Overview of Today s Presentation. Minnesota Model for Adopting Interoperable Electronic Health Records

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1 Update on Meaningful Use Review of Proposed Definition Presented to National HIT Policy Committee on June 16, 2009 Overview of Today s Presentation Meaningful Use vs. Effective Use In the Context of the Minnesota Continuum Review Meaningful Use Criteria in Law & Process for Further Definition Overview of Proposed Definition from HIT Policy Committee June 24, 2009 Liz Carpenter Deputy Director, Center for Health Informatics & e-health Minnesota Department of Health Requests for Feedback & Questions for Consideration Process for Submitting Comments Minnesota Model for Adopting Interoperable Electronic Health Records Breaks achievement of the 2015 Mandate into manageable steps Applies across organizational settings Continuum of EHR Adoption Achievement of 2015 Mandate Adopt Utilize Exchange Assess Plan Select Implement Effective Use Readiness Interoperate Meaningful Use vs. Effective Use In the Context of the Minnesota Continuum for EHR Adoption Effective Use: Is one step along the Minnesota continuum for EHR adoption. The focus of effective use is on transforming health care within an organization by maximizing the use of all components of an EHR system to improve quality and care delivery. Continuum of EHR Adoption Achievement of 2015 Mandate Adopt Utilize Exchange Assess Plan Select Implement Effective Use Readiness Interoperate Meaningful Use: Involves all major categories on the Minnesota continuum of EHR adoption - including adoption, utilization and exchange. Meaningful use focuses on transforming health care by setting benchmarks and time tables to drive uniform implementation of EHRs within an organization and health information exchange across organizations to improve population health and meet health reform goals. MN e-health Pre-Summit

2 Meaningful Use vs. Effective Use In the Context of the Minnesota Continuum for EHR Adoption Continuum of EHR Adoption Effective Use Achievement of 2015 Mandate Adopt Utilize Exchange Assess Plan Select Implement Effective Use Readiness Interoperate Elements of Meaningful Use Included in the HITECH Act The law says meaningful use will include: Having a qualified / certified EHR Must Include e-prescribing Meaningful Use Certified System erx CPOE Labs Quality Reporting Patient Lists & Reminders Standards Use of Coded Formats Lab Reports Med Lists Care Summaries Problems Immunizations Public Health Reports Incentives Demonstrating information exchange. Reporting of quality measures. Effective Use American Recovery & Reinvestment Act Enacted February 2009 Process & Timeline for Further Definition of Meaningful Use Vision for Meaningful Use National HIT Policy Committee Meaningful Use Workgroup Recommendations on definition for 2011 and 2013 Within one (1) month of the initial meeting (6/16) Comments due 6/26 Refine within two (2) months. (7/16) Recommendations on definition for 2015 Within three (3) month of the initial meeting (~8/16) Refine within six (6) months (~11/16) Recommendations on process for defining and revising meaningful use and national priorities on a bi-annual basis. (~12/16) The ultimate vision is to enable significant and measurable improvements in population health through a transformed health care delivery system Recommendations on policies and standards necessary to support meaningful use and the eight (8) specific national priorities of Section 3002(b)(2)(B) of ARRA. Recommendations for removing barriers to meaningful use. Interim Final Rule to be Published by HHS (~12/31) MN e-health Pre-Summit

3 Bending the Curve Towards Transformed Health Achieving Meaningful Use of Health Data These goals can be achieved only through the effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth Phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement. Framework for Proposed Definition of Meaningful Use Proposed Definition Framed by Key Goals: - Improve Quality, Safety & Efficiency - Engage Patients & Families - Improve Care Coordination - Improve Population & Public Health, Reduce Disparities - Ensure Privacy & Security Protections Connecting for Health, Markle Foundation Achieving the Health IT Objectives of the American Recovery and Reinvestment Act April 2009 Specific Feedback Requested On Proposed Definition of Meaningful Use Item 1: We seek specific stakeholder feed back on whether the recommended timeline of requirements is overly aggressive based on thee current state of technology and the demands of new provider workflows, or not challenging enough to result in significant transformation, in light of the declining level of Medicare incentives in future years. -- Preamble to Proposed Meaningful Use Definition Specific Feedback Requested On Proposed Definition of Meaningful Use Item 2: The Workgroup is seeking feedback on how to best frame [EHR-generated] measures including measurement of key public health conditions, measuring health care efficiency, and measuring the avoidance of certain adverse events. These comments will be used to help revise the recommended measurement strategy to include more extensive and refined outcome measures for meaningful use in 2013 and beyond. -- Preamble to Proposed Meaningful Use Definition MN e-health Pre-Summit

4 Improve Quality, Safety, Efficiency DRAFT MEANINGFUL USE CRITERIA (FOCUSED ON 2011) Capture data in coded format Maintain current problem list Maintain active medication list Maintain active medication allergy list Record vital signs (height, weight, blood pressure) Incorporate lab/test results into EHR Document key patient characteristics (race, ethnicity, gender, insurance type, primary language) Document progress note for each encounter (outpatient only) Use CPOE for all order types Use electronic prescribing for permissible Rx Implement drug-drug, drug-allergy, drug-formulary checks Manage populations Generate list of patients by specific conditions (outpatient only) Send patient reminders per patient preference Improve Quality, Safety, Efficiency % Labs incorporated into EHR in coded format % CPOE orders entered directly by physician Report quality measures using HIT-enabled quality measures (HIT-QM) % Diabetics with A1c under control % Hypertensives with BP under control % LDL under control % Smokers offered smoking cessation counseling % Patients with recorded BMI % Colorectal screening for 50+ % Mammograms for women 50+ % Current pneumovax status % Annual flu vaccination % Aspirin prophylaxis for patients at risk for cardiac event % Surgical patients receiving VTE prophylaxis Avoidance of high risk medications in elderly Quality reports stratified by race, ethnicity, gender, insurance type Engage Patients and Families Provide patients with electronic copy of - or electronic access to - clinical information per patient preference Includes labs, problem list, medication list, allergies Provide access to patient-specific educational resources Provide clinical summaries for patients for each encounter MN e-health Pre-Summit

5 Engage Patients and Families Improve Care Coordination % Patients with electronic access to personal health information % Patients with access to patient-specific educational resources % Encounters where clinical summary provided Exchange key clinical information among providers of care Perform medication reconciliation at relevant encounters Improve Care Coordination Report 30 day readmission rate % Encounters where medication reconciliation performed Implemented ability to exchange health information with external clinical entities Problems, labs, medication lists, care summaries % Transitions in care where summary care record is shared (in 2011, could use any modality) 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 MN e-health Pre-Summit

6 Improve Population and Public Health Ensure Privacy and Security Protections Report up-to-date status of childhood immunizations % Reportable lab results submitted electronically Compliance with HIPAA Rules and state laws Compliance with fair data sharing practices set forth in the National Privacy and Security Framework Ensure Privacy and Security Protections Full compliance with HIPAA 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 Clinical documentation recorded (inpatient) Clinical decision support at point of care Evidence based order sets Manage chronic conditions using patient lists and decision support Report to external disease registry Engage patients and families Offer secure patient-provider messaging Access to patient-specific educational resources Record patient preferences Documentation of family medical history Upload data from home monitoring devices MN e-health Pre-Summit

7 Looking Forward: 2013 (continued) Objectives Coordinate care Medication reconciliation at each transition of care Produce electronic summary of care at each transition Retrieve and act on electronic prescription fill data Improve population and public health Receive immunization histories from registries Receive public health alerts Electronic syndromic surveillance data sent to public health agencies Ensure privacy and security protection Use summary or de-identified data when reporting data for population health purposes Looking Forward: 2015 Objectives Improve quality, safety, and efficiency Achieve minimal levels of performance on quality, safety, and efficiency measures Implement clinical decision support for national high priority conditions Achieve medical device interoperability Provide multimedia support (e.g., x-rays) Engage patients and families Provide access for all patients to PHR populated in real time with data from EHR Provide patients with access to self-management tools Capture electronic reporting on experience of care Coordinate care Access comprehensive patient data from all available sources Looking Forward: 2015 (continued) Objectives Improve population and public health Use epidemiologic data derived from EHRs Automate real-time surveillance Provide clinical dashboards Generate dynamic and ad hoc quality reports Ensure privacy and security protection Provide patients with accounting of treatment, payment, and health care operations disclosures Protect sensitive health information Opportunities to Provide Feedback on Proposed Definition Comments to Office of the National Coordinator Deadline: 5 p.m. Eastern, Friday, June 26 Written Comments to: Office of the National Coordinator for Health Information Technology 200 Independence Ave. SW, Suite 729D Washington, DC Attention: HIT Policy Committee Meaningful Use Comments Minnesota e-health Initiative Coordinated Response Feedback to Deadline: 7 p.m. Central, Thursday, June 25 MN e-health Pre-Summit

8 For More Information Liz Carpenter MDH Center for Health Informatics Marty LaVenture MDH Center for Health Informatics MN e-health Pre-Summit

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