DIVURGENT

Hospital Menu Set
Improve quality, safety, efficiency, and reduce health disparity
1. Implement drug-formulary checks: The EP/eligible hospital/CAH has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period

2. Record advance directives for patients 65 years old or older (EH or CAH): More than 50% of all unique patients 65 years old or older admitted to the eligible hospital’s or CAH’s inpatient department (POS 21) have an indication of an advance directive status recorded

Numerator: The number of patients in the denominator with an indication of an advanced directive entered using structured data.
Denominator: Number of unique patients age 65 or older admitted to an eligible hospital’s or CAH’s inpatient department (POS 21) during the EHR reporting period

3. Incorporate clinical lab test results into certified EHR technology as structured data: More than 40% of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data

Numerator: The number of lab test results whose results are expressed in a positive or negative affirmation or as a number which are incorporated as structured data.
Denominator: Number of lab tests ordered during the EHR reporting period by the EP or authorized providers of the eligible hospital or CAH for patients admitted to an eligible hospital’s or CAH’s inpatient or emergency department (POS 21 & 23) whose results are expressed in a positive or negative affirmation or as a number.

4. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach: Generate at least one report listing patients of the EP, eligible hospital or CAH with a specific condition

Engage patients and families
1. Use certified HER technology to identify patient-specific education resources and provide those resources to the patient if appropriate: More than 10% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) are provided patient-specific education resources

Numerator: Number of patients in the denominator who are provided patient education specific resources
Denominator: Number of unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period.

Improve care coordination
1. The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation: The EP, eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23)

Numerator: The number of transitions of care in the denominator where medication reconciliation was performed.
Denominator: Number of transitions of care during the EHR reporting period for which the EP or eligible hospital’s or CAH’s inpatient or emergency department (POS 21 to 23) was the receiving party of the transition

2. The EP, eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral: The EP, eligible hospital or CAH who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals

Numerator: The number of transitions of care and referrals in the denominator where a summary of care record was provided.
Denominator: Number of transitions of care and referrals during the EHR reporting period for which the EP or eligible hospital’s or CAH’s inpatient or emergency department (POS 21 to 23) was the transferring or referring provider.

Improve population and public health
1. Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically)

2. Capability to submit electronic data on reportable (as required by state or local law) lab results to public health agencies and actual submission in accordance with applicable law and practice (EH): Performed at least one test of certified EHR technology’s capacity to provide electronic submission of reportable lab results to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which eligible hospital or CAH submits such information have the capacity to receive the information electronically)

3. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically)

Many clients have asked for a quick summary of the Hospital objectives. Here are the core objectives with numerator and denominator definitions.

CORE SET
Improve quality, safety, efficiency, and reduce health disparity
1. Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record
per state, local and professional guidelines: More than 30% of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one medication order entered using CPOE

Numerator: Patients in the denominator w/ at least one med order entered using CPOE
Denominator: Number of unique patients with at least one medication in their medication list seen by the EP or admitted to an eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period

2. Implement drug-drug and drug-allergy interaction checks: The EP/eligible hospital/CAH has enabled this functionality for the
entire EHR reporting period

3. Record demographics of preferred language, ethnicity, race, gender and date of birth: More than 50% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data

Numerator: The number of patients in the denominator who have all the elements of demographics (or a specific exclusion if the patient declined to provide one or more elements or if recording an element is contrary to state law) recorded as structured data.
Denominator: Number of unique patients seen by the EP or admitted to an eligible hospital’s or CAH’s inpatient or emergency departments (POS 21 or 23) during the EHR
reporting period.

4. Maintain an up to date problem list of current and active diagnoses: More than 80% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry or an indication that no problems are known for the patient recorded as structured data

Numerator: The number of patients in the denominator who have at least one entry or an indication that no problems are known for the patient recorded as structured data in their problem list.
Denominator: Number of unique patients admitted to an eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period.

5. Maintain active medication list: More than 80% of all unique patients seen by the EP or admitted to the eligible hospital’s or
CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data

Numerator: The number of patients in the denominator who have a medication (or an indication that the patient is not currently prescribed any medication) recorded as structured data
Denominator: Number of unique patients seen by the EP or admitted to an eligible hospital’s or CAH’s inpatient or emergency departments (POS 21 or 23) during the EHR
reporting period

6. Maintain Active medication allergy list: More than 80% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data

Numerator: The number of unique patients in the denominator who have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured
data in their medication allergy list
Denominator: Number of unique patients seen by the EP or admitted to an eligible hospital’s or CAH’s inpatient or emergency departments (POS 21 or 23) during the EHR
reporting period

7. Record and chart changes in vital signs: height weight blood pressure, calculate and display: BMI, plot and display growth charts for children 2-20 years and display BMI: For more than 50% of all unique patients age 2 and over seen by the EP or admitted to eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23), height, weight and blood pressure are recorded as structured data

Numerator: The number of patients in the denominator who have at least one entry of their height, weight and blood pressure are recorded as structure data.
Denominator: Number of unique patients age 2 or over seen by the EP or admitted to an eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period.

8. Record smoking status for patients 13 years old and older: More than 50% of all unique patients 13 years old or older seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have smoking status recorded as structured data

Numerator: The number of patients in the denominator with smoking status recorded as structured data.
Denominator: Number of unique patients age 13 or older seen by the EP or admitted to
an eligible hospital’s or CAH’s inpatient or emergency departments (POS 21 or 23) during the EHR reporting period.

9. Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule: Implement one clinical decision support rule

10. Report hospital clinical quality measures to CMS or the States: For 2011, provide aggregate numerator, denominator, and exclusions through attestation as discussed in section II(A)(3) of this final rule. For 2012, electronically submit the clinical quality measures as discussed in section II(A)(3) of this final rule.

Engage patients and families
1. Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request: More than 50% of all patients of the EP or the inpatient or emergency departments of the eligible hospital or CAH (POS 21or 23) who request an electronic copy of their health information are provided it within 3business days

Numerator: The number of patients in the denominator who receive an electronic copy of their electronic health information within three business days
Denominator: The number of patients of the EP or eligible hospital’s or CAH’s inpatient or emergency departments (POS 21 or 23) who request an electronic copy of their electronic health information four business days prior to the end of the EHR reporting period.

2. Provide patient with an electronic copy of their discharge instructions and procedures at the time of discharge upon request. (EH): More than 50% of all patients who are discharged from an eligible hospital or CAH’s inpatient department or emergency department (POS 21 or 23) and who request an electronic copy of their discharge instructions are provided it

Numerator: The number of patients in the denominator who are provided an electronic copy of discharge instructions.
Denominator: Number of patients discharged from an eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) who request an electronic copy of their discharge instructions and procedures during the EHR reporting period.

Improve care coordination
1. Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically: Performed at least one test of certified HER technology’s capacity to electronically exchange key clinical information

Ensure adequate privacy and security protections for personal health information:
1. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities: Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process

In 2010, the transformation of health systems will improve health care quality, efficiency, equity and safety through the use of Health Information Technology (HIT). This will lead to measurable improvement in our nation’s health. The meaningful use of technology is central to the modernization of our health system. In the Interim Final rule (IFR) on Standards and Certification Criteria issued today, the Office of the National Coordinator for Health Information Technology (ONC) has published an initial set of standards, implementation specifications and certification criteria.

In the Notice of Proposed Rulemaking (NPRM), the Centers for Medicare and Medicaid (CMS) outlined provisions governing the Medicare and Medicaid Electronic health record (EHR) incentive programs. These included a proposed definition for the concept of “meaningful use” of EHR technology. It is essential that professionals and hospitals are able to demonstrate meaningful use of a certified EHR system in order to be eligible to receive payments under the incentive program which are provided through the American Recovery and Reinvestment Act (ARRA). Certifications in the IFR are organized into four categories: Content Exchange Standards, Vocabulary Standards, Transport Standards and Privacy and Security Standards. The criteria are designed to be supportive of the staged meaningful use requirements while also laying the foundation for future growth in information exchange and technological innovation. Meaningful use requirements are expected to become more demanding over time as our industry continues to spur adoption through its innovative offerings. An incremental approach to standards adoption requires harmonization with current and future standards to come.

Both the IFR and NPRM can be found at:

http://www.federalregister.gov/inspection.aspx#special

With all of us wondering about meaningful use final objectives and measures, I was surprised to find vendors “guaranteeing” achievement of meaningful use. One such vendor is athenahealth. They say, “We’re so confident that our low-cost, low-risk Web-based EHR service will meet HITECH Act requirements for meaningful use and help you secure your government payments, that we are guaranteeing it and putting our money on the line”. Interesting indeed.

If you haven’t kept up with what the NCQA has been up to in supporting patient centered care initiatives, it’s interesting to look at the program in light of ARRA and the most recent meaningful use definition.

NCQA’s Physician Practice Connections –  The Patient Centered Medical Home (PPC-PCMH) initiative is aimed at recognizing medical practices who are meeting NCQA standards related to providing a patient centric medical home model (for definition, see). This model emphasizes patient centric, holistic care coordinated by a physician.

I have become increasingly concerned lately about the multitude of programs (see my previous post), aimed at improving various components of the healthcare system, due to the amount of confusion it is occurring at the provider level of care. Although all have admirable goals, the lack of coordination may actually freeze the market as providers work to reconcile the various programs and what they must do to receive incentives, achieve meaningful use, obtain NCQA accreditation and so on. What is needed at the Federal and State level is a coordinated effort which aligns these programs and provides clear direction to providers so they can act on implementing strategic and tactical initiatives.

However, it is most interesting how many of these programs/initiatives are aligned in their mission and goals. For example, NCQA’s PCMH “must pass” elements include:

1. Written standards for patient access and patient communication
2. Use of data to show meeting standards
3. Use of paper or electronic based charting tools to organize clinical information
4. Use of data to identify important diagnosis and conditions in practice
5. Adoption and implementation of evidence based guidelines for three conditions
6. Active support of patient self management
7. Tracking system to test and identify abnormal results
8. Tracking referrals with paper based or electronic system
9. Measurement of clinical and/or service performance
10. Performance reporting by physician or across the practice

It is clear that the above elements are largely included in the current definition of meaningful use. In fact, it is virtually impossible to achieve NCQA level 3 recognition without an electronic health record of some sort.

My hope is that providers are able to devote the appropriate resources and develop an overall organizational strategy that will allow them to achieve the greatest success in obtaining incentives, obtaining recognition and of course improving the overall. And most importantly, accomplishing this with the most efficient utilization of resources.

The federal HIT Policy Committee met on Friday, August 14, 2009 in Washington DC to discuss meaningful use. The Committee released a timeline for the next 12 months to finalize a meaningful use definition:

• 3Q09: Develop process for updating meaningful use objectives and measures
– Tag 2011 measures relevant to specialties
• 4Q09: Conduct informational hearings to inform 2013 and 2015 criteria development
• 1Q10: Update 2013 and 2015 criteria
• 2Q10: Work with HIT Standards committee to ascertain availability of relevant standards
• 3Q10: Refine 2013 meaningful use criteria
• 4Q10: Assess industry preparedness for meeting 2011 and initial 2013 meaningful use criteria

The updates on meaningful use are as follows:

• Continue to use National Priorities Partnership (NPP) framework for meaningful use criteria
• Work with NPP and Healthy People programs to identify HIT-sensitive objectives and measures appropriate for meaningful use criteria (exemplars) in 2013 and 2015
• Gather public input on identified gaps in measures needed for MU criteria
– Examples: specialists, smaller practices and hospitals, safety-net providers, patient-supplied information
• Assess industry initial response to 2011 MU program
• Refine 2013 and 2015 MU criteria
• Address barriers to EHR adoption and mitigation strategies

The Committee will hold an informational hearing on ‘meaningful use’ criteria for 2013-15 in October 2009. They will address gaps in appropriate measures for assessing meaningful use, criteria for specialists including: use of measures relevant to specialists, participation in national registries, development of new measures; and feedback & new ideas from provider organizations for meaningful use criteria for 2013& 2015 for the spectrum of physician practices, hospitals, and safety-net providers.

We are looking forward to the upcoming meetings and a final definition on meaningful use.

As I’ve spent more time thinking about the ARRA, I’ve reflected on the multitude of other governmental “stimulus” programs that are available to providers to help improve the quality, safety, and efficiency of healthcare delivery. If providers are unable to navigate the morass of legislation that is the byproduct of all these programs, then it will be increasingly difficult for either the government or the provider community to garner the intended benefits of these programs.

Some of the governmental programs currently in place include: (a) CMS’s Physician Quality Reporting Initiative (PQRI), (b) the e-Prescribing initiative authorized in Section 132 of the Medicare Improvements for Patients and Providers Act of 2008, (c) CMS’ Hospital Compare project, (d) the anti-kickback safe harbors / STARK exceptions for e-prescribing and electronic medical records, and (e) the American Recovery and Reinvestment Act of 2009 (ARRA).

The complexity of these programs has, understandably, caused a significant level of confusion in the healthcare marketplace as providers have struggled with understanding the overall program framework let alone trying to implement strategies that allow them to maximize the benefits and incentives associated with such programs. In short, providers are confused and stymied by the number and complexity of programs available to them in today’s legislative landscape.

Do most providers have the resources in place in order to develop the strategic approaches necessary to leverage the incentives offered in these programs and do it efficiently?

The federal HIT Policy Committee approved revised recommendations for “meaningful use” of electronic health records. The meaningful use workgroup of the HIT Policy Committee met for a second time on July 16, 2009 and has released its newest recommendations. Overall, the committee states that “the focus of meaningful use must be on objectively measurable improvement of health outcomes and actual effective use, not simply to promote the adoption of technology for its own sake.” Meaningful use of HIT is critical to the President’s and Congress’s agenda for health reform, which drives the urgency and the seemingly aggressive nature of the timelines. Thus, the alignment of the planned healthcare reform and meaningful use must be met in order to assure the success of health reform. Although extremely ambitious, the 2015 vision is achievable.

Vision for 2015
• Prevention and management of chronic diseases
o A million heart attacks and strokes prevented
o Heart disease no longer leading cause of death in the US
• Medical Errors
o 50% fewer preventable medication errors
o Health disparities
o The racial/ethnic gad in diabetes control halved
• Care Coordination
o Preventable hospitalizations and re-admissions cut by 50%
• Patients and families
o All patients have access to their own health information
o Patient preferences for end of life care followed more often
• Public Health
o All health departments have real-time situational awareness of outbreaks

Recommendations

Improve Quality, Safety, Efficiency; Reduce Disparities (Timing)
• If an organization cannot meet 2012, the 2013 criteria sets an even higher bar (“rising tide”)
• Recommendation – use of “adoption year” timeframe.
If a provider is not ready by 2011 to meet meaningful use, they can become meaningful users at a later time and still use 2011 criteria as their meaningful use standards for their first adoption year. In other words, a provider’s criteria for meaningful use would be according to adoption year 1 criterion, two years later they would use the 2013 criteria, no matter the start year.

• Computerized physician order entry (CPOE) too fast (primarily hospitals)
– Unintended consequence of trying to implement faster than feasible, considering workflow redesign pre-work
• Recommendation – Establish 10% threshold of CPOE orders for hospitals
• Accommodates pilots, implementations in-progress

• Start clinical decision support earlier
– It’s the payoff (faster)
– Need to implement EHR before turning on rules; also need to populate the database (slower)
• Recommendation – Start with one rule; make it important: “Implement one clinical decision rule relevant to high clinical priority”

Patient and Family Engagement
• Provide access to electronic health information (in addition to electronic copy)
• Included in 2011
• Moved up real-time access to patient information in PHR from 2015 to 2013

Efficiency Measures
• Initial starter set
• % of all medications entered into EHR as generic, when generic options exist in the relevant drug class
• % of orders for high-cost imaging services with specific structured indications recorded
• Claims submitted electronically to both public and private payers
• Eligibility checks performed electronically

Specialists
• General approaches discussed
– “500 criteria” model of something for everyone (yet, very few NQF-endorsed measures)
– “Critical few” model of build and prove out the necessary capabilities using exemplar measures
• Use of exemplar measures that would “exercise” the EHR capabilities and meaningful use of the capabilities to measure and improve care
• Require specialists’ participation in electronic registries (approved by CMS) as relevant and available

Improve Care Coordination
• Need better outcomes measures for care coordination
• NQF has a call for measures in care coordination (NPP priority)
• Propose 2013 measure of 10% reduction in 30-day readmission compared to 2012
• Improvement in NQF-endorsed measures of care coordination

• How to meet health information exchange in 2011 when HIE organizations do not currently exist or do not connect all clinical trading partners
• 2015 should include required participation in nationwide HIE
• Require capability and exchange where possible in 2011
• Defer to HIE workgroup for specific requirements and roadmap

Privacy and Security
• Clarify “under investigation”; could any complaint trigger “investigation”?
– Length of investigation could also potentially cause a missed payment (even if found “not guilty”)
• Intent was to disallow participation in HIT incentives if confirmed HIPAA violation goes unresolved
• Revised wording: “…recommend that CMS withhold meaningful use payment for any entity until any confirmed HIPAA privacy or security violation has been resolved”

• How can federal program “enforce” compliance with state privacy laws?
• Shift to Medicaid section: “…recommend that state Medicaid administrators withhold meaningful use payment for any entity until any confirmed state privacy or security violation has been resolved”

Future Work
• Refine 2015 achievable vision
• Refine 2013 and 2015 meaningful use objectives and measures
• Develop process for ongoing development and refinement of meaningful use objectives and measures
• Review barriers to broad adoption of meaningful use and provide recommendations, to the HIT Policy Committee, for removing barriers

Upcoming HIT Policy Committee Meetings:
• August 12, 2009
• September 18, 2009
• October 27, 2009
• December 15, 2009

Like you, I will be anxiously awaiting the final definition.

The meaningful use workgroup of the HIT Policy Committee has released its initial recommendations for a definition of ‘meaningful use’ of electronic health records. Thanks to Terri Ripley for the notes below from the Committee meeting. I’ll post links to the most valuable information asap.

Vision for 2015

• Prevention and management of chronic diseases
o A million heart attacks and strokes prevented
o Heart disease no longer leading cause of death in the US
• Medical Errors
o 50% fewer preventable medication errors
• Health disparities
o The racial/ethnic gad in diabetes control halved
• Care Coordination
o Preventable hospitalizations and re-admissions cut by 50%
• Patients and families
o All patients have access to their own health information
o Patient preferences for end of life care followed more often
• Public Health
o All health departments have real-time situational awareness of outbreaks

Initial Metrics and Validation
• Provider makes use of, and the patient has access to, clinically relevant electronic information, not just existence of technology
• Achievable whenever possible through automatic reporting from electronic health systems to avoid creating additional unnecessary reporting burden for clinicians
• Verification to be performed by CMS
• Many suitable measures already developed and specified for automated reporting
• Consider use of PQRI HER/ registry receiving capabilities
• Attestation will be necessary for some criteria (at least initially)
• Can use escalation thresholds

Criteria for 2013 and Beyond
• Additional metrics required
o Additional efficiency, “inappropriate use” measures
o Patient Safety
o Care Coordination
• Transition from “pay for reporting” to “pay for outcomes” as per the CMS EHR demonstrations

Improve Quality, Safety, Efficiency 2011 Objectives

• Capture data in coded format
o Maintain current problem list
o Maintain active medication list
o Record vital signs (height, weight, blood pressure)
o Incorporate lab/test results into EHR
o Document key patient characteristics (race, ethnicity, gender, insurance type, primary language)
• Document progress not for each encounter (outpatient only)
• Use CPOE for all order types
o Use electronic prescribing for permissible Rx
o Implement drug-drug, drug-allergy, drug-formulary checks
• Manage populations
o Generate list of patients by specific conditions (outpatient only)
o Send patient reminders per patient preference

2011 Measures
• % Labs incorporated into EHR in coded format
• % CPOE orders entered directly by physician
• Report quality measures using HIT-enabled quality measure (HIT-QM)
o % Diabetics with A1c under control
o % Hypertensives with BP under control
o % LDL under control
o % Smokers offered smoking cessation counseling
o % Patient with recorded BMI
o % Colorectal screening for 50+
o % Mammograms for women 50+
o % Current pneumovax status
o % Annual flu vaccination
o % Aspirin prophylaxis for patients at risk for cardiac event
o % Surgical patients receiving VTE prophylaxis
o Avoidance of high risk medications in elderly
• Quality reports stratified by race, ethnicity, gender, insurance type

2011 Objectives – Engage Patients and Families
• Provide patients with electronic copy of or electronic access to clinical information per patient preference
o Includes labs, problem list, medication list, allergies
• Provide access to patient-specific educational resources
• Provide clinical summaries for patients each encounter

2011 Objectives – Improve Care Coordination
• Exchange key clinical information among providers of care
• Perform medication reconciliation at relevant encounters

Improve Care Coordination – 2011 Measure
• Report 30 day readmission rate
• % Encounters where medication reconciliation performed
• Implemented ability to exchange information with external clinical entities
o Problems, labs, medication lists, care summaries
• % Transitions in care where summary care record is shared (in 2011, could use modality)

2011 Objectives – Improve Population and Public Health
• Submit electronic data to immunization registries where required and can be accepted
• Submit electronic reportable lab results to public health agencies
• Submit electronic syndrome surveillance data to public health agencies according to applicable law and practice

2011 Measures– Improve Population and Public Health
• Report up-to-date status of childhood immunizations
• % Reportable lab results submitted electronically

2011 Objectives– Ensure Privacy and Security Protections
• Compliance with HIPAA Rules and state laws
• Compliance with fair data sharing practices set forth in the National Privacy and Security Framework

2011 Measures– Ensure Privacy and Security Protections
• Full compliance with HIPAA
o Entity under investigation for HIPAA violation cannot achieve meaningful use until entity is cleared
• Conduct or update a security risk assessment and implement security updates as necessary

Looking Forward: 2013 – Objectives

• Improve quality, safety, efficiency
o Evidence based order sets
o Clinical documentation recorded (inpatient)
o Clinical decision support at point of care
o Manage chronic conditions using patient lists and decision support
o Report to external disease registry

• Engage patients and families
o Offer secure patient-provider measuring
o Access to patient specific educational resources
o Record patient preferences
o Documentation of family medical history
o Upload data from home monitoring devices
• Coordinate Care
o Medication reconciliation at each transition of care
o Produce electronic summary of care at each transition
o Retrieve and act on electronic prescription fill data

Looking Forward: 2015 – Objectives
• Improve quality, safety, and efficiency
o Achieve minimal levels of performance on quality, safety, and efficiency measures
o Implement clinical decision support for national high priority conditions
o Achieve medical device interoperability
o Provide multimedia support (e.g., x-rays)
• Engage patients and families
o Provide access for all patients to PHR populated in real time with data from HER
o Provide patients with access to self-management tools
o Capture electronic reporting on experience of care
• Coordinate care
o Access comprehensive patient data from all available sources
• Improve population and public health
o Use epidemiologic data derived from EHRs
o Automate real-time surveillance
o Provide clinical dashboards
o Generate dynamic and ad hoc quality reports
• Ensure privacy and security protection
o Provide patients with accounting of treatment, payment, and health care operations disclosures
o Protect sensitive health information

Click this link to see a detailed matrix:

http://divurgent.com/meaningfuluse.html

Health Data Management has reported that a workgroup of the HIT Policy Committee on June 16 will unveil its recommendations on the definition of “meaningful use” of electronic health records, confirms John Glaser, senior special advisor to the Office of the National Coordinator for Health Information Technology.

“This definition, if approved by the committee, will be forwarded to ONC for consideration,” Glaser said in an e-mail to Health Data Management. The full policy committee also meets on the 16th.

Hospitals and physicians must meaningfully use EHRs to qualify for Medicare and Medicaid incentive payments under the American Recovery and Reinvestment Act. The law requires the Department of Health and Human Services to publish a final rule on the initial definition or definitions of meaningful use by the end of 2009. The definitions likely will expand in subsequent years.

Glaser, vice president and CIO at Partners HealthCare System in Boston, assumed his ONC position in early May to assist National Coordinator David Blumenthal, M.D., for six months.