Public Health as Meaningful Use Criteria

HIT Policy Committee/Meaningful Use Workgroup
Focus on Public Health
Washington, DC July 29, 2010
“What effects public health agencies should expect on population health as we move toward meaningful use of certified EHRs?”

9:00 a.m. Call to Order/Roll Call – Judy Sparrow, Office of the National Coordinator
9:05 a.m. Meeting Objectives and Outcomes: Effect of EHR using Meaningful Use on Public Health Agencies & Their Various Populations
–George Hripcsak, Co-Chair, and
–Arthur Davidson, Denver Public Health

9:15 a.m. Panel 1: Achieving population health through meaningful use: How do governmental public health agencies view the process to date?
Moderator: Art Davidson
Peter Briss, Centers for Disease Control & Prevention
Guthrie Birkhead, New York State Department of Health
Seth Foldy, Wisconsin State Health Officer
Marcus Cheatham, Ingham County Health Department, Michigan
Perry Smith, Council of State and Territorial Epidemiologists

10:45 a.m. Panel 2: Experiences and current status of MU-like projects: How do governmental public health agencies use MU-like criteria or measures to achieve population health?
Moderator: James Figge
Nedra Garrett, Centers for Disease Control & Prevention
Amanda Parsons, New York City Department of Health
Virginia Caine, Marion County Health Department, Indiana
Amy Zimmerman, Rhode Island Health Department
Steven Hinrichs, Nebraska Health Department

12:15 p.m. LUNCH BREAK
1:15 p.m. Panel 3: Potential areas for HIT Policy Committee consideration: Where should the committee focus its attention to support MU measures and criteria that complement the public health mission?
Moderator: Laura Conn
Eileen Storey, National Institute for Occupational Safety & Health
David Ross, Public Health Informatics Institute
James Buehler, Centers for Disease Control & Prevention
Martin LaVenture, Minnesota Office for Health Information Technology
R. Gibson Parrish
Don Detmer

2:45 p.m. Workgroup Discussion
3:15 p.m. Public Comment
3:30 p.m. Adjourn

Instructions and Questions for Panelists
Background Testimony from this hearing will help the Meaningful Workgroup formulate recommendations to the HIT Policy Committee and National Coordinator on what effects public health agencies might expect on population health as the nation moves toward meaningful use (MU) of certified EHRs.

Format of Presentation: The Workgroup respectfully requests that panelists limit their prepared remarks to 5-7 minutes. This will allow the Workgroup to ask questions of the panelists and allow every presenter time to present his or her remarks. We have found that this creates a conversation for a full understanding of the issue. You may submit as much detailed written testimony as you would like, and the Workgroup members will have reviewed this material in detail before the hearing. PowerPoints will not be needed.

Pre-Presentation Questions/Themes: The questions below represent areas the Workgroup intends to explore at the hearing. Please feel free to use them in preparing your oral and written testimony; the Workgroup recognizes that certain questions may not apply to all presenters.

Hearing on: “What effects public health agencies should expect on population health as we move toward meaningful use of certified EHRs”

As providers across the country begin to meaningfully use health information technology to improve health care, we acknowledge the need to pay attention to achieving population health through meaningful use from the viewpoint of governmental public health agencies. Governmental public health organizations have authority over their respective jurisdictions — an authority which comes with a responsibility to convene and collaborate and contribute to societal responsibility through enhanced public health capacity. Public health agencies will be affected by rapid information flows promoted by the adoption of certified EHR products.

By panel, the speakers have been asked to address the following questions in their testimony:

Panel 1: Achieving population health through meaningful use: How do governmental public health (PH) agencies view the process to date?

What are the current electronic data systems, are they interoperable and do they connect to any EHRs for mandated electronic reporting? From your unique jurisdictional view, does your PH agency have the capacity to use the 3 types of data to be sent under Stage 1 meaningful use (MU) criteria in a way that impacts population health? What do you perceive as barriers to MU of PH data and information to achieve desired population health outcomes? How are governmental public health agencies planning to leverage increasing access to community HIT assets (e.g., EHR data, chronic disease registries and MU criteria) or other ONC efforts (e.g., HIE, REC, NHIN, Beacon, SHARP) to support improved population and public health outcomes? Based on your experience, how is PH working toward a more integrated, enterprise approach to data and information sharing and interoperable infrastructure promoted through MU criteria and measures to support improved population health outcomes?

Panel 2: Experiences and current status of MU-like projects: How do governmental public health agencies use MU-like criteria or measures to achieve population health?

What MU-like data and public health applications and/or public health-EHR projects have you developed in your jurisdiction? How do they impact on public health surveillance, care coordination or other essential public health services? How might the results of your public health-EHR project inform and be learning opportunities for: 1) other public health jurisdictions, 2) HIT policy development, 3) evaluation of Stage 1 MU criteria, and 4) considerations for Stages 2 and 3 MU criteria? What are your next priorities for the described public health-EHR project? What should be logical next steps for MU criteria development?

Panel 3: Potential areas where the HIT Policy Committee consideration: Where should the committee focus its attention to support MU measure and criteria that complement the public health mission?

What policy, legal and/or technical issues do you perceive as barriers to getting to improved population health outcomes? Are there any specific approaches to data standards, aggregation and/or infrastructure that would help achieve better population health outcomes? How should PH contribute to the concept of a learning health system? What future state might we envision as public health agencies gain access to population health information to drive improved health outcomes?

Conceptual Comments as Background Document

The focus of this testimony revolves around 2 primary questions:
1. What population health effects should public health agencies expect as the nation moves toward meaningful use (MU) of certified EHRs?
2. How can governmental public health agencies leverage these MU efforts and investments and the goals of a learning health system to improve population health?

The HIT Strategic Framework document makes reference to population health in numerous places. A foot-note defines population health as:
“Population health includes quality improvement, biomedical research, and routine and emergency public health preparedness and response.”

The scope of this session is not as broad as this foot-note. At another date, some issues (e.g., biomedical research) may be dealt with by the Meaningful Use Workgroup or the HIT Policy Committee. Today’s focus will be on the phrases “quality improvement … and routine and emergency public health preparedness and response”. Certainly some discussion may touch on other pieces of this Framework definition but we seek to limit the scope.

To provide some guidelines to our invited testifiers, the Workgroup attempted to give more clarity to the meaning of population health. Admittedly imperfect, each panelist was provided the following definitions to assure a consistent context for discussion:

Population health: a conceptual approach to measure the aggregate health of a community or jurisdictional region with a collective goal of improving those measurements and reducing health inequities among population groups. Stepping beyond the individual-level focus of mainstream medicine, population health acknowledges and addresses a broad range of social determinant factors that impact population health. Emphasizing environment, social structure, and resource distribution, population health is less focused on the relatively minor impact that medicine and healthcare have on improving health overall.

Governmental public health: a core infrastructural entity that organizes an extended community (i.e., health care delivery system, schools, social services, academia, and legislative/regulatory and justice systems) to improve population health

Others have differing opinions about the meaning, required infrastructure, and target population(s) when discussing population health. The following table provides some examples of how varying responsibility perspectives may define the targeted population. The primary focus of this session is the shaded governmental line. Since governmental public health is defined as the core of an extended community infrastructure, many public health actions will both contribute to and/or leverage responsibilites described on other lines.

Population Health Approached by Responsibility Perspective.
This hearing focuses on the Government Responsibility line.

Population Health Approaches by Responsibility Perspective (this hearing will primarily focus on the shaded line) Responsibility	By whom	Target Population	Description	Examples
Societal	Broad public-private coalition	Everyone	Resource distribution, environmental, and social determinant factors affecting the population’s within a community	Societal responses to: 1) obesity, 2) an oil spill, or 3) general health disparities
Governmental	Local, state, federal, and WHO	Everyone	Public health agencies that focus on the entire population	Targeted efforts to immunize against H1N1. Identifying and controlling an outbreak of E coli Post marketing surveillance and management of rosiglitazone adverse events
Accountable Care Organization (ACO)	Hospital, primary care physicians, specialists and other medical professionals in a medical referral region.	ACO member’s patients	Services provided under fee-for-service, but organization’s members coordinate care for shared patients with the goal of meeting and improving on quality benchmarks.	Joint care accountability and shared cost savings from quality and efficiency gains for patient outcomes
Health care organization (HCO)	Quality coordinators, providers and ancillary staff	HCO patients	Quality improvement efforts within the HCO, focused on the HCO population	Care quality and efficiency and patient cared for in a specific HCO
Case Management	Insurer	Insured patients	Population selected for complexity, cost of care and desire to improve outcomes and reduce overall expenses	Patients with diabetes and cardiac co-morbidities who may be offered specific in-home services

MU measures and criteria present an opportunity to integrate efforts across the table rows, creating a more societal perspective. The same population may be represented on multiple rows, suggesting a potential for coordination. The HIT Strategic Framework provides a rationale for that coordination. That document is included in your packet to guide development of your testimony.

Governmental public health organizations invited to testify today have authority over their respective jurisdictions. That authority comes with a responsibility to convene, collaborate and contribute to the societal responsibility described in the table, by enhancing public health capacity. Speaking with and on behalf of the spectrum of health and health care system participants in their jurisdiction is a governmental role. Governmental public health agencies and their various populations (or population perspectives) will be affected by rapid information flows promoted by adoption and meaningful use of certified EHR products. The front line public health practitioners who participated in the planning of these sessions and those invited to testify will hopefully provide a vision of an learning health care system that optimizes knowledge generation throughout the interoperable system described in the strategic framework.

Documents
Agenda [PDF 288 KB]

Conceptual Comments as Background [PDF 39 KB]

Panel 1

Panel 2

Panel 3

e-Healthcare Marketing

Health Information Exchange, Electronic Health Records and Personal Health Records

Public Health as Meaningful Use Criteria

Conceptual Comments as Background Document

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