1. Overview of CMS HIT Initiatives Kelly Cronin Senior Advisor to the Administrator Centers for Medicare and Medicaid Services September 2005

2. A Variation Problem Dartmouth Atlas of Healthcare

3. Decade of HIT: Strategic Framework for Action Goal 1: Inform Clinical Practice Goal 1: Inform Clinical Practice Incentivize Electronic Health Record (EHR) adoptionIncentivize Electronic Health Record (EHR) adoption Reduce risk of EHR investmentReduce risk of EHR investment Promote EHR diffusion in rural and underserved areasPromote EHR diffusion in rural and underserved areas Goal 2: Interconnect Clinicians Goal 2: Interconnect Clinicians Foster regional collaborationsFoster regional collaborations Develop a national health information networkDevelop a national health information network Coordinate federal health information systemsCoordinate federal health information systems Goal 3: Personalize Care Goal 3: Personalize Care Encourage use of Personal Health Records (PHR)Encourage use of Personal Health Records (PHR) Enhance informed consumer choiceEnhance informed consumer choice Promote use of tele-health systemsPromote use of tele-health systems Goal 4: Improve Population Health Goal 4: Improve Population Health Unify public health surveillance architecturesUnify public health surveillance architectures Streamline quality and health status monitoringStreamline quality and health status monitoring Accelerate research and dissemination of evidence into practiceAccelerate research and dissemination of evidence into practice

4. CMS Role in Driving Adoption of HIT: e-prescribing Accelerate adoption of e-prescribing through MMA implementation Accelerate adoption of e-prescribing through MMA implementation Require use of foundation standards to enable uniform exchange of prescriptions in covered under Part D in 2006 Require use of foundation standards to enable uniform exchange of prescriptions in covered under Part D in 2006 Increase connectivity between physicians and pharmacies Increase connectivity between physicians and pharmacies Pilot additional standards in 2006 Pilot additional standards in 2006 Result: enable prescribing clinicians to make evidence based prescribing decisionsResult: enable prescribing clinicians to make evidence based prescribing decisions Reduce medication errors and adverse drug events Reduce medication errors and adverse drug events Select medications that maximize health outcomes and minimize out of pocket costs Select medications that maximize health outcomes and minimize out of pocket costs

5. CMS Role in Driving Adoption of HIT: Incentives for EHRs Accelerate adoption of electronic health records Accelerate adoption of electronic health records Need the right combination of incentivesNeed the right combination of incentives Pending changes to Stark and Anti-kickback Pending changes to Stark and Anti-kickback Pay for performance will require interoperable HIT Pay for performance will require interoperable HIT Enable reporting of quality measuresEnable reporting of quality measures Ambulatory Care Quality Alliance adopted primary and specialty care measures for implementation in new programsAmbulatory Care Quality Alliance adopted primary and specialty care measures for implementation in new programs Future certification of EHRs will facilitate the automated reporting of quality measuresFuture certification of EHRs will facilitate the automated reporting of quality measures

6. Near term opportunities to define intersection of P4P and HIT AQA pilots over next 6 months leveraging existing effortsAQA pilots over next 6 months leveraging existing efforts Regional health information exchange programs starting in areas with P4P programs Regional health information exchange programs starting in areas with P4P programs Bridges to ExcellenceBridges to Excellence MMA 649 p4p demonstration program with HIT incentives implemented in 4 statesMMA 649 p4p demonstration program with HIT incentives implemented in 4 states MMA 646 demonstration program to test system redesign and new payment mechanisms enabled by HITMMA 646 demonstration program to test system redesign and new payment mechanisms enabled by HIT

7. Reduce Risk of EHR Implementation Failure Doctors Office Quality –IT (DOQ-IT) Doctors Office Quality –IT (DOQ-IT) QIOs assist primary care physicians in selection of EHRs QIOs assist primary care physicians in selection of EHRs SOW calls for implementation support in primary care practices in each state SOW calls for implementation support in primary care practices in each state Support re-design of care processes and evidence based decision making while reducing implementation failure Support re-design of care processes and evidence based decision making while reducing implementation failure EHR Certification EHR Certification CMS through AHIC will recommend EHR certification criteria and commercially viable process to SecretaryCMS through AHIC will recommend EHR certification criteria and commercially viable process to Secretary

8. CMS Role in PHRs: Beneficiary Portal Accelerate adoption of personal health records Accelerate adoption of personal health records Encourage use of personalized health tools through the Medicare Beneficiary PortalEncourage use of personalized health tools through the Medicare Beneficiary Portal It will serve as an online tool for beneficiaries to view all their Medicare information, such as claims, deductibles, eligibility, enrollment and other personal dataIt will serve as an online tool for beneficiaries to view all their Medicare information, such as claims, deductibles, eligibility, enrollment and other personal data The portal has been pilot-tested in the state of Indiana and will be launched nationwide in 2005/2006The portal has been pilot-tested in the state of Indiana and will be launched nationwide in 2005/2006 RFI published July 18 th and open door forum on July 20thRFI published July 18 th and open door forum on July 20th

9. CMS Role in Accelerating Adoption of PHRs Responses to RFI indicate broad industry consensus that CMS can help by: Responses to RFI indicate broad industry consensus that CMS can help by: Providing the Medicare data in a way that supports industry efforts to standardize data content and exchange;Providing the Medicare data in a way that supports industry efforts to standardize data content and exchange; Promoting PHRs that can be connected into EHRs;Promoting PHRs that can be connected into EHRs; Assuring the privacy and security of information provided to PHR vendors; andAssuring the privacy and security of information provided to PHR vendors; and Educating beneficiaries about the value of having up-to-date data available electronically to support their care.Educating beneficiaries about the value of having up-to-date data available electronically to support their care.

10. Questions? Kelly Cronin Kelly.Cronin@cms.hhs.gov