network effectsThresholds consistently exceeded

Consistent use across the years

Reporting requirements have considerable costs and burdenPrescriptive, forced march impacts available resources for innovation or to address local priorities

Implications for Stage 3Creating critical mass of users and data in electronic formRising tide is floating boats (e.g., setup for patient engagement, HIE)Once MU functionality is implemented, it is usedGains from stage 1 (and 2) will persistStage 3: Simplify and reduce reporting requirementsStage 3: Rely more heavily on market pull (e.g., new payment incentives); promote innovative approaches ie., reward good behavior7Additional Goals for Stage 3 Address key gaps (e.g., interoperability, patient engagement, reducing disparities) in EHR functionality that the market will not drive alone, but are essential for all providers:to create level playing fieldto create network effectsto fulfill need for a public goodConsolidate MU objectives where higher level objective implies compliance with subsumed process objectivesConsider alternative pathway where meeting performance and/or improvement thresholds deems satisfaction of subset of relevant MU functionality implicitly required to achieve performance/improvement8Consolidation SubgroupChristine Bechtel, Chair9Consolidation Summary43 MUWG objectives proposed in stage 3 RFC Consolidated to 25 objectivesAssumptionsThe full WG will consider RFC feedback and update criteriaAll criteria will be included in certificationFocus on advanced usesex: recording data vs. use dataGive credit for MU objectives that should be standard of practice once passed stages 1 and 2 Identify what needs to be used and certified

10Types of ConsolidationAdvanced within concept of another objectiveDuplicative conceptsobjective becomes certification onlyDemonstrated use and can trust that it will continue11Advanced within Concept of Another ObjectivePatient preferred means of communication (SGRP208)

DemographicsAdded as an additional element

Patient education, per patient preference

Clinical Summary, per patient preference

Certification CriteriaMaintained ObjectiveKey:Reminders, per patient preference

12Duplicative ConceptsImmunization intervention (SGRP401B)

CDS (113)Interventions include preventative care for immunizations

Certification CriteriaMaintained ObjectiveKey:13Structured lab results (SGRP114)

Included in care summary (303)

Included in view, download, transmit (204A)

Demonstrated UsePatient lists and dashboards (SGRP115)Needed for population management and quality measurementHow to measure use?Existing external drivers that will drive use (new models of care)PQRS, value based purchasing, ACOs14CPOE - Advanced within concept of another objective, duplicative concept, demonstrated use15

CPOE for Medication Orders

Needed to provide meds within care summary (303)Needed to provide meds within VDT (204A)Needed for eRx formulary and generic substitutionsCertification CriteriaMaintained ObjectiveKey:Consolidation at a Glance16

Consolidation OverviewReconciliation

eRx formulary


Pt list/dashboardReminders

EH: eMAREH: Lab results EPPGHDClinical summary

Patient education

Secure MessagingNotify of health eventCare plan*Immunization registryAdverse event*Case reports to PHAVDT

ToC Care summary

Advanced directiveRegistries

Synd SurveillanceELRIdentify clinical trialsQuality, safety, reducing health disparitiesReferral loopTest tracking

Imaging results

Electronic notesEngaging patients & familiesImproving care coordinationPopulation & public healtheRx transmissionCertification CriteriaMaintained ObjectiveKey:* Proposed for future stage of MUDemographics17CPOE - medsCDS for immunComm preferenceCPOE - radCPOE - labAmendmentFamily HxProb, med, allg listStructured labVitalsSmoking statusComm preferenceComm preferenceCancer registrySpecialty registryHAI reportsDemographicsAmendmentFamily HxProb, med, allg listStructured labVitalsSmoking statusCPOE - referralsInter prob list*RxHx PDMP*CPOE - medsDeeming SubgroupPaul Tang, Chair18Deeming AssumptionsCannot reliably achieve good performance (or significantly improve) without effective use of HITTherefore: in order to promote innovation, reduce burden, and reward good performance, deem high performers (or significant improvers) in satisfaction of a subset of MU objectives as an optional pathway to qualifying for MU

1919Example Criteria for Deeming for EPsDemonstrate high (top 30 %ile) or improved performance (20% reduction of gap between last year's performance and top quartile). Select two items from each of the categories below: Prevention of high priority diseases (pick 2 from)Breast cancer (mammography screening)Colon cancer (colonoscopy screening)Influenza (flu vax)Pneumonia (pneumococcal vaccine)Obesity (BMI screening and follow up)Cardiovascular disease (LDL screen)HTN (BP screen and follow up)Control of high priority chronic health conditions (pick 2 from)HTN (BP control or improvement)Diabetes (A1c control)Heart attack (LDL control)Asthma (controller med)CHF (ACEI or ARB meds)MI (beta blocker)20Example Criteria for Deeming for EHsDemonstrate high (top 30 %ile) or improved performance (20% reduction of gap between last year's performance and top quartile) for all of the below:Patient safety (pick 2 from)Clostridium difficile Infection (outcome measure)Catheter-Associated Urinary Tract Infection (outcome measure)Central Line-Associated Blood Stream Infection (outcome measure)MRSA (outcome measure)Specific Surgical Site Infection (SSI) Outcome MeasureSevere sepsis and septic shock: Management bundleLate sepsis or meningitis in very low birth weight (VLBW) neonates (risk-adjusted)Measure of pressure ulcersCare coordination (pick 2 from)Experience of care (from HCAHPS)?Hospital-wide-all-cause unplanned readmission measure (HWR)CTM-3, 3-item care transition21Additional RequirementDisparitiesStratify all four population reports by disparity variables

22Deemed MU ObjectivesDeemed in Satisfaction of:CDSeRx formulary, generic subsRemindersElectronic notesTest trackingClinical summaryPatient educationReconcile problems, meds, allergies

*View, download, transmit (VDT), consider adding if stage 2 reports good uptake*Secure patient messaging, consider adding if stage 2 reports good uptakeRemaining Items:Advance directiveeMARImaging resultsEH: provide lab resultsPatient generated data*VDT*Secure patient messagingCare summary Care planReferral loopNotification of health eventImmunization registryELRCase reports to PHASyndromic surveillanceReporting to 2 registriesAdverse event reporting23Additional ConsiderationsPropose performance reporting period to be 6 months vs. 1-year MU reporting period to give providers a chance to deem yet still have time to resort to functional objectives qualification if not meeting deeming thresholdsSpecialists may have fewer options for deeming as determined by available NQF QMs. If not able to report on at least 4 performance measures, then may not be eligible for the deeming pathway

24HITPC CommentsFazardWhile it makes sense to use outcome measures, there may be measures that fall short of total outcomes, but are still closer to outcomes than functional measures. Examples: closing the referral loop, medication safety (functional measures around CPOE), patient experience (maybe pt ed is consolidated). Measures that relate to the functionality, that push further than the functional measure. Need to tie deeming measures to the functional measures that they relate to Supportive in general. Encouraged to be even bolder related to consolidation - deeming with a focus on justification for why it is appropriate to HIT. There is room for more reflectionTerry Cullen/Fazard/ChristinePublish constraints within recommendations in terms of what would qualify for measures. Strategically involve the boards? This is an HIT program related to outcomes innovation related to HIT?How big of a door will be open? ACOs, PCMH deeming? CAHPS, could be useful for providers (accessible through HIT program). Expectations that HIT incentives be spent on HIT and not duplicate other quality incentive programs. Potential to explore HIT CAHPS model more valuable for the provider to know if the display of information is helpful for patients, hold accountable for what directly relates to MU (group not individual level). GayleParticipants in the PQRS pr