The document discusses health IT and achieving interoperability in care transitions, emphasizing the importance of electronic health record compliance and patient access to health information. It highlights various measures under meaningful use certifications and challenges such as the lack of interoperability standards and the complexity of current health information exchanges. The discussion also addresses recommendations for improved software architecture and the roles of participating health organizations.

1. Welcome...
Today’s topic
Health IT: How to Achieve Interoperability Across the Continuum of Care
During today’s discussion, feel free to submit questions at any time
by using the questions box. A follow-up e-mail will be sent to all
attendees with links to the presentation materials online.
Dr. Richard Schreiber
Chief medical
information officer,
Holy Spirit Hospital,
Camp Hill, Pa.
Dr. Clifford Martin
Chief medical officer,
St. Joseph Physician
Network,
Mishawaka, Ind.
Erica Galvez
Interoperability and
exchange portfolio
manager,
Office of the National
Coordinator for Health IT

2. HousekeepingHousekeeping
1. Viewer Window 2. Control Panel

3. Joseph Conn
Reporter,
Modern Healthcare
Now speaking...
Please use the questions box on your webinar dashboard
to submit comments to our moderator

4. Erica Galvez
Interoperability and exchange portfolio manager,
Office of the National Coordinator for Health IT
Now speaking...
Please use the questions box on your webinar dashboard
to submit comments to our moderator

5. Meaningful Use & Certification Relationship for
Transitions of Care
• When looked across both Stages 1 & 2, the
ToC objective includes 3 measures:
• Measure #1: requires that a provider
send a summary care record for more
than 50% of transitions of care and
referrals (Stage 1 and 2)
• Measure #2 requires that a provider
electronically transmit a summary care
record for more than 10% of transitions of
care and referrals using CEHRT or eHealth
Exchange participant (Stage 2)
• Measure #3 requires at least one summary
care record electronically transmitted to
recipient with different EHR vendor or to
CMS test EHR (Stage 2)
Meaningful Use 2014 Edition Certification
• Two 2014 Edition EHR certification
criteria
• 170.314(b)(1) : Transitions of care—
receive, display, and incorporate
transition of care/referral
summaries.
• 170.314(b)(2) : Transitions of care—
create and transmit transition of
care/referral summaries.

6. Feature Focus: ToC Measure(2)
• The eligible provider, eligible hospital or
CAH that transitions or refers their
patient to another setting of care or
provider of care provides a summary of
care record for more than 10% of such
transitions and referrals either:
• (a) electronically transmitted using
CEHRT to a recipient; or
• (b) where the recipient receives the
summary of care record via exchange
facilitated by an organization that is a
NwHIN Exchange participant or in a
manner that is consistent with the
governance mechanism ONC establishes
for the nationwide health information
network.
ToC Measure #2 170.314(b)(2)
• Transitions of care—create and
transmit transition of care/referral
summaries.
• (i) Enable a user to electronically
create a transition of care/referral
summary formatted according to
the Consolidated CDA with, at a
minimum, the data specified by CMS
for meaningful use.
• (ii) Enable a user to electronically
transmit CCDA in accordance with:
• “Direct” (required)
• “Direct” +XDR/XDM (optional, not
alternative)
• SOAP + XDR/XDM (optional, not
alternative)
1
2

7. Patient Electronic Access to Health Info
EPs and EHs: View, Download, Transmit
Measure 1:
• More than 50% patients are provided timely online access to
their health information
Measure 2:
• More than 5% of patients must access their health information
online
EPs: Secure Messaging
Measure 1:
• A secure message was sent using the electronic messaging
function of CEHRT by more than 5% of unique patients (or their
authorized representatives) seen by the EP during the EHR
reporting period.

8. Patient Electronic Access to Health Info
VDT objective
VDT and secure
messaging objective
Secure messaging
objective
Measures
Does the EP/EH
need to use
CEHRT to send
initial information
to patient?
Does the patient
need to
receive/view/downl
oad information
using CEHRT?
Does the patient
need to use CEHRT
to transmit
information?
Does the EP need to
use CEHRT to
receive information
from patient?
VDT measure 1: 50% of unique
patients provided timely online
access to their health information
No Yes N/A N/A
VDT measure 2: 5% of unique
patients view, download or
transmit their health information
to a 3rd party
No Yes
They may, but are
not required to
N/A
Secure messaging measure 1: 5%
of unique patients send a secure
message to the EP
N/A N/A
They may, but are
not required to
Yes

9. Dr. Richard Schreiber
Chief medical information officer,
Holy Spirit Hospital, Camp Hill, Pa.
Now speaking...
Please use the questions box on your webinar dashboard
to submit comments to our moderator

10. Meaningful Use 2 and Interoperability
• Definitely stresses importance of interoperability
• Patient Portal replaces “electronic copy of discharge
information”
• Settles on C-CDA (Consolidated clinical document
architecture)
• Requires sending C-CDA to another vendor, but only once

11. Meaningful Use 2 and Interoperability, cont.
•Direct Messaging (DM)
–NOT an interoperable requirement
–very hard to achieve interoperability with DM
• Outside of EMR
• No clear way to add data to EMR
•Submit labs from EH’s to EP’s
–Nice, but actually done via interfacing, not true
interoperability
–Why not more emphasis on HIE?
• especially for those on different EMRs?

12. Transfer of Care Documents
Most difficult interoperability requirement of MU 2
• HISPs don’t talk to HISPs (lack connectivity)
• Dismally low adoption of direct addresses
• Offset of the reporting periods
–EHs: Federal Fiscal Year (attest Oct 1)
–EPs: Calendar year (attest by Jan 1)
• EPs have not caught up with EHs
• Puts EHs at disadvantage
With thanks to Michael Zaroukian, Colin Banas, Matthew Shafiroff

13. AMA Letter to CMMS and ONC
“JASON2 report funded by the Agency for Healthcare Research
and Quality concisely described the current state of
interoperability, finding “[a]t present, large-scale interoperability
amounts to little more than replacing fax machines with the
electronic delivery of page-formatted medical records.”3 If we
are to move away from this approach, the certification process
must be keenly focused on achieving true interoperability that is
deployed in a fashion that requires minimal user intervention.
We believe ONC should focus less on what specific data points
are exchanged, and more on identifying and coordinating the
standards needed to exchange information.”
• Lack of interoperability standards still impedes progress
1http://www.ihealthbeat.org/~/media/Files/2014/PDFs/CMS%20ONC%20Letter%20Stage%203.
ashx
2named for the Greek hero
3JASON, A Robust Health Data Infrastructure, November 2013
http://www.healthit.gov/sites/default/files/ptp13-700hhs_white.pdf

14. Meaningful Use Stage 3
• Nothing about improved care: disappointing
• Pharmacy benefit/Surescripts/similar pharmacy fill data companies
• To improve med rec we need better “source of truth” of home
med list.
–We already pay for eRx via Surescripts, and they possess
fill data; there is no requirement that they share this data
that in a sense we have already paid for

15. Meaningful Use Stage 3
• No pressure on insurance companies to support
HIE
– They benefit the most financially from reductions in
wasteful duplication and better ability to keep patients out
of the hospital1
• Metric for medication reconciliation still 50%
– Is it ok to let ½ our patients leave the hospital with poor
med lists?
– HITPC declined to
• Strengthen the metric
• Demand that pharmaceutical intermediaries share their data (cited
lack of authority in the law)
1Vest JR, et al. Association between use of a health information exchange
system and hospital admissions. Appl Clin Inform 2014;5(1):219-231.

16. What are the current limitations?
• Lack of nationwide HIE
• Unclear and non-harmonized regulations regarding
send/receive messaging for Direct Messages vs HIE
• Many vendors have certified EHRs which in fact do
not conform to MU requirements
– They can send, but can they
• Receive at all?
• Record upon receipt by intended recipient and
generate a report?

17. What are the current limitations?
• Multiple portals confuse patients
• Requirements for meaningful use with multiple
dependencies all to be achieved simultaneously—
impossible
– Need milestones first, then meaningful use goals
– We are the first MU 2 certified EHR that is trying to connect to an HIE
that has been in Pennsylvania the longest—why is it so hard?
• Ability to attach, forward, and consolidate data so
patients can access one portal, in absence of
centralized HIE

18. Where do we go from here?
• FHIR: Fast Healthcare Interoperable Resource
• JASON recommends:
– Public APIs (application program interfaces)
– “Interoperability issues can be resolved only by
establishing a comprehensive, transparent, and overarching
software architecture for health information.”
–Open software architecture
–Common mark up language (it alone will not support
semantic interoperability—also need APIs)
A Robust Health Data Infrastructure. JASON. The MITRE Corporation.
http://healthit.gov/sites/default/files/ptp13-700hhs_white.pdf

19. Dr. Clifford Martin
Chief medical officer,
St. Joseph Physician Network, Mishawaka, Ind.
Now speaking...
Please use the questions box on your webinar dashboard
to submit comments to our moderator

20. Saint Joseph Physician Network
• Division of Saint Joseph Regional Medical Center- South Bend, IN.
• Member of CHE-Trinity Health
• Comprised of 72 physicians and 18 Non-Physician Providers
• 65% Primary Care Providers & 35% Specialty Providers
•43 providers eligible for Meaningful Use 2

21. Key Components & Partners in our MU 2
Success
•Use of Cerner EMR and NextGen practice management software
• Strong community Health Information Exchange (HIE)
Michiana Health Information Network (MHIN)
• Community laboratory service provider with widespread use in
area
• Experience leadership in HIE and our organization with
implementation of a project of this scope

22. Most Recent Components Installed
• Preventive Care / Health Maintenance Modules
• Patient Specific Education for Exit Care
• Establishing Continuity of Care Documents
• Community Patient Portal
•Strategies to Engage Patients in use of Portal

23. Most Significant Challenges to Success
• Certification of Medical Assistants
• Rapid implementation of required software changes/bundles
• Increased need to utilize data in discrete fields
• Lab test and Radiology procedure terminology
• Processing Speed interruptions

24. Today’s panelists...
Health IT: How to Achieve Interoperability Across the Continuum of Care
During today’s discussion, feel free to submit questions at any time by using the questions box.
Joseph Conn
Reporter,
Modern Healthcare
Dr. Clifford Martin
Chief medical officer,
St. Joseph Physician
Network,
Mishawaka, Ind.
Erica Galvez
Interoperability and
exchange portfolio manager,
Office of the National
Coordinator for Health IT
Dr. Richard Schreiber
Chief medical
information officer,
Holy Spirit Hospital,
Camp Hill, Pa.
TODAY’S MODERATOR

25. Thank you...
... for attending today’s editorial webinar on achieving interoperability across the care continuum.
We also thank our panelists, Erica Galvez, interoperability and exchange portfolio manager, Office of the National
Coordinator for Health IT; Dr. Clifford Martin, chief medical officer, St. Joseph Physician Network,
Mishawaka, Ind.; and Dr. Richard Schreiber, chief medical information officer, Holy Spirit Hospital, Camp Hill, Pa.
Expect a follow-up e-mail within two weeks. For more information,
send an e-mail to webinars@modernhealthcare.com
For more information about additional editorial webinars this year,
please visit modernhealthcare.com/webinars