Transcript The Decade of Health Information Technology Begins:

HIT Standards Committee
Clinical Operations Workgroup Report
Jamie Ferguson, Chair
Kaiser Permanente
John Halamka, Co-chair
Harvard Medical School
21 July, 2009
Clinical Operations Workgroup Members
•
•
•
•
•
•
•
•
•
•
•
•
•
Christopher Chute, Mayo
Linda Dillman, Wal-Mart
Martin Harris, Cleveland Clinic
Stan Huff, Intermountain Healthcare
Kevin Hutchinson, Prematics
Liz Johnson, Tenet Healthcare
John Klimek, National Council of Prescription Drug Plans
Wes Rishel, Gartner
Nancy Orvis, Department of Defense
Don Bechtel, Siemens
Joyce Sensmeier, HIMSS
John Halamka, Harvard Medical School
Jamie Ferguson, Kaiser Permanente
2
Summary
• The workgroup used a two-phase process first to
identify EHR standards, then to assess feasibility for
widespread implementation
– Almost all of the current 2011 MU measures were addressed
• Applicable HHS-adopted, recognized or accepted
standards are recommended for 2013 and for 2011
– Gaps were identified that may affect 2011 MU measures
• Unstructured documents, local and proprietary codes
generally are recommended as allowable alternatives
for 2011 but not for 2013 reporting of MU measures
3
Clinical Operations Workgroup Process
• Review proposed MU objectives and measures
– Initial focus on proposed MU quality measures
• Identify existing EHR standards for MU measures
– Existing HHS adopted, recognized and accepted standards
– Other widely accepted and widely deployed standards
– Gaps in standards for the measure
• Identify the feasibility of widespread implementation of
the identified national EHR standards by 2011 or 2013
or beyond
• “Reality check” notes on requirements and next steps
4
Example of Clinical Operations Process
Pre-decisional Draft Example For Discussion
2011
Measure
HHS
Adopted
EHR
Standards
Other
Widely
Accepted
Standards
Gaps In
Standards
Feasible
For 2011
Feasible
For 2013
Notes /
“Reality
Check”
% patients
at high risk
for cardiac
events on
aspirin prophylaxis
[OP]
Standards
referenced
in HITSP
specifications for
CCD; eprescribing;
medication
management
N/A
Standardsbased
definition of
high risk
patients.
Measures
based on
local or
proprietary
codes
and/or
ICD-9
Measures
based on
SNOMEDCT
problems,
RxNorm
and other
standards
in relevant
HITSP
specifications
Adopted
HHS EHR
standards
are not fully
tested nor
widely
deployed
for this use.
Standards
for patient
selfreporting of
medications
– or –
2013
standards
5
Workgroup Discussions During Process
• Concerns were discussed regarding those have not yet
implemented, as well as those who have implemented
legacy alternatives to HHS adopted standards for MU
• Main concerns for new implementers included ICD-10
• The longer the legacy systems are in place, the more is
built up around them and the greater the upgrade cost
• The workgroup agreed not to let these concerns stand
in the way of progress, and found interim solutions to
ease the path of implementing or upgrading to the
standards
6
Recommendations: Summary
• Meaningful use based on the standards in recognized
and accepted HITSP capabilities is recommended for
2013 and 2011 implementation of the 2011 measures
– Includes many uses of CCD, LOINC, RxNorm and other
standards referenced in HITSP capabilities
• Specific additional alternatives are recommended for
interim periods such as specified allowable uses of
unstructured documents, local/proprietary codes, and
current quality measures for meaningful use in 2011
and 2012
– Most alternatives are not recommended for 2013 and beyond
• See descriptions and details of HITSP Capabilities in
the attached documents
7
Recommendations: Detailed Example
2011
Measure
Recommended
2011 Standards
Recommended
2013 Standards
Directional
Statement Of
Intent
% diabetics with
A1c under
control [EP]
Standards in
HITSP
capabilities 117,
118, 119, 120,
126, 127, 140,
and
local/proprietary
codes, and
unstructured
documents, and
ICD-9 allowed in
place of
SNOMED CT
Standards in
HITSP
capabilities 117,
118, 119, 126,
127, and ICD-10
allowed in place
of SNOMED CT
Remote device
monitoring to be
added in 2013 or
2015
SNOMED CT to
be required as
applicable in
2015
8
Clinical Operations Recommendations
• The workgroup requests Committee approval of the
attached detailed recommendations for 2011 measures
of meaningful use to be forwarded to ONC
• The workgroup requests Committee approval to proceed
and to recommend to ONC if adopted standards may
apply to the 2011 MU measures not yet addressed
– % encounters where med reconciliation was performed
– % reportable lab results submitted electronically
– 30-day readmission rate
• The workgroup recommends that ONC determine how
to address gaps in standards via HITSP, or direct
requests to standards organizations, or other means
9