Connecting Communities

1
Connecting Communities CMS Role

• William Rollow, MD MPH
• Deputy Director,
• Quality Improvement Group
• June 24, 2004

2
CMS Supports Healthcare Information Exchange

• Crucial to IOM goals of safety, timeliness,
  effectiveness, patient-centeredness, efficiency,
  and equitableness
• Must develop within privacy policy framework
• Communities are the appropriate locus of
  development

3
LHIIs With or Without EHRs

• Information exchange does not require providers
  to have EHRs, but it is facilitated when they do
• CMS can help LHII development by stimulating EHR
  adoption and effective use

4
DOQ-IT Doctors Office Quality Information
Technology

• Premise substantial improvement in physician
  office quality cannot be achieved without
  adoption of health information technology and
  process redesign

5
DOQ-IT

• Make high quality, affordable systems more
  available
• Provide assistance to physician offices
• IT adoption decision
• Implementation and workflow efficiencies
• Care management/patient self-management
• Financial incentives MCMP demonstration (MMA
  Sec 649)

6
MCMP

• Four states
• Expected payment methodology
• Expect to require adoption and use of systems
  which meet selected HL7 functional and CHI data
  standards, and at specified point, contribution
  of data to PHR and data exchange through
  available LHIIs
• Expect to require submission to QIO data
  warehouse of cardiac and diabetes measure
  results, based on DOQ/AMA set, with performance
  at target levels
• QIO assistance to physician offices in improving
  process and infrastructure for data collection

7
QIO Data Warehouse

• HIPAA oversight authority gives QIOs ability to
  collect quality data without need for the
  physician to obtain patient consent
• Avoids multiple slices and small numbers
• Single collection process
• Data can be used for multiple purposes
• Confidential assistance
• Public reporting, pay-for-performance with
  consent
• Warehouse and secure data exchange exist
• Is being populated with hospital data
• Physician office data later this year

8
What You Can Expect

• Enhanced VistA product expected to be available
  by year end
• Four state (CA, MA, AR, UT) pilot project
  underway national pilot in fall full
  implementation in August 2005 via 8th SOW
• MCMP demonstration expected to be available to
  physicians in fall of this year