A Leading Provider of Consulting and Systems Engineering

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A Leading Provider of Consulting and Systems Engineering Services to Public Health Organizations August

A Leading Provider of Consulting and Systems Engineering Services to Public Health Organizations August 10, 2011

OFFICE OF THE NATIONAL COORDINATOR Why it matters to the Credentialing Industry www. healthit.

OFFICE OF THE NATIONAL COORDINATOR Why it matters to the Credentialing Industry www. healthit. gov National Credentialing Forum February 2015

ONC Initiatives & Credentialing. EHR Certification & Meaningful Use • e. CQMs and the

ONC Initiatives & Credentialing. EHR Certification & Meaningful Use • e. CQMs and the privileging/re-privileging process Nationwide Interoperability Roadmap • Healthcare Directories- access and permissions to personal health information (PHI) • CMS & private payers pay for interoperability

EHR Certification Meaningful Use & Clinical Privileging & Re-privileging Strategies – 75% of physicians’

EHR Certification Meaningful Use & Clinical Privileging & Re-privileging Strategies – 75% of physicians’ offices and 90% of hospitals have certified EHRs – Electronic Clinical Quality Measures (e. CQMs) is emerging as a primary way for Eligible Professionals (EPs) and Eligible Hospitals (EHs) to report CMS-required quality/performance data – Align Privileging and re-privileging processes with Payers’ pay-for-performance approachincorporate e. CQM data in privileging

2014 Clinical Quality Measures (CQMs) • Eligible Professionals (EPs) are required to report 9

2014 Clinical Quality Measures (CQMs) • Eligible Professionals (EPs) are required to report 9 out of 64 measures – • Eligible Hospitals (EHs) are required to report 16 out of 29 measures – • http: //www. cms. gov/Regulations-and. Guidance/Legislation/EHRIncentive. Programs/Downloads/CQM 2014_Guide. EP. pdf http: //www. cms. gov/Regulations-and. Guidance/Legislation/EHRIncentive. Programs/Downloads/CQM 2014_Guide. EH. pdf For both EPs and EHs, the quality measures selected must cover at least 3 of the 6 available National Quality Strategy (NQS) domains: 1. Patient and Family Engagement 2. Patient Safety 3. Care Coordination 4. Population/Public Health 5. Efficient Use of Healthcare Resources 6. Clinical Process/Effectiveness http: //www. cms. gov/Regulations-and-Guidance/Legislation/EHRIncentive. Programs/2014_Clinical. Quality. Measures. html

Nationwide Interoperability Roadmap • ONC is leading the development of a 10 -year shared

Nationwide Interoperability Roadmap • ONC is leading the development of a 10 -year shared nationwide interoperability roadmap • Who should do what by when in order for the U. S. to achieve full interoperability of health information exchange • Unprecedented collaboration is necessary • All stakeholders should be able to see their responsibilities in the roadmap

Roadmap Vision & Building Blocks. 2021 2017 Providers and individuals send, receive, find, use

Roadmap Vision & Building Blocks. 2021 2017 Providers and individuals send, receive, find, use a basic set of essential health information Granular information access Expanded sources and users of information Improved quality and reduced cost Increased (and scalable) automation 2025 Longitudinal information Ubiquitous precision medicine Reduced time from evidence to practice Virtuous learning cycle (learning health system) Core technical standards and functions Certification to support adoption and optimization of health IT products & services Privacy and security protections for health information Supportive business, clinical, cultural, and regulatory environments Rules of engagement and governance

Health IT Ecosytem as the Learning Health System.

Health IT Ecosytem as the Learning Health System.

Learning Health System Requirements. A. Share governance of policy and standards… • • •

Learning Health System Requirements. A. Share governance of policy and standards… • • • x x x M. Accurate identity matching…. . , including provider identities, system identities…. N. Reliable resource location: The ability to rapidly locate resources, including individuals, APIs, networks, etc. by their current or historical names….

Healthcare Directories. • Used by Health Information Exchanges (HIEs) • Directories now vary but

Healthcare Directories. • Used by Health Information Exchanges (HIEs) • Directories now vary but will include practitioners, providers, payers, administrators • CMS NPPES is modernizing and will link NPIs to Healthcare Directories • Integrating the Healthcare Enterprise (IHE) has the technical framework by which CMS and the Interoperability Roadmap will establish standards for Healthcare Provider Directories (HPD) – http: //www. ihe. net/uploaded. Files/Documents/ITI/IHE_ITI_Suppl_HPD. pdf

Interoperability Roadmap Appendix A: Background Information on Policy Levers. Interoperability Requirements for Credentialing Much

Interoperability Roadmap Appendix A: Background Information on Policy Levers. Interoperability Requirements for Credentialing Much in the same way that public payers could eventually include interoperability as part of the basic standard of care delivered by providers paid under public programs, commercial payers can also explore adding health IT and interoperability requirements to the factors included as part of credentialing processes for providers in their networks. If information regarding health IT capabilities were included as a standard component of credentialing information, payers could determine how to give preference to these attributes when identifying their networks.

Overview of Roadmap Process & Timeline Initial roadmap development Oct 2014 • Online community

Overview of Roadmap Process & Timeline Initial roadmap development Oct 2014 • Online community forum • Listening sessions • Experts convened • Federal workgroups • State engagement • FACA workgroups and joint meeting FACA review and recommendations Jan 2015 • HITPC interoperability and HIE workgroup recommendations including governance subgroup, and JASON task force • Governance and business environment reports • Additional community input Roadmap for public comment Mar 2015 • Update based on public input • FACA review Nationwide interoperability roadmap version 1. 0 12

ONC Public Comment Period. Nationwide Interoperability Roadmap • http: //www. healthit. gov/policy-researchersimplementers/interoperability – Public

ONC Public Comment Period. Nationwide Interoperability Roadmap • http: //www. healthit. gov/policy-researchersimplementers/interoperability – Public comments due April 3, 2015 Interoperability Standards Advisory • http: //www. healthit. gov/standards-advisory – Public comments due May 1, 2014