Stage 3 Draft Recommendations Paul Tang, Chair George Hripcsak, Co-Chair Meaningful Use Workgroup March 18, 2014

Meaningful Use Workgroup Members Chairs Paul Tang, Chair, Palo Alto Medical Center George Hripcsak, Co-Chair, Columbia University Members 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 * Paul Egerman, Software Entrepreneur Marty Fattig, Nemaha County Hospital (NCHNET) Leslie Kelly Hall, Healthwise David Lansky, Pacific Business Group on Health Deven McGraw, Center for Democracy & Technology Marc Overhage, Siemens Healthcare Patricia Sengstack, Bon Secours Health Systems Charlene Underwood, Siemens * Michael H. Zaroukian, Sparrow Health System Amy Zimmerman, Rhode Island Department of Health and Human Services Federal Ex-Officios Joe Francis, MD, Veterans Administration Marty Rice, HRSA Greg Pace, Social Security Administration Robert Tagalicod, CMS/HHS 1 * Subgroup Leads

Agenda HITPC feedback Revisions Listening Session 2

HITPC Feedback Recommendations approved Several HITPC members had concerns about provider burden – Wait for attestation experience from stage 2 before proceeding with recommendations on stage 3 Others felt that the recommendations did not go far enough to enable the use of HIT to improve outcomes – Need to leverage technology to enable interoperability, enable longitudinal care, and capture and manage information to allow people to be fully engaged in their care – Registries, quality measurement, and longitudinal care management are important domains that some members felt should be advanced even further The recommendations start a process of information gathering and were approved under this spirit 3

Improving quality of care and safety: Clinical decision support (CDS) 4 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 2.Chronic disease condition management 3.Appropriateness of lab/rad orders 4.Advanced medication-related decision support 5.Improving problem, meds, allergy lists 6.Drug-drug /drug-allergy interaction checks Red: Changes from stage 2 Blue: Newly introduced Bright Red: edits for clarity Certification criteria: 1.Ability to track “actionable” (i.e., suggested action is embedded in the alert) CDS interventions and user responses actions in response to interventions 2.Perform age-appropriate maximum daily-dose weight based calculation Focus AreaTypeProvider use effortStandards MaturityDevelopment  CDS  Population management  Care coordination Primary care Specialty (selectively) MediumEmerging High

Improving quality of care and safety: Unique device identifier (UDI) 5 Recording FDA UDI to Improve Quality of Care and Safety NEW Menu: Eligible Professionals and Eligible Hospitals record the FDA Unique Device Identifier (UDI) when new device is implanted in a patient patients have devices implanted for each newly implanted device Threshold: High Focus AreaTypeProvider use effortStandards MaturityDevelopment Primary Care Specialty (selectively) LowEmergingMedium Red: Changes from stage 2 Blue: Newly introduced

6 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 (SOGI) – Ability to capture disability status Communication preferences will be applied to visit summary, reminders, and patient education Discussion: Consider using HHS Demographic Data Collection standards and SOGI questions and review the upcoming Institute of Medicine report on social determinants of health Focus AreaTypeProvider use effortStandards MaturityDevelopment  CDS  Patient engagement Primary Care Specialty (selectively) MediumEmergingHigh Red: Changes from stage 2 Blue: Newly introduced Bright Red: edits for clarity

Engaging patients and families in their care: View, download, transmit 7 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 Discussion: For EHs, the information available within 24 hours is the same as in stage 2 (which was at 36 hours) Focus AreaTypeProvider use effortStandards MaturityDevelopment  Patient engagement  Care coordination Primary Care Specialty HighEmergingMedium Red: Changes from stage 2 Blue: Newly introduced

Engaging patients and families in their care: Secure messaging 8 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 thread of responses to a patient-generated message (e.g., no response, secure message reply, telephone reply) Focus AreaTypeProvider use effortStandards MaturityDevelopment  Patient engagement Primary Care Specialty MediumApprovedHigh (tracking) Red: Changes from stage 2 Blue: Newly introduced

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 Improving care coordination: Summary of care 9 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) Focus AreaTypeProvider use effortStandards MaturityDevelopment  Care Coordination Primary Care Specialty HighAdoptedHigh Red: Changes from stage 2 Blue: Newly introduced 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)

Improving population and public health: Registries 10 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. Focus AreaTypeProvider use effortStandards MaturityDevelopment  Population management Primary Care Specialty (selectively) HighEmergingHigh Red: Changes from stage 2 Blue: Newly introduced Bright Red: edits for clarity

Listening Session – Draft Framework April – Date TBD Opportunity for the public to provide feedback on MU3 recommendations Members of the public will register in advance and identify a category for comment Registration information – Name, organization, category, summary of comment Categories – MU3 recommendations - Improving quality of care and safety – MU3 recommendations - Engaging patients and families in their care – MU3 recommendations - Improving care coordination – MU3 recommendations - Improving population and public health – Future of Meaningful Use after stage 3 – Benefits of MU for organizations or quality of care Comments will be limited to 3 minutes Specific times will be identified for each category, limiting the number of comments based upon the time allotted to that category Allow 15 minutes for open comment at the end of the session? 11