Benefits and Challenges of EHR-IIS Real-Time Communication

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1 Benefits and Challenges of EHR-IIS Real-Time Communication Kristen Forney, MPH Citywide Immunization Registry Bureau of Immunization AIRA IIS Meeting 2012

2 OVERVIEW Citywide Immunization Registry (CIR) Background: HL7 Data Exchange Definition and Benefits of Real-time, Bidirectional Challenges Best Practices Supporting Data Future Directions

3 CIR S HL7 DATA EXCHANGE Real-time, bi-directional exchange through a SOAP web service No batch file option for providers First facility began submitting data through the web service in January 2011 Currently 251 facilities sending HL7 data through the web service (126 of which are bidirectional) HL7 submissions now account for ~25% of total CIR data

4 SHIFT IN REPORTING METHOD 100% 90% 80% 39.5% 43.2% 44.0% 41.7% 35.0% 35.8% Immunizations Reported 70% 60% 50% 40% 30% 56.8% 51.7% 47.0% 41.0% 40.1% 41.8% 20% 10% 0% 17.3% 24.9% 22.4% 3.7% 5.1% 9.0% Q Q Q Q Q Q Time Online Registry Batch (flat file) WebService

5 VENDORS Production Office Practicum Quadramed eaddabbo EZVAC EPIC MDLand Enable Health Inc. Cerner AthenaHealth Allscripts Eclypsis OmniMD Test NextGen eclinicalworks Greenway Advanced Data Systems Adaptamed Meditech

6 DEFINITIONS Real-time Synchronous Transport- User submits an HL7 message, and as part of that transaction/connection to the IIS, the application waits for an acknowledgment response Synchronous Processing- Upon receipt of an HL7 message, IIS processes the message and acknowledges the results of processing. Data is immediately accessible to users of the IIS. Bi-directional EHR sends an HL7 query (VXQ or QBP) and receives a response containing patient s immunization history, evaluation and decision support EHR imports IIS data and stores it as structured data

7 WHY REAL-TIME IS IMPORTANT Real-time Querying: Providers can get up-to-date immunization information on their patients while the patient is in the office Real-time Reporting: Providers can get immediate feedback on their submissions (i.e. processed successfully or rejected, immunizations valid or invalid) Necessary for receiving up to date clinical decision support, informing the patient when they are due for next immunization

8 NEW PATIENT- QUERY FOR RECORDS

9 ADMINISTER SHOTS DUE

10 RECEIVE UPDATED DECISION SUPPORT

11 BENEFITS OF REAL-TIME BI-DIRECTIONAL EXCHANGE For Providers: Avoid double data entry (44 CIR facilities have moved from online registry to HL7 web service) Accessibility of information within provider workflow Accuracy of data within provider EHR Allows providers to do quality assurance on their data Can log onto the web application to see results of EHR transaction immediately Data immediately available in IIS for use with school forms, other pre-completed forms

12 BENEFITS OF REAL-TIME BI-DIRECTIONAL EXCHANGE For an IIS: Timeliness Completeness of immunization information (lot number, manufacturer, expiration date, etc) Providers have continuous interaction with the IIS Simplifies the troubleshooting process

13 CHALLENGES OF REAL-TIME HL7 EXCHANGE When should EHR trigger information to send to the IIS? Error logging and correction What happens when a real-time transaction fails? Does the EHR system log these errors and make them accessible to providers? How can the information be corrected and re-sent? How will the EHR handle outages, connection failures?

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17 CHALLENGES OF BI-DIRECTIONAL HL7 EXCHANGE How can we ensure that the IIS finds and returns the correct patient? EHR should send all possible demographic information Exchange registry IDs Will the EHR display IIS data correctly? Thorough testing with the EHR vendor Involve providers in testing How will the EHR de-duplicate immunizations?

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19 BEST PRACTICES FOR REAL-TIME BI-DIRECTIONAL EXCHANGE For IIS: Webinars (or site visits) with providers to understand how their EHR works Set up the ability to restrict queries from specific accounts Send registry ID in HL7 message response Data quality monitoring; daily s For EHRs: Store patient s registry ID and send in all transactions Automatic re-query to get decision support updated Full sync of registry record with EHR record critical for accurate decision support

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21 IMPROVED VFC ELIGIBILITY AND LOT NUMBER AND LOT NUMBER CAPTURE Data source Percent of immunizations with VFC status* Percent of immunizations with lot number** Flat File Online Registry HL7 Web Service Total *Data from all newly administered immunizations reported to the CIR between Jul 1 st, 2011 and Jul 1 st, 2012 for patients < 19 years **Data from all newly administered immunizations reported to the CIR between Jul 1 st, 2011 and Jul 1 st, 2012 for patients <19 years

22 CONCLUSIONS Real-time, bi-directional exchange is feasible Scalable to a large number of facilities Presents a number of benefits to providers and IIS Resulted in more complete data for the CIR Collaborations with EHR vendors are essential

23 FUTURE DIRECTIONS- IIS COMMUNITY Start thinking about Meaningful Use Stage 3 How to build capacity for bi-directional exchange for all IISs Reduce Variability in HL7 implementations between IISs Standardize decision support in HL7 specifications Create a set of recommendations to EHR vendors for best practices

24 THANK YOU! Amy Metroka Vikki Papadouka Angel Aponte Paul Schaeffer Contact Information Kristen Forney Director, EHR-IIS Interoperability Project