Meaningful Use Workgroup

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Meaningful Use Workgroup. Paul Tang, Chair George Hripcsak, Co-Chair. December 20, 2013. 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 WorkgroupDecember 20, 2013Meaningful 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 Tasks12/20/20139:30-11:30 ETReview recommendationsPop/public healthAffordable care Health disparitiesFollow-up itemsReview of feedback from Standards Workgroups included in recommendations review (i.e. case reports, registries, images, PGHD)1/6/20149:30-11:30 ETFollow-up itemsReview of recommendations1/17/1411:00-1:00 ETFollow-up itemsReview of recommendations1/28/141:00-3:00 ETFollow-up itemsReview of recommendations2/4/14

Present to HITPC223Review of Population and Public Health Objectives Stage 3 MUArthur Davidson, MD, MSPHMeaningful Use WorkgroupDecember 20, 2013 Stage 1 Public/Population Health Meaningful Use Measures Review Public Health Efforts Regarding Standards and Interoperability Framework ComponentsReview of proposed Stage 3 Meaningful Use Measures to fix this.45

Hospital 1st v. 2nd v. 3rd yearPH Menu Objective PerformanceSource: CMS Presentation Rob Anthony, December 4, 2013 New guide provides improvementsProgress with providers is better ONC test criteria are making interoperability better PH moving toward accepting data coming form certified productsNext version (Feb 2014) of Implementation Guide (IG) will include bi-directional w/ History and forecast back to providerElectronic Laboratory Reporting (ELR) New version of IG is available to HL7 members and includes many improvementsSyndromic Surveillance (SS)Successful centralized infrastructure utilizing BioSense

Update on Current Measures: - Immunization, ELR, SS Laboratory Reporting (ELR) Pattern of Adherence to StandardsPublic Health has consistently made efforts to abide by standards and in turn minimize impact on clinical partnersProof of PHs commitment to build on standards and processes used for other use cases,. ELR Release 1 (HL7 Version 2.5.1: ORU^R01)1was built on the HISTP Lab-to-EHR Implementation GuideELR Release 2 is the current profile for Electronic Laboratory Reporting to Public Health (MU Stage 1 and 2). Public health has demonstrated readiness for standards and will credibly achieve that for Stage 3. Principle for PH Stage 3 MU10Adhere to Standards and Interoperability Framework Components Whenever FeasibleComponentPurposeConsolidated CDAStandard message formatStructured Data CapturePopulate standard forms

Health eDecisionsClinical decision support (e.g., triggers for PH screening or collecting data)Data Access FrameworkQuery data: 1) by provider and 2) across multiple organizations and by population ReportingStage 3 MU Cancer Implementation Guide (IG) should move to consolidated clinical document architecture (c-CDA) because: EHR vendors are required to use this format for Transition of Care documents in Stage 2 MUeliminates burden of supporting two different formats for cancer reportingc-CDA has harmonized and improved templates across multiple sourcescancer program is ready to move to this new standard c-CDA: Next StepsAlign Cancer IG sections with c-CDA sections (high level completed)Add a new document-level template c-CDA R2: "Ambulatory Healthcare Provider Cancer Event ReportAdd Cancer Diagnosis Section to c-CDA Perform Gap and Overlap analysis of entries, data elements, attributes, and value setsPut new document through HL7 ballot process TimelineHigh level gap analysis performed in November 2013Detailed gap/overlap analysis work starting in January 2014Ballot in May 2014 Health and c-CDA - Progression for some areas13Pertussis (NY State)Pertussis (San Diego)Tuberculosis (Delaware)EHDI (N. Dakota)201220132014+EHDI (Oregon)Cancer Registry to introduce confusion c-CDA are for future bi-directional exchanges, IZ, ELR, and SS are transactional and will stay in the HL7 2.5.1 version.Dont see those moving in the near future.1314

Reporting protocol for HAIExecutable expressions of detection and case reporting algorithms

HAI detection rules applied to patient-specific dataAdditional rules applied to populate full HAI reportHealthcare FacilityReporting system provides protocol and algorithm Publicly Reported HAI dataElectronic HAI ReportClinicalDocumentArchitecture (CDA)Reporting system publishes facility-specific HAI data CDA transmission:Manual uploadAutomated sendElectronic Healthcare Associated Infection (HAI) Detection and Reporting: Supporting Patient SafetySpecifications:eMeasuresDecision rulesComputer codeElectronicsystems:EHRPharmacyADTLabCDCCDCProgramsCMSPublicHealthHealthcareNHSNHeD to avoid an unintended consequence as there are more than 1000 hospitals already reporting to NSHN. Tremendous value in driving to an improved quality and safety environment.May be a perception that this could be a Quality Reporting Document Architecture (QRDA) but given the high participation and current public health infrastructure (to CDC and then retrieved by States or Locals) already we should keep CDA in the standards.

Not ready yet for a transition to the c-CDA, but that might be for a future stage.

1415Sources: Communicable Disease CDA Pilot Project Report. 2012. URL: CDA Pilot Project Report. 2013. URL: for Public Health Pilot ProjectsPublic Health Reporting Architecture

Progress : Whats been completedPublic Health Infrastructure Or Health Information Exchange (HIE)

Form ManagerForm ReceiverContent CreatorForm FillerRequest Form

2. Provide pre-population data3. Pre-populated Report Form4. Populated Report FormSendReceiveCDA ReportContent ConsumerEHR VendorsCore SolutionsConnexinAllscripts(Test Harness)Epic 2012(Test Harness)

Public Health Electronic Health Record SystemProviderInformation Systems:Surveillance SystemsEHDI System

Public Health Information SystemsDelaware Electronic Reporting Surveillance System (DERSS)New Your State Universal Public Health Node (UPHN)San Diego County(Atlas Public Health)Oregon EHDI System (Filemaker)North Dakota EHDI System (OZ Systems)

CDA-based Case Reports:TuberculossisPertussisNewborn Hearing Screening Outcome ReportContinuity of Care Document (CCD)(pre-population data)Public Health Infrastructure(Orion Rhapsody)

HIE(OZ Systems)

Form ManagerForm ReceiverContent Creator15 the IHE profile for structured data capture, earlier version IHE RFD.1516Communicable Disease Reporting CDA/SDC Pilot in NYC and WI

ParseRetrieve FormPre-populate web form4. Send URL with pre-populated web formElectronic Medical Record (EMR) Vendor Test Environ-ment (i.e., EPIC)

Reporting Module/Form Manager

Continuity of Care Document (CCD)NYC and WI Public Health Infrastructure Electronic Disease Surveillance System

Current Progress (as December 2, 2013) Finalize Testing in Vendor Environment5. Physician/ICP submits addition information directly to systemNext Steps Identify, Recruit, and Implement in Hospital using EPIC EMR System

State/Local Surveillance SystemKey OutcomesShift in tradition al public health case report (PHCR) use caseLeverage existing standard (i.e., CCD -> cCDA)Light-weight service for EMR vendors to connect to various jurisdiction reporting end-pointsMinimize development in EMR SystemExtensibility/ portability to other EMR vendorsState and LHD can configure forms based on reporting and business needs specific to jurisdiction Data Capture (SDC)- Tiger Team and Selected PilotsPublic Health Tiger Team Community based effort to identify, develop, and implement SDC Public Health Pilots

Proposed Public Health PilotsEHDICancer ReportingCase Reporting 17 the necessary requirements (including metadata) which will drive the identification and harmonization of standards that will facilitate the collection of supplemental EHR-derived dataDevelop and v