1. HIT Policy Committee Meaningful Use Workgroup Paul Tang, Palo Alto Medical Foundation, Chair George Hripcsak, Columbia University, Co- Chair October 27, 2010

2. Workgroup Membership Co-Chairs: Paul TangPalo Alto Medical Foundation George Hripcsak Columbia University Members: David BatesBrigham & Women’s Hospital Michael BarrAmerican College of Physicians Christine BechtelNational Partnership/Women & Families Neil CalmanInstitute/Family Health Art DavidsonDenver Public Health James FiggeNY State Dept. of Health Linda FischettiDepartment of Veterans Affairs David LanskyPacific Business Group/Health Deven McGrawCenter/Democracy & Technology Latanya SweeneyCarnegie Mellon University Charlene UnderwoodSiemens

3. Agenda Recap of stage 1 recommendation process Process for development of stage 2 recommendations Directional strategies discussed at HITPC

4. Recap of Stage 1 Recommendation Process Apr 29, 2009: NCVHS Meaningful Use hearing May 11, 2009: First HIT Policy committee meeting May 28, 2009: First Meaningful Use (MU) workgroup meeting Jun 16, 2009: First Draft “Meaningful Use matrix” presented at HITPC for feedback Draft released for public comment Jul 16, 2009: HITPC approved MU recommendations Jan 13, 2010: MU NPRM Jul 13, 2010: MU Final Rule

5. Developing Recommendations for Stage 2 (and 3) Deliberative Process Hearings over past year: –Specialists; smaller practices and hospitals –State issues –Health care disparities –Patient and family engagement –Population and public health –Care coordination CMS Final Rule on Meaningful Use ONC Final Rule on EHR certification MU WG framework from July 16, 2009 MU WG deliberations on stage 2/3 criteria

6. Discussion of Philosophical Approaches to Stages 2 and 3 Recommendations Positioning of stage 2 –Incremental change over stage 1 –Stepping stone to stage 3 Migration to outcomes –Stage 3 outcomes based –Stage 2 introduction of outcomes orientation Patient engagement information sharing –Access vs. copy vs. “clinical summaries” –Threshold or mandate? Deeming of external criteria –Accrediting groups –Professional accrediting boards –Other CMS programs

7. Positioning of Stage 2 Discussion Incremental change over stage 1 –Pro: Extends current implementation plans –Con: Continues uncertainty for market for stage 3 Stepping stone to stage 3 –Pro: Establishes a roadmap (and timeline) –Con:

8. Migration to Outcomes Discussion Set Stage 3 outcomes-based measures –Setting performance thresholds Deem satisfaction of process measures by achieving threshold performance measure Direct measure of benefits of HIT Supports value-based purchasing –Reduce dependence on process measures Reduce emphasis on “how” (in favor of “what”); allows for innovation Reduce burden of measuring structure and process Introduce outcomes orientation in Stage 2 (merely examples) –Apply clinical decision support to achieve outcome (vs. use specific type of CDS) –Reduce prescribed major drug interactions (for prescribed drug categories) by x% –Reduce 30-day readmission rate by 10%

9. Patient Engagement Information Sharing Discussion Move towards innovative patient use of data Re: “access” vs. “copy” vs. “clinical summaries” vs. “discharge instructions” Setting differences and information purposes –Ambulatory care [ongoing care] –Hospitals [episodic major event] Types of information sharing –“Access” and “Download”: real-time, on-demand availability of shared EHR content [could replace “copy” in the future] –“Copy”: point-in-time copy of existing electronically available information [transitional stage from paper] –Specific-use documents (examples) Hospital: discharge instructions Ambulatory care: visit summaries

10. Explore Deeming of External Certification Discussion Use external certification to deem satisfaction of specific MU criteria (hypothetical examples) –E.g., Does satisfaction of MU care-coordination criteria satisfy HIT component of ACO? –E.g., Does satisfaction of MU category 1 criteria (quality, safety, efficiency) satisfy HIT component of professional maintenance of certification (MOC) for medical boards? Are there multiple “tracks” for achieving meaningful use? Does achieving high performance on quality measures satisfy certain MU categories?

11. MU Work Plan Timeline Oct 20, 2010: directional guidance from HITPC Dec 13, 2010: present draft MU stages 2/3 criteria Jan, 2011: release draft MU criteria RFC Feb, 2011: analyze RFC submissions and revise MU draft criteria Mar, 2011: present revised draft MU criteria to HITPC 2Q11: CMS report on initial MU submissions 3Q11: Final HITPC recommendations on stage 2 MU ~4Q11: CMS MU NPRM