HIT Policy Committee Consumer Empowerment Workgroup

1. HIT Policy CommitteeConsumer Empowerment Workgroup April 23, 2013 11:00 AM– 12:00 PM Eastern

2. Agenda • Welcome • ONC Consumer Updates • Consumer Engagement Strategy and Key Trends • Patient Generated Health Data Technical Expert Panel • Person at the Center • Outlining a Work Plan and Next steps • Public comment

3. Engaging Consumers is Integral to the FederalHealth IT Strategy • …through information, communication, & tools. www.healthit.hhs.gov/strategicplan

4. Meanwhile, Outside of ONC… We’re in a technological revolution – Technology is getting better, cheaper and faster. 88% of U.S. adults own a cell phone. The demand for information is growing – 80% of Internet users seek health information online. We’re getting connected – Use of Internet, social media and games is increasing our connectivity to one another. Policy is changing – Changing payment models create incentives to keep people healthy, and greater financial responsibility for consumers.

5. Yet There’s An Untapped Demand for Consumer eHealth • 90% agree you should be able to get your own medical info electronically • 2 out of 3 would consider switching to a provider who offers online access • 52% would use a smart phone to monitor health • 69% track a health indicator • 20% have accessed their health info online • 10% have a personal health record (PHR) • 9% have mobile app to manage health • 21% of individuals who track use a form of technology

6. The Three A’s Approach to Consumer Engagement Increase consumer Access to their health information Enable consumers to take Action with their information Shift Attitudes to support patient-provider partnership

7. ONC’s Role

8. Shifting attitudes Shifting ATTITUDES - HealthIT.gov “A One Stop Shop” 7

9. Increasing ACCESS to Health Data Making it easier for consumers to access their health data electronically through: • Financial Incentives for Providers to Provide Patients Access to Data (through Meaningful Use) • ONC’s Blue Button Pledge Program • Increasing Adoption & Enhancing Technical Functionality of Blue Button • Office for Civil Rights “Rights to Access” Education and Enforcement Activities

10. Meaningful Use Supports Patient & Family Engagement *From Request for Comment on Stage 3

11. Enabling Consumers to take ACTION 1. Ensure everyone can access their health information electronically 2. Help application developers use that data to build products and services that help individuals with their health

12. Blue Button Initiative In 2010, Department of Veterans Affairs starts the Blue Button initiative Now over 88 million Americans can download their health record from a portal (CMS, Dept. of Defense, Aetna, and United) Over 1.5 million people across the country have downloaded their health record Office of the National Coordinator for Health Information Technology

13. Limitations of Blue Button and Health Data X X X X Lacks Structure: Data is difficult to parse because data is unstructured Inconsistent: Each system uses different vocabularies and templates No Secure Transport: No defined, widely adopted way to securely transport data Not Seamless: Current applications require too much manual effort by consumers

14. Meaningful Use Stage 2 and Blue Button+ Blue Button+ gives specific guidance to EHR companies in meeting the V/D/T requirements. MU 2 regulations requires these for all certified EHRs Required for Blue Button+

15. Blue Button Mashup Challenge

16. Health Record Design Challenge Health Record Design Challenge healthdesignchallenge.com

17. Geisinger Pilot: Patients can be effectively engaged to provide accurate and reliable feedback • Patients with upcoming appointments invited to complete a medication feedback form prior to their office visit • Key Findings • Patient response exceeded expectations • Patients are eager to provide feedback: On average patient requested at least 2 changes per submitted form • Patients can provide valuable feedback: In 56% of cases pharmacists accepted patient requests for changes

18. Blue Button Pledge

19. Input on Consumer Engagement Strategy via PlanningRoom.org 18

20. Patient-Generated Health Data • ONC asked National eHealth Collaborative to convene a Technical Expert (TEP) Panel to provide input on how to successfully implement patient generated health data (PGHD). • Purpose: identify use cases and best practices for integrating PGHD into clinical workflows to produce an evidence-based report that will support the HIT Policy Committee Meaningful Use Workgroup in developing recommendations for Stage 3 Meaningful Use.

21. Patient-Generated Health Data – MU3 Proposed objective 204B • Provide 10% of patients with the ability to submit patient-generated health information to improve performance on high priority health conditions, and/or to improve patient engagement in care (e.g. patient experience, pre-visit information, patient created health goals, shared decision making, advance directives, etc.). • This could be accomplished through semi-structured questionnaires, and EPs and EHs would choose information that is most relevant for their patients and/or related to high priority health conditions they elect to focus on.

22. PGHD-Related MU3 Proposed objective 204D • Provide patients with the ability to request an amendment to their record online (e.g., offer corrections, additions, or updates to the record) through VDT in an obvious manner. Proposed objective 207 • Use secure electronic messaging to communicate with patients on relevant health information

23. TEP PGHD Comments on Stage 3 • Suggestions to providers, based on case studies, of “promising practices” for • Preparations • Data of value to providers and patients • Processing PGHD

24. Person @ the Center: Vision The power of each individual is unleashed to be active in managing their health and partnering in their health care, enabled by information and technology. • Empowers each individual to be the manager and partner in their health care using health IT tools and resources. • People’s health and quality of life will improve if they have the assistance of information and technology for self-care and shared decision-making with their providers.

25. Continuum of Spheres of Wellness and Health Care

26. Goals

27. Goals

28. Goals

29. Key policy ideas: Reflect suggested changes to support people as they act within and move between the spheres of wellness and health care. Illustrate a way to achieve the vision: Game-changing Broad-reaching in scope Support behavior change Make use of health IT and information-sharing Draft Building Blocks

30. Outlining a Work Plan • Do we see any pressing policy issues in the short or immediate term that need to be addressed? • What are the gaps that we see where technology is outpacing policy? • Are there particular areas where if we did work, it would accelerate impact? • How should we prioritize our work?

31. Next Steps • Homework • Read and comment on Consumer Strategy (as an individual) by May 9th at http://planningroom.org/

32. Background Slides Background Slides for Additional Information

33. Consumer Empowerment Workgroup (WG)Members WG Members • Christine Bechtel, National Partnership for Women & Families (Chair) • Korey Capozza, HealthInsight • James Cartreine, Brigham and Women's Hospital/Harvard Medical School •  Scott Fannin, Greenway Medical Technologies • Leslie Kelly Hall,  Healthwise •  Katherine Kim, San Francisco State University • Sarah Krug, Society for Participatory Medicine •  Rita Kukafka, Columbia University • Patricia MacTaggart, George Washington University • Beth Morrow, Children’s Partnership •  Jan Oldenburg, Aetna • Casey Quinlan, Mighty Casey Media LLC • Clarke Ross, Consortium for Citizens with Disabilities • Mark Savage, Consumers Union • MaryAnne Sterling, Sterling Health IT Consulting, LLC • Ann Waldo, Wittie, Letsche & Waldo LLP • Ryan Witt, drchrono inc Ex Officio Members • Terry Adirim, HRSA • Cynthia Baur, CDC • Bradford Hesse, NIH • Kim Nazi, Veterans Health Administration • Danielle Tarino, SAMHSA • Teresa ZayasCaban, AHRQ

34. Charge & Scope • Charge: Provide recommendations on policy issues and opportunities for strengthening the ability of consumers, patients, and lay caregivers to manage health and health care.  • Scope: • Examples of policy issues the WG may engage in include patient generation of their health data, co-managing and sharing care plans, patient reconciliation of medical records from various sources, and new types & sources of patient data. • Important touch points with other workgroups: • HITPC Meaningful Use WG • HITPC Privacy & Security Tiger Team WG • HITPC Quality Measures WG • HITSC Consumer Technology WG

35. Context: Stage 2 Meaningful Use Final RulePatient & Family Engagement Requirements

36. Context: Stage 2 Meaningful Use Final RulePatient & Family Engagement Requirements 35

37. Context: Stage 2 Meaningful Use Final RulePatient & Family Engagement Requirements

38. Context: Stage 2 Meaningful Use Final RulePatient & Family Engagement Requirements

39. Shared Care Plan: Proposed for Future Stage