HIT Policy Update With John Halamka, MD

HIT Policy Update With John Halamka, MD A Complimentary Webinar From healthsystemcio.com Sponsored by OnBase by Hyland Your Line Will Be Silent Until Our Event Begins Thank You! Slide Deck: http://goo.gl/ppocgj Webex Support 1-866-223-3239 Event #662 088 692

Housekeeping Moderator Anthony Guerra, editor-in-chief, healthsystemcio.com Ask A Question We will be holding a Q&A session after the formal presentations. You may submit your questions at any time by clicking on the QA panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as All Panelists. Download the Deck Go to: http://healthsystemcio.com/presentation/policyupdate-2014q1-webinar.pdf Shortened link below appears on most slides. View the Archive You will receive an email when our archive recording is ready. Separate registration is required. Slide Deck: http://goo.gl/ppocgj Webex Support 1-866-223-3239 Event #662 088 692

Agenda 45 Minutes 20 minutes: John Halamka, MD, CIO, Beth Israel Deaconess Medical Center 5 minutes: A Word From Our Sponsor: Colleen Sirhal, Director of International Healthcare Sales, Hyland 20 minutes: Q&A w/john Halamka Slide Deck: http://goo.gl/ppocgj Webex Support 1-866-223-3239 Event #662 088 692

HIT Policy Update With John Halamka, MD Slide Deck: http://goo.gl/ppocgj Webex Support 1-866-223-3239 Event #662 088 692

Meaningful Use Stage 3 Recommendations Meaningful Use Workgroup recommendations were approved by the Policy committee with dissenting votes 19 proposals Items related to emar, Reminders, Imaging, Family History, Medication Adherence, Amendments, Case Reports were removed from final recommendations but will be included in the transmittal letter Slide Deck: http://goo.gl/ppocgj Webex Support 1-866-223-3239 Event #662 088 692

HITPC Recommended Objectives Improving Quality of Care and Safety 1.Clinical decision support 2.Order tracking 3.Demographics/patient information 4.Care planning advance directive 5.Electronic notes 6.Hospital labs 7.Unique device identifiers Engaging Patients and Families in their Care 8.View, download, transmit 9.Patient generated health data 10.Secure messaging 11.Visit Summary/clinical summary 12.Patient education Improving Care Coordination 13. Summary of Care at Transitions 14. Notifications 15. Medication Reconciliation Improving Population and Public Health 16. Immunization history 17. Registries 18. Electronic lab reporting 19. Syndromic surveillance Slide Deck: http://goo.gl/ppocgj Webex Support 1-866-223-3239 Event #662 088 692 3

Improving quality of care and safety: Clinical decision support (CDS) Use of CDS to Improve Quality of Care and Safety Core: EP/EH/CAH use of multiple CDS interventions that apply to CQMs in at least 4 of the 6 NQS priorities Recommended intervention areas: 1. Preventive care Certification criteria: 2. Chronic disease condition management 1.Ability to track CDS interventions and 3. Appropriateness of lab/rad orders user responses 2.Perform age-appropriate maximum 4. Advanced medication-related decision support daily-dose weight based calculation Improving problem, meds, allergy lists Drug-drug /drug-allergy interaction checks Standards Maturity Development Effort Low High Nature of tracking a response is a substantive effort. Suggest aligning payment reform with an outcome, rather than prescriptive CDS. Red: Changes from stage 2 Blue: Newly introduced Bright Red: edits for clarity 3

Improving quality of care and safety: Order tracking Tracking Orders to Improve Quality of Care and Safety NEW Menu: EPs Assist with follow-up on orders to improve the management of results. Results of specialty consult requests are returned to the ordering provider [pertains to specialists] Threshold: Low Certification criteria: Display EHR should display the abnormal flags for test results if it is indicated in the lab-result message Date complete Notify when available or not completed Record date and time results reviewed and by whom Match results with the order to accurately result each order or detect when not been completed Standards Maturity Development Effort Low High There are a variety of different concepts with varying levels of difficulty included. Suggest including display of abnormal lab results and sign-off. Blue: Newly introduced Bright Red: edits for clarity 4

Reducing health disparities: Demographics/patient information Patient Information Captured and Used to Reduce Health Disparities Certification criteria to achieve goals: Ability to capture patient preferred method of communication Ability to capture occupation and industry codes Ability to capture sexual orientation, gender identity Ability to capture disability status Communication preferences will be applied to visit summary, reminders, and patient education Standards Maturity Development Effort Low Standards are still evolving for some of these items, although occupation and industry codes does has a high standards maturity. Medium Could potentially be HIGH. There are significant workflow changes that could result due to the communication preferences. Patients could provide a default means of communication, without limiting to only that form of communication. Red: Changes from stage 2 Blue: Newly introduced 5

Improving quality of care and safety: Care planning advance directive Recording Advance Directives to Improve Quality of Care and Safety Core for EHs, introduce as Menu for EPs Record whether a patient 65 years old or older has an advance directive Threshold: Medium Certification criteria: ability to store the document in the record and/or include more information about the document (e.g., link to document or instructions regarding where to find the document or where to find more information about it). Standards Maturity Development Effort High Maturity is high if the intent was a simple yes/no check box and link to a URL. Low Development is low, if correctly assumed this was a yes/no check box and link to a URL. 7 Red: Changes from stage 2 Blue: Newly introduced

Improving quality of care and safety: Electronic notes Use of Electronic Progress Notes to Improve Quality of Care and Safety Core: EPs record an electronic progress note, authored by the eligible professional. Electronic progress notes (excluding the discharge summary) should be authored by an authorized provider of the EH or CAH (Core) Notes must be text-searchable Threshold: Low High Standards Maturity Development Effort Medium Concerned about the significant threshold increase. Is the intent to provide the ability to search across multiple notes? High Creating de novo functionality and export capabilities Discharge summary is an ambiguous term. Assume meant "Hospital Course" and "Discharge Instructions" and intends that such text notes be included in the Discharge Summary C-CDA Template or equivalent standard? Red: Changes from stage 2 Blue: Newly introduced Bright Red: edits for clarity 7

Improving quality of care and safety: Hospital Labs Hospital Lab Results shared to Improve Quality of Care and Safety Eligible Hospitals provide structured electronic lab results using LOINC to ordering providers Threshold: Low Standards Maturity Development Effort High High Concerned about LOINC readiness, development could be substantial. Arien is going to determine current status and LOINC readiness. 9 Red: Changes from stage 2 Blue: Newly introduced

Improving quality of care and safety: Unique device identifier (UDI) Recording FDA UDI to Improve Quality of Care and Safety NEW Menu: EPs and EHs should record the FDA Unique Device Identifier (UDI) when patients have devices implanted for each newly implanted device Threshold: High Standards Maturity Development Effort Low Low Development is low if only want a text field, but this provides low utility. Development effort would be much higher if some type of validation is required. This would allow the ability to identify whether a device has been recalled, but would be much harder. Red: Changes from stage 2 Blue: Newly introduced 9

Engaging patients and families in their care: View, download, transmit Access to health Information to Engage Patients and Families in their Care EPs/EHs provide patients with the ability to view online, download, and transmit (VDT) their health information within 24 hours if generated during the course of a visit Threshold for availability: High Threshold for use: low Labs or other types of information not generated within the course of the visit available to patients within four (4) business days of availability Add family history to data available through VDT Standards Maturity Development Effort Low Low maturity if need structured family history. The wording is different than stage 2, was this intended? Medium Significant operational issues. Concerned about timing to make this available to the patient. Workflow and attestation implications, but certification itself is not difficult. Red: Changes from stage 2 Blue: Newly introduced 10

Engaging patients and families in their care: Patient Generated Health Data (PGHD) Use of PGHD to Engage Patients and Families in their Care New Menu: Eligible Professionals and Eligible Hospitals receive provider-requested, electronically submitted patient-generated health information through either (at the discretion of the provider): structured or semi-structured questionnaires (e.g., screening questionnaires, medication adherence surveys, intake forms, risk assessment, functional status) or secure messaging Threshold: Low Standards Maturity Development Effort Low High Developers have to incorporate functionality for both strategies which can be configurable by the provider and results in high development Red: Changes from stage 2 Blue: Newly introduced Bright Red: edits for clarity 11

Engaging patients and families in their care: Secure messaging Functionality Needed to Achieve Goals No Change in objective Core: Eligible Professionals Patients use secure electronic messaging to communicate with EPs on clinical matters. Threshold: Low (e.g. 5% of patients send secure messages) Certification criteria: Capability to indicate whether the patient is expecting a response to a message they initiate Capability to track the response to a patient-generated message (e.g., no response, secure message reply, telephone reply) Standards Maturity Development Effort Low High Red: Changes from stage 2 Blue: Newly introduced The industry already has implemented workflow solutions to ensure closing the loop on communications, prescribe the workflow is inappropriate. Encourage the concept, but discourage the specificity. 13

Engaging patients and families in their care: Visit summary/clinical summary Visit summaries used to Engage Patients and Families in their Care Core: EPs provide office-visit summaries to patients or patient-authorized representatives with relevant, actionable information, and instructions pertaining to the visit in the form/media preferred by the patient Certification criteria: EHRs allow provider organizations to configure the summary reports to provide relevant, actionable information related to a visit. Threshold: Medium Standards Maturity Development Effort Low Uncertain how to define usability or relevant and actionable with a standard. Should not mandate usability, how is usability measured? High This is impossible to certify. Suggest providing patient access through VDT, rather than form/media preferred by the patient. Red: Changes from stage 2 Blue: Newly introduced 13

Engaging patients and families in their care: Patient education Functionality Needed to Achieve Goals Continue educational material objective from stage 2 for Eligible Professionals and Hospitals Threshold: Low Additionally, Eligible Providers and Hospitals use CEHRT capability to provide patientspecific educational material in non-english speaking patient's preferred language, if material is publicly available, using preferred media (e.g., online, print-out from CEHRT). Threshold: Low Certification criteria: EHRs have capability for provider to providing patient-specific educational materials in at least one non-english language Standards Maturity Development Effort Medium Medium, if using infobutton and language. Unsure how useful this objective is. Medium/High Medium/High, depending upon the number of languages supported and the nature the materials available. Red: Changes from stage 2 Blue: Newly introduced Bright Red: edits for clarity 14

Improving care coordination: Summary of care A Summary of Care is Provided at Transitions to Improve Care Coordination EPs/EHs/CAHs provide a summary of care record during transitions of care Threshold: No Change Types of transitions: Transfers of care from one site of care to another (e.g.. Hospital to: PCP, hospital, SNF, HHA, home, etc) Consult (referral) request (e.g., PCP to Specialist; PCP, SNF to ED) [pertains to EPs only] Consult result note (e.g. consult note, ER note) Summary of care may (at the discretion of the provider organization) include, as relevant: A narrative (synopsis, expectations, results of a consult) [required for all transitions] Overarching patient goals and/or problem-specific goals Patient instructions (interventions for care) Information about known care team members Discussion: Although structured data is helpful, use of free text in the summary of care document is acceptable. When structured fields are used, they should be based on standards (not all fields need to be completed for each purpose). Summary of care documents contain data relevant to the purpose of the transition (i.e. not all fields need to be completed for each purpose) Provider Use Effort Standards Maturity Development Effort High Medium=3, Low=2 Vendor: Medium=1, Low=1 High=2, Medium=2, Low=1 Vendor: High=2 Red: Changes from stage 2 Blue: Newly introduced 3

Improving care coordination: Notifications Notifications of Significant Healthcare Events are Sent to Improve Care Coordination NEW Menu: Eligible Hospitals and CAHs send electronic notifications of significant healthcare events within 4 hours to known members of the patient s care team (e.g., the primary care provider, referring provider, or care coordinator) with the patient s consent if required Significant events include: Arrival at an Emergency Department (ED) Admission to a hospital Discharge from an ED or hospital Death Low threshold Provider Use Effort Standards Maturity Development Effort High Medium=2, Low=3 Vendor: Low=2 High=1, Medium=1, Low=3 High=2 Red: Changes Blue: Newly introduced Bright Red: edits for clarity 4

Improving care coordination: Medication Reconciliation Functionality Needed to Achieve Goals No Change Core: Eligible Professionals, Hospitals, and CAHs who receive patients from another setting of care perform medication reconciliation. Threshold: No Change Provider Use Effort Standards Maturity Development Effort Low High=2, Low=3 Vendor: High=1, Low=1 Medium=2, Low=2 Vendor: Low=2 21 Red: Changes from stage 2 Blue: Newly introduced

Improving population and public health: Immunization history Use of Immunization History to Improve Population and Public Health Core: EPs, EHs, CAHs receive a patient s immunization history supplied by an immunization registry or immunization information system, allowing healthcare professionals to use structured historical immunization information in the clinical workflow Threshold: Low, a simple use case Certification criteria: Ability to receive and present a standard set of structured, externally-generated immunization history and capture the act and date of review within the EP/EH practice Ability to receive results of external CDS pertaining to a patient s immunization Provider Use Effort Standards Maturity Development Effort Medium Medium=3, Low=2 Vendor: Medium=2 High=3, Medium=1, Low=1 Vendors: High=1, Medium=1 Red: Changes from stage 2 Blue: Newly introduced 6

Improving population and public health: Registries Transmit Data to Registry to Improve Population and Public Health Menu: EPs/ Menu: EHs Purpose: Electronically transmit data from CEHRT in standardized form (i.e., data elements, structure and transport mechanisms) to one registry Reporting should use one of the following mechanisms: 1. Upload information from EHR to registry using standards c-cda 2. Leverage national or local networks using federated query technologies Discussion: CEHRT is capable (certification criteria only) of allowing end-user to configure which data will be sent to the registries. Registries are important to population management, but there are concerns that this objective will be difficult to implement. Provider Use Effort Standards Maturity Development Effort High Medium=2, Low=3 Vendors: Low=2 High=3, Medium=1, Low=1 Vendors: High=2 Red: Changes from stage 2 Blue: Newly introduced Bright Red: edits for clarity 7

Improving population and public health: Electronic lab reporting Electronic Laboratory Results Submitted to Improve Population and Public Health No Change Core: EHs and CAHs submit electronic reportable laboratory results, for the entire reporting period, to public health agencies, except where prohibited, and in accordance with applicable law and practice Provider Use Effort Standards Maturity Development Effort Low High=3, Low=1 Vendors: Medium=2 High=1, Medium=3 Vendors: High=2 24 Red: Changes from stage 2 Blue: Newly introduced

Improving population and public health: Syndromic surveillance Submit Syndromic Surveillance Data to Improve Population and Public Health EH ONLY Eligible Hospitals and CAHs (core) submit syndromic surveillance data for the entire reporting period from CEHRT to public health agencies, except where prohibited, and in accordance with applicable law and practice Provider Use Effort Standards Maturity Development Effort Medium High=1, Medium=1, Low=2 Vendors: Medium=1, Low=1 High=2, Medium=1, Low=1 Vendor: High=1, Medium=1 25 Red: Changes from stage 2 Blue: Newly introduced

2015 Voluntary Certification NPRM 50 proposals Fixes many shortcomings in 2014 Adds new requirements Embraces Postel s principle Slide Deck: http://goo.gl/ppocgj Webex Support 1-866-223-3239 Event #662 088 692

What does more incremental rulemaking accomplish? Less change between editions of certification criteria. Makes rulemaking more nimble, better able to keep up with industry updates. Provides ample opportunity for public comment and earlier visibility into potential policy directions. 17

2015 Edition highlights Lab orders & CLIA compliance Computerized Provider Order Entry (CPOE) for lab order IG Incorporate lab test results updated IG Clinical Decision Support (CDS) Propose the adoption of the Health edecisions work. Requirements for computable CDS as well as interface requirements needed to request CDS guidance from a CDS supplier. Implantable device list Record and display the unique device identifiers (UDIs) associated with a patient s implanted devices 18

2015 Edition highlights (2) Transitions of Care Propose to separately test and certify: Content capabilities (i.e., Consolidate CDA); and Transport capabilities (i.e., Direct Project specification). Propose to require testing to an edge protocol implementation guide Propose a new performance standard that would require EHR technology to successfully receive Consolidated CDA s no less than 95% of the time. Data quality constraints to improve patient matching 19

2015 Edition highlights (3) Patient Population Filtering for CQMs Ability to create different patient population groupings by, for example: practice site primary and secondary insurance Syndromic Surveillance Propose to revise the 2014 Edition version as well as adopt a 2015 Edition that mirrors those revisions Add certification alternatives for CDA and QRDA III standards 20

ONC HIT Certification Program/Definitions Complete EHR certification Propose to discontinue Outlived original intent Misnomer Only applies to scope of all certification criteria not entire product Exceeds the flexibility now provided in the Certified EHR Technology definition Not necessarily complete No guarantee that it will included all CQM capabilities May not include capabilities designated as optional certification criteria 21

2017 Edition Topics Under Consideration 1. Additional Patient Data Collection Disability information US Military Service Work Information Industry/Occupation 2. Medication Allergy Coding 3. Certification Policy for EHR Modules and Privacy and Security 4. Provider Directories 5. Oral Liquid Medication Dosing 6. Medication History 7. Blue Button + 8. 2D Barcoding 9. Duplicate Patient Records 10. Disaster Preparedness 11. Certification of Other Types of HIT and for Specific Types of Health Care Settings Best way to distinguish beyond EHR technology Specific types of health care settings 22

Hardship Exemption Adds a section for challenges with implementation due to delays in product releases/certification Avoids 2016 penalty Eliminates stimulus opportunity for the missed year Slide Deck: http://goo.gl/ppocgj Webex Support 1-866-223-3239 Event #662 088 692

The Work Ahead Reorganization of HIT Standards Workgroups Complete MU3 evaluation Complete NPRM evaluation Rulemaking in parallel with script development (outside of rulemaking) Hearings and feedback Slide Deck: http://goo.gl/ppocgj Webex Support 1-866-223-3239 Event #662 088 692

The future: 3-year ONC Rulemaking Roadmap (milestones reflect best guestimates) Q1 MU2 EP Start Date CY 2014 CY 2015 CY 2016 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2015Ed NPRM 2015Ed Final Public Comment 2017Ed NPRM & MU3 NPRM 2017Ed Final & MU3 Final Public Comment 2018Ed NPRM Public Comment 2018Ed Final Announced Anticipated MU3 EH Start Date 25

HIT Policy Update Colleen Sirhal, RN, BSN, CPHIMS, Director of International Healthcare Sales, Hyland Slide Deck: http://goo.gl/ppocgj Webex Support 1-866-223-3239 Event #662 088 692

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Contact Information Colleen Sirhal, Director of International Healthcare Sales, Hyland Colleen.Sirhal@hyland.com www.onbase.com/healthcare @OnBase Slide Deck: http://goo.gl/ppocgj Webex Support 1-866-223-3239 Event #662 088 692

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