Sanjeev Tandon, MD, MS Public Health and Electronic Health Records Meaningful Use Office of Surveillance, Epidemiology, and Laboratory Services Public Health Informatics and Technology Program Office

Overview EHR “Meaningful Use ” Final Rule Stages of Meaningful Use Role of CDC in Meaningful Use Impact of Meaningful Use on Public Health

Terminology : EHR Meaningful Use CMS- Centers for Medicare and Medicaid Services ONC- Office of National Coordinator for Health Information Technology EP- Eligible Professional EH- Eligible Hospital CAH- Critical Access Hospital

Terminology (Contd.) JPHIT- Joint Public Health Informatics Taskforce PHIN – Public Health Information Network OSELS- Office of Surveillance, Epidemiology and Laboratory Services MU- Meaningful Use NACCHO- National Association of County and City Health Officials

Terminology (Contd.) CSTE- Council of State & Territorial Epidemiologists NwHIN- Nationwide Health Information Network CQM-clinical quality measures

What is EHR “Meaningful Use”? Meaningful use is defined by 3 requirements 1.Use of certified EHR technology in a meaningful manner 2.Ensuring that this technology can electronically exchange health information to improve quality of care 3.Ensuring that the providers of this technology submit information on quality of care and other selected measures to Secretary HHS Source : Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule

The Regulations EHR Meaningful Use Medicare and Medicaid Programs; EHR Incentive Program; Final Rule: issued by CMS Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR; Final Rules: issued by ONC

Goals EHR Meaningful Use “Meaningful use” rests on 5 pillars of health outcomes policy priority : 1.Improve quality, safety, efficiency, and reduce health disparities 2.Engage patients and families in their personal health development 3.Improve care coordination 4.Improve population and public health 5.Ensure adequate privacy and security protection for personal health information *Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008.

The Big Picture : EHR Meaningful Use Source : Taha Kass-Hout, Centers for Diseases Control and Prevention (CDC) Meaningful Use

Milestone Timelines : Stage 1Meaningful Use

The Balancing Act : EHR Meaningful Use Source : Centers for Medicare & Medicaid Services (CMS) Availability of Technical Assistance and Exchange Capabilities

3 Stages : EHR Meaningful Use Source : Centers for Medicare & Medicaid Services (CMS) Stage 1 Data capture and sharing Stage 2 Advanced clinical processes Stage 3 Improved outcomes

Achieving : EHR Meaningful Use Source : Centers for Medicare & Medicaid Services (CMS) HIT-Enabled Health Reform Meaningful Use Criteria HITECH Policies 2011 Meaningful Use Criteria (Capture/share data) 2013 Meaningful Use Criteria (Advanced care processes with decision support) 2015 Meaningful Use Criteria (Improved outcomes)

Who will get the incentive?

The Pathway to Incentives: EHR Meaningful Use Source: Bill Brand, Public Health Informatics Institute (PHII)

Meaningful Use: What is in the final rule? The meaningful use requirements or objectives are now divided into: Core set -which has 15 mandatory objectives plus measures, and Menu Set – there is a choice to pick 5 of 10 objectives, but it is mandatory to pick at least one population/public health objective. Source : CMS EHR Incentive Program- Final Rule Source: Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule

Meaningful Use: What is in the final rule? Clinical Quality Measures (CQM)- Core, Alternate Core, and Additional CQMs – EPs - Must report 3 core + 3 additional CQM – Eligible Hospitals [EH]- 15 CQM Source : CMS EHR Incentive Program- Final Rule Source: Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule

Public Health Objectives Electronic Health Records Meaningful Use Stage 1of meaningful use has 3 public health objectives which require capability to submit electronic data to: – Immunization Registries or Immunization Information Systems (IIS) – Syndromic Surveillance – Reportable Lab results

Reportable Lab Results: EHR Meaningful Use

Role of CDC in Meaningful Use Accomplishments – Collaborated with CMS and ONC to frame Stage 1 meaningful use requirements – Public health case presented with several national taskforces, workgroups, and forums – Created an EHR-Meaningful Use Listserv to communicate with partners and stakeholders – Convened a cross-agency EHR-Meaningful Use Advisory Group – Collaborated with CSTE on the Joint ELR Taskforce – Implemented an Incident Command Structure (ICS) to focus on ELR issues – Continued collaboration with federal agencies and public health partners for Stage 2-3 requirements

CDC EHR Meaningful Use Advisory Group

Meaningful Use Advisory Group Key Objectives Engage in EHR policy decisions Collaborate with federal and national partners Educate partners and stakeholders on the public health impact of EHR Meaningful Use Guide communication and coordination across the agency

CSTE/CDC Joint ELR Task Force

Joint ELR Task Force Key Objectives Develop a strategic plan for coordination and communication among states, CDC and ONC Facilitate ELR to public health agencies Develop efficient and compliant standards for vendors interfacing with public health Articulate the needs and resources to implement local/state ELR

CDC Meaningful Use Incident Command Structure (ICS)-ELR Focused

Incident Command Structure (ICS) Key Goals 30 states/territories/metros testing for at least one public health menu item 25 testing/20 production for ELR Provision national table of jurisdictional reportable conditions/vocabularies Assess transport and receipt models Aid with integrating high volume ELR flows Plan to harmonize PHIN and NwHIN standards

Major Public Health Challenges Some jurisdictions lack electronic laboratory reporting, syndromic surveillance, immunization registries New standards (e.g., HL7 v ELR) – Vocabularies, message structures, transport mechanisms not always defined Need to migrate old public health systems to new standards Need to migrate old data providers – Old custom approaches Need to on-board new data providers Manage impacts on workload and workflow Few resources provided, declining budgets, workforce

Impact of Meaningful Use on Public Health 1. Meaningful use activities will improve the collaboration between clinical and public health care at local and state levels through: – Implementation of electronic reporting to PH (immunization, laboratory and syndromic surveillance) – Improvement of a patient-centric preventive care (preventive care-oriented quality care measures)

Impact of Meaningful Use on Public Health 2. Meaningful Use rules bring attention to the readiness of State Public Health agencies for a “bi-directional communication” with clinical care providers …..as we move forward. 3. Meaningful use will bring into play, the development of standardized data elements and messaging implementation guides (data exchange) for MU Public Health measures.

Role of CDC in Meaningful Use Steps Ahead Inform selection of Stage 2 and 3 objectives Messaging guide for syndromic surveillance Assist with on-boarding – Stack of code/services to assist with Vocabulary translation Message testing “Direct Project” transport receipt (as opposed to PHIN- MS) – Implementation guide models Aligning cooperative agreements with meaningful use objective achievement

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thanks! If you have any questions, please contact the CDC PHIN helpdesk at: Office of Surveillance, Epidemiology, and Laboratory Services Public Health Informatics and Technology Program Office