## PURPOSE OF MEETING 

The primary objectives of the 13th Web conference of the Electronic
Health Records Workgroup (EHR WG), chaired by Dr. Jon Perlin and Ms.
Lillee Gelinas, were to hear additional presentations in specific
domains related to the Workgroup's broad charge to make recommendations
to the Community to achieve the widespread adoption of certified
electronic health records (EHRs), minimizing gaps in adoption among
providers and to start planning the EHR WG's recommendations in the five
domains related to its broad charge.

## 

## INTRODUCTORY REMARKS

Dr. Perlin and Ms. Gelinas began the meeting at 1 p.m. They welcomed
participants and asked EHR WG members to focus on developing
recommendations to the Community about how to achieve widespread
adoption of certified EHRs. The January 11, 2007, EHR WG meeting minutes
were approved.

Dr. Karen Bell made two points. First, the next meeting of the Community
will be held March 13, 2007, in California, but the presentation of
recommendations by the EHR WG and other workgroups had been postponed to
the April or early June 2007 meeting. Second, the Community decided in
January to proceed with three additional use cases: one on medication
management, one on consumer empowerment, and one in the area of
population health focusing on quality. The staff of the Department of
Health and Human Services (HHS) Office of the National Coordinator for
Health Information Technology (ONC) will be developing the use cases
internally and making them available for public comment in the next few
weeks.

## KEY TOPICS

### 1. Presentations

In the first part of the meeting, EHR WG members heard presentations in
four specific domains related to the Workgroup's broad charge: state of
the technology, legal/regulatory, organizational/cultural, and
financial/business case.

*State-of-the-technology Domain: EHR Demonstrations*. Dr. Blackford
Middleton gave an overview of the capabilities of the Web-based EHR of
Partners HealthCare System, Inc. Partners HealthCare is an integrated
health system in Boston, and its EHR (a descendent of an ambulatory
record used by Brigham & Women's Hospital) has been in use for about six
years. Most people are eagerly moving toward EHR adoption in the
Partners HealthCare environment.

*Legal/Regulatory Domain: Follow-up Letter on Liability Issues Related
to EHRs***.** Dr. Bell summarized the key points of a six-page memo with
answers to EHR WG members' followup questions. The questions were
concerned with increases and decreases in liability related to EHRs from
the legal/regulatory panel that appeared at the January 2007 meeting of
the EHR WG. If any EHR WG member has additional questions or concerns,
ONC staff will ask the panel to address them.

-   The memo, "Followup to Legal/Regulatory Panel at Workgroup's January
    11, 2007, meeting," is available online at
    <http://www.hhs.gov/healthit/ahic/materials/02_07/ehr/response.doc>

*Organizational Domain: EHR Payment Models and Application Service
Provider Environments for Small- and Medium-sized Practices*. Chuck
Parker discussed the payment models that small- and medium-sized
physician practices are using to obtain EHRs (stepped payment, milestone
payments, modular payments, and rental). He also compared three hosting
options for such practices' EHR systems: (1) an EHR-vendor-hosted
application service provider (ASP), (2) a local-hospital-hosted ASP, and
(3) onsite hosting at the physician's office. In addition, Mr. Parker
reported that, with the support of the Centers for Medicare & Medicaid
Services (CMS), Masspro recently established the Doctor's Office
Quality-Information Technology (DOQ-IT) University, an interactive,
Web-based learning system for quality improvement organizations and
physician practices throughout the country.

-   Mr. Parker's presentation entitled "How Do I Pay for an EHR:
    Alternative Purchase Structures," is available online at
    <http://www.hhs.gov/healthit/ahic/materials/02_07/ehr/parker.ppt> .
    His summary of EHR hosting options for small and medium-sized
    physician practices is available online at
    <http://www.hhs.gov/healthit/ahic/materials/02_07/ehr/parker.doc>.

*Financial/Business Case Domain: Malpractice Premium Credit for
Physicians Using EHRs.* Representatives from three organizations --
Mickey Tripathi from the Massachusetts e-Health Collaborative (MAeHC),
Denise Funk from the Connecticut Medical Insurance Company (CMIC), and
Jack King from the Physicians Insurance Agency of Massachusetts (PIAM)
-- discussed a program these organizations have developed that provides
a malpractice premium credit of up to 20 percent to physicians for using
EHRs in the northeastern part of the country. Malpractice litigation and
indemnity payments are particularly high in that part of the country.

-   Ms. Funk's presentation from CMIC, "Value of an EHR to Liability
    Insurers," is available online at
    <http://www.hhs.gov/healthit/ahic/materials/02_07/ehr/cmic.ppt>.

-   Mr. King's presentation from PIAM, "Developing an EHR Malpractice
    Credit Program," is available online at
    <http://www.hhs.gov/healthit/ahic/materials/02_07/ehr/piam.ppt>.

### 

### 2. EHR WG'S AHIC Recommendation Planning Session

In the second half of the meeting, EHR WG members discussed possible
recommendations to the Community to achieve widespread adoption of EHRs,
minimizing gaps among providers. Several documents prepared by ONC staff
to support the discussion are available online at
<http://www.hhs.gov/healthit/ahic/materials>. EHR WG members suggested
possible recommendations in each of the five critical domains related to
the EHR WG's broad charge: financial/business case, legal/regulatory,
cultural/organizational, state of the technology, and privacy and
security. In addition, EHR WG members identified specific topics about
which they felt they needed additional information.

###### A. Financial/Business Case Domain

####### Discussion: Possible Recommendations 

-   Recommendations related to changing physician reimbursement to
    improve the business case for physicians to adopt and use EHRs. The
    Tax Relief and Health Care Act of 2006 (H.R. 6111) authorizes a
    program under which CMS can pay a 1.5 percent bonus payment to
    physician practices that submit quality data through the Medicare
    claims-based processing system. This act also opens the possibility
    that payors will begin paying physicians on the basis of structural
    quality measures in 2008. The EHR WG might consider recommendations
    on how specific structural quality measures (e.g., e-prescribing)
    can be used. More info at: <http://www.cms.hhs.gov/PQRI/>

####### Additional WG testimony requested 

-   Additional information requested from CMS on the VOE project and
    their thoughts on structural quality measures.

#### Staff Action Item #1: Arrange a presentation from CMS on the VOE project and the DOQ-IT Office Systems Survey.

####  {#section-2 .ONC-staff-action}

###### B. Legal/Regulatory Domain

####### Discussion: Possible Recommendations 

-   A recommendation to encourage CMS to issue regulatory guidance
    pertaining to the new Stark regulations giving hospitals and others
    safe harbors to give health information technology (HIT) to
    physician practices to address concerns (e.g., hospital CEOs' fear
    of being thrown into jail, nonprofit hospitals' fear of loss of
    tax-exempt status), which seem to be causing hesitancy.

-   A recommendation to encourage malpractice insurers' broader use of
    malpractice premium credits to encourage physicians to adopt and use
    EHRs.

####### Additional WG testimony requested 

-   Information about the impact of the new Stark regulations giving
    hospitals and others safe harbors to give health information
    technology to physicians.

-   Information from the recent National Governors Association meeting
    about initiatives addressing State-based licensure and other issues
    that could impede the free flow of information between physicians
    and physicians and physicians and patients.

#### Staff Action Item #2: Arrange a presentation on the Stark regulations and their impact on the adoption of HIT by physicians. (NOTE: Mr. Isenstein will send ONC a list of suggested names for presentation.)

#### Staff Action Item #3: Arrange a presentation on the National Governors Association efforts to address State-based issues that impede the free flow of information among physicians and between physicians and patients.

####  {#section-3 .ONC-staff-action}

###### C. Cultural/Organizational Domain

####### Discussion: Possible Recommendations 

-   A recommendation to consider adding support to DOQ-University or
    encouraging its spread, where appropriate, to facilitate the
    adoption of EHRs by small- and medium-sized physician practices.

-   Recommendations to engage health consumers more fully in supporting
    HIT adoption among clinicians.

-   A recommendation that explicitly acknowledges or recognizes a
    potential codependence of some kind between personal health record
    efforts now taking off around the country and efforts to achieve
    widespread adoption of EHRs among providers.

-   A recommendation to the Certification Commission for Healthcare
    Information Technology (CCHIT) to encourage provider practices to
    use the fact that they are using a certified EHR as a marketing tool
    and to educate patients to look for providers who are using
    certified EHRs.

-   A recommendation to establish a national repository of information
    (e.g., basic rules, templates, forms, guidelines, protocols) that
    facilitates knowledge engineering for those implementing EHR
    systems.

####### NO Additional WG testimony requested

###### D. State-of-the-technology Domain

####### Discussion: Possible Recommendations 

-   The WG did not put forth potential recommendations in this critical
    component.

####### More Information Needed

-   Information from CCHIT on the public comments received on the draft
    roadmap for the expansion of EHR certification criteria to physician
    specialty EHRs, discussion of software maturity and how they intend
    to address usability.

#### Staff Action Item #4: Arrange for CCHIT to give testimony to the EHR WG on public comments received on CCHIT's draft roadmap for the expansion of EHR certification criteria to physician specialty EHRs, discussion of software maturity and how they intend to address usability. 

####  {#section-4 .ONC-staff-action}

###### E. Privacy and Security Domain

Ms. Gelinas reminded EHR WG members that the Community now has a
separate Confidentiality, Privacy, and Security Workgroup, which was
recommended by the EHR WG in May 2006. She also reminded them that the
National Center for Vital and Health Statistics (NCVHS) Subcommittee on
Confidentiality and Privacy has made recommendations in this area.

####### Possible Recommendations to the Community

-   A recommendation to support all or some of the 26 recommendations in
    the report of the NCVHS Subcommittee on Confidentiality and Privacy
    entitled *Privacy and Confidentiality in the Nationwide Health
    Information Network* (available at
    <http://www.ncvhs.hhs.gov/060622lt.htm>) and other recommendations
    (e.g., those related to secondary uses of data).

#### Staff Action Item #5: Circulate the 26 recommendations in the June 2006 NCVHS report on privacy and confidentiality to EHR WG members and ask them to rank order the recommendations in terms of physician adoption of EHRs. 

####  {#section-5 .ONC-staff-action}

Dr. Bell noted that the next meeting of the EHR WG is Tuesday, March 20.
There were no public comments. The meeting of the EHR WG ended at 3:50
p.m.

# SUMMARY OF ACTION ITEMS

#### Staff Action Item #1**: Arrange a presentation from CMS on the VOE project and the DOQ-IT Office Systems Survey.**

**Status #1**: Planned for the 3/20 WG meeting.

#### 

#### Staff Action Item #2: **Arrange a presentation on** the Stark regulations **and their impact on the adoption of HIT by physicians. (NOTE: Mr. Isenstein will send a list to ONC of suggested names for presentation.)**

> **Status #2:** Planned for the 4/18 WG meeting, kicking off the
> broadening into the inpatient care setting.

#### 

#### Staff Action Item #3: **Arrange a presentation on the National Governors Association on efforts to address State-based issues that impede the free flow of information among physicians and between physicians and patients.** 

**Status #3:** Planned for the 3/20 WG meeting.

#### Staff Action Item #4: **Arrange for CCHIT to give testimony to the EHR WG on public comments received on CCHIT's draft roadmap for the expansion of EHR certification criteria to physician specialty EHRs, discussion of software maturity and how they intend to address usability.**

> **Status #4:** Planned for the 4/18 WG meeting, kicking off the
> broadening into the inpatient care setting.

#### 

#### Staff Action Item #5**: C**irculate the 26 recommendations in the June 2006 NCVHS report on privacy and confidentiality and other recommendations (e.g., those related to secondary uses of data) to EHR WG members and ask them to rank order the recommendations in terms of physician adoption of EHRs.

**Status #5:** Document circulated with responses due COB 3/15.

[]{.mark}

[]{.mark}

**MEETING MATERIALS**

Agenda

Recommendation Planning Cover Letter

May 2006 Recommendation Letter

Pre-recommendation Planning Document

Testimony Summary Spreadsheet

EHR Response Legal Panel Letter

EHR Response Legal Panel Letter

**Presentations:**

Masspro - How Do I Pay for an EHR?

Masspro - ASP EHR Discussion

Connecticut Medical Insurance Company

Physicians Insurance Agency of Massachusetts

**[Electronic Health Records Workgroup]{.underline}**

**[Members and Designees Participating in the Web
Conference]{.underline}**

*Co-chairs*

Lillee Smith Gelinas VHA, Inc.

Jonathan B. Perlin Hospital Corporation of America, Inc.

*ONC Staff*

Karen Bell HHS, ONC, Office of Health Information

> Technology Adoption

Alicia Bradford HHS, ONC, Office of Health Information

> Technology Adoption

[]{.mark}

*Members*

Carolyn Clancy Agency for Healthcare Research and Quality

Jason DuBois (for Alan Mertz) American Clinical Laboratory Association

Bart Harmon Department of Defense

John Houston NCVHS

Howard Isenstein (for Chip Kahn) American Federation of Hospitals

Connie Laubenthal (for John Tooker) American College of Physicians

Blackford Middleton Health Information and Management Systems Society

Pam Pure McKesson

Robert Smith Department of Veterans Affairs

Jim Sorace (for Barry Straube) CMS

*Presenters*

Denise Funk CMIC

Jack King PIAM

Chuck Parker Masspro

Mickey Tripathi MAeHC

[]{.mark}

######### **Disclaimer:** *The views expressed in written conference materials or publications and by speakers and moderators at HHS-sponsored conferences do not necessarily reflect the official policies of HHS; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.*