August 10, 2011 A Leading Provider of Consulting and Systems Engineering Services to Public Health Organizations.

August 10, 2011

A Leading Provider of Consulting and Systems Engineering Services to Public Health Organizations

OFFICE OF THE NATIONAL COORDINATOR

Why it matters to the Credentialing Industry

www.healthit.gov

National Credentialing ForumFebruary 2015

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EHR Certification & Meaningful Use• eCQMs and the privileging/re-privileging processNationwide Interoperability Roadmap• Healthcare Directories- access and permissions to personal

health information (PHI)• CMS & private payers pay for interoperability

ONC Initiatives & Credentialing

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EHR Certification Meaningful Use & Clinical Privileging

Privileging & Re-privileging Strategies– 75% of physicians’ offices and 90% of hospitals

have certified EHRs– Electronic Clinical Quality Measures (eCQMs) is

emerging as a primary way for Eligible Professionals (EPs) and Eligible Hospitals (EHs) to report CMS-required quality/performance data

– Align Privileging and re-privileging processes with Payers’ pay-for-performance approach- incorporate eCQM data in privileging

2014 Clinical Quality Measures (CQMs)

• Eligible Professionals (EPs) are required to report 9 out of 64 measures– http://

www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM2014_GuideEP.pdf

• Eligible Hospitals (EHs) are required to report 16 out of 29 measures– http://

www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM2014_GuideEH.pdf

• For both EPs and EHs, the quality measures selected must cover at least 3 of the 6 available National Quality Strategy (NQS) domains:

1. Patient and Family Engagement2. Patient Safety3. Care Coordination4. Population/Public Health5. Efficient Use of Healthcare Resources6. Clinical Process/Effectiveness

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html

Nationwide Interoperability Roadmap

• ONC is leading the development of a 10-year shared nationwide interoperability roadmap

• Who should do what by when in order for the U.S. to achieve full interoperability of health information exchange

• Unprecedented collaboration is necessary• All stakeholders should be able to see their

responsibilities in the roadmap

Roadmap Vision & Building Blocks.

2017Providers and individuals send, receive, find, use a basic set of essential health information

2021Granular information accessExpanded sources and users of informationImproved quality and reduced costIncreased (and scalable) automation

2025Longitudinal informationUbiquitous precision medicineReduced time from evidence to practiceVirtuous learning cycle (learning health system)

Core technical standards and functions

Privacy and security protections for health information

Supportive business, clinical, cultural, and regulatory environments

Rules of engagement and governance

Certification to support adoption and optimization of health IT products & services

Health IT Ecosytem as the Learning Health System

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Learning Health System Requirements

A. Share governance of policy and standards…• x• x• x

M. Accurate identity matching….., including provider identities, system identities….

N. Reliable resource location: The ability to rapidly locate resources, including individuals, APIs, networks, etc. by their current or historical names….

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• Used by Health Information Exchanges (HIEs)• Directories now vary but will include practitioners, providers,

payers, administrators• CMS NPPES is modernizing and will link NPIs to Healthcare

Directories• Integrating the Healthcare Enterprise (IHE) has the technical

framework by which CMS and the Interoperability Roadmap will establish standards for Healthcare Provider Directories (HPD)– http://

www.ihe.net/uploadedFiles/Documents/ITI/IHE_ITI_Suppl_HPD.pdf

Healthcare Directories

Interoperability RoadmapAppendix A: Background Information on Policy Levers

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Interoperability Requirements for Credentialing Much in the same way that public payers could eventually include interoperability as part of the basic standard of care delivered by providers paid under public programs, commercial payers can also explore adding health IT and interoperability requirements to the factors included as part of credentialing processes for providers in their networks. If information regarding health IT capabilities were included as a standard component of credentialing information, payers could determine how to give preference to these attributes when identifying their networks.

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Overview of Roadmap Process & Timeline

Initial roadmap development

• Online community forum• Listening sessions• Experts convened• Federal workgroups• State engagement• FACA workgroups and joint meeting

FACA review and recommendations

• HITPC interoperability and HIE workgroup recommendations including governance subgroup, and JASON task force

• Governance and business environment reports

• Additional community input

Roadmap for public comment

• Update based on public input• FACA review

Oct 2014

Jan 2015

Nationwide interoperability

roadmapversion 1.0

Mar 2015

ONC Public Comment Period.

Nationwide Interoperability Roadmap• http://www.healthit.gov/policy-researchers-i

mplementers/interoperability– Public comments due April 3, 2015

2015 Interoperability Standards Advisory• http://www.healthit.gov/standards-advisory

– Public comments due May 1, 2014

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