HIT Policy Update. A Complimentary Webinar From healthsystemcio.com Sponsored by OnBase by Hyland

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1 HIT Policy Update A Complimentary Webinar From healthsystemcio.com Sponsored by OnBase by Hyland Your Line Will Be Silent Until Our Event Begins at 12:00 ET Thank You!

2 Housekeeping Moderator Anthony Guerra, editor-in-chief, healthsystemcio.com Ask A Question We will be holding a Q&A session after the formal presentations. You may submit your questions at any time by clicking on the QA panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as All Panelists. Download the Deck Go to Download today's deck at: Shortened URL at bottom of all slides View the Archive You will receive an when our archive recording is ready. Separate registration is required.

3 Agenda Approximately 45 Minutes minutes: John Halamka, MD, CIO, Beth Israel Deaconess Medical Center 5 minutes: A Word From Our Sponsor: Lorna Green RN, BSN, Healthcare Executive Advisor, OnBase by Hyland 10 minutes: Q&A w/john Halamka

4 HIT Policy Update

5 Agenda Meaningful Use Stage 3 recommendations Sustainable Growth Rate Fix 21st Century Cures Senate Help Committee Activities Argonauts Project Update

6 Architecture, Services, APIs workgroup General Recommendations HL7 FHIR not ready for national standard (but on the cusp) usage encouraged as part of the functional requirement in NPRM Healthcare Provider Directory (HPD) not ready for national standard should be removed from NPRM XDM Package Processing general agreement - with slight modifications CAQH CORE Should NOT be in the NPRM 6

7 Architecture, Services, APIs workgroup Orchestration Patterns Peer to Peer and Peer to Peer with delegated auth Likely covered by Argonaut project Publish Subscribe General pattern notification of an event Clinical Decision Support as a Service Example of more generalized orchestration patterns Workflow triggered call to outside services Background Conversation Human Review Conversation Return recommendations - content IHE related publication example of specific implementation 7

8 Content Standards Workgroup Adopted Standards Clinical Quality Measures: Health Quality Measure Format (emeasure) DSTU, Release 2 Common Clinical Data Set: Using SNOMED and Consolidated CDA standards as specified below. API Access to Common Clinical Data Set: FHIR Quality Reporting: HL7 Implementation Guide for CDA R2: Quality Reporting Document Architecture Category I, DSTU Release 3 (US Realm) and Errata (September 2014) SNOMED & LOINC September 2014 Release of the U.S. Edition of SNOMED CT and LOINC version 2.50 Consolidated CDA: 2.1 if available in time for the final rule with backwards compatibility. Only certify one version of Consolidated CDA no interim period with two versions Refinement still needed for identification of food/ substance-reactions/ intolerances, labs and med order entry Citation of standards should be done in a manner that allows maintenance updates to be published. Perhaps just adding or subsequent maintenance releases 8

9 Content Standards Workgroup Rejected Standards Clinical Decision Support HL7 Version 3 Standard: Clinical Decision Support Knowledge Artifact Specification, Release 1.2 DSTU (July 2014), HeD standard Release 1.2 Data Segmentation for Privacy HL7 Implementation Guide: Data Segmentation for Privacy (DS4P), Release 1 Electronic Sending of Medical Document (ESMD) Author of Record Level 1: Implementation Guide Electronic Delivery of Service (edos) HL7 Version Implementation Guide: S&I Framework Laboratory Test Compendium Framework, Release 2, Version 1.2 (edos) NCPDP Formulary and Benefit Standard (prefer Real Time Prescription benefit) 9

10 Implementation and Testing Workgroup General Recommendations Unique Device Identifier (UDI) Problematic for a number of reasons particularly for ambulatory practices Immunizations mapped to NDC codes is problematic Consolidated CDA Creation Performance C-CDA good concept but more clarity & version constraint needed We are in favor of C-CDA clarity and constraint but not of the creation performance requirements Adopt C-CDA 2.1 Recommend against requiring all the document templates to be mandatory. (List of document types) Safety Enhanced Design Do not require recruitment of clinical end users for testing, reduce testing burden Web Content Accessibility Guidelines Postpone raising WCAG level to 2.0 Level AA due to lack of quality compliance test tools 10

11 Implementation and Testing Workgroup General Recommendations Encounter Diagnoses ONC clarify that this is meant to be the billing diagnoses and whether necessary to include all billing diagnoses for encounters or simply the primary one Implantable Device List Most devices are not inserted in an ambulatory environment Pharmacogenomic data standards We are recommending to not adopt any pharmacogenomic standards as they are not mature. Data Portability We recognize the vital importance of data portability and interoperability, and the need to promote and enable both We recommend against adopting specific standards to enable broad generic data portability because of the complexity involved We recommend adopting standards for bulk export of C-CDAs Automated Numerator Recording & Automated Numerator Calculation There should be no requirement for automated numerator recording for any measure where to do so would require additional clinical documentation that is not necessary for patient care 11

12 Congressional Activity Sustainable Growth Rate Fix 21st Century Cures Burgess Interoperability Language Senate HELP Committee hearings

13 Sustainable Growth Rate Fix Provides a 5 percent bonus to providers who receive a significant portion of their revenue from an alternative payment models or patient centered medical home (PCMH). Participants need to receive at least 25 percent of their Medicare revenue through an APM in This threshold increases over time. The policy also incentivizes participation in private-payer APMs. Establishes a Technical Advisory Committee (TAC) to review and recommend physician-developed APMs based on criteria developed through an open comment process. Posts quality and utilization data on the Physician Compare website to enable patients to make more informed decisions about their care. Allows qualified entities (QEs) to provide analysis and underlying data to providers for purposes of quality improvement, subject to relevant privacy and security laws. Allows qualified clinical data registries to purchase claims data for purposes of quality improvement and patient safety.

14 21st Century Cures Interoperability Language 1. The "entirety" of the record is not a useful word to use. There are thousands of data elements that have no meaning outside of an EHR. Suggest referencing the "Core Data Set" outlined in the ONC Interoperability Roadmap, which includes the information most important to treating patients during a transition of care. 2. Accept the idea of standards bodies contracts, but reduce the funding and don't require adoption of their recommendations in certification. Consider pointing to efforts like Argonauts and Carequality as standards activities funded outside of contracts. 3. Accept the idea of information blocking, but define it so narrowly that the legislation would only apply in egregious circumstances. Consider a form of monitoring rather than leaving enforcement open ended and up to the courts. 4. Reinforce the need for patient authorization for non-treatment uses of their identified data. 5. Give providers the ability to control what requestors have access and when, based on the requestors ability to follow appropriate privacy and patient safety regulations as well as the need to maintain security, reliability and scalability of EHR systems.

15 99 FHIR Resources (50 DSTU1, 49 DSTU2**) 16 Argonaut Common MU Dataset Resources in blue Clinical Administrative Infrastructure Financial - # -

16 HIT Policy Update Q Lorna Green RN, BSN Healthcare Executive Advisor OnBase by Hyland

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18 Enterprise Imaging Strategy Goal: Availability of any medical image, any time, anywhere to any authorized user in context of the patient s record

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20 OnBase Workflow

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24 OnBase by Hyland OnBase Patient Window Medical Imaging Viewer OnBase VNA OnBase Anywhere Universal Scope Capture Mobile solutions

25 Q&A Click on the Q&A panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as All Panelists.

26 Thank You! Thanks to our featured speaker: John Halamka! Thanks to our sponsor: Lorna Green & OnBase by Hyland You will receive an when our archive recording is ready. (Separate registration is required) CHIME CHCIO Credits Attending our Webinars = 1 CEU Sponsorship opportunities: Nancy Wilcox nwilcox@healthsystemcio.com Questions/Comments: Anthony Guerra aguerra@healthsystemcio.com Go to to view our upcoming schedule and see the last 12 months of archived events.