1. Meaningful Use, Standards and Certification Under HITECH—Implications for Public Health InfoLinks Community of Practice January 14, 2010 Bill Brand, MPH, CPHIE

2. Overview Vision and goals for ARRA/HITECH Key provisions of the proposed rules for Meaningful Use – Implications for public health Key provisions for establishing EHR standards and certification process Implications for public health Discussion

3. HITECH Vision To improve the health of Americans and the performance of the nation’s health system through health information technology (HIT). An important component of health reform Harness the full potential of digital technology to prevent and treat illnesses and to improve health.

4. HITECH Goals Improve quality, safety, efficiency, and reduce health disparities Engage patients and families Improve care coordination Ensure adequate privacy & security protections for personal health information Improve population and public health

5. ONC Activiites Definition of ‘Meaningful Use’ and Setting Standards for Electronic Health Record Incentive $60M Program to Fund Strategic Health IT Advanced Research Projects Health IT "Beacon Communities" $80 Million Available to Support Health IT Workforce www.healthit.hhs.gov

6. D. Blumenthal, ONC, 12/09

8. Community College Workforce Training Center Beacon Community Regional Extension Center NHIN Neighboring State Neighboring State Neighboring State D. Blumenthal, ONC, 12/09 A FRAMEWORK FOR IT ADOPTION IS EMERGING: AN EXAMPLE STATE

9. NPRM for Meaningful Use “Medicare and Medicaid EHR Incentive Program” Specifies how meaningful use is defined, what providers have to do to “prove” MU, and how incentive payments will be applied Available through both Medicare and Medicaid programs 60 day comment period from Jan. 13

10. Overall Requirements Use of certified EHR technology in a meaningful manner; e.g., eRx Certified EHRs connected for HIE to improve quality of care Quality and other measures reported to HHS

11. Staged Implementation: Stage 1 Electronic capture of health information in a coded format Tracking key clinical conditions and communicating outcomes for care coordination Implementing clinical decision support tools to facilitate medication and disease management Reporting for public health purposes.

12. Staged Implementation Stage 2: Builds on stage 1; computerized provider order entry; electronic transmission of diagnostic test results; research Stage 3: Builds on stage 2; promotes improvements in quality and safety; patient access and involvement; improved population health data

13. Pathway to ARRA Incentives Adopt certified EHR system Achieve Meaningful Use Objectives Apply for payments CCHIT-certified or new certifying bodies yet to be named Stage 1: 25 measures; 17 require only attestation In either Medicaid or Medicare program

17. Implications for public health Assess and ensure readiness in 3 areas: – For 2011, IIS, ELS and syndromic surveillance – Both testing capability of systems to report (and actual submissions of immunization data where required and accepted) Increase capacity for data management and analysis Coordination across programs, state HIT coordinator, state HIE plan, Medicaid, enterprise architecture plan, etc.

18. STANDARDS AND CERTIFICATION

19. Purposes of IFR Criteria for certifying EHR technologies – Applies to vendors Standards to be used in achieving Meaningful Use objectives

20. Standards Content – How to describe the ‘what’ Vocabulary – Specific, unambiguous nomenclature Transmission – How the ‘what’ is sent Privacy and Security

21. Immunization Standards Vocabulary: CVX codes Content: HL7 v2.3.1 or 2.5.1 (2011) Providers must perform at least one test of EHR capacity to send to the immunization registry (2011)

22. Surveillance Standards Vocabulary: Based on PH agency requirements; move to Geocoded Interoperable Population Summary Exchange (GIPSE) in 2013? Content: HL7 v2.3.1 or 2.5.1 (2011) Providers must perform at least one test of EHR capacity to send if the entity has the capacity (2011)

23. Many Other Standards of Interest Structured lab data Demographics: race, preferred language, etc. BMI Smoking status Reduction of disparities Aggregate numerator and denominator quality data

24. Implications for Public Health Need to stay informed and incorporate e- health priorities into your thinking and vocabulary – Work within the e-health pressures and drivers for your partners Align your efforts with the population health priorities – Participate in setting the priorities, the metrics and in interpreting and communicating the results

25. Implications for Public Health Develop a workforce strategy – IT, informatics, HIE, data analytics – Work with academic institutions to define the unique informatics needs of public health Contribute to a unified public health perspective and voice – Your associations, JPHIT, PHDSC – Work to align CDC and other funding with HITECH priorities

26. Implications for Public Health Seek a certifying approach/entity for certification of public health information systems? – CCHIT modular certification around MU requirements? – Broader PHIN requirements?

27. Summary HITECH presents an unprecedented opportunity for public health agencies to partner with healthcare around HIE and population health improvement – Funding, policy and regulations are aligned – Private and public sector buy-in Expectations for public health capabilities around HIE will increase. Your participation matters!!

28. D iscussion Bill Brand: bbrand@phii.orgbbrand@phii.org ONC: www.healthit.hhs.govwww.healthit.hhs.gov HIMSS: ww.himss.org/EconomicStimulus/ww.himss.org/EconomicStimulus/