1. HIT Standards Committee Consumer Technology Workgroup April 18, 2013 9:00 AM– 10:00 AM Eastern

2. Agenda Welcome ONC Consumer/Patient Activities Continue introductions with activities Standards inventory planning (see Meaningful Use Stage 2 table) Next steps Public comment 1

3. ONC Consumer/Patient Activities Consumer Engagement Strategy Blue Button Public input on Consumer Engagement Patient-Generated Health Data “Person @ the Center” 2

4. Office of Consumer eHealth slides 3

5. Input on Consumer Engagement via PlanningRoom.org 4

6. Patient-Generated Health Data ONC asked National eHealth Collaborative to convene a Technical Expert (TEP) Panel to provide input on how to successfully implement patient generated health data (PGHD). Purpose: identify use cases and best practices for integrating PGHD into clinical workflows to produce an evidence-based report that will support the HIT Policy Committee Meaningful Use Workgroup in developing recommendations for Stage 3 Meaningful Use. 5

7. Patient-Generated Health Data – MU3 Proposed objective 204B Provide 10% of patients with the ability to submit patient- generated health information to improve performance on high priority health conditions, and/or to improve patient engagement in care (e.g. patient experience, pre-visit information, patient created health goals, shared decision making, advance directives, etc.). This could be accomplished through semi-structured questionnaires, and EPs and EHs would choose information that is most relevant for their patients and/or related to high priority health conditions they elect to focus on. 6

8. PGHD-Related MU3 Proposed objective 204D Provide patients with the ability to request an amendment to their record online (e.g., offer corrections, additions, or updates to the record) through VDT in an obvious manner. Proposed objective 207 Use secure electronic messaging to communicate with patients on relevant health information 7

9. TEP PGHD Comments on Stage 3 Suggestions to providers, based on case studies, of “promising practices” for – Preparations – Data of value to providers and patients – Processing PGHD 8

10. Person @ the Center: Vision The power of each individual is unleashed to be active in managing their health and partnering in their health care, enabled by information and technology.  Empowers each individual to be the manager and partner in their health care using health IT tools and resources.  People’s health and quality of life will improve if they have the assistance of information and technology for self-care and shared decision-making with their providers. 9

11. Continuum of Spheres of Wellness and Health Care 10

12. Goals 11

13. Goals 12

14. Goals 13

15. Draft Building Blocks 14 Key policy ideas: – Reflect suggested changes to support people as they act within and move between the spheres of wellness and health care. – Illustrate a way to achieve the vision: Game-changing Broad-reaching in scope Support behavior change Make use of health IT and information-sharing

16. Consumer Technology Workgroup (WG) Members WG Members Brian Ahier, Gorge Health Connect, Inc. Christine Bechtel, National Partnership for Women & Families Brian Carter, Cerner AJ Chen, HHS NPA Region IX Health Equity Council John Derr, Golden Living, LLC Tonya Dorsey, BCBS/South Carolina Arthur Henderson, Affinity Networks, Inc. Susan Hull, Wellspring Consulting Elizabeth Johnson, Tenet Healthcare Corporation Russ Leftwich, TN Office of eHealth Mohit Kaushal, West Health Tom Jones, Tolven Health Holly Miller, MedAllies, Inc. Sally Okun, PatientsLikeMe Yair Rajwan, Visual Science Informatics, LLC John Ritter, HL7 EHR Work Group Anshuman Sharma, Ubiqi Health Fred Trotter, Not Only Dev Ex Officio Members Kim Nazi, Veterans Health Administration Susan Woods, Veterans Health Administration 15

17. Member Introductions – continued See Workgroup Member/Activity WORD table 16

18. Patient Engagement Standards Inventory 17 Meaningful Use Objectives for Patient Engagement and Care Coordination Standards Identified for Stage 2 Gaps

19. Next Steps Homework – Complete table of member activities, related standards, and MU priorities; email to maryjo.deering@hhs.gov maryjo.deering@hhs.gov – Read and comment on Consumer Strategy (as an individual) by May 9 th @ http://planningroom.org/ http://planningroom.org/ 18

20. Background Slides for Additional Information 19

21. Charge & Scope Charge: Provide recommendations on standards and interoperability issues and opportunities related to strengthening the ability of consumers, patients, and lay caregivers to manage health and health care for themselves or others. Scope: – Examples of issues to be addressed include portability of patient data, patient access to and generation of their health data, and incorporating patient preferences for a variety of issues, such as care plans. – Important touch points with other workgroups: HITPC Consumer Empowerment Workgroup Meaningful Use Workgroup 20

22. 21 Stage 2 Final Rule EP Objective: Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP. EP Measure: 1. More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information subject to the EP's discretion to withhold certain information 2. More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information EH Objective: Provide patients the ability to view online, download, and transmit information about a hospital admission EH Measure: 1. More than 50% of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH have their information available online within 36 hours of discharge 2. More than 5% of all patients (or their authorized representatives) who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH view, download or transmit to a third party their information during the reporting period Context: Stage 2 Meaningful Use Final Rule Patient & Family Engagement Requirements

23. 22 Stage 1 Final RuleStage 2 Final Rule Provide clinical summaries for >50% of all office visits within 3 business days EP Objective: Provide clinical summaries for patients for each office visit EP Measure: Clinical summaries provided to patients or patient-authorized representatives within 1 business day for more than 50 percent of office visits. We clarify that the following information (or an indication that there is no information available) is required*: ● Patient name. ● Provider's name and office contact information. ● Date and location of the visit. ● Reason for the office visit. ● Current problem list. ● Current medication list. ● Current medication allergy list. ● Procedures performed during the visit. ● Immunizations or medications administered during the visit. ● Vital signs taken during the visit (or other recent vital signs). ● Laboratory test results. ● List of diagnostic tests pending. ● Clinical instructions. ● Future appointments. ● Referrals to other providers. ● Future scheduled tests. ● Demographic information maintained within CEHRT (sex, race, ethnicity, date of birth, preferred language). ● Smoking status ● Care plan field(s), including goals and instructions. ● Recommended patient decision aids (if applicable to the visit). *an EP could withhold information from the clinical summary if they believe substantial harm may arise from its disclosure through an after-visit clinical summary Context: Stage 2 Meaningful Use Final Rule Patient & Family Engagement Requirements 22

24. 23 Stage 1 Final RuleStage 2 Final Rule MENU: Use certified EHR to identify patient-specific educational resources for >10% of all patients EP/EH Objective: Use Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient EP CORE Measure: Patient specific education resources identified by CEHRT are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period EH CORE Measure: More than 10 percent of all unique patients admitted to the eligible hospital's or CAH's inpatient or emergency departments (POS 21 or 23) are provided patient- specific education resources identified by Certified EHR Technology Context: Stage 2 Meaningful Use Final Rule Patient & Family Engagement Requirements

25. 24 Stage 2 Final Rule EP Objective: Use secure electronic messaging to communicate with patients on relevant health information EP Measure: A secure message was sent using the electronic messaging function of Certified EHR Technology by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period Context: Stage 2 Meaningful Use Final Rule Patient & Family Engagement Requirements

26. Shared Care Plan: Proposed for Future Stage 25 Stage 3 Request for Comment (Proposed for Future Stage) EP/ EH / CAH Objective: EP/ EH/CAH who transitions their patient to another site of care or refers their patient to another provider of care For each transition of site of care, provide the care plan information, including the following elements as applicable: Medical diagnoses and stages Functional status, including ADLs Relevant social and financial information (free text) Relevant environmental factors impacting patient’s health (free text) Most likely course of illness or condition, in broad terms (free text) Cross-setting care team member list, including the primary contact from each active provider setting, including primary care, relevant specialists, and caregiver The patient’s long-term goal(s) for care, including time frame (not specific to setting) and initial steps toward meeting these goals Specific advance care plan (Physician Orders for Life-Sustaining Treatment (POLST)) and the care setting in which it was executed. For each referral, provide a care plan if one exists Measure: The EP, eligible hospital, or CAH that transitions or refers their patient to another site of care or provider of care provides the electronic care plan information for 10% of transitions of care to receiving provider and patient/caregiver. Certification Criteria: Develop standards for a shared care plan, as being defined by S&I Longitudinal Coordination of Care WG. Some of the data elements in the shared care plan overlap content represented in the CDA. Adopt standards for the structured recording of other data elements, such as patient goals and related interventions