April 19, 2012

Meaningful Use and Public Health

Thursday, April 19, 2012

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Thursday, April 19, 2012

Outline of Webinar

Welcome and Introductions  

What is Meaningful Use of EHRs? Why Should LHDs

Care?

Overview of Stage 2•Potential impacts on LHDs•Local-State collaboration

Opportunities for future LHD Input and Engagement for

Stage 3

Q&A

Thursday, April 19, 2012

Speakers

Seth Foldy, Senior Advisor for the Public Health Surveillance &

Informatics Program Office at the Centers for Disease Control and

Prevention (CDC)

James Daniel, Public Health Coordinator for the Office of the National

Coordinator for Health Information Technology (ONC)

Seth Foldy, MD MPH FAAFPSenior Advisor

Public Health Surveillance and Informatics Program Office

CDC and Meaningful Use: Strengthening the Link Between

Healthcare Providers and Public Health

Office of Surveillance, Epidemiology, and Laboratory Services

Public Health Surveillance and Informatics Program Office

Changing Policy Drivers: ARRA HITECH >$20B Medicare/Medicaid incentives to

Implement certified Electronic Health Record (EHR) technology

Use EHR to achieve objectives related to improving:• Care quality, safety and efficiency, including:

o Creation of patient registries (conditions, devices, etc,)o Reporting of quality measureso Clinical decision support (automated warnings/advice)

• Coordination of care• Patient and family engagement• Privacy & security• Population and Public Health (next slide)

Office of National Coordinator for HIT $2B for information exchange, training, Beacon exemplars

Policy Drivers: ARRA HITECH Act

Population & public health objectives include Electronic lab reporting of reportable results Syndromic surveillance Communication with immunization registries Cancer registry reporting

3 stages of aggressive timelines (Oct 2010, 13, 15)

New national standards impact local and state PH

The Early Days…

Today!

Births and fetal deathsBirth defects & congenital disordersImmunizationsCommunicable diseasesReportable test resultsOutbreaksPoisoningOccupational injuriesOther injuriesAdverse events and effectsCancerOther chronic disease reportsVisits and hospitalizations (Syndromic surveillance)Quality reportsDeaths and associated data

HealthcareHealthcare

Public Health

Meaningful Use STAGE 1 Electronic Information Exchange

Births and fetal deathsBirth defects & congenital disordersImmunizationsCommunicable diseasesReportable test resultsOutbreaksPoisoningOccupational injuriesOther injuriesAdverse events and effectsCancerOther chronic disease reportsVisits and hospitalizations (Syndromic surveillance)Quality reportsDeaths and associated data

HealthcareHealthcare

Public Health

Likely Meaningful Use STAGE 2 Electronic Information Exchange

HL7 2.5.1

Births and fetal deaths?Birth defects & congenital disorders?ImmunizationsCommunicable diseases? Reportable test resultsOutbreaksPoisoning?Occupational injuriesOther injuriesAdverse events and effects?CancerOther chronic disease reports?Visits and hospitalizations Syndromic surveillanceQuality reportsDeaths and associated data?

HealthcareHealthcare

Public Health

Possible Meaningful Use STAGE 3Electronic Information Exchange

Immunizations &decision support

Items in green are being considered by S&I FrameworkPH ReportingInitiative – CDA?

Four information sources for Population Health

Meeting Tomorrow’s Challenges• S&I Framework Public Health Reporting

Initiative http://wiki.siframework.org/Public+Health+Reporting+Initiative

– Harmonized use case and value sets from several user stories

• Communicable disease reports• Child health reports• Adverse event reports• Chronic disease reports• Administrative/quality reports

• Possible implementation guide by Stage 3• QueryHealth Initiative

http://wiki.siframework.org/Query+Health

Problem Solving

Meaningful Use Technical Assistance Team Experts in immunization, syndromic and lab reporting Policy interpretation from ONC, CMS Technical assistance resources

All-party conference call ID rapid solution– OR Log problem for longer term fix Request the team: meaningfuluse@cdc.gov

QUESTIONS, INSIGHTS, DISCUSSION

More info:www.cdc.gov/ehrmeaningfulusewww.cdc.gov/phin

Or drop a line to: meaningfuluse@cdc.gov

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.atsdr.cdc.gov

Public Health Surveillance and Informatics Program Office

(Proposed)www.cdc.gov/osels

www.cdc.gov/ehrmeaningfuluse

Table of Contents

• Review of Stage 1• NPRM and Stage 2• Health Information Exchange Models• Regional Extension Centers

04/10/23 Office of the National Coordinator for Health Information Technology 18

Stage 1 Meaningful Use Menu: Improve Population and Public Health

Communicate with public health agencies

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

19

Standards for Public Health Transactions in Stage 1 Meaningful Use

20

Stage 2 Timeline

• CMS and ONC NPRM published March 7• 60 Day Comment Period• Stage 2 Begins 2014

Stage 2 EP Public Health Measures

• 1 EP core measure = immunizations• EPs have to pick 3 of 5 menu measures• 2 new PH Stage 2 EP menu measures-

– Successful ongoing transmission of cancer case information– Successful ongoing transmission of data to a specialized

registry

Stage 2 Public Health EP Core Measure

• One PH EP measure that moved from the Stage 1 menu to the Stage 2 core:– Successful on-going submission of immunization

data• Changed from testing to on-going submission

Stage 2 Public Health EP Menu Measures

• Successful ongoing transmission of syndromic surveillance data

– New– Changed from testing to on-going submission

Stage 2 Public Health EP Menu Measures

• Successful ongoing transmission of cancer case information– New– Changed from testing to on-going submission

Stage 2 Public Health EP Menu Measures

• Successful ongoing transmission of data to a specialized registry– New– Changed from testing to on-going submission

Stage 2 Public HealthEH Measures

• Three public health EH measures that moved from the menu to the core for Stage 2:– Successful ongoing transmission of immunization data– Successful ongoing submission of electronic syndromic

surveillance data– Successful ongoing submission of reportable laboratory

results• No public health EH measures in the menu

Stage 2 Public Health Measures and HIE

• The on-going submission requires the provider and the public health agencies to identify an electronic process for data to move from EHRs to public health– Efficient– Automated– Secure

• For the Stage 1 public health objectives, beginning in 2013, we also propose to add "except where prohibited" to the regulation text, because we want to encourage all EPs, eligible hospitals, and CAHs to submit electronic immunization data, even when not required by State/local law

Stage 2 Public Health Measures and HIE

• Some State Public Health Agencies are using Health Information Exchange entities to collect the EHR data from providers on their behalf

• In addition to accepting direct provider to public health data submission

Stage 2 Public Health Measures and HIE

• What is the means of transmission for on-going submission?

• Meaningful use of EHR = generate the data file and submit it

• Certification of EHRs = how the EHR generates the file

• The transport layer is what’s in between

• States may also specify the means of transmission of the data or otherwise change the public health measure, as long as it does not require EHR functionality above and beyond that which is included in the ONC EHR certification criteria as finalized for Stage 2 of meaningful use.

Stage 2 Public Health Measures and HIE

• HIE intermediaries can just capture the data for PH; or

• HIE intermediaries can accept the data from EHRs and transform it into the correct version of HL7 (and are certified as an EHR module to do so)

Take Away Points

• Health Information Exchange infrastructure underpins a scalable, efficient and lower-cost mechanism for thousands of providers to interact with a small number of lower-budget public health entities

• Interfaces can be costly and the cost burden may fall onto the provider or public health entity- HIEs (noun) could ameliorate this issue

Models for HIEs to Help Public Health

• Data Aggregation• Translation Services• Transformation Services

04/10/23 Office of the National Coordinator for Health Information Technology 35

Regional Extension Centers

• Communication– Requirements

• On-boarding process– Test and Queue– Receipt of test messages (Michigan)

• Vendor negotiation– Contracts– Communication of vendor capacity

Public Health Implementation Flow

37

Thursday, April 19, 2012

Resources

ONC HIT Policy Committee workgroups

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__hit_policy_committ

ee_workgroups/1470

Standards and Interoperability Framework

Public Health Reporting Initiative:

http://wiki.siframework.org/Public+Health+Reporting+Initiative

QueryHealth Initiative http://wiki.siframework.org/Query+Health

Thursday, April 19, 2012

Q&A

Please type your questions in the box

Thursday, April 19, 2012

Upcoming NACCHO ePublic Health Events

Webinar Series:

Integration and Interoperability Across Public Health, Human

Services, and Clinical Systems 

http://www.naccho.org/topics/infrastructure/informatics/resources/spring-

2012-webinars_ephi.cfm

Thursday, April 19, 2012

Contact Information

Vanessa Holley, MPH

Program Analyst, ePublic Health

vholley@naccho.org

(202) 507-4239