What Did I Work on in Washington? John Glaser April 16, 2010

Electronic Health Records as a Foundation TIME Transformational Change in Health Care Delivery & Population Health Technology Adoption ?

% 50% Size of Practice > 50 physicians Percentage physicians DesRoches CM et al., N Engl J Med 2008;359: % 13% Level of EHR Function Fully Functional Basic System Percentage EHR Adoption in Physician Office Practices

American Recovery and Reinvestment Act (ARRA) Title XIII $2B to the Office of the National Coordinator for Health IT to develop the foundation necessary for broad adoption of EHRs Title IV $23B in Medicare and Medicaid financial incentives to providers who are Meaningful Users of certified, interoperable EHRs (first payment year FY 2011)

The Core Idea Adoption Meaningful Use Outcomes

Examples of Meaningful Use Maintain an up-to-date problem list of current and active diagnoses At least 80% of patients seen or admitted have at least one entry Record smoking status for patients 13 and older At least 80% of patients seen or admitted have “smoking status” recorded Send reminders to patients per patient preference for preventive/follow-up care Reminders sent to 50% of all patients seen that are over 50 years old Provide patients with an electronic copy of their health information At least 80% of patients who request an electronic copy are provided it within 48 hours Provide summary of care record for each transition of care or referral Summary provided for at least 80% of all transitions of care or referrals Capability to provide electronic syndromic surveillance data to public health agencies Perform at least one test of capacity to provide such data

Providers Must Submit Quality Measures Physicians - Core quality measures - Smoking status - Blood pressure - Drugs to be avoided by the elderly - Set of 3-5 specialty-specific measures Hospitals - Thirty-five measures (currently submitting nine for PQRI)

EHRs Must Support Standards Problem List (ICD-9-CM or SNOMED) Patient summary (HL7 CDA R2 CCD) Lab orders and results (LOINC) Prescriptions (NCPDP SCRIPT 10.6) Units of measure (UCUM)Quality reporting (CMS PQRI 2008 Registry XML) Medication List (RxNorm)Submission to public health agencies (HL )

FY 11 Privacy and Security Standards Must be Implemented

To Receive Payments and Avoid Penalties Providers Must Implement applications needed to support meaningful use Certify their electronic health record Support required data, transaction and quality measure reporting standards Meet privacy and security standards Achieve meaningful use goals

Status of Strategy Meaningful Use NPRM has been released and comments are being reviewed Standards and certification criteria IFR has been released and comments are being reviewed Certification process NPRM was released in February and comments are being received

To Support the Achievement of Meaningful Use Several Grant Programs have been Developed Extension centers to provide EHR assistance to: Public or not for profit hospitals or critical access hospitals Federally qualified health centers Entities in rural and other areas that serve uninsured, underinsured, and medically underserved individuals Individual and small group primary care practices State health information exchanges (HIE) to: Develop and implement HIE privacy and security requirements Develop interoperability directories and technical services Coordinate with Medicaid and state public health programs Ensure effective HIE governance and accountability

To Support the Achievement of Meaningful Use Several Grant Programs have been Developed Workforce development grants to: Establish electronic health record curriculum Provide training through community colleges and universities Develop competency-based exams Beacon communities Identify 15 communities that will address a community health concern using interoperable electronic health records

To Support the Achievement of Meaningful Use Several Grant Programs have been Developed Advanced research centers (SHARP) to fund breakthrough research in: Security of health information technology Patient-centered cognitive support Healthcare application and network platform architectures Secondary use of EHR data

Status of Strategy Grants/contracts have been awarded for: Regional extension centers State health information exchanges Workforce development Research centers Beacon community grants will be announced shortly

CMS Estimates of the Number of Providers who will be Meaningful Users in 2011 Scenario Eligible ProfessionalsLow10%13%15% High36%40%44% HospitalsLow30%35%46% High43%58%73% Baselines considerations (2008): 29% of hospitals have some level of medication CPOE (AHA) 4% of eligible professionals have a full function electronic health record

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