Electronic Health Records and Meaningful Use - A Year in Review Charlene Underwood, MBA, FHIMSS Senior Director, Government & Industry Affairs HIMSS Board Chair Member, HIT Policy Meaningful Use WG July 22, 2011 Page 1 A9133-1134-E1-4A00 Copyright 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Agenda ARRA HITECH Overview Meaningful Use Definition CMS EHR Incentive Program Current Implementation Status Relationship to Health Reform A Glimpse to the Future
American Recovery & Reinvestment Act (ARRA) HITECH February 17, 2009 First Steps Adoption of certified EHRs Meaningful use of EHRs Incentive payments to eligible professionals and hospitals Investment in nationwide HIT infrastructure Grant money for demonstration projects The Intended Destination High quality, safe, effective, and equitable care for all Seamless patient-centric care Realigned incentives and measures that foster prevention, intervention, coordination, effectiveness Regional clinical information interoperability on a national backbone The goals are quality and efficiency If we encourage better performance, then physicians are going to find ways to improve. And health information technology is one crucial way to do that. David Blumenthal MD, MPP National Coordinator for Health Information Technology, ONC
ARRA HITECH Stimulus Funds and Meaningful Use An Eligible Provider Using A Certified EHR and Demonstrating Meaningful Use Qualifies for $$$ 4
HITECH Framework for Meaningful Use of Electronic Health Records (EHRs) Blumenthal D. N Engl J Med 2009;10.1056/NEJMp0912825
Meaningful Use Players HIT Policy/ Standards Committees HITPC MU Work Group Paul Tang, MD Co-Chair, Palo Alto Medical Foundation George Hripcsak, MD Co-Chair, Columbia University Michael Barr, MD American College of Physicians David Bates, Brigham & Women s Hospital Christine Bechtel, National Partnership for Women & Families Neil Calman, The Institute for Family Health Art Davidson, Denver Public Health Department Marty Fattig, CEO, Nemaha County Hospital James Figge, MD New York State Department of Health Joe Francis, Veterans Administration David Lansky, Pacific Business Group on Health Deven McGraw, Center for Democracy & Technology Judy Murphy, RN Aurora Health Care Latanya Sweeney, Carnegie Mellon University Karen Trudel, CMS/HHS Charlene Underwood, Siemens Consumer/Patient Groups, Employers, Government, Multi-stakeholder Groups, Providers, Vendors
Meaningful Use Workgroup Recommendations Achieving Meaningful Use 2009 2011 2013 2015 HIT-Enabled Health Reform SOURCE: HITECH Policies 2011 Meaningful Use Criteria (Capture/share data) 2013 Meaningful Use Criteria (Advanced care processes with decision support) 2015 Meaningful Use Criteria (Improved Outcomes)
Meaningful Use Workgroup Recommendations Health Outcomes Policy Priorities* 1. Increase quality, safety, efficiency, and reduce health disparities 2. Engage patients and families 3. Improve care coordination 4. Improve population health 5. Ensure privacy and security protections *Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America s Healthcare. Washington, DC: National Quality Forum; 2008.
ARRA HITECH Final Regulations Published June / July 2010 Certification Program for HIT Office of the National Coordinator (ONC) Meaningful Use (MU) Rule Center of Medicare and Medicaid (CMS) Standards, Specifications, and Certification Criteria (ONC)
Medicare & Medicaid EHR Incentive Program Meaningful Use Rule Defines eligible hospitals ( EHs) and eligible professionals ( EPs) Creates 3 Stages of implementation; Establishes payment years & reporting periods; Provides details on Stage 1 goals and requirements - covering 2011 and 2012.
Meaningful Use Stages Adopted Meaningful Use Workgroup Recommendations Stage Focus Date Range Stage 1 Stage 2 Stage 3 Episodic care management: data capture, basic medication management function, electronic measure reporting, infrastructure for health information exchange, patient engagement, and population health Chronic care management: expands on stage 1, advances clinical decision support to manage chronic disease and health information exchange to coordinate care, more support for patient engagement and public health reporting Patient Engagement and Population Health: promotes more advanced function and health information exchange to help providers do care management across settings and enable patients to do more self care. Adds more support for public health. Starting in 2011 Starting in 2013 Starting in 2015
Medicare Incentives - Eligible Hospitals & CAHs Stage of Meaningful Use by Payment Year First Payment Year Payment Year 2011 2012 2013 2014 2015 2011 Stage 1 Stage 1 Stage 2 Stage 2 TBD 2012 Stage 1 Stage 1 Stage 2 TBD 2013 Stage 1 Stage 1 TBD 2014 Stage 1 TBD 2015 TBD Note: For the first payment year only, CMS proposes to define the term EHR reporting period to mean any continuous 90-day period within a payment year in which an EP or eligible hospital successfully demonstrates meaningful use of certified EHR technology. Starting with the second Payment year and any subsequent payment years for a given EP or eligible hospital, CMS would define the term EHR reporting period to mean the entire payment year.
Meaningful Use at a High Level Requirements Store, display, and report on key patient data Support provider initiatives for safe medication management Assist in identification of problems Promote exchange of clinical information (interoperability) in a standard way that others can use Provide patients with clinical information electronically Protect security and privacy using standards Report on clinical quality measures
Meaningful Use Objective and Measures Flexible Approach Core Set Hospitals & Critical Access Hospitals - 14 Objectives/Measures Eligible Professionals - 15 Objectives/Measures Must achieve the measure for all Core Set Objectives Exclusions may apply Menu Set 10 Objectives/Measures Must meet the measure for all but five of the objectives EPs and EHs must choose at least one Population Health measure from the Menu Set as part of their Stage1 requirements. Exclusions may apply and measures that are inapplicable do not penalize the EP or EH (ex: if one does not apply, EH/EP needs to meet 4 of 9 rather than 5 of 10) Menu objectives not achieved during Stage 1 become required in Stage 2
Clinical Quality Measures - Eligible Hospitals & CAHs Electronically Captured and Generated Measures Measure Emergency Department (ED)-1 NQF 0495 ED-2 NQF 0497 Stroke-2 NQF 0435 Stroke-3 NQF 0436 Stroke-4 NQF 0437 Stroke-5 NQF 0438 Stroke-6 NQF 0439 Stroke-8 NQF 0440 Stroke-10 NQF 0441 Venous Thromboembolism (VTE)-1 NQF 0371 VTE-2 NQF 0372 VTE-3 NQF 0373 VTE-4 NQF 0374 VTE-5 NQF 0375 VTE-6 NQF 0376 Title Emergency Department Throughput admitted patients median time from ED arrival to ED departure for admitted patients Emergency Department Throughput admitted patients admission decision time to ED departure time for admitted patients Ischemic stroke Discharge on anti-thrombotics Ischemic stroke Anticoagulation for A-fib/flutter Ischemic stroke Thrombolytic therapy for patients arriving within 2 hours of symptom onset Ischemic or hemorrhagic stroke Antithrombotic therapy by day 2 Ischemic stroke Discharge on statins Ischemic or hemorrhagic stroke Stroke education Ischemic or hemorrhagic stroke Rehabilitation assessment VTE prophylaxis within 24 hours of arrival Intensive Care Unit VTE Prophylaxis Anticoagulation overlap therapy Platelet monitoring on unfractionated heparin VTE discharge instructions Incidence of potentially preventable VTE
Dr. Blumenthal and the Age of Meaningful Use February 23, 2011 An incentive program, rewarding not only deployment of EHRs but also their effective use for patient benefit; A new national infrastructure to support deployment and beneficial use of EHRs; and A vision for an informationpowered leap in the quality, safety and effectiveness (including cost effectiveness) of our health care system.
Current Implementation Status Growing Momentum Meaningful Use Planning to achieve MU Hospitals 81% Physicians 41% April 2011 - >42,000 providers registered; >150 200 attested to Meaningful Use May 2011 Incentive Payouts Medicaid: $83M from 15 states ($17M EPs and $66M EHs) Medicare: $75M Certification June 2011 525 Ambulatory EHR Certified Products: 359 Complete EHR Products 166 Modular EHR Products 263 Inpatient EHR Certified Products 61 Complete EHR Products 202 Modular EHR Products Regional Extension Centers ONC supporting 62 RECs nationwide May 2011 60,000+ providers have enrolled for REC assistance Workforce Training ONC supports six month training at 84 community colleges 3,400 complete curriculum this spring 10,000 per year is future goal
Rollout of ARRA and Meaningful Use Stage 2 January 13, 2011 Request for Comment Issued HIT Policy Committee (HIT-PC) Meaningful Use (MU) Workgroup issued a request for input on Draft Objectives/Measures for Stage 2. March - June 2011 MU Workgroup prepared recommendations to the HIT-PC which will then modify/approve and send to CMS. Approved on June 8th. June September 2011 HIT Standards Committee identifies standards and certification criteria. September 1Q2012 CMS and ONC formulate proposed rules for objectives, measures, standards, and certification criteria. 1Q2012 CMS and ONC prepare CMS Proposed Rule (Incentive Program with Objectives/Measures) and ONC Interim Final Rule (Standards & Certification Criteria). 2Q2012 CMS and ONC publish Final Rules (per above).
Stage 2 / 3 MU Request for Comment Industry Response 422 comments submitted which contained thousands of individual comments. Providers and software developers stressed need for adequate lead time, flexibility, focus, clarity, and standards. Suggested building on the momentum of stage 1 by increasing thresholds and minimize net new function. Consumer advocates, payers, and other non-provider stakeholders want stiffer requirements. Many unknowns being proposed. Anticipate impact in clinical quality measures, where a significant increase is expected.
Meaningful Use WG Stage 2 / 3 Recommendations Approved by HIT Policy Workgroup June 8, 2011 Changes to Stage 2 Timing Stage 2 objectives and measures (core & new) EH: ~30 EP: ~32 Stage 1 Core: Thresholds increased and objectives have more requirements. 2 eliminated or merged. Stage 1 Menu: 10 objectives moved to core New Stage 2 objectives: EH: 6 EP: 8 Greater and deeper health information exchange and more patient engagement.
Meaningful Use WG Timeline Recommendations Approved by HIT Policy Committee June 8, 2011 Delay transition from stage 1 to stage 2 by one year only for providers who qualify for MU in 2011 (for hospitals, stage 2 starts Oct 1, 2013, for EPs, stage 2 starts Jan 2, 2014). Medicare Incentives - Eligible Hospitals & CAHs Stage of Meaningful Use by Payment Year First Payment Year Payment Year Stage 1 for EHs who 2011 2012 2013 attest 2014 for MU 2015 in 2011 2011 Stage 1 Stage 1 Stage 2 Stage 2 TBD 2012 Stage 1 Stage 1 Stage 2 TBD 2013 Stage 1 Stage 1 TBD 2014 Stage 1 TBD 2015 TBD
Meaningful Use WG Stage 2 / 3 Objectives At a Glance - (revised, no change, menu to core, new)
Meaningful Use Stage 2/3 Defintion Other Dependencies and Timing Considerations Definition of ready-to-implement standards for stage 2. Availability of validated electronic specifications for Clinical Quality Measures. Definition of certification criteria for usability in stage 2 timeframe.
CMS Views MU is not the center of the Universe! HIT Policy Committee - April 13, 2011 Tony Trenkle, director of the CMS Office of e-health Standards and Services, and member of the HIT Policy Committee: "Meaningful Use is not the center of universe. We can write rules for ACOs and test things at the CMS Center for Innovation. "We have to adopt a more global mindset besides Meaningful Use." Do you think Trenkle wants the Meaningful Use bar to go higher? No, he wants the committee to stop piling on and go for simplicity over complexity. From Healthcare CIO
New Head of ONC - Farzad Mostashari, MD April 8, 2011 Succeeds Dr. David Blumenthal Previously Deputy National Coordinator for Programs and Policy at ONC Joined ONC in July 2009 Before ONC, NYC Health and Mental Hygiene Dept. as Asst. Commissioner for Primary-care information project ONC grew from 38 FTEs to 138 (2/10 to 2/11) Will focus on alignment with health reform and improving communications
ARRA and Health Reform ARRA (HITECH) February 19, 2009 Meaningful Use Certified EHRs Incentives Quality reporting Affordable Care Act (PPACA) March 23, 2010 Expanding coverage Reforming the delivery system Financing reform Medicare and Medicaid payment Building more primary care Wellness and prevention Quality and safety Regulatory oversight
Medicare Shared Savings Program Proposed rules for accountable care organizations Intent is to use the best, most advanced models of care, using modern technologies, including telehealth and electronic health records. Goals are better care, better health and lower cost growth. Promote evidence-based medicine and patient engagement Coordinate care via telehealth, remote patient monitoring or other enabling technology. HIT that can aggregate and analyze data, provide patientlevel feedback and provide alerts at the point of care. Stress HIT as a core competency well beyond meaningful use Attend to care transitions using EMRs and HIEs. Support patient-centered medical homes and health homes. Don Berwick, CMS Administrator Information management making sure patients and all health care providers have the right information at the point of care will be a core competency of ACOs.
Achieving Meaningful Use provides the foundation for Accountable Care 2011 IT Investment Priorities Patient Data Privacy and Security Continuity of Care Ancillary Systems Document Reporting Capabilities Clinical Documentation Importance for Meaningful Use Population Health Surveillance Immunization Registries Interoperability Health CPOE / CDSS Information Closed-Loop Exchange (HIE) Medication Administration Ambulatory EMR ICD-10 Personal Health Record Performance Monitoring Tools Data Analytics Infrastructure Cost Analytics Tools Source: 2011 The Advisory Board Company Importance for Accountable Care
What they asked for?
The Role of the CxO ICD-10 CM Meaningful Use Hospital Value-based Purchasing Program Accountable Care Organizations Hospital Readmissions Hospital-acquired Conditions Payment Bundling
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