Meaningful Use Stage 1 and Public Health: Lesson Learned

Meaningful Use Stage 1 and Public Health: Lesson Learned NAACR Presentation August 16, 2012 James Daniel, MPH Public Health Coordinator Office of the National Coordinator for Health IT

Agenda Overview of Public Health Measures REC/HIE Programs Message to Public Health Real World Meaningful Use Technical Assistance Team Medicaid Funding 8/30/2012 Office of the National Coordinator for Health Information Technology 2

Advanced clinical processes Improved outcomes Data capture and sharing 3

Stage 1 Meaningful Use Menu: Improve Population and Public Health Communicate with public health agencies Objective 1 Ambulatory Measure Hospital Measure Immunization Registries 2 Reportable Lab Results 2 (ELR) Syndromic Surveillance 2 1 test of submission to state immunization registry (unless no registries are capable) with continued submission if successful (y/n) N/A 1 test of submission to public health (unless no ph agency is capable) with continued submission if successful (y/n) 1 test of submission to state immunization registry (unless no registries are capable) with continued submission if successful (y/n) 1 test of submission to public health (unless no ph agency is capable) with continued submission if successful (y/n) 1 test of submission to public health (unless no ph agency is capable) with continued submission if successful (y/n) 1. Unless an EP, eligible hospital or CAH has an exception for all of these objectives and measures they must complete at least one in this group as part of their demonstration of a meaningful use to be eligible for incentives. 2. Public health agencies may specify how to test the data submission and to which specific destination Source: Dr. Paul Kleeberg, Clinical Director, Key Health Alliance 4

Standards for Public Health Transactions in Stage 1 Meaningful Use Public Health Domain Immunizatio n Registries (IIS) Reportable Lab Results (ELR) Syndromic Surveillance Exchange Standards Standard - HL7 2.3.1 Implementation Guide for Immunization Data Transactions using Version 2.3.1 of the Health Level Seven (HL7) Standard Protocol Implementation Guide Version 2.2 Standard - HL7 2.5.1 HL7 2.5.1 Implementation Guide for Immunization Messaging Release 1.0 Standard - HL7 2.5.1 HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 Standard - HL7 2.3.1 Standard - HL7 2.5.1 Guide available, not required for Stage 1: Implementation Guide for Syndromic Surveillance: Emergency Department and Urgent Care Data Release 1.0 Note: Ambulatory / In-patient Guide under development Vocabulary Standards HL7 Standard Code Set CVX - Vaccines Administered, July 30, 2009 version Logical Observation Identifiers Names and Codes (LOINC ) version 2.27 5

Paper-Based Practice Support Network REC-Provider Partnership Fully Functional EHR Regional Extension Center Community College Workforce Communities of Practice Health Information Technology Research Center (HITRC) Education and Outreach Workforce Vendor Relations Implementation Workflow Redesign Functional Interoperability Privacy and Security Meaningful Use Population Health Health Care Efficiency Patient Health Outcomes 6

Workforce Provide EHR training to providers and staff Interoperability & HIE Assist providers in meeting functional interoperability requirements Implementation Support Provide EHR project management support Vendor Selection Assess practice s IT needs and help select/ negotiate vendor contracts REC Services Meaningful Use Assist providers on achieving Meaningful Use objectives Outreach & Education Share best practices to select, implement, and meaningfully use EHRs Privacy & Security Implement best practices to protect patient information Practice & Workflow Design Assist practices in improvement of daily operations 7

Models for RECs to Help Public Health Communication to Providers Requirements/Process for meeting PH Measures Provider training Vendor engagement Contract negotiations for PH interfaces Provide access to certified EHR modules Ohio Provide Transport mechanisms 8/30/2012 Office of the National Coordinator for Health Information Technology 8

Facilitates and expands the secure electronic movement and use of health information Federal-State collaboration Prepares States to support their providers in achieving HIE MU goals, objectives and measures Four year program, total funding available $548 million 56 states/state designated entities and territories awarded in February and March of 2010 States need an ONC approved State Plan before Federal funding can be used for implementation 9

Ensure ALL eligible providers within every state have at least one option available to them to meet the three program priorities. E-prescribing the ability to generate and transmit permissible prescriptions electronically (erx) Receipt of structured lab results the ability to incorporate clinical lab test results into EHR as structured data Sharing of patient care summaries across unaffiliated organizations the ability for every provider to provide a summary care record for each transition of care or referral 10

Models for HIEs to Help Public Health Filtering results New Mexico ELR Incorporate structured lab results New Mexico Provide access to certified EHR modules Ohio Provide Transport mechanisms 8/30/2012 Office of the National Coordinator for Health Information Technology 11

Public Health HIE / HUB Directly to Public Health Directly to Public Health Hospital Scenario 1 Scenario 2 Scenario 3 Complete EHR EHR and/or LIMS EHR and/or LIMS MU Compliant Messages HIE (Routing to PH, no transformation of message format) HIE (Routing to PH, no transformation of message format) HIE (Routing to PH, with transformation of message format) MU Compliant Messages Message Receiver Message Receiver Message Receiver Data Stores and Applications Data Stores and Applications Data Stores and Applications Eligible hospitals must certify all modules, since EHR is not performing all MU functions

Certification Process that electronic health records (EHRs) and modules go through to ensure they meet meaningful use objectives and specified standards. Standards for testing are published by National Institute of Standards and Technology (NIST). Certification process is performed by the Authorized Testing and Certification Bodies (ATCB).

Stage One

Testing The eligible hospitals/eligible professionals (EP) exchange messages with public health agency (PHA) to get the correct format and values as determined by PHA In Queue Follows successful testing Eligible hospitals/ep may be prioritized by PHA for validation at a later date Validation Public health evaluation of new electronic data. Comparison with paper submission or previous electronic data flows Production Data is continuously being sent to the PHA and is being monitored for quality assurance

Common Problems Communication with Health Department Providers must ask PHA if they are ready and where to send message Resources available at cdc.gov/meaningfuluse Transport Provider responsibility versus Public Health authority

Meaningful Use Public Health Technical Assistance Team Example Issues EP using a vendor s product was not populating Provider ID information in the immunization message which was not acceptable to the immunization registry. Facilitated discussion between the state DOH, registry, and vendor resulting in an interim solution for testing and vendor s commitment to address issue in the next release of the product. State DOHs challenged to support MU testing and on-boarding of providers / hospital to initiate data submission. Suggested the state DOH consider the Test & Queue methodology - identify minimal criteria for passing a test message, then queue the successful providers / hospitals, and on-board based on the state s priorities. Physician who does very few immunization during a year (less than 10) and is getting conflicting information on whether have to test/submit data or whether they are excluded.. Any immunization given in 90 day reporting period requires reporting to PHA. Must send test message, but encouraged health department to utilize test and queue to prioritize providers. 17 Office of Surveillance, Epidemiology, and Laboratory Services Division of Informatics Practice, Policy & Coordination

Meaningful Use Public Health Technical Assistance Team Example Issues (cont) Hospitals sending data through legacy systems for Syndromic or ELR from systems that are either not MU certified or are not sending MU transactions Facilitated discussion between PHA and HIE. HIEs often have certified technology for submission of PH measures so the HIE could serve as the official submitter of the PH data. County/Local Health Departments trying to determine eligibility for EHR Incentive payments. Started a sub-group of the ONC/CDC MU Community of Practice. Local Health Departments receiving technical assistance from RECs even if not eligible for incentive payments. Hospital missing certified technology module necessary to submit data to PH. Facilitated discussion between hospital, state DOH, REC, and HIE to identify an option for the hospital to use certified technology available through the HIE to submit data to PH. 18 Office of Surveillance, Epidemiology, and Laboratory Services Division of Informatics Practice, Policy & Coordination

Meaningful Use Public Health Technical Assistance Team Team s Purpose and Goals Assist in resolving issues and problems preventing successful achievement of the Meaningful Use public health objectives Provide focused policy and technical expertise Identify successful methods used to resolve similar issues Rapidly resolve misunderstandings and simple problems Document and learn from the real problems occurring the field 19 Office of Surveillance, Epidemiology, and Laboratory Services Division of Informatics Practice, Policy & Coordination

Meaningful Use Public Health Technical Assistance Team How to request assistance? To request technical assistance from the MU PH TA team, send an email to the CDC Meaningful Use Mailbox (meaningfuluse@cdc.gov) with Request for Technical Assistance in the Subject line. Please include a detailed description of the issue or problem and your contact information. 20 Office of Surveillance, Epidemiology, and Laboratory Services Division of Informatics Practice, Policy & Coordination

Medicaid Funding Approved State Medicaid Health Plan Up to 90% Reimbursement Infrastructure Costs Other potential costs

Meaningful Use Public Health Technical Assistance Team Questions? 22 Office of Surveillance, Epidemiology, and Laboratory Services Public Health Informatics and Technology Program Office

Potential Cancer Reporting in Meaningful Use Stage 2 Wendy Blumenthal, MPH Health Scientist Cancer Surveillance Branch Division of Cancer Prevention and Control Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control

Stage 1 Lessons Learned Things to Think about for Cancer Reporting Transport Proposed: Public health agency will determine transport method We will provide technical assistance wherever possible Work with your RECs and HIEs Provide/assist with transport mechanisms Format transformation Provider communication Vendor engagement Meaningful Use Public Health Technical Assistance Team meaningfuluse@cdc.gov Provides assistance to: EHR vendors, providers, HIEs, RECs, and cancer registries

On-boarding process Lessons Learned (con t) Test & Queue methodology Proposed: Ongoing production for entire reporting period Importance of single national standard Central Cancer Registries have agreed to use single standard Implementation will be easier than for some Stage 1 programs because they have local implementation that vary from state to state Medicaid funding Make connection with state Medicaid director or ask your commissioner to make the connection Potential funding for infrastructure and operational costs NAACCR Physician WG and CDC will develop guidance to help address many of the issues raised

Other Resources CDC Meaningful Use website: http://www.cdc.gov/ehrmeaningfuluse/ HIE and REC points of contact list to be provided HITRC portal Request form and instructions: http://www.cdc.gov/ehrmeaningfuluse/hitrc_portal.html Single stop for current information related to the Public Health Meaningful Use Nationwide Call and includes call in information, presentations, and other related documents Public Health Community of Practice (CoP): Purpose is to increase collaboration between Public Health Associations, Regional Extension Centers and State Health Information Exchange members who are working towards enabling eligible providers and hospitals achieve meaningful use objectives related to public health.

Thank you! Wendy Blumenthal wblumenthal@cdc.gov 770-488-1131 Sandy Jones sft1@cdc.gov 770-488-5689 For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control