1. Electronic Submission of Medical Documentation (esMD) Face to Face Informational Session Charter Discussion – 9:30am – 10:00am October 18, 2011

2. Agenda Brief background on ONC and CMS partnership Charter Review esMD Initiative Scope & Priorities Public Participation 2

3. esMD Initiative: CMS and ONC Partnership History of esMD: esMD has been a CMS Project for 2 years esMD has been working with the ONC NwHIN/Spec Factory for 2 years and has accomplished the development of the esMD Profile (www.connectopensource.org)www.connectopensource.org esMD is joining the Standards & Interoperability Framework: To engage the expertise of the S&I Community To collaborate with Initiatives already underway (Provider Directories, TOC/CDA) To prevent the creation or adoption of standards for esMD that might conflict with other National Standards To apply the S&I Process and artifact templates to the esMD initiative To get ideas about how to solve some technical problems (i.e. Digital Certificate, Signatures of the author at the document level) 3

4. esMD Initiative: CMS and ONC Partnership, cont. As an administrative process managed by CMS, esMD is owned by CMS: Initiative Sponsor – CMS’ Melanie Combs-Dyer CMS esMD is the Key Stakeholder for the esMD Requirements, but wants to incorporate community input to promote national standards esMD Initiative will be driven by CMS, with support from the S&I Framework Utilize reusable S&I Templates Engage S&I Community participation to gather expertise Ensure consistency and prevent conflicts with other S&I Initiatives esMD requirements will be applicable to other stakeholders outside CMS Potential relevance to claims submission processes and auditing processes applied elsewhere S&I Framework provides support in the selection and adoption of national standards for use in these processes 4

5. esMD DRAFT Charter 5 Challenge Healthcare payers request and receive medical documents from providers in order to perform administrative functions such as identify improper payments. Currently, Medicare Review Contractors request approximately 2 million medical documents per year by sending a paper request letter to the healthcare providers. These providers usually have only 2 options for submitting the requested records: 1) mail paper or 2) send a fax. Scope Statement The Electronic Submission of Medical Documentation (esMD) pilot intends to give providers a new mechanism for submitting medical documentation to Medicare Review Contractors. The S&I Framework esMD Initiative will focus on Interoperability and Nationwide Standards needed to support esMD requirements. Target Outcomes Identify gaps in CDA Structured Document to support Progress Notes and Orders, and other documents as required for Medicare Review and similar activities Leverage work of Provider Directories, Certificate Interoperability, Transitions of Care, and Data Segmentation Initiatives as they apply to esMD Define technical issues and relevant standards associated with Author Level Digital Signatures Identify and address business process and infrastructure issues associated with Author Level Digital Signatures Identify and forward policy issues, if any, to appropriate policy bodies Develop a list of recommended Standards (potentially including new work by SDOs) and Operating Rules, if appropriate, to be incorporated in a reference Implementation for esMD Dependencies CMS & esMD community members to participate in S&I Initiatives that are relevant to the outcomes of esMD NwHIN support for secure transport and other infrastructure Timeline12 months (notional) Standards ASC X12n Administrative Transactions, HL7 CDA, security and digital certificate standards HL7 Records Management-Evidentiary Support (RM-ES) EHR system profile and guidelines Other Standards as appropriate Stakeholders Providers, Provider Organizations EHR Vendors and Vendor Associations (e.g. AHIMA, HIMSS) State HIEs, HIE Vendors HIT Vendors, HIHs, Claims Clearinghouse, HIOs, ROI Vendors Medicare, Medicaid, and Commercial Payers SDOs CAQH CORE

6. esMD Priorities 6 esMD Priority I Submission of Structured Medical Documents Author level Digital Signatures esMD Priority II Request for Medical Records Provider Registration (Trading Partner Agreements) Additional Administrative Transactions Eligibility Verification Claim Status Inquiries Prior Authorization Appeals Claim Submissions Review Results Letters Demand Letters Core Outcomes Identify gaps in CDA Structured Document to support Progress Notes and Orders, and other documents as required for Medicare Review and similar activities Leverage work of Provider Directories, Certificate Discovery, Transitions of Care, and Data Segmentation Initiatives as they apply to esMD Define technical issues and relevant standards associated with Author Level Digital Signatures Identify and address business process and infrastructure issues associated with Author Level Digital Signatures Identify and forward policy issues, if any, to appropriate policy bodies Develop a list of recommended Standards, potentially including new work by SDOs, to be incorporated in a reference Implementation Guide for esMD

7. Public Participation As an S&I Initiative, esMD is requesting public participation and input to identify and assess existing standards and define requirements Targeted Participants: HIHs HIT/EHR Vendors and Vendor Associations State HIEs, HIE Vendors Claims Clearinghouse, HIOs, ROI Vendors Medicare, Medicaid, and Commercial Payers Providers, Provider Organizations SDOs CAQH CORE Others with Expertise/Interest in Digital Signatures, Provider Directories, or Claims Attachments 7

8. Public Participation, cont. Because of CMS’ process and procedures affect so many providers an other payers, CMS want to obtain input from the outside world on the following topics: Requirements, Use Case, and selection of Standards for Digital Signature of the author of a document in a medical record Requirements, Use Case, and selection of Standards for Structured Content Requirements, Use Case, and selection of Standards for use of Provider Directories in esMD process Implementation Guides developed for esMD 8