1. HIT Policy Committee Meaningful Use Workgroup Paul Tang, Palo Alto Medical Foundation, Chair George Hripcsak, Columbia University, Co- Chair December 13, 2010

2. Workgroup Membership Co-Chairs: Paul TangPalo Alto Medical Foundation George Hripcsak Columbia University Members: David BatesBrigham & Women’s Hospital Michael BarrAmerican College of Physicians Christine BechtelNational Partnership/Women & Families Neil CalmanInstitute for Family Family Health Art DavidsonDenver Public Health Marty FattigNemaha County Hospital James FiggeNY State Dept. of Health Joe FrancisVeterans Administration David LanskyPacific Business Group/Health Deven McGrawCenter/Democracy & Technology Judy MurphyAurora Health Care Latanya SweeneyCarnegie Mellon University Karen TrudelCMS Charlene UnderwoodSiemens

3. Agenda Overview of MU WG’s work plan Review HITECH statutory constraints High-level summary of comments Discussion of timing options

4. MU Stage 2 Recommendations Work Plan Hearings on stage 2 in 2010: –Specialists; smaller practices and hospitals –State issues –Health care disparities –Patient and family engagement –Population and public health –Care coordination Dec, 2010 HITPC feedback on initial stage 2 draft criteria Jan, 2011 Request for Comment (due Feb 25, 2011) Mar, 2011 ONC summarizes 422 organizational comments Apr/May: MU WG revises draft recommendations in response to RFC input, other WG recs (e.g., IE, P&S, PCAST, QM) May 11, 2011: Present revised set of stage 2 MU recommendations to HITPC May 13: Hearing on specialists and feedback from field June 8, 2011: Final stage 2 MU recommendations for HITPC approval

5. May 13: Specialists & Feedback from Field Care Coordination Among Specialists, Primary Care, Care Management, Patients EHR Support of Specialists in Patient Care + CDS Population Data, including Registries Experience from the Field

6. HITECH Statutory Constraints Impact on Meaningful Use Stages Timeline Medicare incentives are front-loaded (max for EP: 2011-12; Hospitals: 2011-13) and diminish over time No incentives if not meaningful user by 2014 for Medicare Final payments in 2016 for Medicare, 2021 for Medicaid Once qualifying for MU, failing to meet the relevant MU stage requirement in any year results in missed payments under Medicare. In Medicaid, can receive full payment as long as 6 qualifying years of payment by 2021 Medicare penalties for failing to qualify as meaningful user begins in 2015 for Medicare; no penalties under Medicaid Criteria for qualifying as meaningful user can be raised by HHS beyond 2015  Incentive policy lever is front-loaded; Medicare penalties persist

7. High-Level Summary of Comments -- 1 422 organizations submitted comments Changes to existing objectives generally supported –Some question as to degree (such as increasing threshold and broadening the definition, e.g., CPOE) Strong support for these new objectives: –eRx for discharge prescriptions –Electronic clinical progress notes –Electronic medication administration record –Patient-provider secure messaging –Recording patient preferences for communications Mixed support for these new objectives: –Advanced directives for EPs –View & download longitudinal record –List of care team members –Longitudinal care plan

8. High-Level Summary of Comments -- 2 Concerns about new objectives often related to: –Clarity of definitions/expectations –Timeline for developing and implementing new functionality Request for recording structured family health history data Responses to specific HITPC questions: –Strong support for group reporting option –Support for consideration of alternative (outcomes-oriented) option for demonstrating MU –Importance of incorporation of patient-reported data and strategies for segmentation of different types of it

9. Timing of Stage 2 Some support current timeline (e.g., consumers /purchaser, health plans, disease management organizations) Some propose lengthening timeline (e.g., hospitals, physicians, EHR vendors) Timing issues: –EHR vendor development time (e.g., specification, development, testing, deployment) –HIE governance time (e.g., trust-building, policy development, standards implementation) –Provider implementation and training time For new functionality: –Final Rule/Certification criteria  vendor development  provider implementation  reporting period  MU qualification for incentives For existing functionality (already certified): –Final Rule  provider implement increment  reporting period  MU qualification for incentives

10. Illustrative Timing Options for Stage 2 1.Maintain current timeline and one-year reporting period; or 2.Maintain current timeline and permit 90-day reporting period (gain up to 9 months delay); or 3.Delay transition from stage 1 to stage 2 by one year (providers could get third-year payment for meeting stage 1 expectations); or 4.Phase-in approach that separates existing from new functionalities 1.2013: Stage 2a using existing certified EHR functions with all-core objectives, increased performance thresholds and new quality measures 2.2014: Stage 2b objectives requiring new EHR functionalities take effect 5.Other?

11. Summary General support for stage 2 recommendations Some new requirements need further clarification and attention to some detailed questions Significant concern about time required for development and implementation of new functionality MU WG is working on reconciliation of comments and addressing details of new requirements Will present full draft recommendations at May 11 HITPC meeting for feedback prior to final recommendations on June 8

12. Discussion of Timing Options for Stage 2 1.Maintain current timeline and one-year reporting period; or 2.Maintain current timeline and permit 90-day reporting period (gain up to 9 months delay); or 3.Delay transition from stage 1 to stage 2 by one year (providers could get third-year payment for meeting stage 1 expectations); or 4.Phase-in approach that separates existing from new functionalities 1.2013: Stage 2a using existing certified EHR functions with all-core objectives, increased performance thresholds and new quality measures 2.2014: Stage 2b objectives requiring new EHR functionalities take effect 5.Other?