Meeting Name
Location:
Meeting Date and Time:
Next Meeting Scheduled:
LCC Pilots WG Meeting
Web / Conference Call
Monday, March 3, 2014 @ 11:00am ET
Monday, March 10, 2013 @ 11:00am ET
Agenda
 Welcome and Announcements
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FACA Updates
HIMSS Updates
Certification Criteria Updates
LTPAC Engagement Tool Presentation
Next Steps
Attendance
Name/Affiliation
Abhishek Khowala
Anita Yuskauskas
Annalisa Wilde
Atia Amin
Barbara Gage
Becky Angeles
Becky McClaren
Benjamin Flessner
Beth Halley
Brett Marquard
Catherine Payne
Cathy Walsh
Cheryl Irmiter
Chris Clark
Christol Green
Cindy Levy
David Nessim
Dawn Foster
Deb Castellanos
Diane Evans
Donna Doneski
Elaine Ayers
Elizabeth Amato
Ernest Grove
Elizabeth Serraino
Evelyn Gallego
Gayathri Jayawardena
Gordon Raup
Harrison Fox
Holly Miller
Holly Urban
Iona Thraen
Jack Kemery
Janel Welch
Jeffrey Levy
Jennie Harvell
Jennifer VanWinkle
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Email
akhowala@nyehealth.org
anita.yuskauskas@cms.hhs.gov
awilde@healthix.org
atia.amin@network-health.org
bgage@brookings.edu
rebecca.angeles@esacinc.com
bmcclaren@starmulticare.com
benjamin@epic.com
ehalley@mitre.org
brett@riverrockassociates.com
catherine.payne@erlanger.org
cwalsh@starmulticare.com
cirmiter@easterseals.com
chris.r.clark@wv.gov
christol.green@anthem.com
clevy@shapehitech.com
david.nessim@mckesson.com
dawn.foster@cerner.com
deb.castellanos@xerox.com
diane.evans@impact-advisors.com
donna@nasl.org
eayres@nih.gov
eamato@nyehealth.org
egrove@shapehitech.com
elizabeth.serraino@omnicare.com
evelyn.gallego@siframework.org
gayathri.jayawardena@esacinc.com
graup@datuit.com
hfox@ccitiny.org
hmiller@medallies.com
hurban@zynx.com
ithraen@utah.gov
jwelchrd@earthlink.net
jeff@careathand.com
Jennie.Harvell@hhs.gov
jennifer.vanwinkle@mckesson.com
Attended
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Name/Affiliation
Jim Younkin
Joanne Lynn
Kari Ballou
Kate Wetherby
Kathleen McGrow
Kathy Applin
Kelton Swartz
Kris Cyr
Kunal Agarwal
Larry Atkins
Larry Garber
Larry Seltzer
Laura Heerman Langford
Laurene Vamprine
Lee Unangst
Leigh Sterling
Lenel James
Les Morgan
Lester Keepper
Liora Alschuler
Lisa Peters-Beumer
Lorie Smith
Lynette Elliott
Marie Chesley
Mark Roche
Matthew Arnheiter
Michael Lardieri
Mina Rasis
Okaey Ukachukwu
Pam Russell
Pat Rioux
Paul Burnstein
Paul Lomayesva
Renee Tolliver
Rich Brennan
Rita Torkzadeh
Robert Drake
Robin Bronson
Rodolfo Alvarez del Castillo
Russ Leftwich
Scott Zacks
Stacy Mandl
Steve Stasiak
Su-Hsiu Wu
Sue Mitchell
Susan Campbell
Susan McKeever
Tara McMullen
Terry O’Malley
Tom Moore
Vincent Lewis
Wan Li
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Email
jryounkin@geisinger.edu
joanne.lynn@altarum.org
kballou@aorn.org
kathryn.wetherby@samhsa.hhs.gov
kmcgrow@umaryland.edu
kathy.applin@ahch.org
kelton.swartz@cerner.com
kristopher.cyr@accenture.com
kagarwal@ccitiny.org
latkins@ltqa.org
Lawrence.Garber@reliantmedicalgroup.org
lseltzer@ntst.com
laura.heerman@imail.org
laurene.vamprine@erlanger.org
unangstl@cc.nih.gov
lsterling@ethin.org
lenel.james@bcbsa.com
lesmorgan.gh@gmail.com
lkeepper@shapehitech.com
liora.alschuler@lantanagroup.com
lpeters@easterseals.com
lorie.smith@maine.gov
lynette.elliott@esacinc.com
marie.chesley@mckesson.com
mrochemd@gmail.com
marnheiter@ntst.com
mikel@thenationalcouncil.org
mrasis@nyehealth.org
okaey.ukachukwu@caradigm.com
prussell@corhio.org
p.rioux@elsevier.com
paul.burnstein@mdiachieve.com
paul.lomayesva@intersystems.com
rtolliver@mchs.com
rdb@nahc.org
ritork3@gmail.com
robert_drake@lcca.com
robin.bronson@allscripts.com
radcastillo@yeamanandassociates.com
russell@thecomio.com
scott.zacks@gmail.com
stella.mandl@cms.hhs.gov
sstasiak@chpnet.org
swu@ele.uri.edu
suemitchell@hotmail.com
Bostoncampbell@mindspring.com
smckeever@adsdatasystems.com
tara.mcmullen@cms.hhs.gov
tomalley@partners.org
tmoore@healthix.org
vincent.lewis@gsihealth.com
wli@ntst.com
Attended
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Name/Affiliation
Wen Dombrowski
Zabrina Gonzaga
Email
wen@vnahg.org
zabrina.gonzaga@lantanagroup.com
Attended
Yes
Discussion
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The meeting was introduced with a reminder for participants to join the LCC Work Group via the “Join the
Initiative” tab in the wiki and to complete the Pilot Survey on the LCC Pilots WG wiki page.
Meeting reminders were presented and included LCC WG, relevant HL7 WG meetings and meeting dates
and times.
Timelines and milestones were presented and Pilot Work Group Purpose and Goals were restated.
FACA Updates
 HITPC Quality Measures Workgroup
o The 2014 draft work plan for the first two quarters includes certification to support quality reporting
in LTPAC and BH settings.
 HITPC Certification and Adoption
o On Feb. 7th, the Workgroup had an in-depth discussion of the Behavioral Health EHR Certification
Draft Recommendations one at a time. Their objective was to determine which of the proposed
areas of certification are “key heath IT capability needed” in the Behavioral Health care setting.
o The sixth proposed key area was Clinical Quality Measures
o The group could not reach consensus on this topic, so ONC will ask the Quality Measures WG to
have a representative speak regarding opportunities for LTPAC and BH settings as they relate to
future work.
o The LTPAC/BH discussion was continued in the Feb. 14th meeting.
o The work group will finalize LTPAC/BH EHR certification recommendations by the next meeting.
HIMSS Updates
 Healthstory Vignette at Interoperability Showcase
o Liora will be presenting a demonstration of the SEE tool in an upcoming Pilots meeting (TBD)
o There was great interest in new care plan standards
 CMS ‘Improving Quality in Home and Community Based Services Populations’ (Education Session 123)
o Important because ONC has been working with CMS’s TEFT team to launch the new Electronic
Long Term Services and Supports initiative (eLTSS), for which program support will be provided by
this LCC support team
o Described Home and Community Based Services (HCBS) programs and importance of
standardizing client assessments across all HCBS programs
o Discussed status of CMS CARE project to develop standardized client assessment items
o Introduced upcoming new S&I Initiative: electronic Long-Term & Support Services
o Projected start date is Q2 2014
 ‘Nutrition Data in Care Coordination-Making an Impact’ (Education Session 197)
o Described IMPACT project and new revisions to C-CDA standard to include new nutrition templates
o Demonstrated key clinical scenarios where nutrition care is a critical element of the care plan
o This demonstration gave the opportunity to drill down into the different template levels and how a
CDA document is laid out.
o They just submitted a proposal for the AHIMA LTPAC Conference to demonstrate how to put
together not only the nutrition section but also the Care Plan document.
2015 EHR Certification Criteria Proposed Rule
 Released for public comment on Feb. 21 2014: http://www.gpo.gov/fdsys/pkg/FR-2014-02-26/pdf/201403959.pdf
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Voluntary certification program; not tied to MU3
Timeline provides ONC opportunity to shift regulatory approach to a more incremental and frequent
approach of publishing rules (every 12 to 18 months)
Proposed new capabilities, standards-based requirements and public comment solicitations on potential
future certification criteria included in this proposed rule will help inform ONC on what to consider for
inclusion for the 2017 Edition in support of MU3 (to be published by Fall 2014)
Public Comments due April 28, 2014 via www.regulations.gov
o 2015 Final rule to be published by Summer 2014
o 2017 NPRM to be published by Fall 2014
Highlights from this new proposed rule include the following:
o New certification criteria to support patient population filtering of clinical quality measures
o New and updated implementation specification for several certification criteria including ToC, CDS,
and Public Health reporting
o Policy revisions that changes certification approach for ToC
o Path for certification of ‘non-MU’ EHR technology
o Codifies ONC regulatory guidance provided in FAQ issued in 2014 Edition Final Rule
o Revision to 2014 Edition syndromic surveillance certification criterion
o Closer alignment with other HHS program policies(e.g. CLIA) and to address OIG
recommendations
o Discontinuation of ‘Complete EHR’ definition and issuance
o Solicit comment on new capabilities and standards-based requirements for potential future
certification criteria
This new proposed rule also incudes updates to the C-CDA Standard:
o Proposes the adoption of the updated CCDA standard (current in ballot) in 170.205(a): Patient
Summary Record to include the new sections & templates:
o New document templates: Care Plan; Referral Note; Transfer Summary
o New sections for: Goals; Health Concerns; Health Status Evaluation/ Outcomes; Mental Status;
Nutrition; Physical Findings of Skin
o Proposes reference use of new standard in proposed 2015 Edition ToC Certification criterion as
well as three other certification criteria: VDT, Clinical Summary and Data Portability
o Proposes EHR technology must be capable of including the UDI for patient’s implantable device(s)
as data within a CCDA formatted document
Discussion ensued to determine the best course of action to disseminate this information. General
consensus agreed on multiple avenues:
o AHIMA presentations
o Email distribution
o Repurpose LCC All Hands WG meeting time slot for presentations
o Ask CMMI to leverage the use of the new standard
o Mass media through community members or private parties (someone other than government)
o Consumer advocates
o AARP newsletters
o National Partnership for Women and Families
o N3C (National Care Coordination Coalition)—Robin Golden
o Additional feedback and suggestions can be submitted to Evelyn or Lynette via email
Presentation: An Outreach and Educational Campaign on Electronic Health Information Exchange for
Persons Receiving Long-Term/Post-Acute Care Services Proposed Next Steps (Jennie Harvell)
 The presentation began with the agenda as follows:
o Brief overview of Need for HIE with and by LTPAC
o Barriers to HIE by LTPAC
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o Draft HIE Curriculum for LTPAC Providers and Methods of Delivery and Evaluation
o Discussion: HIE education/support provided and/or needed in Pilot Sites
Overview of Need
o Health Information Exchange (HIE) with and by LTPAC and BH providers is necessary to support
transitions of care (ToC) and instances of shared care.
o Experts in ToC identify “improving information flow and exchange” as the most important tool to
improve care transitions.
o Interoperable HIE has the potential to empower individuals and increase transparency; enhance
the ability of health care providers, payers, and regulators to study care delivery and payment
systems; and achieve improvements in care, efficiency, and population health.
o Health Information Exchange at times of ToC and during shared care is often incomplete and
impacts quality, safety, and costs of care:
 Significant percentage of adverse drug events (ADEs) occur at times of ToC and resulting
in hospital readmissions and billions in unnecessary costs.
 Information is often missing when:
 multiple physicians treat patients following a hospital discharge, and
 the patient is sent to the Emergency Department.
o Health information exchange is expected to:
 improve communication;
 reduce medication errors and adverse drug events, unnecessary and redundant
tests/procedures, avoidable hospitalizations and emergency room visits; and
 reduce health care costs.
Barriers to HIE with and by LTPAC
o While some LTPAC providers use health IT and EHRs, their use lags behind that of physicians and
acute care hospitals, and use of HIE is even less common.
 Approximately 43% of nursing homes (NHs) and home health agencies (HHAs) are
reported to have some type of EHR. Resnick et al 2009 (for NHs) and 2010 (for HHAs).
 Only 6% of long-term acute care hospitals, 4% of rehabilitation hospitals, and 2% of
psychiatric hospitals have a basic EHR system.
o EHRs (without HIE capabilities) are estimated to cost less than 1% of revenues for for-profit midsize NH chain providers and HIE costs have declined significantly.
o There is widespread recognition (by providers and State and Federal officials) that many LTPAC
providers lack important information about HIT/EHRs and HIE, and that this a key barrier to their
participation in HIE.
o Premise: Providing education/information about HIT/EHRs/HIE to LTPAC providers will accelerate
their engagement in HIE.
Proposal: Pilot an HIE Curriculum focusing on Exchange with LTPAC
o There is very little funding available at this time for this type of project so this is only a proposed
idea.
o Pilot an outreach and education campaign that focuses on HIE between LTPAC providers and
others.
o The curriculum would target:
 LTPAC providers (i.e., NHs, long-term care hospitals, in-patient rehabilitation facilities,
HHAs, and home and community based providers); and
 their health information trading partners (e.g., physicians, hospitals, State Health
Information Exchange Organizations, Medicaid programs, etc.).
o The curriculum would be piloted using different delivery methods:
 Webex
 National Conference Presentations
 Local Face-to-Face Presentations/Small Conferences
o
o
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The curriculum would include the following topics from the following perspectives:
 Federal perspective: includes information on: benefits of HIE, HIT/EHR adoption and use in
LTPAC, business drivers for HIE, activities for accelerating HIE (e.g., incentives, program
requirements, HIT standards, EHR certification, and costs).
 Local LTPAC Provider Perspective: includes information on: considerations/lessons learned
during HIT/EHR planning, acquisition, and implementation (e.g., considerations and impact
on work force, work flow, costs/benefits, and barriers/stumbling blocks and solutions (if
any)).
 State Perspectives: includes information on: HIE activities the State has implemented/will
implement that involve LTPAC providers and the type of information exchanged, technology
used and methods for obtaining/accessing the technology, technology/exchange costs to
the LTPAC provider, issues encountered in implementing the HIE activity and their
resolution, and how the LTPAC provider can learn more.
Delivery Method and Evaluation
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Discussion and Feedback
o Do you agree with the premise that providing information about HIT/EHRs/HIE will accelerate
provider participation in HIE activities?
o Have Pilot sites identified the need for education on HIT/HIE among program participants? If so, for
which participants?
o What types of education/information have pilot participants needed?
o What methods have been used to deliver needed information to pilot participants?
o Have pilot sites targeted their education efforts to certain types of pilot participants?
o How do/could pilot sites assessed the effectiveness of their educational efforts?
o What resources have been/could be leveraged to support the delivery of needed
education/information to pilot participants?
o
o
o
o
o
o
o
o
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Comment: If you want to drive across town now you need a car that works and a driver, and this
education is clearly to find drivers. My gut feeling is that the cars—the EHRs—could be better.
This may involve the need to push vendors to improve their products so they can support CDA
documents and health information exchange.
Comment: I’m concerned about the security of this information and the concern from the
physicians is that they are stewards of their patients’ information. Once they hand it off to HIEs
there’s an interest to coordinate to make sure the information is reliable and secure. I don’t hear
much about this. The advocacy has to be from both the clinical and patient perspectives.
Comment: There are three pillars required in order to have successful exchange: 1) it has to be
useful, 2) it has to be usable and 3) it has to be trustworthy. Your point is absolutely true. If we
don’t properly communicate that it’s secure, we haven’t built the trust.
 Response: It sounds like this is a two part thing. Not only making sure the technology
being used has the ability to maintain that level of security and that that is communicated to
the patient, but also how secure the information is across various trading partners.
 Response: That last part is crucial when we’re talking about long term services and
supports, because it involves multiple trading partners. Right now we’re hearing from
physicians that they don’t even know the capacity of community agencies. If that’s
happening at the practice level when it comes to EHRs, that has to be part of the discussion
as well.
Comment: This process is going to be far more incremental than getting to a full-blown electronic
exchange. We could focus on helping trading partners identify their high value exchange and let
them work on figuring out those using a common menu we could come up with for requesting
services, acknowledging requests…a whole series of handshakes we could start each individual
site doing on paper (based on the CDA) and let that be the first step.
Question posed: For the people on this call, how have you approached education for standing up
your pilots?
 Response: For IMPACT we did learning collaboratives and discussed problems and
change management to help develop trust. It was cross-community. We basically took a
chunk out of our health care community looking for organizations doing high volume
referrals to each other to talk about problems with transitions of care and coordinating care.
We had everyone talk about their challenges and how hard it is to pull information together.
We tried to have others understand what it was like on the other side, which helped build
trust and prove a need for the ability to exchange information and improve the usability of
the information.
Question posed: Were there issues of downstream security of information?
 Response: It was a very small part of the conversation. There was more concern with the
nursing facilities because they had less experience with protecting PHI. There was a bigger
trust issue around whether it’s possible for someone to steal the data to try to steal patients.
Comment: There’s a possibility of increasing the salience of a threat of a set of common
malpractice claims when we screw up the care of patients. The rate of errors in transitions and
care planning generally is astonishing. If we don’t start getting systems that really work, we leave
ourselves open to that sort of threat. Not only does it need to be trustworthy but also if you don’t do
it, you’re going to get nailed. There’s a possibility that CMS could start wiggling some of these
things into participation surveys, quality measures and so forth. Think of the impact if you could put
on Nursing Home Compare if they have the ability to reliably exchange care plan with more than
half their trading partners or more than half of their residents or clients for home health. It could
drive the entire industry to conform.
Response: Last year in the Medicare Physician Fee Schedule, there was a framework included in
that Physician Fee Schedule Rule about care coordination, including care plans. For folks who
didn’t have a chance to see that rule, I would go back to look at it and think about that framework
and trying to leverage different kinds of rulemaking opportunities this way.
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An announcement will be distributed to the LCC Community regarding a high level summary of the new
rule. Additional content for that announcement can be sent to Evelyn.
Next Steps
 Homework Assignments:
o Complete Pilot Survey
o Sign up as and LCC Committed Member
o Submit Pilot Documentation Proposals
 Available on the LCC Pilot WG wiki: http://wiki.siframework.org/LCC+Pilots+WG
 Email to Lynette Elliott (lynette.elliott@esacinc.com)
 The next meeting will be held Monday, March 10th at 11am ET.
Action Items
Name
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Task
Due Date