Larry Wolf

Certification / Adoption Workgroup

May 13th, 2014

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Agenda

• Update from May HITPC Meeting• Update from Certification Hearing• Proposed LTPAC Patient Assessment

Recommendation• Next Steps: – LTPAC / BH Voluntary Certification Blog– Listening Session – Thursday, 05/22/2014

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Workplan

Date Call Schedule 5/1 /2014 Review 2015 NPRM Recommendations, Review Voluntary Certification Recommendations,

Updates from Privacy and Security TT and Quality Measures WG

5/6/2014 HITPC Recommendations

Week of 5/12/2014 Blog on Voluntary Certification for LTPAC and BH

5/7/2014, 5/8/2014 Certification Hearing

5/13/2014 Update from May HITPC, Certification Hearing. Refine Proposed Voluntary Certification Recommendation on LTPAC Patient Assessments

5/22/2014 Listening Session on Voluntary Certification for LTPAC and BH

5/28/2014 Review Voluntary Certification Public Comment, Finalize Voluntary Certification Recommendations.

06/10/2014 HITPC Recommendations

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Update from May HITPC

• TOC & Privacy Recommendations Approved by HITPC w/ the following clarifications: – Alignment with MU: TOC certification criteria and standards should align with ONC’s

Meaningful Use criteria and standards to ensure interoperability across systems and to encourage exchange.

– Updated with MU: Starting with the 2014 Edition of CEHRT, criteria and standards for other settings should be updated when MU criteria and standards are updated.

• Data Segmentation/Consent Management– Provider Workflow: HITPC requested that the Privacy & Security Tiger Team (P&S TT)

conduct additional outreach to stakeholders to determine the workflow impact of data segmentation and consent management of documents. The P&S TT will engage in this outreach in May

– Definition of Disclosure: P&S TT also will work with SAMHSA to determine the definition of disclosure used for purposes of 42 CFR part 2

– Report Back to HITPC: P&S TT anticipates reporting back to HITPC in June with updated recommendations

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Update from May HITPC

HITPC Feedback on Draft Quality Measurement Recommendations for LTPAC / BH Voluntary Certification• Noted that the proposed behavioral health quality measures are process focused,

and should be more focused on outcomes.• Consider how data already collected from LTPAC/BH providers (e.g., by CMS) could

provide a foundation for quality measurement in the setting• Interested in additional vendor feedback on the proposed quality measure

recommendations • Consider international examples of ways to integrate behavioral health, maternal

health, social care programs, etc. to render a holistic view of the patient2015 NPRM Feedback• HITPC to provide ONC with 2015 NPRM discussion ‘sentiments’

– Certification should be ‘lean and mean’– Balance between maturity of standards and infrastructure needed to support policy

(e.g., Meaningful Use, Advanced Care Models)

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Feedback from Certification Hearing

– The certification process is overwhelming for some (timeframes, complexity)

– Certification of immature criteria/standards are concerning

– The certification schedule involves tight timelines and cycles that vendors must work within

– Certification regulations lack clarity– Feedback mechanisms beyond the NPRM process

are needed– Certification can stifle innovation

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Certification Hearing Outcomes

Key Points:• ONC should organize a Certification Kaizen– Need for active collaboration with all

stakeholders, including CMS– Kaizen process is more effective than responding

to NPRMs• Certification efforts should focus on

interoperability, privacy and security, and quality measures

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Proposed LTPAC Setting Specific Recommendation

Voluntary Certification for LTPAC and BH

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LTPAC Patient Assessments

Policy Opportunity: – Alignment among federal programs around data and

standards– Patient assessments can be key drivers of

interoperability • Previous standards mapping work has been done (e.g.,

mapping assessment content to vocabulary standards, CCDA)

– Responsive to certification hearing concerns regarding the lack of interoperability

LTPAC Setting Specific Recommendations

• NEW Support the ability to create, maintain, and transmit (in accordance with CMS requirements) assessment instruments and data sets for LTPAC in, for example, MDS 3.0 (Nursing Homes), OASIC-C (Home Health), IRF-PAI (Inpatient Rehabilitation Facility), CARE subset (for Long Term Care Hospital), and a Hospice Item Set.

• NEW Support the use of accepted vocabulary standards to enable the reuse of assessment data for: o various clinical purposes; and o administrative purposes.

• NEW Support the ability of the provider or a designated third party to create and exchange interoperable LTPAC Assessment Summary CDA documents.

FUTURE WORK• Harmonization of federal content and format for patient assessments with ONC specified EHR

standards (e.g. consistent standards on demographics).• Make the data element library publically available and link content to nationally accepted standards.

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Interoperability of LTPAC Patient Assessment Data

Focus Area Type Provider Use Effort Standards Maturity DevelopmentEffort

Care Coordination LTPAC Medium Medium (some mapping to MU2 standards, not widely adopted by LTPAC)

High