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
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