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HIT Policy CommitteeHIT Policy Committee
Review of Meaningful Use Core Objectives and Existing Measures – Relevance to Specialty and Small Practices and Small Hospitals
Paul TangPalo Alto Medical Foundation
George HripcsakColumbia University
October 27, 2009
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Workgroup Members
Co-Chairs:• Paul Tang, Palo Alto Medical Foundation• George Hripcsak, Columbia University
Members:• David Bates, Brigham & Women’s Hospital• Christine Bechtel, National Partnership for Women & Families• Neil Calman, The Institute for Family Health• Art Davidson, Denver Public Health Department• David Lansky, Pacific Business Group on Health• Deven McGraw, Center for Democracy & Technology• Latanya Sweeney, Carnegie Mellon University• Charlene Underwood, Siemens
ONC Lead:• John Glaser
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Approximate Timeline
• 4Q09/1Q10: Conduct informational hearings to inform 2013 and 2015 criteria development
• 2Q10: Work with HIT Standards Committee to ascertain availability of relevant standards
• Mid-2010: Refine 2013 meaningful use criteria
• 4Q10: Assess industry preparedness for meeting 2011 and initial 2013 meaningful use criteria
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Rationale
• Not all objectives and measures appropriate for all eligible professionals
• How to decide, specify, and maintain mapping
Groups of professionals
Eligible professionals
Objectives & measures
Groups of measures
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Organizing Principles
• Eligible Professionals– Profession: MD, DO, DDS, DMD, nurse mid-wife, NP, PA, etc.
(Medicare vs Medicaid)– Role: Primary Care, Specialty
• Objectives and Measures– Process, Quality, Efficiency– Prevention, etc.
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Process
• Early MU Emphasis on Primary Care– Key role of primary care– Fewer specialty measures available– Number and complexity of specialties
• Begin with a Simple Framework
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Framework
• Core measures – all providers– use CPOE for all orders (process)– avoid use of high-risk medications in the elderly (quality)– percent of patient encounters with insurance eligibility confirmed
(efficiency)
• Adult primary care measures– report percent of diabetics with A1c under control
• Pediatric primary care measures– report up-to-date status for childhood immunizations
• Specialty measures– cross all specialties: closing the loop on referrals– specialty-specific measures
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Who is Primary Care?
• Family medicine
• All or some of internal medicine
• Other professions
• Specialties like obstetrics and gynecology?– Serve as many patients’ sole provider– Preventive care versus treatment
• Role: specific to profession, professional, or patient?
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Issues in Grouping Measures
• Adult & pediatric, Male & female, Cancer survivor, …– Stay simple, use denominator to differentiate
• Self-Selected Quality Measures– Select and track a quality measure for your specialty
• Use of Registries
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Hospitals
• At present, all hospitals responsible for all objectives and measures
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Plan
• Edit the framework based on upcoming testimony
• Create a matrix that maps objectives and measures to professionals
• Circulate back for feedback
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QUESTIONS AND DISCUSSION