HIT Policy Committee Adoption Certification Workgroup Summary of Findings from the Implementation Workgroup hearing on January 10/11, 2011 Paul Egerman, Chair Marc Probst, Co-Chair February 2, 2011

22 Hearing Structure Implementation Workgroup Chairs: Judy Murphy Liz Johnson Paul Egerman – Co Chair Adoption Certification Workgroup Marc Probst – Co Chair Adoption Certification Workgroup Members of Adoption Certification Workgroup who participated in hearing: Rick Chapman - Kindred Healthcare Larry Wolf – Kindred Healthcare Joseph Heyman - American Medical Association

Brief History 3 Adoption Certification planned to assess Meaningful Use efforts, challenges and learnings Implementation Workgroup formed within Standards Committee with similar focus ONC asked Adoption Certification Workgroup to combine efforts on hearing in January 2011

Real World Experiences - MU Hearing Panels 1.Implementation Support – Regional Extension Centers (Monday, Jan 10th) 2.Implementation Support – EHR Certification (Monday, Jan 10th) 3.Implementation Support – Health Information Exchange (Tuesday, Jan 11th) 4.Early Adopters Seeking Attestation - Eligible Providers Experience (Tuesday, Jan 11th) 5.Early Adopters Seeking Attestation – Eligible Hospitals (Tuesday, Jan 11th) 4

Panelist Questions Identify your challenges, barriers, and successes. Outline the implementation approaches and methodologies you used that worked and didn’t work. Include any real-world user stories, illustrations, or examples. Discuss your outcomes/results. Include any surprises or unexpected outcomes and how you addressed them? Describe your experience using the ONC and CMS communications regarding the meaningful use criteria, standards specifications and measurement. 5

6 MU Experience Hearing- Presenters Panel 1: Implementation Support – Regional Extension Centers Mat Kendall, Office of the National Coordinator Paul Kleeberg, MD, Clinical Director, MN/ND Regional Extension Assistance Center Dan Nelson, Desert Ridge Family Practice, Phoenix, AZ Lisa Levine, MPH, Vice President-Operations, Family Health Center of Worcester, MA Clayton Gillett, Executive Director, O-HITEC, Oregon’s Regional Extension Center Panel 2: Implementation Support—EHR Certification Carol Bean, Office of the National Coordinator Alisa Ray, Executive Director, CCHIT Patricia Daiker, RN, Vice President, Medhost John Travis, Senior Director – Regulatory Compliance, Cerner Brad Melis, Founder and Executive Vice President, ChartLogic

7 MU Experience Hearing- Presenters Panel 3: Implementation Support – Health Information Exchange Claudia Williams, State HIE, Office of the National Coordinator Linda Reed, CIO, Atlantic Health & Board Member, NJ Health Connect James A. Fuzy, President & CEO, Mississippi Health Partners Reid W. Coleman, MD, Lifespan, RI Panel 4A: Early Adopters of Meaningful Use Seeking Attestation – Eligible Providers’ Experience, Part 1 Careen Whitley, MD, Hill Physicians Group, San Francisco, CA Lyle Berkowitz, MD, Northwestern, IL Robert Murry, PhD, MD, Hunterdon Healthcare, NJ Scott Hammer, MD, Southern Delaware Medical Group Josh Seidman, ONC – Reactor

8 MU Experience Hearing- Presenters Panel 4B: Early Adopters of Meaningful Use Seeking Attestation – Eligible Providers’ Experience, Part 2 Scott Monteith, MD, Michigan State University & Private Practice Willa Drummond, MD, Professor, University of Florida Richard Sadja, CFO, Family Practice, Glendale, CA Harm Scherpbier, MD, CMIO, Main Line Health, PA Robert Anthony, Centers for Medicare and Medicaid - Reactor Panel 5A: Early Adopters of Meaningful Use Seeking Attestation – Hospital Experience, Part 1 Joanne Sunquist, RN, CIO, Hennepin CO Medical Center, MN Nancy Vogt, Deputy Chief Compliance Officer, Aurora Health Care, WI Chuck Christian, CIO, Good Samaritan Hosp, IN Denni McColm, CIO, Citizen’s Memorial Hospital, MO Robert Anthony, Centers for Medicare and Medicaid - Reactor

9 MU Experience Hearing- Presenters Panel 5B: Early Adopters of Meaningful Use Seeking Attestation – Hospital Experience, Part 2 Brian Jacobs, MD, VP & CMIO, Children’s National Medical Center, Washington DC Russ Branzell, CIO, Poudre Valley Regional Medical Center, CO Joel C. Berman, MD, CMIO, & Josie Bendiks, CIS Director, Concord Hospital, NH Len Bowes, MD, Intermountain Health, UT Robert Anthony, Centers for Medicare and Medicaid - Reactor

10 Summary of Hearing – Meaningful Use 1.The ONC efforts toward Meaningful Use have raised awareness to the benefits of EHR 2.Medical malpractice insurance costs rising due to MU (separate hearing?) 3.More clarity in Meaningful Use definition 4.Using the system meaningfully versus achieving Meaningful Use (focus more on outcomes) 5.Need for clear path with end goal stated and flexibility allowed to get there

11 Summary of Hearing – Meaningful Use (continued) 6.Seeking MU has derailed organization's HIT strategic plan - and not necessarily in a way that improves quality and efficiency of patient care 7.Functionality does not equate to usability 8.Quality Measures are a sore point 9.TIME – keep the bar high, but be more realistic in the timeframes to achieve

12 Summary of Hearing – Certification 1.Certification seems to be working well 2.Communications: concern with CMS' responsiveness to questions and the completeness of their FAQ pages 3.Choreography with the other agencies: Concern about the "moving target" status of certification tests 4.Failure of certification to reflect how software is developed 5.Concern that some vendors being certified for Stage 1 will not be capable of meeting stages 2 and 3

13 Summary of Hearing – REC/HIE 1.REC is not consistent, but several comments on positive value of REC 2.Various questions around the viability of HIE 3.Concern by REC’s of having favored vendor lists

14 Summary of Hearing – General 1.Layering on of various federal requirements 2.“A bad standard is better than 3 standards” 3.Confusion about rules of the road 4.Several workforce worries

Top Ten Recommendations (adaption from HITSC) 1.Provide adequate time. 2.Keep it simple. Don’t let “perfect be the enemy of “good enough.” 3.Keep the implementation cost as low as possible. 4.Design for the little guy. 5.Pick a standard(s) soon. 6.Address workforce issues. 7.Increase focus on “usability”. 8.Improve choreography between federal agencies impacting HIT. 9.Create a crosswalk between MU and certification requirements. 10.Provide adequate time (purposely listed again). 15

Next Steps Continue working with the HITSC Implementation Workgroup Chairs How to continue influence MU Workgroup efforts Hearing in late spring on legal considerations of MU and EHR 16