1. Health IT Policy Committee and Health IT Standards Committee Work Product Collaboration of the Health IT Policy and Standards Committees Policy and Standards Federal Advisory Committees on Health Information Technology to the National Coordinator Consumer Task Force Donna Cryer, co-chair Patty Sengstack, co-chair May 16, 2016

2. Health IT Policy Committee and Health IT Standards Committee Work Product Agenda Welcome and Introductions Overview of Charge Overview of consumers’ access to health information – consumer and provider perspectives Overview of the ONC’s Office of Consumer eHealth Review Workplan and discuss next steps 2

3. Health IT Policy Committee and Health IT Standards Committee Work Product Membership 3

4. Health IT Policy Committee and Health IT Standards Committee Work Product Charge Convened on an as needed basis, the task force will provide insight on ONC/HHS projects/initiatives with a consumer focus to ensure the person remains at the center, engaging the experience and feedback of both patients and providers. »Initial focus: The task force will discuss consumer and provider perspectives on patient engagement and provide feedback on a tool ONC is developing to help providers with patient activation and engagement. 4

5. Health IT Policy Committee and Health IT Standards Committee Work Product Where are we going HHS goals for Medicare value-based payments 5

6. Health IT Policy Committee and Health IT Standards Committee Work Product Delivery System Reform Focus Areas 6 Encourage the integration and coordination of clinical care services Improve population health Promote patient engagement through shared decision making Create transparency on cost and quality information Bring electronic health information to the point of care for meaningful use Promote value-based payment systems – Test new alternative payment models – Increase linkage of Medicaid, Medicare FFS, and other payments to value Bring proven payment models to scale Pay Providers Deliver Care Distribute Information } { “Improving the way providers are incentivized, the way care is delivered, and the way information is distributed will help provide better care at lower cost across the health care system…” Source: Burwell SM. Setting Value-Based Payment Goals ─ HHS Efforts to Improve U.S. Health Care. NEJM 2015 Jan 26; published online first.

7. Health IT Policy Committee and Health IT Standards Committee Work Product EP Patient Engagement Measures under Meaningful Use Stage 2 and 3 Stage 2 (Obj 6) Use clinically relevant information from the CEHRT to identify patient-specific education resources and provide those resources to the patient (Obj 8) Provide patients with ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP (Obj 9) Use secure electronic messaging to communicate with patients on relevant health information Stage 3 Patient Electronic Access (Objective 5): (M1) For more than 80% of all unique patients seen by the EP: The patient (or the patient authorized representative) is provided timely access to view online, download, & transmit his or her health information; and Ensure information available for patient information is available for the or patient—authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the API in the provider’s CEHRT. (M2) Use clinically relevant information from the CEHRT to identify patient-specific education resources and provide those resources to the patient Coordination of Care through Patient Engagement (Objective 6) (M1): For 2017, during the EHR reporting period, more than 5% of all unique patients(or patient-authorized representative)seen by the EP actively engage with the EHR made accessible by the provider. An EP may meet the measure by either—(1) view, download or transmit to a third party their health information; or (2) access their health information through the use of an API that can be used by applications chosen by the patient and configured to the API in the provider’s CEHRT; or (3) a combination of (1) and (2). Measure 2: For 2017, more than 5% of all unique patients seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient- authorized representative. 7 For more information, visit https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html

8. Health IT Policy Committee and Health IT Standards Committee Work Product Increasingly More Patients Have Online Access Source: https://www.healthit.gov/sites/default/files/briefs/oncdatabrief29_patientengagement.pdf 8

9. Health IT Policy Committee and Health IT Standards Committee Work Product US Hospitals are adopting additional patient engagement capabilities 9 Source: http://dashboard.healthit.gov/evaluations/data-briefs/hospitals-patient- engagement-electronic-capabilities.phphttp://dashboard.healthit.gov/evaluations/data-briefs/hospitals-patient- engagement-electronic-capabilities.php

10. Health IT Policy Committee and Health IT Standards Committee Work Product Value of Online Access 10

11. Health IT Policy Committee and Health IT Standards Committee Work Product Individuals are Engaging with their Health Records Online 11 Sources: http://www.nejm.org/doi/pdf/10.1056/NEJMsa063979http://www.nejm.org/doi/pdf/10.1056/NEJMsa063979 http://www.nationalpartnership.org/research-library/health-care/HIT/engaging-patients-and-families.pdf

12. Health IT Policy Committee and Health IT Standards Committee Work Product Individuals are Engaging with their Health Records Online 12 Source: http://www.nejm.org/doi/pdf/10.1056/NEJMsa063979

13. Health IT Policy Committee and Health IT Standards Committee Work Product More Online Access Leads to Better Care 13

14. Health IT Policy Committee and Health IT Standards Committee Work Product Many Physicians Support Patients Updating their Health Records http://newsroom.accenture.com/news/most-us-doctors-believe-patients-should-update-electronic-health-record-but-not-have-full-access-to-it-according-to-accenture-eight-country-survey.htm 14

15. Health IT Policy Committee and Health IT Standards Committee Work Product There are still gaps in consumers’ information 15 Source: http://www.nejm.org/doi/pdf/10.1056/NEJMsa063979

16. Health IT Policy Committee and Health IT Standards Committee Work Product Individuals can serve as the hub for information exchange 16

17. Health IT Policy Committee and Health IT Standards Committee Work Product ONC Provider Research Based on feedback from providers and hospitals that some Meaningful Use requirements for patient access were “unfair,” we went into the field to find out more. We spoke to 19 people in total: »1 Internal Medicine solo practitioner »6 Family Practice/Internal Medicine, part of groups or hospital systems »1 SVP and Chief Medical Officer at hospital system »4 CIO or Directors of IT at hospital system »2 Office Managers »1 Physician’s Assistant »1 CEO and 3 Directors at hospital system 17

18. Health IT Policy Committee and Health IT Standards Committee Work Product What did we learn? Overall, providers and hospitals believe electronic health records and patient access to them will, ultimately, improve patient care and outcomes. Providers, office staff, and hospitals reported seeing some improvements to their work since moving EMRs. However, physicians and hospital personnel desperately wanted to talk about the larger, systemic issues that prevent them from being able to use patient data in as meaningful way as they would like. 18

19. Health IT Policy Committee and Health IT Standards Committee Work Product The Challenges Informants identified three areas that inhibit a doctors’ and hospitals’ ability to use patient data (and provide patient access) in a way that will improve patient care : 19 Interoperability and information flow Rules and Regulations Patient Awareness

20. Health IT Policy Committee and Health IT Standards Committee Work Product 1. Interoperability and Info Flow EHR systems don’t always work well together, causing fragmented care or duplications Every practice and hospital has a different EHR system and they don’t communicate with one another Patients have too many portals Doctors have systems overload Paper keeps getting introduced into the system Lack of unique patient identifier results in duplicate information in systems and no sure-fire way to merge records or create a complete record for an individual Specialists aren’t as motivated to go electronic and create holes in what could be a closed electronic system Cost of EHRs and connections to other systems is carried by PCPs and outstrips the incentives (partially due to lack of interoperability) 20

21. Health IT Policy Committee and Health IT Standards Committee Work Product 2. Rules and Regulations Specificity of Meaningful Use measurements means that doctors and hospitals create new workflows simply to be in compliance Time to become compliant isn’t always sufficient; attestation periods too long Regulation changes cause chaos and more money Regulations aren’t on a scale Some hospitals/institutions interface with organizations that aren’t required to participate in Meaningful Use. Their burden is higher and sometimes unattainable 21

22. Health IT Policy Committee and Health IT Standards Committee Work Product 3. Patient Awareness PCP practices and hospitals felt that educating patients about access to their health information falls squarely on their shoulders Practices spend time and money getting patients signed up for portal access, but it is achievable compared to some of the larger interoperability and regulations challenges they face 22

23. Health IT Policy Committee and Health IT Standards Committee Work Product Office of Consumer eHealth, Office of the National Coordinator for Health IT Mission Empower individuals and their families with the information and technology they need to manage their health and partner in their care. 23

24. Health IT Policy Committee and Health IT Standards Committee Work Product Consumer eHealth Strategy Contribute Share/Use Culture Change Access 24

25. Health IT Policy Committee and Health IT Standards Committee Work Product Accomplishments and Milestones Estimate more than 150 million individuals have access to at least one source of digital health data Developed Tools/Resources for Consumers and Providers and Launched a Nationwide Campaign Gone Global – UK, Canada, Sweden, etc. and Inspired Other Movements Around Energy & Education Data Developed a Portfolio of Recommended Technical Standards and Regulations Supporting Patient Access Grew Blue Button Pledge Support to 650+ Organizations Achieved an enthusiastic following of supporters and thought leaders. Hosted a Sold Out Consumer Health IT Summit 4 years in a row. Public-Private Partnership & Close Collaboration with Other Federal Partners Catalyzed development of 13 consumer apps

26. Health IT Policy Committee and Health IT Standards Committee Work Product Looking Ahead- ONC consumer-focused products/initiatives 2016 ONC Annual Meeting – June 2 nd Consumer Day 2016 ONC Annual Meeting Challenges »Consumer Health Data Aggregator ChallengeConsumer Health Data Aggregator Challenge »Move Health Data Forward ChallengeMove Health Data Forward Challenge Conduct consumer research Develop consumer and provider tools and resources Advance the Blue Button Initiative 26

27. Health IT Policy Committee and Health IT Standards Committee Work Product Proposed Workplan 27 Meeting DatesTask Monday, May 16 at 2:00pmIntroductions, review of charge, overview of consumer access Wednesday, May 26 at 1:00pmDiscuss Blue Button Initiative Monday, June 13th at 1:00pmFinalize feedback on Blue Button Initiative and Introduction to ONC tools Wednesday, June 23 - Committee MeetingShare feedback with Committee Thursday, June 30th at 1:00pmOverview and review of ONC tools Meeting TBDReview of ONC tool Meeting TBDReview of ONC tool Wednesday, August 10 – Committee Meeting Share feedback with Committee

28. Health IT Policy Committee and Health IT Standards Committee Work Product Collaboration of the Health IT Policy and Standards Committees Policy and Standards Federal Advisory Committees on Health Information Technology to the National Coordinator Consumer Task Force Donna Cryer, co-chair Patty Sengstack, co-chair