Indiana State Department of Health Immunization Program June 17 th, 2014

 Stage 1 Meaningful Use  Stage 2 and ongoing submission  VFC Providers requirements versus Stage 2  Meaningful Use Registration Web Portal ◦ Do I need to setup all of my facilities?  Sending data to CHIRP – Transport Layers  Troubleshooting  When does Meaningful Use end?  Question and Solutions

 Meaningful use is using certified electronic health record (EHR) technology to:  Improve quality, safety, efficiency, and reduce health disparities  Engage patients and family  Improve care coordination, and population and public health  Maintain privacy and security of patient health information  Ultimately, it is hoped that the 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 Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs. Source: HealthIT.gov

 Core Objective – Public Health Reporting ◦ Stage 1 – maybe optional ◦ Stage 2 - required  Indiana State Department of Health is the Public Health Authority for the State of Indiana  Accept, validate, document provider attestments for Stage 1 and Stage 2

 Children and Hoosier’s Immunization Registry Program  Began in September 2002 as state wide IIS  Prior to CHIRP Indiana used ImmTime  Over 4,000 providers and 8,000 users  ~42,000 HL7 messages accepted each day  Accepts HL7 2.0 through VXU type messages ◦ All valid messages received will create an ACK response  Connected to all Indiana HIEs

CHIRP, CHIRP, CHIRP MU, MU, MU ACK, ACK, ACK

ISDHIndiana State Department of Health PHAPublic Health Authority MUMeaningful Use MU(X)Usually MU1 or MU2, referring to the stage of Meaningful Use HL7Health Level-7, a healthcare message standard developed by Health Level Seven International VXUVaccine Update/Add HL7 Message type, can be or message VXQVaccine Query Message, used with message QPBVaccine Query Message, used with message HIEHealth Information Exchange ACKAcknowledgement response for VXU message submitted And many more… Common terms that pop during a Meaningful Use call/

 HL7 VXU ◦ Required fields - 8 ◦ VXU, VXQ and ADT  Test messages  Accepted versus failed message  Onetime and ongoing  Additional year attestments  Began in 2011 ◦ First CHIRP Meaningful Use Attestment February 2011

 HL7 VXU message ◦ Required fields – 42  New segments for ◦ OBX – required and optional ◦ RXR ◦ NK1 and PID patient guardian  Testing requirements for Stage 2 ◦ Message approval prior to submitting to production ◦ 30 day suggested timing by the ONC  Ongoing Submission – 90 days? ◦ Does it need to be done during attestment ◦ What if there is an error

MSH|^~\&|EMR_VENDOR|SENDING_FAC|CHIRP|OR| ||VX U^V04^VXU_V04| |P|2.5.1|||AL| PID|1||123456^^^^MR||TEST_PATIENT^CHIRP^^^^^L|| |F|| ^Undefined Race^CDCREC|||||EN||VAR|||||UN^Unknown^99USI||||||||N PD1||||""||||U|||01^No Reminder^HL70215|N| ||Y^Advanced Directive Code - Y|A| | PV1||||||||||MED RXA|0|1| | |03^MMR^CVX|0.5|mL^milliliter^UC UM||00^New Immunization Record^NIP001|ABC123^RABBIT^BUNNY^^^^^^TEST|1234ABC^^^CHIRP TEST FACILITY|||| ||AB^Abbott Laboratories^MVX|||CP|A RXR|SUBQ^^HL70162|LD^LEFT DELTOID^HL70163||^SUBCUTANEOUS OBX|1|CE| ^Vaccine funding program eligibility category^LN|1|V01||||||F||| |||VXC40^Eligibility captured at the immunization level^CDCPHINVS OBX|2|CE| ^vaccine type^LN|2|||||||F OBX|3|TS| ^Date vaccine information statement published^LN|2| ||||||F OBX|4|TS| ^Date vaccine information statement presented^LN|2| ||||||

 Provider registers each physical location with ISDH via Meaningful Use Portal  Providers registers each location to CHIRP via the Provider Enrollment Agreement  HL7 user account setup for testing  Provider or vendor submits messages to CHIRP review and approval ◦ Recommend contacting CHIRP after submission for review  Provider moves messages into production ◦ Ongoing 90 day clock begins

 New VFC policy requirement including use of VFC codes and lot numbers in HL7 message ◦ PV1 Codes ◦ OBX Codes  What fields do I need to send to make sure my lot inventory will decrement  If I am sending the new MU2 message do I meet the VFC policy? ◦ that meet VFC requirements vs  July 31 st – VFC policy date

 MU Message ◦ OBX segment with V0 VFC eligibility code ◦ OBX segment with lot number funding source ◦ RXA segment with complete lot number, manufacturer, and administering facility (RXA.11)  Existing Message ◦ PV1 segment with V0 VFC eligibility code, code is located in PV1.20 placement ◦ All messages with a valid VFC code, i.e. V02 (Medicaid) will be assumed Public Supplied by CHIRP ◦ RXA segment with complete lot number, manufacturer, and administering facility (RXA.11)

 Only Stage 2 are required to register ◦ Stage 1 is optional registration  All providers need to register  Each physical location to be attested should register ◦ We do not recommend registering each provider  Providers may register for Immunization, Synrdomic, and ELR attestments  confirmation once registration is complete

Provider Group Indiana PG Hosp Indy PN West PG Hosp Warsaw PG Hosp Muncie PG Physician’s Network PN North PN Indy PN Main PN South PN East Dr. Jones Smith, MD Dr. Jones Smith, MD Dr. Jones Smith, MD Specialist Team PA Rogers NP Wishka PA Rogers NP Wishka PA Rogers NP Wishka PA Rogers NP Wishka

PG Hosp Indy PN West PG Hosp Warsaw PG Hosp Muncie PN North PN Indy PN Main PN South PN East

 Providers can register for their Stage 2 Meaningful Use Attestment at anytime  ISDH recommends registering 30 days prior to the start of your 90 day attestment window  Providers must register by their 60 th day of attestment time period ◦ Registering later shortens the window to test and move interface into production  90 day ongoing and 90 day attestment window do not need to match up

 Submitting from your HIE ◦ HIE will act as a pass through ◦ Meets Stage 2 transport layer  Connecting to CHIRP directly ◦ HTTPS Post/SOAP connection  Standard created by CDC and used by most Immunization Information Systems ◦ Message sent using secured SSL certificate  Sent from your EMR/EHR Cloud Vendor ◦ Uses HTTPS connection Only connections that support bidirectional messages can be used

 OBX Segments ◦ All administered messages should include VIS data in OBX ◦ VFC providers need to include VFC eligibility for all administered patient records 0 through18 years of age  Historical vaccines ◦ Contains fewer details but still need to meet minimums including patient data and facility ◦ When in doubt, do not submit historical data  Sending via Cloud EMR ◦ Each provider needs to register and attest individually ◦ Cloud EMR will only need to test initial messages

 Stage 2 Year 1 Attestments ◦ 90 day ongoing submission of data to PHA  Stage 2 Year 2 Attestments ◦ 365 day ongoing submission of data to PHA  Stage 3 – 2016 ◦ Improving quality, safety, and efficiency, leading to improved health outcomes ◦ Decision support for national high-priority conditions  CHIRP forecast included in message response ◦ Patient access to self-management tools  MyVaxIndiana

 Accept, validate, document provider attestments for Stage 1 and Stage 2  Official documents of Meaningful Use status can be downloaded from ISDH Meaningful Use Portal

Please feel free to ask any questions Raymond Epps Cameron Minich CHIRP Contacts Meaningful Use

CHIRP Web page ISDH Meaningful Use Portal spx Indiana Immunization Coalition