Clinical Decision Support
Technical Expert Panel Meeting

June 26, 2009

8:00 AM to 3:00 PM ET

Facilitator: Eta Berner

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Agenda
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• 8:00 am to 8:30 am Continental Breakfast

• 8:30 am to 9:30 am TEP Feedback on Status Reports

• 9:30 am to 11:15 am Contractor Challenges and Questions for the TEP

  • 9:30 am – 10:15 am GLIDES

  • 10:15 am to 10:30 am Break

  • 10:30 am – 11:15 am CDSC
    

• 11:15 am to 12:00 pm American Recovery and Reinvestment Act of 2009 (ARRA)

• 12:00 pm to 1:00 pm Lunch

• 1:00 pm to 1:30 pm ARRA and CDS discussion, continued

• 1:30 pm to 2:30 pm CDS Contracts’ Option Years

• 2:30 pm to 3:00 pm TEP Closing Discussion and Next Steps

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TEP Feedback on Contractors’
Status Reports

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GLIDES Accomplishments

• Asthma Smartform design completed for Nemours Specialty Centers. Training in progress.
  

• Obesity prevention Smartform design completed for Nemours Primary Care. Training in progress.
  

• Obesity Prevention CDS design completed at Yale Primary Care. Rollout underway.
  

• Manual chart reviews of discrepancies between Yale pulmonologists and CDS. Interviews with pulmonologists completed and qualitative analysis underway. PRA submitted.

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GLIDES Project Timeline

Pre-Implementation

5

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CDSC Accomplishments

• KM Lifecycle Assessment

  • Completed all site visit reports…beginning in-depth analysis

  • Creating webinars of best practices from each site

• Knowledge Translation and Specification

  • Completed encoding content into semi structured and structured levels for all 3 content areas

• KM Portal

  • Completed functional specification

• Vendor Generalization/CCHIT

  • Submitted recommendations to AHRQ for the CCHIT, HITSP, and Health IT vendors

  • completed paper on CDS capabilities of Health IT vendors

• CDS Services

  • Initiated CCD factory, continuing with development of rules service

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CDSC Accomplishments cont.

• CDS Demonstrations

  • Met with LMR team to answer questions about PHS demonstration

  • Completed gap analysis

• CDS Dashboards

  • Completed generic specs for CAD, DM, HTN measures

  • Met with designer to work on dashboard prototype design

• Evaluation

  • Created detailed evaluation protocol

• Content Governance Committee

  • Collected actionable DM rules from all sites

  • Analyzing the KM Process and Tools assessment, which was given to all sites

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Contractors’ Challenges and Questions for the TEP

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GLIDES Questions for TEP

• What is realistic and feasible in terms of encouraging common governance, attitudes and approaches to CDS implementation across the country?

• What is the optimal way to categorize, document and disseminate CDS implementation best practices across the guideline implementation community?

• What is realistic and feasible in terms of expecting a more consistent outlook to CDS among the varied user community at an academic institution?

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CDSC Questions for TEP

Evaluation

• Besides classic evaluation rates (e.g., override, acceptance, and firing rates) and quality metrics (e.g., the percentage of patients without recorded HgA1c), what other kinds of measures should be used to evaluate our CDS?

• What overarching CDSC measures should we consider in the scope of this project?

Rules

• What should we collect in regards to compiling “top” actionable decision support rules for the Content Governance Committee efforts? 

Dissemination

• What are our alternative dissemination channels, as we lost Masspro, our dissemination partner?

• Do you have input/guidance/pointers of other knowledge sharing/research collaboration agreements that might be useful.

• Are there research programs that could use CDSC/GLIDES results to continue our work on the standards?

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American Recovery and Reinvestment Act of 2009

Jonathan White, MD

Director, Health IT

June 26, 2009

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ARRA HITECH Provisions

• Subtitle A: Promotion of Health IT

• Subtitle B: Testing of Health IT

• Subtitle C: Grants and Loans Funding

• Subtitle D: Privacy

• Title IV: Medicare and Medicaid Incentives

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Subtitle A: Promotion of Health IT

• Definitions
  

  • “Qualified Electronic Health Record—The term ‘qualified electronic health record’ means an electronic record of health-related information on an individual that—
    

    • “includes patient demographic and clinical health information, such as medical history and problem lists; and
      

    • “has the capacity—
      

      • “to provide clinical decision support;

      • “to support physician order entry;

      • “to capture and query information relevant to health care quality; and

      • “to exchange electronic health information with, and integrate such information from other sources.”

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Subtitle A: Promotion of Health IT

• ONC

• HIT Policy Committee

• HIT Standards Committee

• Adoption of recommendations and standards

• Application of standards by Federal agencies and the private sector

• Federal health IT

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Subtitle B: Testing of Health IT

• NIST Testing of standards

• Research and Development Programs

  • IHCIE Research Centers

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Subtitle C: Grants and Loans Funding

• Immediate infrastructure funding

• Health IT Extension Program

  • Health IT Research Center

  • Health IT Regional Extension Centers

• State Grants to Promote Health IT

• Grants to develop loan programs

• Education Programs

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Subtitle D: Privacy

• Application of security and privacy provisions and penalties to business associates

• Notification of breach

• Education on health information privacy

• Restrictions on and accounting for disclosure

• Improved enforcement

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Title IV: Medicare and Medicaid Incentives

• Incentives for professionals and hospitals (and penalties eventually)

• Meaningful use

  • Meaningful Use of Certified EHR Technology (which shall include E-prescribing)

  • Information Exchange

  • Reporting on measures

• Begins 2011; penalties start 2015

• NCVHS Hearing (see separate slide deck)

• Health IT Policy Council

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Discussion

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Closing and Next Steps

Upcoming Meetings:

• August 19th Teleconference (3 to 5 PM ET)

• October 21st In-Person Meeting (location TBD)