HIT Policy CommitteeHIT Policy Committee

Clinical Operations Workgroup ReportClinical Operations Workgroup Report

Jamie FergusonKaiser Permanente

John HalamkaHarvard Medical School

16 July, 2009

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Clinical Operations Workgroup Process

• Review proposed MU objectives and measures – Initial focus on proposed MU quality measures

• Identify existing EHR standards for MU measures– Existing HHS adopted, recognized and accepted standards– Other widely accepted and widely deployed standards– Gaps in standards for the measure

• Identify the feasibility of widespread implementation of the identified national EHR standards by 2011 or 2013 or beyond

• “Reality check” notes on requirements and next steps

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Example of Clinical Operations Process

Pre-decisional Draft Example For Discussion, page 1 of 2

2011 Measure

HHS Adopted EHR Standards

Other Widely Accepted Standards

Gaps In Standards

Feasible For 2011

Feasible For 2013

Notes / “Reality Check”

% patients at high risk for cardiac events on aspirin pro-phylaxis [OP]

Standards referenced in HITSP specific-ations for

CCD; e-prescribing; medication manage-ment

N/A Standards- based definition of high risk patients.

Standards for patient self-reporting of medications

Measures based on local or proprietary codes and/or

ICD-9

– or –

2013 standards

Measures based on SNOMED-CT problems, RxNorm and other standards in relevant HITSP specifi-cations

Adopted HHS EHR standards are not fully tested nor widely deployed for this use.

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Example of Clinical Operations Process

Pre-decisional Draft Example For Discussion, page 2 of 2

2011 Measure

HHS Adopted EHR Standards

Other Widely Accepted Standards

Gaps In Standards

Feasible For 2011

Feasible For 2013

Notes / “Reality Check”

% lab results incorpor-ated into EHR in coded format [OP,IP]

Lab result standards referenced in HITSP specific-ations for

commun-ication of lab results and lab documents, including LOINC and UCUM.

HL7 v2.x; HL7 v3 CDA

Standards and imple-mentation guidance for blood bank, surgical pathology, and genetic test results

Measures based on local and/or proprietary codes

– or –

2013 standards

Measures based on standards in relevant HITSP specifi-cations for lab results including LOINC and UCUM.

Adopted HHS EHR standards are not fully tested nor widely deployed for this use.

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Clinical Operations Workgroup Status

• A first draft of the existing EHR standards identification is complete for all proposed quality measures

• A first draft of the widespread implementation feasibility assessment for 2011 and 2013 is complete for most proposed quality measures

• Many of these same EHR standards and widespread implementation feasibility assessments will apply to MU measures other than those for quality reporting

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Clinical Operations Workgroup Next Steps

• Complete the identification of existing EHR standards and widespread implementation feasibility and timing for the standards for all MU proposed measures– Includes cross-workgroup discussions

• Harmonization of workgroup recommendations for standards and widespread implementation feasibility of the standards– E.g. consistent standards applicable for different measures

• Develop Standards Committee recommendations based on workgroup recommendations