1. Quality Measures Workgroup Recommendations QUALITY MEASURE WORKGROUP RECOMMENDATIONS Mar 2, 2011

2. Stage 1 Quality Measure Objectives EPs must report on 3 required core CQMs, and if the denominator of 1 or more of the required core measures is 0, then EPs are required to report results for up to 3 alternate core measures. EPs must also select 3 additional CQMs from a set of 38. It is acceptable to have a '0' denominator provided the EP does not have an applicable population. In sum, EPs must report on 6 total measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures from the menu set.

3. Stage 1 CQMs Objective Core Measures Alternate Core Menu Set Stage 1 Clinical Quality Measures

4. Stage 1 Quality Measures (Core/Alternate) Core Measures – Adult Weight Screening and Follow-up – Hypertension: Blood Pressure Management – Preventive Care and Screening Measure Pair: a.Tobacco Use Assessment b. Tobacco Cessation Intervention Alternate Core (if core measures do not apply) – Childhood Immunization Status – Preventive Care and Screening: Influenza Immunization for Patients  50 – Weight Assessment and Counseling for Children Adolescents Menu Set – 3 measures from a set of 38 specialty-related clinical quality measures

5. Stage 2 & 3 Measure Selection Stage 2 & Stage 3 Measures ONC de novo measures (balanced with Methodology, Evidence, Standards) Harmonization Process –HHS input (CMS, HRSA, CDC etc.) HITPC/QMWG suggested measures Additional 69 retooled measures (Total of 113 retooled measures – including 44 Stage 1 measures)

6. QMWG − Domain Framework for Stage 2 Clinical Appropriateness/Efficiency Population & Public Health Patient & Family Engagement Care Coordination Patient Safety

7. Projected Timeline (draft) 3/11, HITPC endorses QMWG recommendations 3/11 − 6/11, ONC to initiate measure development activities 6/11 − 12/11, Stage 2 measure concepts/specifications to be defined and put out for public comment 1/12 − 4/12, Development of de novo Stage 2 measures based on QMWG guidance to be completed

8. Policy Issues to Consider Framework for Stage 2 CQMs – Balance core measures with “specialty” measures – Inclusion of Stage 1 and “retooled” measure set Exchange and interoperability infrastructure to facilitate implementation of innovative measures (e.g.- standardized Transition of Care document, ability to incorporate longitudinal data) Available infrastructure for patient reported outcomes Available standards and vocabulary sets to adopt measures (Standards Committee)

9. Next Steps Recommendations will inform ONC on measure selection and harmonization process for Stage 2 and Stage 3 Meaningful Use Recommendations will inform measure development work in potential procurement process Recommendations will inform HIT Standards Committee Quality Workgroup on standards and necessary vocabulary sets for development and implementation of e-measures Inform other FACA groups regarding necessary exchange infrastructure to facilitate implementation of novel measures