[Federal Register Volume 79, Number 131 (Wednesday, July 9, 2014)]
[Notices]
[Pages 38895-38897]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-16016]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Office of the National Coordinator for Health Information 
Technology; Announcement of Requirements and Registration for ``EHR 
Innovations for Improving Hypertension Challenge''

AGENCY: Office of the National Coordinator for Health Information 
Technology, HHS.
    Award Approving Official: Karen DeSalvo, National Coordinator for 
Health Information Technology.

ACTION: Notice.

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SUMMARY: The goal of the EHR Innovations for Improving Hypertension 
Challenge is to seek practices that have used clinical decision support 
(CDS) to implement the most clinically successful examples of an 
evidence-based blood pressure treatment protocol, gather details about 
these tools

[[Page 38896]]

and their implementation, and then drive widespread implementation of 
those tools by other providers. In Phase 1 (three months), practices 
will document the CDS tools they used to implement an evidence-based BP 
control protocol, as well as describe the details and results of the 
implementation. Practices must demonstrate high BP control levels and/
or improvement to ensure that tools and strategies merit replication 
across practice settings. In Phase 2 (nine months), practices and their 
partners will conduct, evaluate and document dissemination strategies 
for tools identified in Phase 1, emphasizing widespread, effective use 
of these tools by other practices. Submitters must demonstrate 
successful use of these tools in at least 2 additional practices.
    The statutory authority for this challenge competition is Section 
105 of the America COMPETES Reauthorization Act of 2010 (Public L. No 
111-358).

DATES: 
     Phase I submission period: July 7-October 6, 2014.
     Phase I winners announcement, tools posted: October 27, 
2014.
     Phase II submission period: October 28, 2014-July 31, 
2015.
     Phase II winners announcement: August/September, 2015.

FOR FURTHER INFORMATION CONTACT: Adam Wong, [email protected] 
(preferred), 202-720-2866.

SUPPLEMENTARY INFORMATION:

Subject of Challenge Competition

Phase 1 Details

    1. Purpose: Identify CDS tools and approaches effectively used by 
individual practices to improve blood pressure so they can be spread to 
other practices.
    2. Participants: A practice implementing the protocol must lead the 
submission. Practices are encouraged to form teams supporting their 
entry that include organizations such as a Regional Extension Center 
(REC), EHR developer, quality organization and/or professional society.
    3. Duration: 3 months.
    4. Required to submit:
    a. Provide data on BP control rate and/or improvement, as well as 
data on hypertension prevalence in the practice (prevalence data is 
collected to better understand the organization's hypertension 
screening results, but is not used for review)
     Submission requires more than 70% BP control (<140/90) in 
hypertension patients; specifications used to determine this rate must 
be the same as that used for PQRS 236/NQF 0018 and/or
     Significant improvement over time in BP control: Provide 
the percent of the patient population whose BP rate was improved over a 
specified period. Each submission will be evaluated based on the 
percent improvement and time period but no specific threshold for these 
must be met as a part of submission requirements.
     Information about the patients affected by the CDS 
interventions to help describe the Challenge's reach and effects, 
including: Size of the practice's patient population and hypertension 
prevalence; Aggregate demographic information on the patient population 
(e.g., disparities); and Specialty and demographic information about 
the practice (e.g., number/type of providers, setting [rural vs. 
urban], type [academic vs. community]).
    b. Describe Protocol elements addressed (use structured narrative; 
we encourage but do not require that submitters address all five 
elements):
     BP measurement/recording (e.g., use of documentation 
templates, highlighting abnormal BPs in EHR).
     BP follow-up and patient recall (e.g., use of registry 
reports).
     Medication selection and titration (e.g., use of order 
sets).
     Patient engagement (e.g., use of patient education and 
goal setting tools, templates for documenting and responding to home BP 
readings, patient reminders for medications/appointments).
     Workup/referral for poor control (e.g., reference 
information, hypertension-specific consult order forms).
    c. Describe EHR/health IT tools used to implement protocol (generic 
description; screenshots optional) and details about deployment so that 
others can replicate it.
     Order sets, registry reports, documentation templates/
tools, medication protocols, patient engagement/education tools, 
referral templates, reminders, etc.
     Tool descriptions can include generic version of 
intervention (e.g., contents of order set, documentation template, 
rule), screenshots, and/or implementable artifacts. We encourage, but 
do not require, use of the format described in the HL7 CDS Knowledge 
sharing implementation guide (also called the `Health eDecisions' 
format).
    d. Describe how the tools are deployed in workflow.
     Use CDS/Quality Improvement worksheets for standard 
presentation/replication (e.g., similar to QI case example within the 
CDS/QI resources recently provided by ONC \1\).
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    \1\ These resources are available at: bit.ly/CDS4MU; see 
specifically II.A: CHC Inc. and Ellsworth QI Case Studies.
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Phase 2 Details

    1. Purpose:
     The ultimate goal is that many organizations (e.g., 
professional societies, developers, quality organizations, RECs) spread 
use of the effective tools and related workflows from Phase 1 to many 
additional practice settings.
     Phase 2 submitters will develop and implement strategies 
for disseminating the CDS interventions recognized from Phase 1 as 
having the greatest value for BP control.
     Organizations with the greatest spread results and further 
spread potential will be selected for recognition, including a single 
winner, from the Phase 2 Challenge component.
    2. Participants: Phase 2 Challenge applicants can include any 
organization or collaboration that is able to widely spread successful 
use of EHR/CDS-enabled BP treatment protocols using tools recognized 
during Phase 1. Phase 2 submitters need not have participated in Phase 
1.\2\
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    \2\ Phase 2 success will likely require partnership with 
organizations that have significant size and reach--such as 
specialty societies, quality organizations, RECs, health IT products 
or services vendors--to support tool dissemination goals.
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    3. Duration: 9 months.
    4. Required to submit:
    a. Evidence that the tools and artifacts were implemented, or 
implementation is underway, in at least 2 other practices or provider 
groups.
     As part of describing the spread strategy, submitters must 
describe the CDS tools that were used to implement the hypertension 
control protocol; the format for this is based on that from Phase 1, 
and also includes any modification made to the tools so they could 
spread. We encourage, but do not require, use of the format described 
in the HL7 CDS Knowledge Sharing Implementation Guide (i.e., the 
`Health eDecisions' format).
    b. Results from spreading CDS tools to other practices: Ideally 
blood pressure control/improvements similar to that achieved from the 
tools in Phase 1, but, at a minimum, compelling evidence of significant 
value from tool implementation.
    c. Evidence of intent from other practices (i.e., in addition to 
those practices covered in 4.a above) to replicate the BP protocol 
approach using the CDS tools.

[[Page 38897]]

    d. Information about the patients affected by the CDS 
interventions, including:
     Size of practice's patient population and hypertension 
prevalence;
     Aggregate demographic information on the patient 
population (i.e., disparities); and
     Specialty and demographic information about the practice 
(e.g., number of providers, setting [rural vs. urban], type [academic 
vs. community]).
    This information will help define the Challenge's reach and 
effects; the Challenge is intended to affect many different practices 
sizes and types.
    e. Practice deployment strategy summary and critical success 
factors for spreading CDS tool implementation to enhance BP control.

Eligibility Rules for Participating in the Competition

    To be eligible to win a prize under this challenge, an individual 
or entity--
    (1) Shall have registered to participate in the competition under 
the rules promulgated by the Office of the National Coordinator for 
Health Information Technology.
    (2) Shall have complied with all the requirements under this 
section.
    (3) In the case of a private entity, shall be incorporated in and 
maintain a primary place of business in the United States, and in the 
case of an individual, whether participating singly or in a group, 
shall be a citizen or permanent resident of the United States.
    (4) May not be a Federal entity or Federal employee acting within 
the scope of their employment.
    (5) Shall not be an HHS employee working on their applications or 
submissions during assigned duty hours.
    (6) Shall not be an employee of Office of the National Coordinator 
for Health IT.
    (7) Federal grantees may not use Federal funds to develop COMPETES 
Act challenge applications unless consistent with the purpose of their 
grant award.
    (8) Federal contractors may not use Federal funds from a contract 
to develop COMPETES Act challenge applications or to fund efforts in 
support of a COMPETES Act challenge submission.
    An individual or entity shall not be deemed ineligible because the 
individual or entity used Federal facilities or consulted with Federal 
employees during a competition if the facilities and employees are made 
available to all individuals and entities participating in the 
competition on an equitable basis.
    Entrants must agree to assume any and all risks and waive claims 
against the Federal Government and its related entities, except in the 
case of willful misconduct, for any injury, death, damage, or loss of 
property, revenue, or profits, whether direct, indirect, or 
consequential, arising from my participation in this prize contest, 
whether the injury, death, damage, or loss arises through negligence or 
otherwise.
    Entrants must also agree to indemnify the Federal Government 
against third party claims for damages arising from or related to 
competition activities.

Registration Process for Participants

    To register for this Challenge, participants can access http://www.challenge.gov and search for ``EHR Innovations for Improving 
Hypertension Challenge.''

Prize

    Phase 1 will have up to 4 winners, each of whom will receive a 
$5,000 prize. Other Phase 1 submitters who provide CDS tools that 
reviewers select for spread during Phase 2 dissemination efforts will 
receive non-monetary recognition (e.g., Honorable Mention).
    Phase 2 will have a single winner of a $30,000 cash prize. Other 
Phase 2 submitters, whose CDS tool dissemination and implementation 
strategies the reviewers deem commendable, will receive non-monetary 
recognition (e.g., Honorable Mention).

Payment of the Prize

    Prize will be paid by contractor.

Basis Upon Which Winner Will Be Selected

    The review panel will make selections based upon the following 
criteria:

Phase 1

     BP Control (<140/90) among hypertension patients.
    [cir] BP control rate: Specifications used to determine this rate 
must be the same as that used for PQRS 236/NQF 0018) 
and/or
    [cir] BP control rate improvement: Percentage point increase in BP 
control rate over a specified time. Submissions will be evaluated based 
on the percent improvement, if this is provided by submitters, but no 
specific threshold must be demonstrated as a part of submission 
requirements.
     Comprehensiveness and innovation in addressing the 
protocol elements using EHR or other health IT.
     CDS tool implementation description detailed enough so 
that others could replicate it.
     Ease with which others could implement the same approach 
(e.g., if the strategy required a high degree of custom development 
that cannot easily be shared, then it would be harder for others to 
replicate).

Phase 2

     Number of practices in which the CDS interventions were 
implemented, or implementation is underway.
     Number of practices expressing interest in replicating the 
CDS-enabled protocol implementation approach in addition to those that 
actually implemented it during Phase 2.
     CDS tool implementation spread efforts resulting in 
demonstrated BP control improvements. Absent actual BP control 
improvements, demonstration of compelling evidence that CDS tool 
implementation has made a positive impact on BP care processes and/or 
that BP control improvements are likely.
     Comprehensiveness and innovation in supporting BP protocol 
elements with CDS tools.
     Likelihood that the submitter's approach to spreading the 
CDS tool-enabled BP protocol implementation can be further replicated 
beyond Phase 2.
    In order for an entry to be eligible to win this Challenge, it must 
not use HHS' or ONC's logos or official seals in the Submission, and 
must not claim endorsement.

Additional Information

    General Conditions: ONC reserves the right to cancel, suspend, and/
or modify the Contest, or any part of it, for any reason, at ONC's sole 
discretion.
    Intellectual Property:
     Each entrant retains title and full ownership in and to 
their submission. Entrants expressly reserve all intellectual property 
rights not expressly granted under the challenge agreement.
     By participating in the challenge, each entrant hereby 
irrevocably grants to Sponsor and Administrator a limited, non-
exclusive, royalty-free, worldwide license and right to reproduce, 
publically perform, publically display, and use the Submission to the 
extent necessary to administer the challenge, and to publically perform 
and publically display the Submission, including, without limitation, 
for advertising and promotional purposes relating to the challenge.

    Authority:  15 U.S.C. 3719.

    Dated: June 26, 2014.
Karen DeSalvo,
National Coordinator for Health Information Technology.
[FR Doc. 2014-16016 Filed 7-7-14; 8:45 am]
BILLING CODE 4150-45-P