ToC+-+Success+Metrics+Meeting+Minutes+08-02-2011

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**Meeting**: ToC Success Metrics Meeting 6

 * **Topic** || **Owner** || **Time Allotted** ||
 * Update of Current Status || Amy Berk || 3:00-3:10 ||
 * Review of the Stakeholders for ToC Success Metrics || Dr. Miller || 3:10-3:35 ||
 * Discussion of Feasibility of Metrics || Dr. Miller || 3:35-3:55 ||
 * Next Steps || Dr. Miller || 3:55 4:00 ||
 * Adjourn ||  || 4:00 ||

Attendees:
__Workgroup Attendees:__ Emily Mitchell, Teresa Mota, Susan Campbell, J. Michael Fitzmaurice, Dave Shevlin, Allen Hobbs, Andriy Selivonenko, Chris Andreou

__Panelist Attendees:__ Dr. Miller, Dr. Leftwich, Amy Berk, Smriti Singal, Brandy Hays

Action Items:

 * Date || Description || Status || Notes ||
 * 08/09/11 || Create Glossary for Metrics || In Progress || Dr. Leftwich & Dr. Nezda ||
 * 08/09/11 || Attend ToC Success Metrics Workgroup || In Progress || All SWG members to attend ||
 * 08/09/11 || Continue Walkthrough of Metrics; Nail down the definition, aspect, numerator, denominator of each metric || In Progress || Dr. Leftwich to lead in Holly’s absence ||

ToC Success Metrics Spreadsheet Discussion:

 * __General Topic:__**
 * Dr. Miller will be out on vacation until August 23, 2011; Dr. Leftwich will be replacing her in her absence
 * __Inclusion of Stakeholders:__**
 * Stakeholders need to be taken into consideration for the success metrics for which they would apply to;
 * HISP; Health Information Service Providers ---The clinician makes the package; and the box and the tape are the patient data; and the HISP sends the package to one clinician to another clinician or from the patient to the HER
 * EHR vendors
 * PHR vendors
 * Clinicians
 * Patients
 * Demonstrate in the table which stakeholders the metrics apply to so we would be able to measure it; have included all of the stakeholders going across the top; indicated with an “x” in the box whether that metric would apply to that stakeholder.


 * __Review of Adoption Category:__**
 * Various stakeholders applied to the adoption metrics; refer to the spreadsheet
 * HISP involved in Stage I; and for Stage II MU; point to point exchange, HISP would be involved
 * EHR for Stage I; they would have portals or tethered health records, they would be involved there; ability through direct to upload discreet data; point to point, her to her to a tethered PHR very readily
 * The message could go from the EHR to PHR
 * The EHRs and the PHRs will readily be able to report how many instances of message exchange they are responsible for; these metrics would be highly reportable
 * For Stage II MU measures; the ability to transfer the core data elements; HISP responsibility for delivery; eHR has to send core data elements across the system and then the other eHR receives the data
 * Agreement on measures
 * Is there a metrics that says we need the data elements needed to compute the performance measures? Whether fully specified by the government? Up to us in terms of the work we do for this committee ---what the numerator is, denominator.
 * Action Item: What the specification for the measure is complete; add column; Complete Y/N DONE
 * Only talking about Core Data Elements for Stage II
 * Other adoption uptake metrics;
 * Provider Directory; only applies to the HISP
 * Provider Directory Query Protocols; only applies to the HISP
 * Certificates; HISP and Clinical Organizations (issuance of certificates)
 * Clinical Data Model; have talked about interoperability and the CIM that has been worked on for the ONC; there would be uptake by the EHR and PHR vendors
 * How many EHR vendors have included the CIM?
 * How many PHR vendors have included the CIM?
 * The ability to transfer the core data elements; have the EHR/PHR vendor included this functionality? Yes/no?
 * The ability to transfer variable data elements; have the EHR/PHR vendor included this functionality? Yes/no?
 * Are the care providers doing ToC LIVE in a test system; involves all of the stakeholders?
 * Are the care providers doing ToC LIVE in a Production system; involves all of the stakeholders?
 * The measurement would stop; we would stop the measuring in 2014; as updated or adopted, we would expect to see Live in Test but many more Live in Production
 * If documented in the EHR then 100% transfer of the core data elements would be transfer; transmit vs detect? Detect to be able to count ---this then would be part of certification of EHRs for Stage II
 * Are we able now to do this? It isn’t known yet; whether all the core measures have been transmitted; may depend on whether schematrons can be used in a production mode in addition to using summary of care documents
 * Can we capture this transmission and count it?....still an open question; follow up with the RI group to get an answer per Susan
 * More a system of attestation by the vendors; not the role of ONC to look at clinical data to ensure the data is in the system ---ONC could not inspect the messages in anyway. The transmission of messages is covered under HIPAA.
 * Stage II would require that a system certified by the specs that have been developed per the Framework ; and then the EHR vendor would have to prove it as they certifyA call to the vendor; can you transfer these core data elements in your message? This practice would suffice the count.
 * Internal validation for the HER/PHR to en-certain that they are able to create the messages with the core data elements
 * Looking at exchange and the integrity of the content (audit issue) is the way to approach this
 * As we start to talk about the ability to transfer core data elements; as the projects go through their build and development; it becomes clear that once Core Data Elements are published, they will be interested that they are exchanged
 * For Stage II; Core Data Elements would be taken up as part of Certification (100% of the core data elements)
 * Action Item: Placeholder here; Are all elements required in each metric? Dependent if elements available being typed in on the drop down. ---DONE


 * __Review of Process Category:__**
 * Review of Metrics
 * Stakeholders; same as adoption
 * Refer to matrix as to what was discussed:
 * Clinical organization vs. Eligible Providers; if we talked about EP, (80% of care is delivered in practices of 8 MDs or less; need ToC); if we talk about a large organization; the integration of an EHR for their MDs; anyone can see anything; EP not the stakeholder to measure uptake of ToC; large, medium, and small organizations so they all have equal weight
 * # of Discharge Messages; # export vs # import
 * # of D/C Message; core and variable; do the same walk across all stakeholders
 * Perform the same down the category
 * Is this going out? Are people using it? Actively being used to create workflow efficiencies?
 * Out of What Total? Total d/c’s, consults? That would be available to pull out of most her systems
 * __Are these measurable metrics that we have on our list?__
 * Availability of information at the point of care; how many HER vendors can display core data? and how many clinical organizations overall adopted that ability; implemented that functionality? How many EHR vendors can display core and variable data at the POC? And implemented?
 * May want to specify as whether in test or production? May want to have both
 * Survey questions around:
 * Avoidance of data elements; these next several would require us to survey clinicians
 * Timeliness of the data received
 * Workflow;
 * Graphical User Interface
 * Upload of Discreet Data
 * Receive the data in the exchange and you set up that exchange
 * Continuity of service and continuity in diagnosis
 * Need to understand the metrics behind the data; is the data meaningful?
 * __Next Steps:__**
 * Leftwich – Continue this walk of the Metrics to be discussed
 * Nail down the definition, aspect, numerator, denominator of each metric

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