Larry Wolf, chair Marc Probst, co-chair Certification / Adoption Workgroup March 6, 2014

Agenda Review of Agenda Review Final LTPAC/BH EHR Certification Recommendations Description of the Standard Occupational Classification (SOC): Revision Process – Inclusion of Health IT in the SOC Evaluation of ONC Funded Workforce Programs: Key Findings – Norma Morganti Tools, Training and Transformation: Health IT Training needs and competencies for practice transformation – Norma Morganti Next Steps Public Comment 1

Updated C/A WG Schedule Date Schedule 3/6/2014Finalize LTPAC/BH recommendations; Review of standard occupational classification codes recommendations 3/11/2014Recommendations to HITPC 3/19/2014Discuss feedback from March HITPC meeting, update recommendations as needed 3/26/2014Update to the HITSC 4/2/2014Update recommendations as needed 4/8/2014Revised recommendations to HITPC (if needed) 2

Organizing Principles for Recommendations 3

Recommendation for Some LTPAC/BH Providers § (a)(14) - Support the ability to record whether an advance directive exists for the patient In addition, if approved by HHS for MU, support the ability to store an advance directive document in the record or provide a link to the advance directive in a repository or other location. [MUWG- identified MU 3 criteria]. Future work: Standards for content of the advance directive Advance Care Planning Advance Care Planning Public Health Transmission to Immunization Registries (LTPAC Only) Public Health Transmission to Immunization Registries (LTPAC Only) Support the ability to electronically generate immunization information for electronic transmission using ONC specified standards. § (f)(2) Clarification needed: Some LTPAC settings provide immunizations to the individuals in their care. Reporting to public health is valuable for understanding immunization coverage for this vulnerable population. However, the workgroup is concerned that the existing certification criteria was developed with a focus on children, not adults. Data Portability § (b)(7) - Support the ability to electronically create a set of export summaries on all patients, formatted in accordance with the CCDA. More info was requested on previous WG call. See below. The data portability criterion is meant (as a first step) to support data migration if a provider were changing systems. Question: Does the MU2 final rule address receiving the CCDA? Answer: Yes, this is addressed in (b)(1). “Receive, display, incorporate" is one of two TOC certification criteria. Future work: Standards for content of the advance directive

Additional WG Recommendations Some WG members commented that ‘past history’ is not part of the MU certification criteria but noted that this information can be important, particularly in LTPAC/BH. Clarification needed: Is this criteria being recommended for inclusion in certification ? By ALL providers? Recommend ONC track national trends in LTPAC and BH health IT adoption. Such efforts should include tracking use by functionality and criteria. Recommend national survey data on LTPAC/BH EHR adoption and use utilize definitions that are consistent with those in the MU program. 5

Feedback from CMS Survey of State Surveyors Survey conducted in Jan-Feb 2014 to identify barriers and challenges surveyors encounter when surveying facilities that have implemented full or partial EHR systems. (Approximately 988 responses received ) Themes Access Need for full access to the EHR (often partial access provided) Need immediate access (not hours or days later) Need access to the MDS, preferably the entire document rather than separated into section Need access to closed charts, including care plans Navigating the EHR system Want a list of the documents located within specific tabs Want systems that have tabs like paper charts; ability to move between sections without going to main menu Found viewing documents in “print mode” helpful because of page consolidation Found features such as history (i.e. changes in wounds over time), search, and sort of notes useful Noted systems should be user-friendly for entering data as well as retrieving, reviewing information Documentation Need for printouts (e.g. nurses notes, physician notes) with patient identification Need ability to tell who authored or modified documentation, along with the exact time of modification Reports of Value Weight reports, vital signs, medications administered over time, use of certain types of medications like antipsychotics, and medications that are given late. 6

LTPAC Setting Specific Recommendations NEW Support the ability to provide surveyors with immediate electronic access to the complete EHR, consistent with federal requirements (e.g., access to current and prior patient assessments and care plans, point of care documentation, nurses and physicians notes, accident and incident reports, closed records for persons discharged or deceased, etc.) NEW Support the capability of surveyors to obtain a copy of portions of the record, with patient identification, as needed to perform the surveyor’s role. FUTURE WORK Support surveyor navigation of the EHR. (e.g. Implementation guide describing the functions in the EHR that surveyors need). More work is needed in this area. Support the QIS process. More work is needed in this area. Support the creation of report templates needed by surveyors (e.g., weights, vitals, medications administered over certain periods, track use of certain medications) 7 Survey and Certification LTPAC Setting Specific Recommendations

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