Larry Wolf, chair Marc Probst, co-chair Certification / Adoption Workgroup January 21, 2014.

Larry Wolf, chairMarc Probst, co-chair

Certification / Adoption Workgroup

January 21, 2014

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Agenda

• Review of Agenda• HITPC Charge: Step Two – Continued discussion of proposed LTPAC health IT

Certification Criteria

• Next Steps• Public Comment

Patient-Specific Educational Resources

• “75 percent of [long term care] provided by families in the home, and by non-licensed personnel and agencies going into the home.”• “we need to figureout the presentation layer that appeals to patients and families, … have one record that all parties can tap into, upload to, download from, right through to the end of the person’s life…”

• Support the ability to use ONC specified standards to electronically retrieve patient-specific education from content/knowledge resources. [MU 2 certification criteria]

• Previous certificationefforts have supported the process for patient educational resources

• 12/2 C/A WG call: Patientportals are available across all LTPAC provider types. However, frequency and breadth of use is unknown.

LTPAC Hearing Proposed Areas for Certification

Prior LTPAC Certification Efforts (HL7 LTC FP /

CCHIT LTPAC)

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Incorporating Laboratory Tests & Values/Results

“The [CDS] systems thatwe've developed use signals that require the presence of admission, discharge, transfer, lab, and medication data…there are existing standards for lab, including LOINC and medications, NCPDP, and are widely available to support [AD detection and management].” “Due to our recentcertification process, we've built in some key capabilities. We can now import lab results…”

“Indeed, we find that sharing…lab results and just the exchange of demographics … have been the primary interest.”

• Support the ability to electronically receive, incorporate, and display clinical laboratory tests and values/results in accordance with the HL7 Version 2.5.1 Implementation Guide and with laboratory tests represented in LOINC

[MU 2 certification criteria]

• Previous certificationefforts have supported receiving and incorporating, displaying lab results

• Neither the LTC FP northe CCHIT LTPAC criteria explicitly identify the ONC specified lab data components, for a test report

LTPAC Hearing Proposed Areas for Certification

Prior LTPAC Certification Efforts (HL7 LTC FP /

CCHIT LTPAC)

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Clinical Decision Support

• “CDS can greatly improvethe detection and management of [adverse consequences] and improve [regulatory compliance] and inclusion of medication specific CDS should provide alignment with and support existing federal and state programs...” • “the level ofopportunity for using [CDS] at the time of prescribing can be quite significant. For example, …clear opportunity to optimize the way antibiotics are being used and other antimicrobials”

• “we should try and link[CDS rules] to those harm related events to try and reduce that ”

Support the ability to have:• Evidence-based decision

support interventions. • Linked referential clinical

decision support. • Clinical decision support

configuration.• Automatically and

electronically interact• Source attributes• Drug-drug, drug-allergy interaction checks. [MU 2 certification criteria]

• Prior certification effortshave supported CDS interventions based on problems, medications, medication allergies, demographics & labs

• No match on referenceinformation, source attribution, and electronic triggering for clinical decision support.

LTPAC Hearing Proposed Areas for Certification

Prior LTPAC Certification Efforts (HL7 LTC FP /

CCHIT LTPAC)

Clinical Health Information

• “CMS documentationrequirements of an annual comprehensive med review. This structured document contains the pharmacist provided reconciled active med list, allergy list, indications for each active medication, and special instructions for the patient…can be used by pharmacists and other health care providers in all practice settings including LTPAC and behavioral health.”

• “…We could require some interoperability of at least a small set of data, the medications, diagnoses, care plans, function, mental status, likely course”

• Support the ability to record, change, and access the:o Problem listo Medication listo Medication Allergy listusing ONC specified standards[MU 2 certification criteria]

• Support clinical information reconciliation. [MU 2 certification criteria]

• Support Electronic Notes. [MU 2 certification criteria]

• Prior certification effortshave supported the ability to electronically record, change, and access problem list, medication list , medication history, active medication allergy list and medication allergy history.

LTPAC Hearing Proposed Areas for Certification

Prior LTPAC Certification Efforts (HL7 LTC FP /

CCHIT LTPAC)

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Patient Demographics

“exchange of demographics and using some of the older ADT standards have been the primary interest…”

• Support the ability to record, change, and access patient demographic data

using ONC specified standards [MU 2 certification criteria]

• Neither LTC FP nor CCHITcriteria identify explicit demographic data elements to be captured and maintained.

• Neither LTC FP nor CCHITinclude criteria addressing the ability to record, change, and access preliminary cause of death in the event of a mortality.

LTPAC Hearing Proposed Areas for Certification

Prior LTPAC Certification Efforts (HL7 LTC FP /

CCHIT LTPAC)

Advance Care Planning

• “We need advanced plansin all records, we need to know who the surrogate is, and not just a yes/no. We need to be able to code the major decisions…We need to make the core elements available to the patient, family, and caregiver. “

“…it is becoming actually harmful and dangerous to have in the electronic record only a yes/no on an advanced directive. Now, a majority of states accept the POLST—we could readily digitize most of the POLST entries, and we could readily scan and attach to the record a real document”

• Support the ability to recordwhether an advance directive exists for the patient [MU 2 certification criteria]

• Support the ability to store anadvance directive document in the record or provide a link to the advance directive in a repository or other location. [MUWG-identified MU3 Criteria under consideration]

• Support the ability to retain versions of the advance

directive document in the record or enable links to earlier versions of the advance directive document.

•Future work: Standards for content of the advance directive

Prior certification has indicated:

• the type of advance directives completed

• when last reviewed, time stamp entry of information

• name and relationship of party completing the advance directive

• location and or source of legal documentation

*More info in supplemental mapping materials

LTPAC Hearing Proposed Areas for Certification

Prior LTPAC Certification Efforts (HL7 LTC FP /

CCHIT LTPAC)

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Medication Related Criteria

• “the practice ofprescribers entering orders electronically into the EHR will decrease the chance for errors in the interpretation of prescriber orders.”

• “a significant number oforders are changed today verbally or via telephone, …..keystroke errors are frequently identified in our business as contributors to adverse events that result in patient harm.”

• “Pharmacistselectronically accessing and exchanging clinical information in these settings are vital to meeting institutional quality and safety medication management processes.”

Support for: • e-MAR• Electronic prescribing• Drug-formulary checks[MU 2 certification criteria]

• Previous certificationefforts have supported the ability to:

o record, change and access each of the order types (i.e., meds, labs, radiology /imaging)

• Verify right patient• NCPDP SCRIPT v10.6• Automatically andelectronically check whether a drug formulary exists for patient or drug

LTPAC Hearing Proposed Areas for Certification

Prior LTPAC Certification Efforts (HL7 LTC FP /

CCHIT LTPAC)

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Computerized Provider Order Entry (CPOE)

• “A subset of the criteriarules, such as e-prescribing, labs and other diagnostic data, and activities of daily living [from the ONC 2014 certification criteria would support TOC], could apply”

• Support the ability to electronically record, change, and access the following order types: (i) Medications; (ii) Laboratory; and (iii) Radiology/imaging.[MU 2 certification criteria]

• Previous certificationefforts have supported the ability to record, change and access each of the order types (i.e., meds, labs, radiology/imaging)

LTPAC Hearing Proposed Areas for Certification

Prior LTPAC Certification Efforts (HL7 LTC FP /

CCHIT LTPAC)

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Public Health - Transmission to Immunization Registries

• “defining a health ITstandard for… influenza vaccine administration… would enable…information…exchanged between… providers as well as … state vaccination registries. This could reduce duplication of immunization …among different…providers caring for the same person, reduce… individual’s risk of receiving multiple vaccinations…, and provide [PH] with reliable information and vaccine coverage within communities”

• Support the ability toelectronically generate immunization information for electronic transmission using ONC specified standards. [MU 2 certification criteria]

• Previous certificationefforts have supported the ability to record, change, and access immunization information.

• Neither the LTC FP northe CCHIT LTPAC criteria address creating immunization information for transmission using the HL7 v2.51 Immunization Messaging standard or HL7 Standard Code Set CVX – Vaccines Administered.

LTPAC Hearing Proposed Areas for Certification

Prior LTPAC Certification Efforts (HL7 LTC FP /

CCHIT LTPAC)

LTPAC Setting-Specific Criteria: Federally Required Patient Assessments

• “The handling of theMDS, … census data, care planning, quality assurance activities, by and large …are primarily used for internal operations of the SNF. There are a number of SNFs that would like to be able to transmit data… but the interoperability structure in the state is not terribly well developed for communicating between hospitals and SNFs, SNFs and home health or home care, assisted living.

• Support the ability to create,maintain, and transmit (in accordance with CMS requirements) assessment instruments and data sets for LTPAC: MDS 3.0, OASIC-C , IRF-PAI, CARE subset for LTCH, and a Hospice Item Set. [Criteria not in MU]

• Support the use of acceptedvocabulary standards to enable the reuse of assessment data for:

o various clinical purposes; and

o administrative purposes. [Criteria not in MU]

• Support the ability of the provider or a designated third party to create and exchange interoperable LTPAC Assessment Summary CDA documents[Criteria not in MU]

• Previous certificationefforts have supported the ability to create, maintain, transmit, and reuse assessment content.

LTPAC Hearing Proposed Areas for Certification

Prior LTPAC Certification Efforts (HL7 LTC FP /

CCHIT LTPAC)

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LTPAC Setting-Specific Criteria: Federally Required Patient Assessments

• “LTPAC reportingrequirements should be harmonized with clinical data required for patient care.”

• CMS believes that datauniformity…across settings, is critical to facilitate … transfer of information. It’s also what’s needed…to develop and implement measures that can be harmonized across settings... “

Future work: • Harmonization of federalcontent and format for patient assessments with ONC specified EHR standards (e.g. consistent standards on demographics).

• Make the dataelement library publically available and link content to nationally accepted standards.

• Previous certificationefforts have supported the ability to create, maintain, transmit, and reuse assessment content.

LTPAC Hearing Proposed Areas for Certification

Prior LTPAC Certification Efforts (HL7 LTC FP /

CCHIT LTPAC)

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LTPAC Setting-Specific Criteria: Survey and Certification

• “Surveyors need promptand complete access to the EHR to complete surveys as required.”

• “It would be interestingto consider if an EMR certification program could also include certain interoperability with this QIS [Quality Indicator Survey] software.”

•“it [is] imperative for the surveyors …to look across modules of the EMR to understand the timeline of how the different care components fit together.”

• Support the ability topromptly provide surveyors with access to the complete EHR, consistent with federal requirements. [Criteria not in MU]

Future work:• Support surveyornavigation 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.

• Prior certification hassupported surveyor access to the complete EHR, consistent with federal requirements.

LTPAC Hearing Proposed Areas for Certification

Prior LTPAC Certification Efforts (HL7 LTC FP /

CCHIT LTPAC)

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Tracking LTPAC EHR Adoption and Use Trends

Additional Proposals:• As ONC advances LTPAC certification, ONC

should track national trends in LTPAC health IT adoption. Such efforts should include tracking use by functionality and criteria.

• National survey data on LTPAC EHR adoption and use should utilize definitions that are consistent with those in the MU program.

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