Overview of CMS EHealth Initiatives

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Overview of CMS E-Health Initiatives

• Tony Trenkle
• Director, Office of E-Health Standards and
  Services
• April 4, 2006

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CMS eHealth Priorities
Supporting the Administration and HHS eHealth
Initiatives
Leveraging Public and Private Sector Partnerships
Providing Healthcare Quality Improvement
CMS eHealth
Meeting Stakeholder Expectations
Increasing Efficiency of Operations
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Areas of Focus

• Promote key CMS initiatives
• Support ONC/AHIC initiatives
• Promote collaboration

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Promote Key CMS Initiatives

• E-prescribing
• Personal Health Records (PHRs)
• Quality HIT (e.g., P4P, evidence development)
• HIPAA

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Support ONC/AHIC Initiatives

• AHIC Workgroups
• Consumer Empowerment
• Electronic Health Record
• Chronic Care
• Bio-Surveillance
• Standards Harmonization
• HIT Policy Council
• Federal Health Architecture

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Key CMS E-Health Initiatives

• Support for Personal Health Records
• E-Prescribing
• Standards Implementation

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Personal Health Records (PHRs)

• Short-term Objective-Define CMS role(s) to meet
  our beneficiary needs for PHRs
• Potential CMS Roles
• Make Medicare data available to PHRs
• Support standards for PHRs
• Support interoperability between PHRs and between
  PHRs and EHRs
• Certify PHRs as meeting certain functionality,
  security and privacy requirements
• Educate beneficiaries on the uses and benefits of
  PHRs

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CMS PHR Activities To-Date

• Solicit input on CMS potential role
• Open Door Forum-Complete
• Request for Information-Complete
• Develop action plan and issues paper-Internal
  review
• Begin feasibility testing-Award in May
• Coordinate CMS operational requirements with the
  overall ONC strategy-On-Going

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Personal Health Records - RFI

• In July 2005, CMS released a Request for
  Information soliciting public feedback on CMS
  role with regard to PHRs
• CMS received over 50 responses from groups such
  as
• Large and small PHR vendors
• National associations
• Health plans
• Provider groups

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RFI Responses

• What do beneficiaries need?
• Summary of claims -diagnoses, procedures
• Benefit information what they are entitled to
• Health screening and immunization reminders
• What should CMS make available?
• All data demographics, claims, benefits,
  coverage
• Real-time data, if feasible
• Only provide data to PHR vendors meeting criteria
  for functionality, privacy and security

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PHR-Future Activities

• Build infrastructure to support wide-spread
  dissemination of CMS data to PHRs (technical,
  policy)
• Work with partners on standards and certification
• Promote education and outreach

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E-Prescribing Under the MMA

• Foundation standards final rule November 2005
• Pilots began January 2006
• Report to Congress on pilots April 2007
• Final standards final rule April 2008

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E-Prescribing under the MMA

• MMA creates an ambulatory electronic prescribing
  program under Part D
• Voluntary for physicians and pharmacies
• Part D plans must support e-prescribing, should
  their physicians and pharmacies desire to do it
• If e-prescribing is done, must use standards
  promulgated now and in the future
• Only includes non-controlled substances.

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Foundation Standards

• NCPDP SCRIPT for prescriptions
• ASC X12 270/271 for eligibility and benefits
  inquiries and responses between prescribers and
  Part D sponsors
• NCPDP Telecommunications Standard for
  eligibility and benefits inquiries and responses
  between dispensers and Part D sponsors

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Pilot Testing

• Required to pilot test standards for which there
  is not adequate industry experience
• Voluntary participation via agreements with the
  Secretary
• Conducted during CY 2006
• Pilot testing results will be used to develop
  final e-prescribing standards to be adopted in
  2008

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Additional Standards to be Tested

• Formulary and benefit information - NCPDP
  standard using RxHub protocol
• Exchange of medication history NCPDP standard
  medication history message using RxHub protocol
• Structured and Codified Sig Test structured and
  codified SIGs (patient instructions) developed
  through standards development organization
  efforts
• Clinical drug terminology Determine whether
  RxNorm terminology translates to NDC for new
  prescriptions, renewals and changes
• Prior authorization messages - New version of
  ANSI ASC X12 278

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Awardees

• Applications underwent rigorous review by review
  panel that consisted of national experts in
  pharmacy, e-prescribing, health IT
• Five awardees
• RAND
• Brigham and Womens Hospital
• SureScripts
• Achieve Health
• KePRO/University Hospitals Health Systems

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Southeastern Michigan Electronic Prescribing
Initiative

• Awarded grant to MedCo to evaluate the impact of
  SEMI
• Complementary to the pilot project
• Will provide short-term lessons learned from one
  of the nations largest electronic prescribing
  programs

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HIPAA Update

• Electronic Health Care Claims Attachments
  Proposed Rule
• This is one of the last transaction standards to
  be adopted under HIPAA.
• Over 100 individual comment submissions and
  thousands of comments being reviewed by CMS and
  SDOs. Extended comment period closed January 23,
  2006.
• Technical X12 version HL7 specifications
  LOINC codes CDA version (1.0 vs. 2.0)
• Policy solicited vs. unsolicited number of
  requests for an individual claim privacy and
  minimum necessary issues.

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HIPAA Update

• Proposed rule affects all covered entities under
  HIPAA (health plans, health care clearinghouses
  and certain health care providers).
• Health plans required to be able to accept or
  send the transactions.
• Providers have the option of using the
  transaction.
• Health care clearinghouses, if contracted to
  provide the transaction on behalf of the health
  plan or health care provider, must conduct the
  standard transaction
• Standards proposed
• Six types of claims attachments - emergency
  department ambulance rehabilitation (9
  disciplines) medications laboratory results
  clinical reports.
• Two new X12 transactions - the request (277) and
  the response (275) version 4050.
• Clinical Document Architecture (HL7 CDA Release
  1.0) to carry the information.

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HIPAA Update

• 2nd round of modifications to Transactions and
  Code Sets proposed rule under development
• ICD-10 CMS considering NCVHS recommendation to
  move from ICD-9 to ICD-10

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• QUESTIONS?