Click to edit Master title style Public Health Reporting Meaningful Use Stage 1 and 2 Laura Rappleye Altarum Institute Deputy Director, Center for Connected Health Kristy Brown Michigan Department of Community Health Meaningful Use Public Health Testing Support January 14, 2015 1/14/2015 1 1
Agenda 1. Overview of M CEITA and Meaningful Use (MU) 2. Stage 1 Public Health Objectives and Steps to Meet the Measures 3. Stage 2 Public Health Objectives and Steps to Meet the Measures 4. Questions 2
Who is M-CEITA? Michigan Center for Effective Information Technology Adoption (M-CEITA) One of 62 ONC Regional Extension Centers (REC) providing education & technical assistance to primary care providers across the country Founded as part of the HITECH Act to accelerate the adoption, implementation, and effective use of electronic health records (EHR), e.g. 90-days of MU Funded by ARRA of 2009 (Stimulus Plan) Purpose: support the Triple Aim by achieving 5 overall performance goals THETRIPLE AIM Improve patient experience Improve population health 3Reduce costs Improve Quality, Safety & Efficiency Engage Patients & Families Performance Measurement Improve Care Coordination Improve Population And Public Health Meaningful Use Ensure Privacy And Security Protections Certified Technology Infrastructure 3
M-CEITA s Services Our services are highly subsidized for qualified providers. These Health IT services include: Meaningful Use Support Security Risk Assessment Targeted Process Optimization (Lean) Attestation/Audit Preparation 4
Meaningful Use Overview and Program Basics 5
Meaningful Use as defined by CMS Meaningful Use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities Engage patients and families Improve care coordination and population and public health Maintain privacy and security of patient health information Ultimately, it is hoped that 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
Meaningful use: Path to better outcomes and quality Stage 2 Advanced clinical processes Stage 3 Improved outcomes Stage 1 Data capture and sharing Better clinical outcomes Improved population health outcomes Increased transparency and efficiency Empowered individuals More robust research data on health systems For more information on meaningful use of EHRs, visit: http://www.cms.gov/ehrincentiveprograms/35_meaningful_use.asp 7
Stage 1 and Stage 2 MU Objective Comparison 9 8
Click to edit Master title style Stage 1 Public Health Objectives 1/14/2015 9 9
Stage 1 Public Health Objectives 3 of the 9 menu set are public health objectives Must select 1 public health measure Stage 1 Menu Items Immunizations Capability to submit electronically to registries/systems Syndromic Data Capability to submit electronically to public health agencies Eligible Professional (EP) or Hospital? Both Both Reportable Laboratory Results Capability to submit electronically to public health agencies Hospitals 10
Stage 1 Public Health Exclusions CMS Final Rule Exclusions An eligible professional and/or hospital does not administer immunizations during the reporting period An eligible professional who does not collect reportable syndromic data during the reporting period The public health agency/immunization registry does not have the capacity to receive immunizations, syndromic data and/or reportable labs The public health agency/immunization registry prohibits submission of immunizations, syndromic data and/or reportable labs Valid Exclusion in Michigan? Yes Yes NO! No* * Syndromic data is not accepted from the following provider types, and therefore an exclusion is permitted: Dentists, Dental Surgeons, Podiatrists, Optometrists/Ophthalmologists, Chiropractors, and Certified Nurse midwives. 11
Frequently Asked Question Question What is syndromic data? Answer Aset of de identified data collected from emergent care and ambulatory care settings used to detect bioterrorism(anthrax), emerging infections(foodborne illness, influenza), and naturally occurring outbreaks. Example data collected: Chief complaint or encounter reason (presenting symptoms), date of onset, age, temperature, date/time of admissions or visit Source: https://www.michiganhealthit.org/wp-content/uploads/msss-submission-guide- Inpatient-Ambulatory-Dec2013-Revision.pdf 12
Frequently Asked Question Question If an eligible professional can exclude from both of the public health measures, how should they select the 5 menu items? Answer If an EP can be excluded from both public health menu objectives, the EP may meet the menu requirement one of two ways: 1. Claim an exclusion from only one public health objective and report on four additional menu objectives from outside the public health menu set. (Only valid if EP can justifiably claim exclusions on all other menu objectives) 2. Report on five menu objectives from outside the public health menu set. Source: https://questions.cms.gov/faq.php?id=5005&faqid=2903 13
Public Health Systems Supporting Stage 1 Michigan s Public Health Systems Immunizations Syndromic Reportable Labs Michigan Care Improvement Registry (MCIR) Michigan Syndromic Surveillance System (MSSS) Michigan Disease Surveillance System (MDSS) 14
Meeting the Measure(s) Stage 1, Year 1 Submit One Test Before or During the Reporting Period Must use the standards (i.e. HL7 2.5.1) and technology the EHR is certified to use for the public health measure Submission of actual patient information is not required for the one test If the public health agency considers the one test unsuccessful, the failed test satisfies the measure If the test is successful, regular reporting with the entity with whom the successful test was conducted is required, in accordance with applicable law and practice 15
Frequently Asked Question Question If multiple eligible professionals (EPs) are using the same certified EHR technology across several physical locations, can a single test or onboarding effort serve to meet the measures of these objectives? Answer The intent of the public health objectives is to demonstrate that a provider has the full capability to use their certified EHR technology to successfully submit data to public health agencies in a live setting. Under changes made in the Stage 2 Final Rule, providers within the same organization that use the same certified EHR technology and share a network for which their organization either has operational control of or license to use can conduct one test or one single effort to register and onboard that covers all providers in the organization. For example, if a large group practice of EPs with multiple physical locations uses the same EHR technology and those locations are connected using a network that the group has either operational control of or license to use, then a single test would cover all EPs in that group to meet this objective. Source: https://questions.cms.gov/faq.php?id=5005&faqid=3819 16
Steps to Submit 1 Test Message Stage 1, Year 1 17
Attesting Yes Stage 1, Year 2 Follow-Up Submission Regular reporting with the entity with whom the successful test was conducted is required, in accordance with applicable law and practice Demonstration of engagement with the public health agency meets the measure (As of 7/29/2013) Engagement in the form of communications showing evidence of action in year 2 Provider needs to demonstrate: Another test is not beneficial to move towards follow-up submission Follow up submission is not possible in year 2 Source: https://questions.cms.gov/faq.php?id=5005&faqid=8910 Medicare auditors are requesting proof of engagement with the public health agencies during year 2 18
Steps for Stage 1, Year 2 Follow Up Submission 19
Click to edit Master title style Stage 2 Public Health Objectives 1/14/2015 20 20
Stage 2 Public Health Objectives Stage 2 Eligible Professionals Core or Menu? Stage 2 Hospitals Core or Menu? Immunizations Capability to submit electronically to registries/systems Core Immunizations Capability to submit electronically to registries/systems Core Syndromic Data Capability to submit electronically to public health agencies Menu Reportable Laboratory Results Capability to submit electronically to public health agencies Core Cancer Case Reports Capability to identify and report to a registry Menu New Syndromic Data Capability to submit electronically to public health agencies Core Specialized Case Reports Capability to identify and report specific cases (i.e. birth defects) to a registry Menu New 21
Stage 2 Public Health Exclusions CMS Final Rule Exclusions An eligible professional and/or hospital does not administer immunizations during the reporting period Valid Exclusion in Michigan? Yes An eligible professional who does not collect reportable syndromic data, diagnose and treat cancer or the disease associated with the specialized registry Ahospital who does not have an emergency or urgent care department for syndromic reporting An EP and/or hospital operates in a jurisdiction for which no immunization registry/public health agency or is capable of accepting the specific standards required for Certified EHR Technology at the start of their EHR reporting period An EP operates in a jurisdiction where no immunization registry/public health agency provides information timely on capability to receive immunization, syndromic, reportable labs, cancer case and specialized reports A hospital operates in a jurisdiction where no immunization registry/public health agency provides information timely on capability to receive immunization, syndromic and reportable labs An EP and/or hospital operates in a jurisdiction for which no public health agency is capable of accepting the specific standards required by Certified EHR Technology at the start of their EHR reporting period can enroll additional eligible hospitals or EPs. Yes Yes No No No No * Syndromic data is not accepted from the following provider types, and therefore an exclusion is permitted: Dentists, Dental Surgeons, Podiatrists, Optometrists/Ophthalmologists, Chiropractors, and Certified Nurse midwives. 22
Public Health Systems Supporting Stage 2 Michigan s Public Health Systems Immunizations Syndromic Reportable Labs Cancer Specialized Registry Michigan Care Improvement Registry (MCIR) Michigan Syndromic Surveillance System (MSSS)* Michigan Disease Surveillance System (MDSS) Michigan Cancer Surveillance Program (MCSP) cancer registry Michigan Birth Defects Registry (MBDR) 23
Meeting the Measure(s) Providers can attest YES, if they meet one of four scenarios: Scenario 1 Submitting case information prior to Stage 2 using a 2014 ONC certified EHR AND Continues to submit during the EPs reporting period Scenario 2 Scenario 3 Registered intent within 60 days of the EPs reporting period AND Achieved ongoing submission during the Stage 2 reporting period Registered intent within 60 days of the EPs reporting period AND Engaged in the required testing and validation process leading to ongoing submission Scenario 4 Registered intent within 60 days of the EPs reporting period AND Awaiting an invitation to engage in the required testing and validation process 24
Failing to Meet the Measure(s) Providers will NOT meet the measure, if they fail to respond to PHA requests Scenario 1 Fails to register their intent by the deadline*** Scenario 2 Fails to participate in the onboarding process as demonstrated by failure to respond to the PHA written requests for action within 30 days on two separate occasions. ***It is permissible to register intent on the 60 th day of the reporting period 25
What is Onboarding? The Testing and Validation Process to: Ensure the provider has entered the required public health information into the EHR Ensure the EHR technology has electronically extracted the information and formatted it to meet the certification requirements and standards Ensure the data sent is what the public health agency is expecting before adding the data to the public health system (Data Quality Assurance) 26
Public Health Meaningful Use Onboarding Steps 1 2 3 4 5 Learn about Reporting Requirements Register Intent for Ongoing Submission Test and Validate for Quality Assurance Establish a Transport Method Send Production Reports and Monitor Data Quality 27
Learn about the Requirements Visit https://www.michiganhealthit.org/public-health/ Public Health Meaningful Use FAQs Contact Information Implementation Guides Link to the Registration Site Share the implementation guides with your vendor/technical support 28
Register Intent Go to MDCH s Registration of Intent Site: https://mimu.michiganhealthit.org/ Review the tip sheets before registering Register the intent of all providers in the organization Completion of the registration is the invitation to begin testing and validation: 29
Frequently Asked Question Question Do eligible professionals and/or hospitals who registered for immunization and/or syndromic testing in Stage 1, and are actively engaged in testing and validation, need to reregister to continue in Stage 2? Answer No, EPs and hospitals who registered for immunization and syndromic testing during Stage 1, do not need to re register. To be recorded as registered for Stage 2, providers should send an e mail stating they have entered in Stage 2 and are actively engaged in testing and validation. Immunization e mail: mu_mcirhelp@mphi.org Syndromic e mail: DCHPublicHealthMU@michigan.gov 30
Begin the Testing and Validation Process - Scenario 3 Site Generates New Reports Submit Reports in Accordance with IG Site Remediates Issues PHA Team Evaluates (DQA) PHA Team Provides Feedback 31
Establish Your Transport Method Scenario 3 Visit http://mihin.org/exchanges/ to find a qualified organization or HIE to transport the public health electronic reports Follow your HIEs instructions for sending ongoing public health electronic reports MiHIN Qualified HIE MiHIN Validation 32
Send Production Reports Monitor the transport feed to ensure the electronic reports/messages are submitted regularly Respond to the public health team s requests to improve data quality Correct data quality issues identified Keep record of the MU ongoing submission status that is e- mailed to the contact recorded during the registration process 33
Questions? www.michiganhealthit.org/public-health/ www.mceita.org Laura Rappleye Laura.Rappleye@altarum.org Kristy Brown DCHPublicHealthMU@michigan.gov 34