Lohnes presentation HIMSS Meaningful use

8/7/2019 Lohnes presentation HIMSS Meaningful use

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ea g u se - us y e spec ve

Maggie Lohnes, RN, FHIMSS

Western States Health-e Connection SummitApril 12, 2010


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Topics

What is HIMSS Who is the HIMSS Public Policy Committee

MU Impact to Healthcare Providers

MU Impact to Vendors

HIMSS Public Comments for Meaningful Use

Additional Resources

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Resources

Meaningful Use HIMSS Recommendations on Meaningful Use

Standards and Certification Criteria

HIMSS Recommendations

Health Insurance Reform

Health IT Provisions

Other Items

FDA and EHRs as Medical De ices

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HIMSS

e ea care n orma on an anagemen ys ems oc e y

(HIMSS) is a comprehensive healthcare-stakeholdermembership organization exclusively focused on providing

(IT) and management systems for the betterment of healthcare.

, . .,Brussels, Singapore, and other locations across the UnitedStates, HIMSS represents more than 23,000 individualmembers of which 73% work in atient care deliversettings.

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30 not-for-profit organizations.


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The HIMSS Public Policy Team

Public Policy Steering Committee (PPSC)Make recommendations

vot ng mem ers year terms

4 non-voting members (CHIME, ME/PI Community,

NACHC, and Federal Health Community) 3 Board Liaisons (Burde, Keeler, and Paramore)

HIMSS Government Relations Roundtable (HGRR)

Cha ter Advocac Roundtable CAR

HIMSS Business Diversity Roundtable

HIMSS Affiliate Roundtable

Individual members and staff


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HIMSS Public Policy Committee , , , ,

Vice-Chair: Fred Hannett, MPA, Managing Partner, The Capital Alliance Neal Ganguly, FHIMSS, MBA, VP and CIO CentraState Healthcare System Bruce Gordon, BA, Program Manager Mitre Corporation

, , , , Kathleen Fortney, Director, Business Development Northrop Grumman Susan Schade, FHIMSS, CIO Partners Healthcare System

Carladenise Edwards MS, Ed, PhD, Chief of Staff, Georgia Dept of Community Health,

Ruth Perot, MAT, Executive Director Summit Health Herb Smaltz PhD, FHIMSS, CIO Ohio State Medical Center Benjamin McLarin, Management Engineering Consultant, Sacramento, California

Dave Roberts, VP Government Relations Tom Leary, Senior Director, Federal Affairs K. Meredith Taylor, MPH, HIMSS Director, Congressional Affairs

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, ,


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HIMSS Public Policy Activities

Annual Public Policy Summit 3 Asks to Congress

December 2008 - A Call to Action: Supporting Healthcare Reform through Health

(update for delivery June 2010)

Strong Chapter Advocacy Liaison program

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MU Impact to Providers

Perfect Storm of HITECH, State Medicaid Initiatives,

Tight implementation lead time for those without

automation Capital funding obstacles

System selection support

Quality reporting validation

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MU Impact to Vendors

HIMSS Electronic Health Record Vendor Association (EHRVA) supportedby HIMSS but operates independently - developed comments (available at

himssehrva.org) with concerns regarding:

Timelines for implementation, particularly to generate and report quality data

Finalizing certification process and authorized certificating entities

Earlier timing for Stage 2 NPRMs -- i.e., by end of 2010

Refine all or nothing approach ; scale back on MU criteria

Reduce number of quality measures; focus on measures with EMR specs

Refine certification criteria

Provide more robust approaches to HIE Refine/strengthen standards proposals

Narrow definition of "hospital-based professionals"

About the EHR Association: Contact Elizabeth (Liddy) West for more

information [email protected] 520-730-8212 9


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Meaningful Use

HIMSS Public Comments


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Five Broad Healthcare Goals for

. , , ,health disparities

2. En a e Patients and Families3. Improve Care Coordination

4. Ensure adequate privacy and security protections

for Personal Health Info5. Improve Population and Public Health

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HIMSS Recommendations on MU

Incentive Program Eligibility and CCN: Correctsthe unintended impact of using CMS Certification

um ers to ent y osp ta s or ncent ve

payments.

ncen ve rogram g y an : orrec s

the NPRM on Hospital-based professionals (HBPs)

EHR that the provider is using as well as Place of

Service (POS) settings, reducing substantially the

number of professionals who are excluded from

incentives as HBPs. 12


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Incentive Program Eligibility Need Legislative Fix

Additional eligible professional categories over the course ofthe timeline for the edicare and Medicaid Pro ramsElectronic Health Record Incentive Programs on such actionitems as:

Expanding the care delivery setting to encompass more parts of thecontinuum of care

Collectin standardized clinical erformance measures as a b roduct

of care delivery and clinician documentation that support workflowand improve care delivery

Enhancing programs and funding availability for patient educationofferings and the advancement of personal health records and how toleverage patients personal health information to improve clinicaloutcomes. 13


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Criteria for Meaningful Use: Streamlines Criteriafor Meanin ful Use that reco nizes the im act on

workflow; places an emphasis on realistic

percentages for metrics; and allows for partial credit Quality Metrics for Meaningful Use: Streamlines

the Quality Metrics and ensures the measures can be

ea t -ena e as part o t e care process

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Privacy and Security: Supports the adherence toexisting privacy and security law and regulation

without creating duplicate or redundant regulatory

requirements. Health Information Exchange: Supports the

governments intent to accelerate the use of HIE as

capabilities increase after Stage 1 and suggests thegovernment place more emphasis on standards-based

HIE in the Stage 2 and 3 MU requirements15


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certified technology to be employed to supportcertified EHR technology to help providers achieve

meaningful use, so long as the provider has certified

EHR technology. Health IT Implementation Timelines: Recognizes

the impending strain on healthcare community from

e po en a er ec orm o ea pro ectimelines required for Meaningful Use and the

,

with the conversion to ICD-10 and X-12 5010standard.16


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Quality Metrics Recommendations

. m na e ore easure e or g e

Professionals

.

adequately vetted to ensure they can be captured and

3. Implement an aggressive Quality Measures Testing

Pro ram

4. Align current Quality Measure Reporting with new

re uirements to avoid du lication

5. Limit reporting on quality measures in 201117


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Standards and Certification Criteria IFR

Relevant Themes Creates a floor for standards, implementation

spec ca ons, an cer ca on cr er a ormeaningful use.

1. Vocabulary

2. Content exchange3. Transporting of information

. r vacy an secur ty

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Standards & Certification Criteria

Definitions: Seeks clarification on several definitions,

functionality of CPOE (data capture and order creation);

definition

Venue of Care su orts Con ressional intent of hos ital-

based professional

Intero erabilit in Sta e I: Re uests clarification on im actof interoperability requirements and testing and certificationrequirements on complete and modular EHRs for Stage I.

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Standards & Certification Criteria

Supports the Adoption of one patient record summary to supportMU Stage II and beyond

Supports the use of CCD or CCR in Stage I

Supports a push toward administrative simplification using theCORE rocess

Supports maturation of the eligibility verification processbased on CORE Phase II by 2014

ecommen s rev s ng e conom c mpac ssessmen Small Business criteria assessment not consistent with

CCHIT data

Supports ONC efforts to monitor industry developments on

health data security 21


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Certification Process


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Formulation Of Certification Proposal

1. HIT Policy Committee recommendations2 oordination ith the HIT tandards and

Certification Criteria Interim Final Rule and theMedicare and Medicaid Incentive Programs

3. Consultations with NIST

4. Timeliness related to the beginning of the

Medicare and Medicaid EHR IncentivePrograms


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Coordination with HIT Standards and Certification

IFR and Medicare/Medicaid EHR Incentive

Proposed Rule Third and final element of Department of Health and Human

Services (HHS) coordinated rule makings to define themeaningful use of Certified EHR Technology and support the

achievement of meaningful use. As required by the HITECH Act, eligible professionals and

eligible hospitals must demonstrate meaningful use of certifiedEHR technology in order to receive incentive payments under

t e e care an e ca ncent ve programs. This proposed rule creates the certification programs under

which Complete EHRs and EHR Modules could be tested andcert e an su sequent y use as ert e tec no ogy.


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HIT Certification Programs Proposed Rule

Propose both temporary and permanent certification

Currently test and certify Complete EHRs and EHR Modules

In the future, permanent certification program could alsoinclude testing and certification of other types and aspects ofHIT.

This proposed rule marks the beginning of the formal notice andcomment rulemaking described in CGD.

,

certification will supersede the CGD. Authorization process will constitute the new method for

recognizing certification bodies.


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Temporary Certification Program

National

CoordinatorNIST

uthorize

Develo

ps

ONC-Authorized

Testin & Certification Bodies

Test

Methods

Tests and CertifiesCom lete EHRs/EHR Modules

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Vendors/

Self-DevelopersSource: ONC - HIT Policy Committee Presentation


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Overview of Temporary Certification Program

ONC-Authorized Testing and Certification Body (ONC-

ATCB) An or anization or or anizations

Submit an application to National Coordinator to demonstrate

competency to test and certify Complete EHRs and/or EHR

Under temporary certification program, an applicant for ONC-

ATCB must be able to test and certify Complete EHRs and/or

EHR Modules Anticipated that only a few organizations would qualify

and at least one certification body has been authorized by the

National Coordinator


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Overview of Permanent Certification Program

Permanent Pro ram

ONC-Approved Accreditor (ONC-AA)

- -

ACB)

a ona o un ary a ora oryAccreditation Program (NVLAP)


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Introduces ONC-Approved Accreditor (ONC-AA) u respons t es assume y t e at ona

Coordinator under the temporary certification program

National Coordinator where a ro riate will seek tomove as many of the temporary certifications

programs processes as possible to organizations in the

.

Only one at a time


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ONC Authorized Certification Body (ONC-ACB) ONC-ACB in the permanent certification program is different than an

- n t e temporary cert cat on program.

Under permanent certification program, National Coordinators

authorization would be valid only for certification. National Coordinators authorization would no longer be valid for the

purposes of testing Complete EHRs and EHR Modules.

Proposed that NIST through the National Voluntary Laboratory

Accreditation Program (NVLAP) would be responsible for accreditingtesting laboratories and determining their competency

NIST would be solely responsible for overseeing activities related to

testing laboratories


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Permanent Certification Program[Testing] [Certification]

NISTNational

CoordinatorNVLAP

uthorizes

ONC-AA

Accre

dit

ONC-AuthorizedNVLAP-Accredited

ccre s

Tests Certifies

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Vendors/

Self-Developers

EHR Modules

EHR Modules

Source: ONC - HIT Policy CommitteePresentation


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Health IT Provisions

in Healthcare Insurance Reform Law


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Health IT Provisions in Healthcare

1. On May 23, 2010, President Obama signed into law HR,

Act.

2. The U.S. Senate passed H.R. 3590 on December 24,, . .

March 21, 2010.

3. Also on the March 21, 2010, the House passed theReconciliation Act of 2010 HR 4872 which makes

changes to HR 3590. The Senate is expected to considerHR 4872 during the week of March 22, 2010.

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In ur n R f rm L i l i n

HR 3590 aims to increase healthcare coverage among

Americans and implement broad reforms within the

Insurance industry

ms to expan ea t nsurance coverage to

million currently uninsured Americans

Prohibits insurance com anies from den in covera e

to individuals with preexisting conditions (effectiveimmediately for children and applies to all individuals

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.

xpan s e ca o cover n v ua s w ncome

less than 133 percent of the federal poverty level, or

$29,327 for a family of four Closes the gap in prescription drug coverage

Prohibits insurance companies from placing lifetime

caps on coverage Requires health plans to allow young adults, up to age

26 to remain on their arents insurance olic


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R f rm L i l i n

Leverages health IT to improve the quality, cost, and

Supports programs to foster the reporting of quality measures

through the use of health IT rects t e esta s ment o stan ar s to ac tate t eenrollment of individuals in health plans, as well as standardsto enable the determination of an individuals eligibility and

nanc a respons ty or spec c serv ces pr or to or at t epoint of care

health IT to test new, more effective healthcare delivery

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Leverages health IT to improve the quality, cost,.

Aims to increase the use of health IT in long-term care

settings through financial assistance Directs the use of health IT in health risk assessments for

Medicare beneficiaries

Esta is es incentive payments for ea t p ans an provi ersthat apply health IT in improving healthcare outcomes

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FDA and EHRs as Medical Devices

Per FDA, health IT has advanced so far that the professional

intermediary is no longer required or used Under the Federal Food Dru and Cosmetic Act health IT

software is a medical device.

Per voluntary reports from patients, clinicians, and user

facilities, the FDA cites data indicating 260 reports of HIT-related adverse events, including 44 reported injuries and 6reported deaths

Because these reports were purely voluntary, they may

represent only the tip of the iceberg in terms of HITproblems that may exist

FDA UNDECIDED AT THIS TIME!

- Testimony of Dr. Jeffery Shuren, Director for FDA Center for Devices and Radiological Health to the HIT Policy Committee 2/25/10


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3 FDA Options for Engagement

Postmarket Safety

Option 3: Traditional FDA Regulatory Framework


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Additional Information

For additional information related to ARRA, please access the

http://www.himss.org/EconomicStimulus/

Comments on Meaningful Usehttp://www.himss.org/content/files/HIMSSResponseCMS_

Standards and Certification Criteria

http://www.himss.org/content/files/HIMSSresponseONC_IF.p

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Additional information concerning health IT provisions

included in healthcare reform legislation can be accessed

through the HIMSS website:

http://www.himss.org/ASP/topics_healthcarereform.asp

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Documents

Lohnes presentation HIMSS Meaningful use