Overview. Vision for Immunization Registry Integration with Electronic Health Records

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1 Overview Background of Minnesota s Immunization Registry and EHR environment Current Immunization Integration with EHRs in Minnesota Vision for Immunization Registry Integration with Electronic Health Records Vision of MN e-health group in 2006 Lessons learned from HCMC/MDH partnership for integration of asthma tool with electronic health record Kevin Larsen, MD, FACP CMIO HCMC 2008 Minnesota E-Health Initiative 6/25/08 Minnesota Immunization Information Connection, MIIC Immunization Registry Started as regional Minnesota registries in late 1980s Migrated to state MIIC system by early 1990s % of providers participating 70% of children with 2 or more immunizations million clients in MIIC Popular with providers and patients alike Minnesota Electronic Health Record Environment State of large, integrated health systems, Allina, Fairview, Health Partners etc High rate of electronic health record penetration with CPOE in hospitals and clinics alike Single vendor, Epic, has large market penetration Large, integrated installations in multi-facility care systems 75% of Minnesota patients will have a record a health system with Epic in 2009 Highly collaborative health care environment, especially in the electronic health record area 1

2 Epic Integrated clinical and billing applications with CPOE and patient chart across the continuum of care Active Minnesota Epic User group Shares ideas Shares lessons learned Shares code and configuration At least 2 currently funded Minnesota/Epic health IT research projects Medical record sharing in Emergency departments Integration of state asthma application with EHR Current State of Integration Many health systems with EHRs are sending EHR data directly to MIIC One health system built the report- then shared it with the other health systems Typically a batch job- weekly, monthly Most sending clinical data, rather than just billing data Clinical users launching MIIC outside of EHR workflow may or may not be documenting in MIIC At worst duplicate documentation is happening In EHR In MIIC What are the advantages of capturing immunization data from EMRs over billing systems? EMRs and immunization registries are both designed to capture clinical data; billing systems are primarily for administrative purposes. Information such as chickenpox history, vaccine contraindications, and refusal of vaccines can be captured in an EMR but not typically in billing systems. EMR data is often entered by the clinical staff who saw the patient, eliminating steps that could potentially result in transcription or coding errors. What is available from MIIC that is not typically in an EMR? Specific information on shots given elsewhere information already contained in the MIIC and readily available to your staff without them having to call around to collect it. Decision support vaccine-specific recommendations on what shots can be given today. This includes the earliest date a vaccine can be given, the recommended date, and the overdue date. MIIC also shows when a series is complete or if the patient is now too old to complete a series. School access to MIIC, so having a clinic s immunization data in the registry greatly reduces school calls to your staff for immunization histories. Tracking of MnVFC eligibility categories needed for annual reporting to MDH. What s in the future for EMRs and MIIC? A seamless EMR interface that would enable clinics to query MIIC without leaving their EMR. The clinic would get back not only the consolidated patient history of vaccines no matter where the vaccines were given but also the recommended immunizations for today (decision support). Ordering MnVFC vaccines through MIIC. Health Plans obtaining immunization HEDIS data from MIIC instead of requiring a clinic to run (and possibly pay separately for) an ad hoc report from their EMR. Vision for Integration 2005 Allina, a Minnesota Health System, and MDH developed requirements for one way and 2 way exchange Stalled due to lack of bandwidth during Allina s implementation 2006 MN E-Health Advisory Committee work group on MIIC-EHR Interoperability Developed vision, standards and project plan for integration Requested funding from MN legislature- not funded 2

3 Our Vision Fully integrate bi-directional immunization data exchange between the MIIC immunization registry and EHRs, with centralized decision support from the registry. A person s entire immunization history, along with alerts for any needed vaccines, is readily available within electronic medical records (EMR) used in Minnesota through a real time, two-way exchange between the state s immunization registry and the EMRs. What would that look like? Clinician works in the EHR From the immunization record in the EHR launches the MIIC registry MIIC displays entire immunization history of that patient across all MN health care current immunization schedules (decision support) Provider orders and documents administration of immunization in EHR EHR sends immunization record immediately to MIIC MIIC does reporting of HEDIS and other quality measures of immunization Details from Our Report A one-way, real time HL7 exchange feature that automatically sent to MIIC any immunization data entered into the EMR; and A two-way exchange feature that enabled: clinic staff to query MIIC from within the EMR s immunization screen for any given patient (for instance with a Check Immunizations button on the screen); for the login credentials and patient identifiers to be sent behind the scenes to MIIC; for MIIC to return the patient s history and vaccine forecasts, and for the EMR to display that information within its immunization screen; for the user to be able to select whether or not to load any of the information to the EMR; for any new data entered into the EMR to be automatically sent to MIIC; and to automatically log out of MIIC when the immunization screen is left What Happened to Our Vision? Large portion of Epic interface built by Allina and Fairview Willing to share that free with other Minnesota Epic customers Someone needed to fund the development of MIIC to accept the 2 way interface 3

4 HCMC/MDH Interactive Asthma Action Plan HCMC s Center for Urban Health Awarded an AHRQ contract to: update MDH Asthma Action Plan computer application integrate it with Epic Share application and integration freely Similar partnerships, similar end goals Develop software to share Develop software to integrate to multiple EHRs Develop interface that is seamless and easy for clinicians Maintain and report from a disease registry out of an EHR Maintain decision support in the small application (registry) Lesson Learned from the EHR Tradeoff between adoption and portability Governance is challenging Support model is needed Lesson Learned from the EHR End user adoption based on value and ease of use Ease of use dependent on tight integration Tight integration=vendor specificity Therefore a tradeoff between adoption and portability Governance is challenging Multiple stakeholders including Clinician endusers- want easy, integrated access Health care organizations- need budget justification for resource outlay IS departments of health care organizations Multiple projects, multiple priorities Assuring security of data, assuring privacy Maintenance of interfaces, new applications Department of Health Budget and timelines independent of health care organizations Ownership of applications Researchers- want analysis for proof of concept, can drive budget and timelines, due to funding Support Model is Needed Implementation Registry- will likely need some build and test for each EHR EHR interface- build largest for first customer from each vendor, but with each will need some resources Maintenance Registry- need staff with skill to handle changes in data stream, staff to run reports for health department and providers EHR- staff time to maintains integration, trouble shoot issues (duplicate records etc) Analysis- need proof of concept for population and for health care delivery organizations 4

5 Next Steps MN E-Health Initiative re-convene our MIIC-EHR Immunization work group Solicit funding for MIIC end of the interface Develop ROI analysis for health care providers (HEDIS, MN Free Vaccine etc) Develop governance model Develop support model Solicit funding for analysis of proof of concept 5