Meaningful Use Workgroup Pathways for Meaningful Use Stage 3

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Meaningful Use Workgroup Pathways for Meaningful Use Stage 3

1Stages of Meaningful UseImproving OutcomesStage 12011-13Stage 22014-15Stage 32016-172Original 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)

3Lessons 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 i.e., reward good behavior4Additional 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 goodConsider alternative pathway where meeting performance and/or improvement thresholds deems satisfaction of subset of relevant MU functionality implicitly required to achieve performance/improvementConsolidate MU objectives where higher level objective implies compliance with subsumed process objectives5Deeming Pathway6Deeming 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

77Example 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)8Example 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 transition9Additional RequirementDisparitiesStratify all four population reports by disparity variables

10Deemed MU ObjectivesDeemed in Satisfaction of:CDSRemindersElectronic 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 reporting11Additional 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 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

12Consolidation Work13Consolidation Summary43 objectives, consolidated to 25AssumptionsThe full WG will consider RFC feedback and update criteriaAll criteria will be included in certificationFocus on advanced uses (e.g. recording data vs. use data)Give credit for objectives that should be standard of practice after stages 1 and 2

14Types of ConsolidationAdvanced within concept of another objectiveDuplicative conceptsobjective becomes certification onlyDemonstrated use and can trust that it will continue15Advanced 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

16Duplicative ConceptsImmunization intervention (SGRP401B)

CDS (113)Interventions include preventative care for immunizations

Certification CriteriaMaintained ObjectiveKey:17Structured 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)18CPOE - Advanced within concept of another objective, duplicative concept, demonstrated use19

CPOE for Medication Orders

Needed to provide meds within care summary (303)Needed to provide meds within VDT (204A)Certification CriteriaMaintained ObjectiveKey:Consolidation at a Glance20

Consolidation OverviewReconciliation

CDS

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 healtheRxCertification CriteriaMaintained ObjectiveKey:* Proposed for future stage of MUDemographics21CDS for immunComm preferenceCPOE - radCPOE - labAmendmentFamily HxProb, med, allg listStructured labVitalsSmoking statusComm preferenceComm preferenceCancer registrySpecialty registryHAI reports*DemographicsAmendmentFamily HxProb, med, allg listStructured labVitalsSmoking statusCPOE - referralsInter prob list*RxHx PDMP*CPOE - meds