DRAFT Stage 3 Update Paul Tang, Chair George Hripcsak, Co-Chair Meaningful Use Workgroup August 16, 2013

DRAFT August 7 HITPC Meeting High-level summary of feedback received from HITPC: Core Comment AreasFeedback Focus on OutcomesConnect MU3 objectives with outcomes DeemingPositive; review eCQM pipeline and recommendations of QM/ACO TT

DRAFT Functional Objective Feedback Stage 3 should clearly signal outcomes – Tie MU3 objectives to outcomes measures – Link to HHS quality strategy (e.g., NQS, Million Hearts) – Link to future payment models (e.g., accountable care organizations) – Consider shifting structure of recommendations to focus on outcomes The use of certification-only criteria should be strategically limited

DRAFT Deeming Feedback Deeming concept focuses on achieving good outcomes Appreciate the flexibility of this alternative pathway Need outcomes-oriented eCQMs Must all the data measures come from the EHR? What about claims data?

DRAFT Next Steps Address HITPC concerns Provide framework recommendations – Present high level outcomes-driven framework to HITPC at September Meeting – Follow up in Oct or Nov with more detailed recommendations (QM/ACO TT in Oct)

DRAFT Recommendations for Presentation to HITPC in September 2013

DRAFT Core Recommendations 1.Focus on health and care outcomes 2.Use eCQMs to measure identified care outcomes 3.Incorporate functional deeming as an option for MU3 compliance

DRAFT Recommendation 1: Focus on initiatives that help improve care outcomes

DRAFT Moving towards outcomes for MU3 MU3 Improved Quality of Care Healthier Living / Disease Prevention Improved Safety Increased Patient Engagement Improved Care Coordination Accessible and Affordable Care

DRAFT MU Categories Derived from National Priorities Partnership Goals Work with communities to promote wide use of best practices to enable health living and well-being Improved Quality of Care / Healthier Living Promote the most effective prevention, treatment, and intervention practices for the leading causes of mortality, starting with cardiovascular disease Healthier Living & Disease Prevention Ensure person- and family-centered care Increased Patient Engagement Make care safer Improved Safety Promote effective communication and care coordination Improved Care Coordination Make quality care affordable for people, families, employers, and governments Accessible and Affordable Care National Priorities Partnership Goals MU3 Care Outcomes Align with NPP

DRAFT Care Outcome: Improved Quality of Care Stage One CPOE Initial CDS Patient lists Problem lists Meds lists Medication allergies Drug-allergy checks Vitals Lab results Smoking eRx Patient reminders Stage Two CPOE+ CDS+ Patient lists+ Imaging Hospital labs Progress notes Stage Three Recommendation CDS++ Real-time dynamic dashboards (for clinical and population health management) Advanced CDS interventions (e.g., chronic disease management, test ordering, prevention, accuracy of lists) Medication adherence Order tracking (e.g., closing the loop)

DRAFT Care Outcome: Healthier Living & Disease Prevention Stage One Immunization PH reporting Patient education Stage Two CDS+ Cancer registry Family history Electronic lab reporting Stage Three Recommendation CDS interventions that use family history CDS interventions to manage chronic conditions

DRAFT Care Outcome: Increased Patient Engagement Stage One Clinical summary Online access Patient education Stage Two View, download, transmit Secure messaging Stage Three Recommendation Patient generated health data Communication preferences Amendments

DRAFT Care Outcome: Improved Safety Stage One CPOE CDS eRx Medication allergies Medication reconciliation Stage Two CPOE+ CDS+ eMAR Stage Three Recommendation CDS++ Use of Common Formats (e.g., adverse event reports, healthcare associated infections)

DRAFT Care Outcome: Improved Care Coordination Stage One Summary of care Stage TwoStage Three Recommendation Health event notification (e.g., ED visit, admission to hospital) Close the referral loop

DRAFT Care Outcome: Accessible and Affordable Care for All Stage One Race Ethnicity Language Formulary checks Stage TwoStage Three Recommendation Capture of additional information – Occupation – Sexual orientation and gender identity – Veteran status Capture FDA Unique Device Identifier (UDI)

DRAFT Recommendation 2: Use eCQMs to Measure Identified Care Outcomes

DRAFT Core Recommendation 2 Use CQMs to Measure Outcomes Improved Quality of Care CV Risks Blood Pressure Control LDL Control Healthier Living/ Disease Prevention Immunization (i.e., flu, pneumonia, childhood vaccinations) Cancer Screening (i.e., colon, prostate, cervical) Improved Safety Falls Pressure Ulcer HAI Morphine Equivalent “Never Give Together” Time in Therapeutic Range for Warfrin Outcomes Proposed eCQMs

DRAFT Core Recommendation 2 Use CQMs to Measure Outcomes Increased Patient Engagement Knee Hip Heart Failure (functional status) Improved Care Coordination Close the referral loop Reciprocal referrals Care transitions for hospitals Readmissions Accessible and Affordable Care Choosing Wisely Do not overtreat A1C Reduce CT scans for headache ED throughput MRI back pain Radiation dosing Adherence (reference CBO) Health Improvement Outcomes Proposed eCQMs

DRAFT Recommendation 3: Implement Deeming Pathway

DRAFT Recommendations on Functional Deeming Providers who have already met all functional objectives in stages 1 and 2 should be allowed to “deem” Deeming allows high MU performers (or significant improvers) to attest for MU by satisfying a subset of MU objectives; this would be an optional pathway to achieve MU “Deeming” promotes innovation, reduces burden, and rewards good performance CMS should survey the landscape for available eCQMs that are outcomes-oriented and consider their use as deeming measures; in addition, new development of eCQMs may be necessary 20

DRAFT Next Steps Approve outcomes framework for MU stage 3 MU WG to review objectives for alignment with outcomes framework Receive input on eCQMs from QM/ACO TT (Oct) Present additional recommendations to HITPC in Nov 21