1. Draft – discussion only Consumer Workgroup STAGE 3 Meaningful Use & 2015 VDT Certification NPRM Review Christine Bechtel, chair April 20, 2015

2. Consumer Workgroup Members Christine Bechtel, Bechtel Health Advisory Group (Chair) Dana Alexander, Caradigm Leslie Kelly Hall, Healthwise Ivor Horn, Seattle Children’s Erin Mackay, National Partnership for Women & Families Philip Marshall, Conversa Health Amy Berman/Wally Patarawan, The John A. Hartford Foundation Will Rice, Walgreens/Take Care Health Systems Clarke Ross, Consortium for Citizens with Disabilities; American Association on Health and Disability Luis Belen, National Health IT Collaborative for the Underserved Kim Schofield, Lupus Foundation of America (GA Chapter) Work@Health Program for CDC MaryAnne Sterling, Patient & Caregiver Advocate Nicholas Terry, Indiana University, Robert H. McKinney School of Law Ex Officio Members Cynthia Baur, HHS, CDC Teresa Zayas Caban, HHS, AHRQ Danielle Tarino, HHS, SAMHSA Theresa Hancock, Veterans Affairs Bradford Hesse, HHS, NIH Wendy J. Nilsen, HHS, NIH ONC Staff Chitra Mohla, Office of Policy (Lead WG Staff) 2

3. 3 Agenda I.Workgroup Charge II.Review Objective 5 of Stage 3 of the Medicare & Medicaid Electronic Health Record (EHR) Incentive Program III.Review VDT certification criteria in the 2015 Certification NPRM

4. Consumer Workgroup Charge Provide input and make recommendations on policy issues or opportunities to use health IT to: – Engage consumers and families in their own health and health care – Enable consumer-provider partnerships supported by health IT – Elevate consumer voices to shape health system transformation 4

5. Objective 5: Patient Electronic Access to Health Information 5 Objective: Provide electronic or API access to health information and educational resources. Must meet all measures. MEASURE 1: For > 80% of unique patients, patient provided access to health information within 24 hours of availability 1)Using patient portal 2)Using an ONC-certified API used by 3 rd party app or device MEASURE 2: Use CEHRT to identify patient-specific educational resources & provide electronic access to those material >35% of unique patients Exclusion: EP with no office visits. EP/EH in area with insufficient broadband

6. Proposed Measure 1 6 MEASURE 1: For > 80% of unique patients, patient provided access to health information within 24 hours of availability To calculate the percentage To calculate the percentage: DenominatorThe number of unique patients seen by the EP or the number of unique patients discharged from an eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period. NumeratorThe number of patients in the denominator who are provided access to information within 24 hours of its availability to the EP or eligible hospital/CAH. ThresholdThe resulting percentage must be more than 80 percent in order for a provider to meet this measure. ExclusionAn EP may exclude from the measure if they have no office visits during the reporting period

7. Request for Comment What additional requirements might be needed to ensure that if the eligible hospital, CAH or EP selects the API option— 1.the functionality supports a patient’s right to have his or her protected health sent directly to a third party designated by the patient; and 2.Patients have at least the same access to and use of their health information that they have under view, download and transmit option. 7

8. Request for Comment on Exclusion Comment on Exclusion 1. Whether an exclusion is still appropriate for providers located in counties with <50% of housing having 4Mbps broadband 2. Whether to create exclusion for EPs having no office visits 8

9. Request for Comment on Alternates to Proposed Measure 1 Proposed: Patient or patient authorized representative is provided access to view online and transmit their health within 24 hours of availability to the provider; or the patient or patient authorized representative is provided access to an ONC-certified API that can be used by third- party applications or devices to provide access to their health information within 24 hours Alternate A Patient or patient authorized representative is provided access to view online and transmit their health within 24 hours of availability to the provider; and the patient or patient authorized representative is provided access to an ONC-certified API that can be used by third- party applications or devices to provide access to their health information within 24 hours Alternate B Patient and patient authorized representative is provided access to view online and transmit their health within 24 hours of availability to the provider; or the patient or patient authorized representative is provided access to an ONC-certified API that can be used by third- party applications or devices to provide access to their health information within 24 hours Alternate C the patient or patient authorized representative is provided access to an ONC-certified API that can be used by third- party applications or devices to provide access to their health information within 24 hours 9 For > 80% of all unique patients seen by EP or discharged from EH, CAH inpatient or ER

10. Request for Comment on Alternate Proposals Providers to Meet Measure 1 (pp 101-103) Current VDT functions are widely in use and represent current standards for patient access. 1. Alternate A would require both functions to be available instead of allowing the provider to choose between the two; 2. Alternate B would require the provider to choose to have either both functions, or just an API function; and 3. Alternate C would require the provider to only have the API function. For Alternate C, the use of a separate view, download, and transmit function would be entirely at the provider's discretion and not included as part of the definition of meaningful use. Questions: - Whether these two technologies (portal and API) be optional or both required - If API is required, should still be required to offer a portal? - Problems with measuring patient access using an API rather than a portal? 10

11. Patient-Specific Education Materials MEASURE 2: Use CEHRT to identify patient-specific educational resources & provide electronic access to those material >35% of unique patients (Stage 2 was 10%) 11 To calculate percentage: DenominatorThe number of unique patients seen by the EP or the number of unique patients discharged from an EH or CAH inpatient or ED during EHR Reporting period NumeratorThe number of patients in the denominator who were provided electronic access to patient-specific educational resources using clinically relevant information identified by the CEHRT ThresholdThe resulting percentage must be more than 35% in order for the provider to meet the measure ExclusionsAn EP may exclude from the measure if they have no office visits during the EHR reporting period

12. 2015 Edition Proposed Rule Health IT Certification Criteria Review VDT certification criteria in 2015 Certification NPRM ( Reference VDT certification document) Addressing Health Disparities 12

13. 2015 Edition Proposed Rule: Addressing Health Disparities 13 Proposed Certification CriteriaWhat the Functionality Can Support Documentation of social, psychological, and behavioral data (e.g., education level, stress, depression, alcohol use, sexual orientation and gender identity) Allow providers and other stakeholders to better understand how these data can affect health, reduce disparities, and improve patient care and health equity Exchange of sensitive health information (data segmentation for privacy) Allow for the exchange of sensitive health information (e.g., behavioral health, substance abuse, genetic), in accordance with federal and state privacy laws, for more coordinated and efficient care across the continuum. Accessibility of health IT Compatibility of certified health IT with accessibility technology (e.g., JAWS text-to- speech application) More transparency on the accessibility standards used in developing health IT More granular recording and exchange of patient race and ethnicity Allow providers to better understand health disparities based on race and ethnicity, and improve patient care and health equity.

14. 14 PUBLIC COMMENT