Meaningful Use, Standards and

Certification Under HITECH—Implications

for Public Health InfoLinks Community of Practice January 14, 2010Bill Brand, MPH, CPHIE

Overview

• Vision and goals for ARRA/HITECH

• Key provisions of the proposed rules for Meaningful Use– Implications for public health

• Key provisions for establishing EHR standards and certification process• Implications for public health

• Discussion

HITECH Vision

To improve the health of Americans and the performance of the nation’s health system through health information technology (HIT).

•An important component of health reform

•Harness the full potential of digital technology to prevent and treat illnesses and to improve health.

HITECH Goals

• Improve quality, safety, efficiency, and reduce health disparities

• Engage patients and families

• Improve care coordination

• Ensure adequate privacy & security protections for personal health information

• Improve population and public health

ONC Activiites• Definition of ‘Meaningful Use’ and Setting

Standards for Electronic Health Record Incentive

• $60M Program to Fund Strategic Health IT Advanced Research Projects

• Health IT "Beacon Communities" • $80 Million Available to Support Health IT

Workforce• www.healthit.hhs.gov

D. Blumenthal, ONC, 12/09

D. Blumenthal, ONC, 12/09

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A FRAMEWORK FOR IT ADOPTION IS EMERGING: AN EXAMPLE STATE

NPRM for Meaningful Use • “Medicare and Medicaid EHR Incentive

Program”• Specifies how meaningful use is defined,

what providers have to do to “prove” MU, and how incentive payments will be applied

• Available through both Medicare and Medicaid programs

• 60 day comment period from Jan. 13

Overall Requirements

• Use of certified EHR technology in a meaningful manner; e.g., eRx

• Certified EHRs connected for HIE to improve quality of care

• Quality and other measures reported to HHS

Staged Implementation: Stage 1 • Electronic capture of health information in a

coded format• Tracking key clinical conditions and

communicating outcomes for care coordination

• Implementing clinical decision support tools to facilitate medication and disease management

• Reporting for public health purposes.

Staged Implementation • Stage 2: Builds on stage 1; computerized

provider order entry; electronic transmission of diagnostic test results; research

• Stage 3: Builds on stage 2; promotes improvements in quality and safety; patient access and involvement; improved population health data

Pathway to ARRA Incentives

CCHIT-certified or new certifying bodies yet to be named

Stage 1: 25 measures; 17 require only attestation

In either Medicaid or Medicare program

Implications for public health• Assess and ensure readiness in 3 areas:

– For 2011, IIS, ELS and syndromic surveillance– Both testing capability of systems to report (and actual

submissions of immunization data where required and accepted)

• Increase capacity for data management and analysis

• Coordination across programs, state HIT coordinator, state HIE plan, Medicaid, enterprise architecture plan, etc.

STANDARDS AND CERTIFICATION

Purposes of IFR

• Criteria for certifying EHR technologies– Applies to vendors

• Standards to be used in achieving Meaningful Use objectives

Standards

• Content– How to describe the ‘what’

• Vocabulary – Specific , unambiguous nomenclature

• Transmission– How the ‘what’ is sent

• Privacy and Security

Immunization Standards• Vocabulary: CVX codes

• Content: HL7 v2.3.1 or 2.5.1 (2011)

• Providers must perform at least one test of EHR capacity to send to the immunization registry (2011)

Surveillance Standards

• Vocabulary: Based on PH agency requirements; move to Geocoded Interoperable Population Summary Exchange (GIPSE) in 2013?

• Content: HL7 v2.3.1 or 2.5.1 (2011)

• Providers must perform at least one test of EHR capacity to send if the entity has the capacity (2011)

Many Other Standards of Interest • Structured lab data

• Demographics: race, preferred language, etc.

• BMI

• Smoking status

• Reduction of disparities

• Aggregate numerator and denominator quality data

Implications for Public Health

• Need to stay informed and incorporate e-health priorities into your thinking and vocabulary– Work within the e-health pressures and drivers for

your partners

• Align your efforts with the population health priorities – Participate in setting the priorities, the metrics

and in interpreting and communicating the results

Implications for Public Health

• Develop a workforce strategy– IT, informatics, HIE, data analytics– Work with academic institutions to define the

unique informatics needs of public health

• Contribute to a unified public health perspective and voice– Your associations, JPHIT, PHDSC – Work to align CDC and other funding with HITECH

priorities

Implications for Public Health

• Seek a certifying approach/entity for certification of public health information systems?– CCHIT modular certification around MU

requirements?– Broader PHIN requirements?

Summary• HITECH presents an unprecedented

opportunity for public health agencies to partner with healthcare around HIE and population health improvement– Funding, policy and regulations are aligned– Private and public sector buy-in

• Expectations for public health capabilities around HIE will increase.

• Your participation matters!!

Discussion

Bill Brand: bbrand@phii.org

ONC: www.healthit.hhs.gov

HIMSS: ww.himss.org/EconomicStimulus/