Meaningful Use Stage 2 as it Relates to the Lab Implementing the Public Health Agency Interface. Interface

Transcription

1 Meaningful Use Stage 2 as it Relates to the Lab Implementing the Public Health Agency Interface Interface

2 Topics Covered Meaningful Use Stage 2 (MU2) Electronic Lab Results (ELR) interface Lab Results to Ambulatory Interface (LRI) EHR interface Basic knowledge required for these interfaces MU2 elements that an LIS needs to support ELR Project Service Path Lessons Learned What is the Industry saying?

3 What is Meaningful Use (MU)? The Health Information Technology for Economic and Clinical Health Act (HITECH) provisions of the American Recovery and Reinvestment Act (ARRA) provides financial incentives to encourage the adoption and meaningful use of certified Electronic Health Record technology. (EHR or CEHRT) Meaningful Use (MU) is a set of standards defined by the Centers for Medicare & Medicaid Services (CMS) that govern the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria.

4 Goal of Meaningful Use Using certified electronic health record (EHR) technology to: Improve quality, safety and efficiency by reducing health disparities Engage patients and family Improve care coordination and public health Maintain privacy and security of patient health information

5 Benefit of Meaningful Use Ultimately, it is hoped that the meaningful use compliance will result in: Better clinical outcomes Improved population health outcomes Increased transparency and efficiency Empowered individuals More robust research data on health systems

6 Stages of Meaningful Use Stage 1: Data Capture and Sharing Stage 2: Advanced Clinical Processes Stage 3: Improved Outcomes

7 Criteria to demonstrate meaningful use under Stage 2 To demonstrate meaningful use under Stage 2 criteria eligible hospitals (EH) and critical access hospitals (CAHs) must meet 16 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 19 core objectives.

8 Eligible Hospital and Critical Access Hospital Meaningful Use Core Measure 8 Objective: Incorporate clinical lab test results into Certified EHR Technology as structured data. Measure: More than 55 percent of all clinical lab tests results ordered by authorized providers of the eligible hospital or CAH for patients admitted to its inpatient or emergency department during the EHR reporting period whose results are either in a positive/negative affirmation or numerical format are incorporated in Certified EHR Technology as structured data.

9 Eligible Hospital and Critical Access Hospital Meaningful Use Core Measure 14 Objective: Capability to submit electronic reportable laboratory results to public health agencies, where except where prohibited, and in accordance with applicable law and practice. Measure: Successful ongoing submission of electronic reportable laboratory results from Certified EHR Technology to a public health agency for the entire EHR reporting period

10 Eligible Hospital and Critical Access Hospital Meaningful Use Menu Set Measure 6 Objective: Provide structured electronic lab results to ambulatory providers. Measure: Hospital labs send structured electronic clinical lab results to the ordering provider for more than 20 percent of electronic lab orders received.

11 LRI - Interface to Ambulatory MU2 Menu Objective 6: Provide structured electronic lab results to ambulatory providers. Standard Required HL7 Version Implementation Guide: S&I Framework Lab Results Interface, Release 1 US Realm, July Vocabulary Required Logical Observation Identifiers Names and Codes (LOINC ) > Database version 2.40 SNOMED CT can be used, optional, not required

12 EHR Interface to Inpatient EMR MU2 Core Objective 8: Incorporate clinical lab tests results into Certified EHR Technology as structured data. LIS provides messages for this core objective. Receiving systems will certify for this objective. This objective is for inpatients only Follows standards set for the LRI message

13 ELR Interface to Public Health MU2 Core Objective 14: Capability to submit electronic reportable laboratory results to public health agencies. Standards Required HL Implementation Guide: Electronic Laboratory Reporting to Public Health Release 1 (US Realm), February, 2010 and its Errata as published by the HL7 Public Health and Emergency Response Work Group, October, 2011 Vocabulary Required IHTSDO SNOMED CT International Release July 2012 and US Extension to SNOMED CT March 2012 Release Logical Observation Identifiers Names and Codes (LOINC ) Database version 2.40 OID UCUM

14 Required Vocabulary LOINC Coding Logical Observation Identifiers Names and Codes (LOINC) is a database and universal standard for identifying medical laboratory observations ELR HL7 standards require LOINC coding for : Orderable Test Specimen/Analyte/Method Antibiotic Susceptibility Panel Antibiotic Methodology

15 Required Vocabulary SNOMED CT Systematized Nomenclature of Medicine (SNOMED CT ) provides the core general terminology for the electronic health record (EHR) ELR HL7 standards require SNOMED CT coding for: Organism Ordinal Results Specimen Specimen Source

16 Required Vocabulary UCUM The Unified Code for Units of Measure (UCUM) is a code system intended to include all units of measures being contemporarily used in international science, engineering, and business ELR HL7 standards require UCUM coding for: Numeric result with a unit of measure

17 Required Vocabulary OID An Object Identifier (OID) is a globally unique identifier whose value is created by a registration authority according to the ISO 9834 series of standards. ELR HL7 standards require OID coding for > Sending Application

18 What MU Stage 2 elements does an LIS need to support? LOINC coding SNOMED CT CLIA number NPI number County coding Contact information and associated note Phone number and associated note Fax and associated note

19 What MU Stage 2 elements does an LIS need to support? Naming convention Prefix, First name, Last name, MI, Suffix, Professional designation Patient Demographic Information Race Ethnicity Next of Kin Account type

20 Sample ELR Project Service Path Receive MU2 training Research State s ELR website Begin ELR cross walk spreadsheet Engage with State Department of Health Complete ELR cross walk spreadsheet Build two test messages

21 Sample ELR Project Service Path Submit test messages to vendor Interface Analyst (IA) for validation using the National Institute of Standards and Technology (NIST*) tool Work with IA to determine what translation tables need to be built Consult regularly with vendor Project Manager (PM), Implementation Consultant (IC) and IA via Webinars Weekly or Bi-Weekly calls Department of Health Update calls

22 Department of Health (DOH) ELR Project Path Step1 = Registration: Eligible hospital (EH) notifies public health of interest in submitting electronic laboratory reporting data for Meaningful Use. Step 2 = Pre-Testing: EH generates and evaluates electronic laboratory reporting test messages. Step 3 = Testing: EH sets up data transport option and submits test messages to public health

23 Department of Health (DOH) ELR Project Path Step 4 = Validation Queue: EH is placed on a waitlist for validation. Step 5 = Validation: EH establishes an electronic data feed to public health, maintains traditional paper based reporting and participates in data validation activities. Step 6 = Production: EH reports via electronic feed and participates in periodic quality assurance activities.

24 Lessons Learned Might need additional staff to Implement ELR More than just an Interface Resources needed from > Lab > LIS > IS > State DOH Get in touch with State DOH early on in the process

25 Lessons learned Insure that LIS vendor will provide on going support Work with State to get messages validated States change requirements frequently Vendors need time to adjust to the changes End User needs time to incorporate the changes

26 What is the Industry saying: CMS ehealth Summit 12/6/2013 Skills acquired in Stage 1 are adequate but Stage 2 resource needs are greater Resource scheduling (coordination of internal staff, vendor and DOH for ELR) Conflicting initiatives ELR, EHR, ICD10 MU requirements dictate what EHR vendors and users must determine how

27 What is the Industry saying: CMS ehealth Summit 12/6/2013 MU steps are 2 year cycles, but implementation requires more than 5 years in Stage 2 Vendor: Specifications/Coding/Testing/Certification and Rollout User: Configuration/Testing/Training/Implementation and Adoption DOH: Staffing/Regulation changes/connectivity

28 Poll conducted by Stoltenberg Consulting at 2013 HIMSS Conference The survey showed an array of frustrations for providers 50 percent pointed to lack of resources as the biggest barrier to achieving meaningful use 23 percent cited tight time frames 15 percent experienced lack of buy-in from others in their organizations 12 percent competed with other health IT projects

29 In Conclusion Plan for your upgrade to meet your facility s timeline for Meaningful Use Attestation Budget for, and purchase the various interfaces and services that will be required Contact your State for reportable disease information Determine a LOINC and SNOMED CT mapping strategy Test, test, test!