1. August 12, 20151 Meaningful Use *** UDOH Informatics Brown Bag Robert T Rolfs, MD, MPH

2. August 12, 20152 Meaningful Use Background Health Information Technology for Economic and Clinical Health Act (HITECH Act) Use Health IT to –Improve health of Americans –Improve performance of health care system Components –Funding for health IT infrastructure including HIE –Incentives (Medicare and Medicaid) for meaningful use –Strengthen privacy and security of health information –Designated Office of National Coordinator (ONC) in HHS as lead

3. D. Blumenthal, ONC, 12/09

4. Medicaid/Medicare Meaningful Use Incentive Program Goals –improving quality, safety, efficiency, and reducing health disparities; –engage patients and families in their health care; –improve care coordination; –improve population and public health; and –ensure adequate privacy and security protections Mechanism –Incentives to eligible physicians and hospitals that Use certified electronic health record (EHR) Meet criteria for meaningful use August 12, 20154

5. Electronic Health Record Qualified & Certified Qualified EHR –patient demographic and clinical health information, such as medical history and problem lists; and has the capacity: to provide clinical decision support; to support physician order entry; to capture and query information relevant to health care quality; and exchange electronic health information with, and integrate such information from other sources Certified EHR –A Complete EHR or a combination of EHR Modules, each of which meets the requirements included in the definition of a Qualified EHR; and has been tested and certified … certification criteria established by secretary ONC issued Interim Final Rule that established certification criteria Certification criteria –Coordinated with meaningful use requirements –Designed to assure that a certified EHR can meet meaningful use requirements August 12, 20155

6. Certification of EHR’s Organization of the IFR 6 Initial set of standards are organized into four categories as recommended by HIT Policy and Standards Committees: Vocabulary Standards (i.e., standard nomenclature used to describe clinical problems and procedures, medications, and allergies); Content Exchange Standards (i.e., standards used to share clinical information such as clinical summaries, prescriptions, and structured electronic documents); Transport Standards (i.e., standards used to establish the communication protocol between systems); and Privacy and Security Standards (e.g., authentication, access control, transmission security – encryption) which relate to and span across all of the other types of standards.

7. EHR Certification Criteria Public Health examples Lab order and results - c apable of receiving LOINC codes Lab data reported to PH (hospitals only) –capable of packaging as HL7 2.5.1 –Send LOINC codes when LOINC codes received from laboratory Capable of submitting reports to immunization registries –Packaged as HL7 2.3.1 or HL7 2.5.1 –Using the HL7 standard code set CVX - Vaccines Administered as the vocabulary standard. Clinical decision support –Automatically generate in real-time alerts or care suggestions based on clinical decision support rules Record, retrieve and transmit syndrome-based surveillance information to PH agencies –HL7 2.3.1 or HL7 2.5.1 –Codes according to PH agency requirements August 12, 20157

8. Meaningful Use Proposed CMS Requirements Stage 1 (2011) –electronically capturing health information in a coded format –using that information to track key clinical conditions and communicating that information for care coordination –implementing clinical decision support tools to facilitate disease and medication management –reporting clinical quality measures and public health information Stage 2 (2013) –encourage the use of health IT for CQI at the point of care –encourage exchange of information in the most structured format possible –orders entered using computerized provider order entry –electronic transmission of diagnostic test results and other such data needed to diagnose and treat disease Stage 3 (2015) –improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health. August 12, 2015 8

9. Pathway to ARRA Incentives Adopt certified EHR system Achieve Meaningful Use Objectives Apply for payments CCHIT-certified or new certifying bodies yet to be named Stage 1: 25 measures; 17 require only attestation In either Medicaid or Medicare program Medicaid incentives Eligible professionals – volume thresholds (medicaid percentage) Eligible hospitals – acute care and children’s hospitals States may request CMS approval to implement meaningful use measures above the minimum

12. Implications for public health Assess and ensure readiness in 3 areas: –For 2011- IIS, ELS and syndromic surveillance –Ready to test capability of systems to report –Receive actual submissions of immunization data where required and accepted –Increase capacity for data management and analysis Increase understanding by program staff of potential of these programs to achieve public health goals –Improved care (alerts and reminders) –Measurement of care quality (ABCS) –Surveillance (ELR, EHR reporting) Cross program coordination and resource sharing Should Utah Medicaid program propose changes to the requirements for providers under the Medicaid incentive program?

13. More information http://healthit.hhs.gov http://www.himss.org/EconomicStimulus/ August 12, 201513

14. Change

15. Ambition