1. Achieving Meaningful Use: Public Health Session 10 April 13, 2011

2. Agenda Introduction –Overview of how Direct can be used to meet MU requirements for reporting to public health and immunization registries Panelists –Emily Emerson, MIIC Manager/IT Unit Supervisor., Minnesota Department of Health –Paul Tuten, VP Product Management, ABILITY Q&A Poll 2

3. Meaningful Use Requirements Meaningful Use: Stage 1 Final Rule (italics optional Stage 1) and Proposed Objectives for Stages 2 and 3 Stage 1 Final RuleProposed Stage 2Proposed Stage 3 Submit immunization data EH and EP: Mandatory test. Some immunizations are submitted on an ongoing basis to Immunization Information System (IIS), if accepted and as required by law EH and EP: Mandatory test. Immunizations are submitted to IIS, if accepted and as required by law. During well child/adult visits, providers review IIS records via their EHR. Submit syndromic surveillance data Move to core. Mandatory test; submit if accepted 3

4. State HIE Program Responsibilities The Program Information Notice to State HIE grantees (dated July 6, 2010) outlined key responsibilities that states and SDEs must address in 2011, specifically to address and enable three priority areas: e-prescribing, receipt of structured lab results, and sharing patient care summaries across unaffiliated organizations. Multi-stakeholder process Convene public health officials Leverage public health agencies to conduct environmental scan Perform gap analysis Monitor/track MU capabilities Set baseline, monitor & track meaningful use capabilities in the state % health departments electronically receiving immunizations, syndromic surveillance, and notifiable laboratory results Strategy to fill MU gaps Use phased approach Help build capacity for public health depts. to accept immunizations, syndromic surveillance, and notifible lab results from providers Work with REC to start with gaps among small providers, hospitals, etc. Consistency with national policies /standards Ensure consistency with national standards, NWHIN specifications, federal policies and guidelines Implement a flexible approach Alignment with Medicaid and public health Establish an integrated approach that represents Medicaid and public health programs 4

5. Why Direct for Public Health? MU-compliant. Direct use cases tied to MU priority areas, including public health. Standardized. Direct provides a standardized transport mechanism for patient care summaries. Simple. Simplicity helps adoption among low volume practices and small, independent providers. Scalable. Direct can be utilized beyond 2011 in meeting future stages of meaningful use requirements and other business goals. 5

6. Direct Immunization Data Exchange in Minnesota Minnesota Immunization Information Connection (MIIC) Overview Public Health Reporting on Immunizations for Meaningful Use EHR-IIS Interoperability Grant Direct Project Participation 6

7. MIIC Interoperability Status 7

8. MIIC Quick Stats MIIC is the statewide immunization information system; live since May 2002 MIIC contains 5.7 million clients/patients Over 45 million immunizations 8,324 active users Over 2,300 log-ins occur every day Variety of providers enrolled (~3,000) 8

9. Data Exchange in MIIC Direct data entry – 14% Batch file process – 83% -Batch includes flat file format and HL7 2.3.1 and 2.4.1 Real-time HL7 – 3% -New standard is 2.5.1 9

10. MIIC and MN State Certified HIOs Agreements in place between MDH/MN-HIE and MDH-CHIC HIO’s web portal will display IZ of patients based upon MIIC data Plans to utilize HL7 real-time messaging For additional info on Minnesota state certified HIOs, refer to: http://www.health.state.mn.us/e-health/index.html http://www.health.state.mn.us/e-health/index.html 10

11. Three Paths of EHR-MIIC Integration Data from EHR to MIIC “real time” –2 clinic systems sending real-time HL7 Ability to query MIIC from within EHR to receive immunization history and forecast –https post –Integrated into three different EHR systems True bi-directional exchange –To date, unrealized… 11

12. Meaningful Use and Public Health Reporting for Immunizations Successful data submissions to MIIC include those with all of the following characteristics: Submitted from a certified EHR technology Follows MIIC HL7 Version 2.3.1 specifications Capabilities to accept HL7 2.5.1 under development and will be ready in Summer 2011 Includes MIIC-accepted CVX codes Sent to MIIC via a secure transport mechanism Currently it is PHINMS, secure ftp, or direct upload into MIIC, but other options are being explored as part of EHR-IIS interoperability grant 12

13. EHR-IIS Interoperability Grant Minnesota Project Objectives Project Period: September 2010 – August 2012 The MDH received $1.38 million in September 2010 Implement HL7 version 2.5.1 messaging for receiving immunizations records into MIIC Establish a secure, more automated standard method of exchanging HL7 messages Increase the number of electronic interfaces between EHRs and MIIC Enhance the capability of MIIC to meet the public health requirements of meaningful use related to immunizations 13

14. Direct Project Evolution Initial meeting of interested stakeholders at MDH (MIIC, OHIT and ISTM) with HISP Vendor (formerly Visionshare, now ABILITY) in Sep 2010 To meet current message transport environment that MDH supports, decision to use secure PHINMS communication standard as destination edge protocol Provider recruitment done by HISP vendor and Hennepin County Medical Center (HCMC) participated in Direct pilot project 14

15. Direct Project Evolution, continued… Technical details of transport protocols worked between HISP vendor and technical teams of sender and receiver Project went live on January 12, 2011 Currently, HCMC is sending production immunization data to the MIIC immunization registry using direct project specifications and using PHINMS as destination protocol, a one direction push of data 15

16. Direct Public Health Immunization Pilot Architecture Source: Adapted from Direct Project site http://wiki.directproject.org/Pilot+Project+Brief+-+VisionShare+and+Public+Health 16

17. Future Directions Increasing provider participation and moving to better electronic exchange with nationally recommended transport standards Increasing timeliness and completeness of immunization reporting Advanced reports such as assessment and patient follow up available to end users True bi-directional exchange! 17

18. Acknowledgements – True Team Effort! MDH Leadership Marty LaVenture, Director, e-Health and Office of Health IT Jim Golden, State Government HIT Coordinator John Paulson, MDH Chief Information Officer Kris Ehresmann, Director, IDEPC Margo Roddy, IDEPC/Immunization Program Mgr MIIC Team: Aaron Bieringer, Steve Felton, Diana Jaeger, Linda Luebchow, Priya Rajamani, Erin Roche, Linda Stevens, Karen White, Jeff Williams ISTM Team: Mark Hollock, Gerry Skerbitz, Keith Hammel, Spencar McCaa HP: David Kaiser, Mike Loula 18

19. Minnesota Pilot Internet Sends Batch Flat File of Immunizations (Will Migrate to HL7 VXU) ABILITY Network Secure Data Facility Internet MDH / MIIC Receives Direct Message Routes thru PHINMS “Gateway” Receives via PHINMS Edge Protocol Stores in MIIC Registry HCMC 19

20. Have a different HISP? Internet ABILITY Network Secure Data Facility Internet MDH / MIIC HCMC Provider HISP #2 Continues to Receive Direct Message Routes thru PHINMS “Gateway” Provider w/ a Different HISP Sends Direct Message to MDH 20

21. Unable to generate HL7 VXU? Internet HISPs can Provide Integration and/or Content Translation Services, Locally or “In The Cloud” HISP Internet Public Health Agency Provider 21

22. Don’t have an EMR yet? Internet ABILITY Network Secure Data Facility Internet Public Health Agency Hosted Web Application(s) to Generate HL7 VXU Message… and more. Provider 22

23. Immunization Reporting “App” 23

24. E-Mail Interface 24

25. Patient Involvement via PHRs Internet ABILITY Network Secure Data Facility Internet Public Health Agency Provider PHR Routes Direct Message to Both Recipients: Public Health Agency & Patient PHR Receives Message; Stores and Displays for Patient 25

26. PHR (w/ HL7 VXU Support) 26

27. Lessons Learned (HISP View) Default to Direct for Provider-to-DoH Exchange –Benefits from universal addressing, bi-directional routing, and bi-directional PKI security –Providers a single, uniform edge on the DoH side Meet Providers Where They Are At –Direct is flexible w/ respect to edge protocols –HISPs should provide a range of options to meet providers’ needs and offer an upgrade path 27

28. Nirvana (or nearly)? HISP B DoH Provider A HISP A Provider B Provider C Patient PHR Provider REST sFTP SOAP Web App Direct (SMTP) Direct (SMTP) Backbone Single Protocol; DoH Choice 28

29. Additional Direct Pilots w/ Public Health Redwood MedNet –Immunization Reporting Health Information Network of South Texas –Immunization Reporting Information available at: http://wiki.directproject.org/Implementation+Geographies 29

30. Q&A Emily J. Emerson MIIC Manager/IT Unit Supervisor Minnesota Department of Health 651.201.5546 Emily.Emerson@state.mn.us Paul M. Tuten, Ph.D. Vice President, Product Management ABILITY Network Inc. 612.460.4372 paul.tuten@abilitynetwork.com

31. Poll 31