Understanding Vendor Offerings Maximizing the benefit of your HL7 abilities Brandy Altstadter March 7, 2006

Real-time and Batch HL7 Implemented approximately 90 interfaces in eight states and one regional registry Over three years of end-to-end provider export development with HL7 Worked to develop CIRSET transport methodology

Breadth of HL7 Use Birthing Hospitals Health Foundation / Clinical System State-to-State Local Public Health Solutions Indian Health Services (IHS) Lead Data Billing Systems Electronic Medical Records (EMRs)

Electronic data capture Private providers expanding to Electronic Medical Records Used electronic billing / scheduling for more than 20 years Liability concerns Recommendations from professional associations More vendor competition Long-term investment

Provider expectations Most would prefer to send data electronically Large practices must Need to populate their EMR with history data Want bi-directional interfaces SEND private data to registry RECEIVE data they don’t have from registry to put back into their EMR record Want to complete child health profiles Want to meet HEDIS goals for immunization Monetary incentives

Vendor status with HL7 “Yes, we are HL7 compliant!” Can only send demographic data via HL7. Patient care documentation is not “modulated.” Can send the immunization data but can’t receive it. Can receive data but don’t have a place in the application to put the new documentation. HL7 is not HL7 Multiple types of HL7 messaging. Few making their core product “registry ready”

Questions to Ask Can the system store entire immunization record, or just administered shots? If the entire immunization record is stored, can the system differentiate between historical and administered? Can vaccinations be modified or deleted? Can the lot number and manufacturer be stored ? Will the entire patient record be sent each time, or just new changes?

HL7 Communication Grid Receive Send QueryUpdate Receive queries and return immunization records VXQ - VXR - VXX Send queries and receive immunization records VXQ - VXR - VXX Receive immunization records VXU - DFT - ORU Send immunization records VXU - DFT - ORU

Business Process Provider indicates desire to conduct electronic data transfer Enrollment agreement in SIIS secured Identify who the provider considers their primary contact for the vendor. Usually sales personnel Could be hospital IT department Review HL7 specifications with vendor. Conference calls as needed to answer initial questions from the vendor’s development team.

Business Process Testing – 2 Step Process Message format validation Short file, 2 to 3 messages Message content (data quality) Large file, 1000 immunizations Finalize for SIIS production SIIS director and Vendor decide on upload process and schedule. Ongoing QA by State SIIS.

Data Quality – Common Errors Missing additional demographics used in matching Test patients included in production data Unrecognized immunization codes Historical immunizations are not designated properly Deletes are not handled properly No unique identifier for patient No unique identifier for physician

Case Review 1 - Cerner Initial Contact Historical data (clinical visit) populate registry Interested in two-way interface Had some existing HL7 capability Cerner reviewed and updated interface capability against HL7 specification Implementation Test of outbound messages Feedback and Revision Outbound real-time transfer to SIIS Working on accepting inbound messages

Issues encountered No support for real-time HTTPS Not ready to accept data from registry, interface will be one way Misc. Message Content Issues Deletes accidentally sent as adds Vaccinations not mapped properly Production data included test patients Manufacturer codes were not encoded properly Some vaccinators with the same name were submitted with different ids

Case Review 2 - Misys Initial Contact Had existing HL7 but had DFT messages only Can only send current data not historical data SIIS Enhancements Added support for DFT messages Implementation Testing Feedback and Revisions Batch upload to state SIIS server

Issues encountered – Case 2 Billing message (DFT) format All charges are sent - immunization charges are not filtered Immunization specific fields not included: Manufacturer Lot Number VFC Eligibility Sends patient or guarantor address No historical data Additional steps at the provider site File uploaded weekly New extract needs to be restarted after upload

Vendor List Logician/Centricity EMR by GE Centricity ORU message from LabLink interface Initially, outbound messages only Looking to make core product “registry ready” Cost “To be determined” STC using conversion tool to accept messages. Insight by QS Technologies VXU and VXQ messages Real-time Performs updates and queries Built-in functionality

Vendor List Touch Works EMR by Allscripts Also have Touch Chart for smaller physician offices Bidirectional interface Batch transfer Cost – High Vision OPM by Misys DFT message Outbound only **Windows product is not capable of export** Batch transfer Cost - High

Vendor List Epic EMR VXU message Bidirectional interface in development Batch vs. Real time – to be determined Cost – High Physicians Workstation Suite by Integrated Healthware VXU message Interested in bidirectional interface Real-time outbound messages Cost - Unknown

Vendor List McKesson DFT message Large hospital system software Outbound only Batch transfer Cost – Very High WebMD VXU message Outbound only Batch transfer Cost - High

Vendor List IC-Chart by Integreat Concepts VXU message Inbound and Outbound Two-way batch transfer on a weekly basis Cost – Unknown Benchmark Systems VXU Messages Inbound only Batch transfers on a weekly basis

Conclusions Cost of export is still the biggest barrier to provider participation in registry. Negotiate cost of export in system purchase price. Providers are the Vendor’s customer – Not registries AAP and AAFP have technology committees working with vendors on EMRs. Encourage providers to pressure their vendor Providers want complete data in their EMR New incentive for registry participation.

Conclusion (cont.) Know the right questions to ask the vendor about HL7 messaging capabilities. Educate providers on value of HL7 messaging capabilities New providers have been raised on technology Find the “Tech Champion” in the group