1. HIT Policy Committee Clinical Operations Workgroup Report Jamie Ferguson Kaiser Permanente John Halamka Harvard Medical School 16 July, 2009

2. 2 Clinical Operations Workgroup Process Review proposed MU objectives and measures –Initial focus on proposed MU quality measures Identify existing EHR standards for MU measures –Existing HHS adopted, recognized and accepted standards –Other widely accepted and widely deployed standards –Gaps in standards for the measure Identify the feasibility of widespread implementation of the identified national EHR standards by 2011 or 2013 or beyond “Reality check” notes on requirements and next steps

3. 3 Example of Clinical Operations Process Pre-decisional Draft Example For Discussion, page 1 of 2 2011 Measure HHS Adopted EHR Standards Other Widely Accepted Standards Gaps In Standards Feasible For 2011 Feasible For 2013 Notes / “Reality Check” % patients at high risk for cardiac events on aspirin pro- phylaxis [OP] Standards referenced in HITSP specific- ations for CCD; e- prescribing; medication manage- ment N/AStandards- based definition of high risk patients. Standards for patient self- reporting of medications Measures based on local or proprietary codes and/or ICD-9 – or – 2013 standards Measures based on SNOMED- CT problems, RxNorm and other standards in relevant HITSP specifi- cations Adopted HHS EHR standards are not fully tested nor widely deployed for this use.

4. 4 Example of Clinical Operations Process Pre-decisional Draft Example For Discussion, page 2 of 2 2011 Measure HHS Adopted EHR Standards Other Widely Accepted Standards Gaps In Standards Feasible For 2011 Feasible For 2013 Notes / “Reality Check” % lab results incorpor- ated into EHR in coded format [OP,IP] Lab result standards referenced in HITSP specific- ations for commun- ication of lab results and lab documents, including LOINC and UCUM. HL7 v2.x; HL7 v3 CDA Standards and imple- mentation guidance for blood bank, surgical pathology, and genetic test results Measures based on local and/or proprietary codes – or – 2013 standards Measures based on standards in relevant HITSP specifi- cations for lab results including LOINC and UCUM. Adopted HHS EHR standards are not fully tested nor widely deployed for this use.

5. 5 Clinical Operations Workgroup Status A first draft of the existing EHR standards identification is complete for all proposed quality measures A first draft of the widespread implementation feasibility assessment for 2011 and 2013 is complete for most proposed quality measures Many of these same EHR standards and widespread implementation feasibility assessments will apply to MU measures other than those for quality reporting

6. 6 Clinical Operations Workgroup Next Steps Complete the identification of existing EHR standards and widespread implementation feasibility and timing for the standards for all MU proposed measures –Includes cross-workgroup discussions Harmonization of workgroup recommendations for standards and widespread implementation feasibility of the standards –E.g. consistent standards applicable for different measures Develop Standards Committee recommendations based on workgroup recommendations