Ensuring Meaningful Use of your IIS: The Kansas Perspective 2011 National Immunization Conference Washington, DC March 30, 2011 Mike McPherson

Objectives Understand Immunization Information System (IIS) role in HITECH Act Understand Regional Extension Center (REC) role Describe importance of IIS participation in statewide Health Information Exchange (HIE) development Identify IIS needs in an HIE

What is Meaningful Use Financial incentive Through use of certified EHR End goal: Incentive ($$) Reduction medical errors Prominent theme EHR, incentive, payment

Achieving Meaningful Use HITECH Policies Phase 1 (Capture/share data) Phase 2 (Advanced care processes with decision support) Phase 3 (Improved Outcomes) Achieving Meaningful Use 2015 2013 2011 2009

Why Submit to an Immunization Information System? Objective: Health outcomes policy priority Specifically – Improving population and public health Care goal: Patient’s health care team communicates with public health agencies Other public health criteria: Syndromic surveillance Reportable lab results

Kansas IIS Partners KS Regional Extension Center KS Medicaid agency KS Health Information Exchange (HIE) EHR Vendors

Regional Extension Centers Provide training and support services to assist doctors and other providers in adopting EHRs Offer information and guidance to help with EHR implementation Give technical assistance as needed

HIE Implementation States submitted HIE-plan to ONC Important that IIS be a stakeholder Participate as much as possible Make existing capabilities known Express future development plans

Kansas IIS: KSWebIZ ~1.9 million patients Over 15 million vaccination events HL7 Interface Bi-directional, realtime since 2007 Direct Entry Web-enabled user interface over SSL. Vaccine inventory module Separate IIS devoted to meaningful use

HIE Considerations Meaningful use acceptable via HIE ONC certified gateway One interface vs. interface per EP/EH Potential that HIE encompass a number of EHR vendors

HIE Considerations… Consent capturing Technical aspects Are agreements in place? Technical aspects Exchange format? MPI/RLS participation?

Conclusion Understand meaningful use Know details of IIS submission Establish communication with partners Medicaid Regional Extension Center EHR Vendors Participate in HIE efforts

Contact Information Mike McPherson KS IIS Interface Coordinator Kansas Department of Health & Environment 785-296-1319 mmcpherson@kdheks.gov http://kdheks.gov/immunize/webiz.html

References Final Rule - edocket.access.gpo.gov/2010/pdf/2010-17207.pdf HIT Initial Set of Standards …. - edocket.access.gpo.gov/2010/pdf/2010-17207.pdf NIST MU tester - xreg2.nist.gov:8080/HL7V2MuValidation2011/ NIST MU use cases - xw2k.nist.gov/healthcare/use_testing/finalized_requirements.html ONC - healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204 List of certified EHR products - onc-chpl.force.com/ehrcert CDC IIS MU - cdc.gov/osels/phitpo/mu/immunization.html CDC IIS standards - cdc.gov/vaccines/programs/iis/stds/standards.htm NIST test VXU_V04 messages - xreg2.nist.gov:8080/HL7V2MuValidation2011/#documentation.htm HITECH 101 - www.everythinghitech.com/everything-hitech/hitech-101-program-overview.html EHR Incentive spec sheets - https://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC-Core-and-MenuSet-Objectives.pdf http://www.cchit.org/products/onc-atcb/all/all/2011/67,39, http://onc-chpl.force.com/ehrcert/ehrproductcriteriasearch

Backup Slides

Final Rule Text §170.302(k) Submission to immunization registries. Electronically record, modify, retrieve, and submit immunization information in accordance with: (1) The standard (and applicable implementation specifications) specified in §170.205(e)(1) or §170.205(e)(2); and (2) At a minimum, the version of the standard specified in §170.207(e).

Specifics §170.205(e)(1) §170.205(e)(2) §170.207(e) HL7 2.3.1 and Implementation Guide for Immunization Data Transactions using Version 2.3.1 of the Health Level Seven (HL7) Standard Protocol Implementation Guide Version 2.2 §170.205(e)(2) HL7 2.5.1 and HL7 2.5.1 Implementation Guide for Immunization Messaging Release 1.0 §170.207(e) HL7 Standard Code Set CVX - Vaccines Administered

NIST 2.3.1 Example VXU

Additional Information Simulated transfers not acceptable Test data is okay Unsuccessful test considered valid Only one test per certified EHR in multi-EP environment After successful test EP/EH should institute “regular” reporting

What To Expect Next Plan/Execute Stage 1 Prepare for Stage 2 Contact partners Regional Extension Center (REC) State Medicaid agency State HIE agency Prepare for Stage 2 <back from comment period?>

Available Resources RECs State Medicaid agency NIST CDC AIRA Education MU SME State Medicaid agency NIST Tools and use cases CDC IIS MU IIS standards AIRA

Eligible Provider Medicaid Medicare Physician Dentist certified nurse-midwife nurse practitioner physician assistant practicing in a Federally Qualified Health Center (FQHC) or a Rural Health Clinic, led  by a physician assistant doctor of medicine or doctor of osteopathy doctor of dental surgery or dental medicine doctor of podiatric medicine doctor of optometry chiropractor

Eligible Hospital Acute care Critical access hospital Excluding long term care facilities Critical access hospital Children’s hospital Hospital based EPs not eligible

List of Certified HIT Products onc-chpl.force.com/ehrcert Select Practice Type Ambulatory 269 certified products * Inpatient 101 certified products * Submission to immunization registries General Criteria 170.302(k) * As of 2/15/2011

45 CFR 170.302(k) 45 CFR Part 170 identifies: 170.302 General Criteria Initial Set of Standards Implementation Specifications Certification Criteria for EHR Technology 170.302 General Criteria 25 Criteria 170.304 Ambulatory Criteria 10 Criteria 170.306 Inpatient Criteria 10 criteria

Offer information and guidance to help with EHR implementation REC NIST Provide training and support services to assist doctors and other providers in adopting EHRs Offer information and guidance to help with EHR implementation Give technical assistance as needed Responsible for leading core health IT testing infrastructure Tools to verify HL7 2.3.1 & 2.5.1 validation View errors Downloadable Java apps Use cases to help you test

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Payoff What’s the ROI Too early to tell. Reach out early and often

Eligible Provider/Hospital EHR Vendor Design, Develop EHR Sell Certified EHR ONC (ACTBs) Certification Eligible Provider/Hospital Follow-up Self Attest-ment Purchase Certified EHR Submit to IIS [1] Success Resolve w/ IIS Fail Public Health State Medicaid Accept/Enhance MU Criteria IIS Attestment* Design, Develop MU IIS Accept VXU Audit Submission Work w/ EP/EH [1] EP/EH performs immunizations and there’s a registry to receive the information electronically.

IIS Ready for Meaningful Use? Is your IIS HL7 compliant? What other PH criteria are available in your state? Reportable lab results Public health surveillance Does your state Medicaid agency plan to follow/enhance MU criteria? Have you contacted your REC yet? What are your state HIE plans?