5/2/2013
Nebraska Quality Forum
May 9, 2013
John Gorman, Wide River TEC/NeHII
Michelle Hood, DHHS
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What are the Public Health requirements for
Meaningful
g
Use?
Why is health information exchange
important for Public Health?
How do I exchange my Public Health data?
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Objective
Eligible Professionals (EPs) Measure
Eligible Hospitals (EHs) and CAHs Measure
Immunization
Registries
Core Set – Successful ongoing
submission of electronic immunization
data from certified EHR Technology
(CEHRT) to an immunization registry or
immunization information system for
the entire EHR reporting period (unless
no registries
i i are capable)
bl )
Core Set - Successful ongoing submission
of electronic immunization data from
certified EHR Technology (CEHRT) to an
immunization registry or immunization
information system for the entire EHR
reporting period (unless no registries are
capable)
bl )
Reportable Lab
Results (ELR)
N/A
Core Set - Successful ongoing submission
of electronic reportable laboratory
results from CEHRT to a public health
agency for the entire EHR reporting
period (unless no PH agency is capable)
Syndromic
Surveillance
Menu Set - Successful ongoing
submission of electronic syndromic
surveillance data from CEHRT to a public
health agency for the entire EHR
reporting period (unless no PH agency is
capable)
Core Set - Successful ongoing submission
of electronic syndromic surveillance data
from CEHRT to a public health agency for
the entire EHR reporting period (unless
no PH agency is capable)
Cancer
C
Reporting
Menu S
M
Set - Successful
S
f l ongoing
i
submission of cancer case information
from CEHRT to a cancer registry for the
entire EHR reporting period (unless no
PH agency is capable)
N/A
Reporting to
Specialized
Disease
Registry
Menu Set - Successful ongoing
submission of specific case information
from CEHRT to a specialized registry for
the entire EHR reporting period (unless
no PH agency is capable)
N/A
Ref: CDC
http://www.cdc.gov/ehrmeaningfuluse/Docs/Summary%20of%20PH%20Objectives%20in%20Stage%202
%20MU%20ONC%20and%20CMS%20Final%20Rules.pdf
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Allows Public Health to create and strengthen
cross-jurisdictional public health programs and
collaborations.
collaborations
Gives State and Local Health Departments a
better understanding of the communities’ health
needs.
Better health promotion, prevention, and
treatment programs.
Near real time data provides immediate analysis
and feedback to public health officials.
Improved detection of syndromes, diagnoses,
and outbreaks.
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Epidemiologists are able to analyze data near
g a year
y
of more to
real time,, instead of waiting
receive data.
Can detect both syndromes as well as specific
diagnoses.
Can detect and/or monitor outbreaks
Can quickly communicate findings to
appropriate programs (within NDHHS) and
local health departments for follow up and
prevention measures.
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Used to provide access (to authorized users) to
complete immunization records across the State
of Nebraska
Nebraska.
Contains over 9.5 million immunizations on over
1.2 million clients/people
System uses data to determine validity of doses
administered and recommend future
vaccinations.
Public access portal available for immunization
record search.
Capable of uni-directional and bi-directional
exchange of immunization data
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Data is received near real time to allow for
y analysis
y
timely
Epidemiologic staff (state and Local Health
Departments) have direct access to monitor
and analyze the data in their jurisdictions and
to identify specific diagnoses of
communicable and chronic diseases
E id i l i staff
Epidemiologic
ff provide
id ffollow
ll
up,
education, prevention, and outbreak control
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Originally established to track influenza like
illness (ILI)
Now used for many different health outcomes
including:
◦
◦
◦
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Sexual Assault
Heat Related Injuries
Acute Cardiovascular Events
Diarrheal Diseases
Gastrointestinal Disease Outbreaks
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Emergency Department:
◦ Contains about 20 data elements used to identify
syndromes or trends of illnesses and injuries in a
geographical area.
 NDHHS uses ICD-9 diagnostic codes and algorithms to scan
free text for key words
 The health information collected includes patient visit
identifier, age, gender, race, zip code, reason for visit (chief
complaint), diagnostic codes, etc.
 However, no personal identifiers such as patient name,
address of residence,
residence social security number
number, etc
etc., are
included
◦ Results from these analyses can be used to determine if
there is a significant impact on public health in a specific
area or region.
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Inpatient
◦ Shares similar data set with Emergency
g
Dept
◦ Also used to detect syndromes rather than specific
diagnoses
◦ Pilot project designed to improve the accuracy and
detection, tracking, and analysis of cardiovascular
disease (CVD) events.
 Identify at-risk populations
 Develop effective prevention plans
 Monitor trends
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Syndromic Surveillance system
◦ Captures and analyzes indicators to detect
syndromes
◦ Creates charts, tables, graphs, and time series
reports
◦ Provides web-based information distribution back
to DHHS, local health departments, and providers.
◦ Provides interactive, user-friendly access to
customized,
d user d
defined
f dd
data analysis
l
via secure,
web based remote access.
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System is installed and Nebraska specific
reports/functionality
p
y are being
g developed
p
Our objective is to use ESSENCE to process
and present Emergency Department data,
inpatient, death certificate, and ELR data.
We are planning to explore additional sources
of data that can be processed by ESSENCE
◦ Poison controll d
data, Over-the-Counter
h
(
(OTC)
) sales,
l
etc.
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Syndrome Groups
◦ ESSENCE parses chief complaint text strings into syndrome
groupings,
g
p g , and applies
pp
algorithms
g
for the detection of
outbreaks and other health events.
◦ These syndrome groups are based on the information
provided in the chief complaint.
◦ ICD-9-CM codes can be used to perform advanced queries.
◦ Syndrome groups categorized by ESSENCE are:
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Botulism-like
Gastrointestinal (GI)
Influenza Like Syndrome (ILI)
Injury
Neurological
Rash
Respiratory
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Immunizations
Reportable Labs (ELR)
Syndromic Surveillance
Cancer & Other Disease Registries
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Things to Consider
◦ Is your EMR or HIE certified to send immunization
data out of your system?
◦ Do you have staff trained to administer ongoing
interface connections?
◦ What role will your EHR vendor play to address
issues and/or updates? Check your contracts.
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Connection Options
◦ Direct Connections with NESIIS
◦ NeHII Immunization Gateway
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Connection Benefits
◦ Ongoing updates to Registry
◦ “Source off Truth” will reside in the Registry
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Immunization Query & Data Push to EMRs
◦ The State Registry and Immunization Gateway are
capable of sending immunization file updates to
your EMR
◦ Check with your EMR Administrator if you can query
for and accept Immunization Data from your
Registry
 How can they accept the data? View Only?
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Things to Consider
◦ Are you currently using a reference lab for testing?
 Confirm if your lab is already submitting ELR data to
the NDHHS
 What is your volume of reportable disease findings?
 Will help determine appropriate method to report
results to NDHHS
 NDHHS capable of accepting 2.5.1 formatted data
(required by MU)
 NDHHS transport method is PHINMS (free software
package)
◦ Are you capturing your ELR as discrete data and are
LOINC codes mapped?
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Workflow
Reference: CDC.gov:PHIN Messaging Guide for Syndromic Surveillance: Emergency
Department and Urgent Care Data, Release 1.1 (August 2012)
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How is the data sent?
◦ Admission/Discharge/Transfer (ADT) data
messages are the
h primary
i
data
d
source
 ADT structure provides more flexibility for message
exchange that captures data from emergency
department (ED) and urgent care (UC) patient visits
 EHRs transmit ADT messages as part of their normal
operation and configuration
◦ Delivered through an HL7 interface with NDHHS
 NDHHS acceptt HL7 2.5.1
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 Transport method is PHINMS
◦ NeHII currently accepts ADT data from all facilities
submitting clinical data to the HIE
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Things to Consider
◦ Minimum data set requirements are not entirely
dependent on Federal CDC/Meaningful Use
standards
 “actual data elements and their specifications are
subject to change in accordance with applicable state
and local laws and practices”
◦ Ask your EHR vendor how they plan to meet
Nebraska’s
Nebraska
s data specifications for Syndromic
Surveillance reporting
Reference: CDC.Gov: Implementation Guide for Ambulatory Healthcare Provider Reporting
to Central Cancer Registries August 2012
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Additional information on exchanging
y
data with
Immunization,, ELR and Syndromic
NDHHS can be found at:
http://dhhs.ne.gov/publichealth/epi/pages/
MeaningfulUSe.aspx
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Anticipated Workflow
Reference: CDC.Gov: Implementation Guide for Ambulatory Healthcare Provider Reporting
to Central Cancer Registries August 2012
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EHR Requirements
◦ The EHR shall use the list of reportable cancer
diagnosis codes established by the cancer registry
community to identify an encounter for a patient
with cancer
◦ The EHR shall create a valid HL7 CDA R2 document,
“Ambulatory Healthcare Provider Cancer Event
Report”
 “Data
“D
elements
l
that
h are not in
i the
h EHR but
b are iin an
alternative information system should be retrieved for
inclusion in the ambulatory healthcare provider cancer
event report or entered manually “
Reference: CDC.Gov: Implementation Guide for Ambulatory Healthcare Provider Reporting
to Central Cancer Registries August 2012
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EHR Requirements (continued)
◦ The EHR should transmit the Ambulatory Healthcare
Provider Cancer Event Report as soon as
documentation of the patient encounter is
completed (real time reporting).
◦ At a minimum, EHR should have the capability to
transmit the Ambulatory Healthcare Provider Cancer
Event Reports on a daily basis.
 “Th
“The use off the
h word
d "Should"
"Sh ld" allows
ll
registries
i i and
d
physician offices to agree upon an alternative
frequency”
Reference: CDC.Gov: Implementation Guide for Ambulatory Healthcare Provider Reporting
to Central Cancer Registries August 2012
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Things to consider
◦ Determine what data elements are required to be
reported to the Cancer Registry
◦ Confirm if you are currently, or will in the future,
capture all required data within your Ambulatory
EMR
◦ Determine what frequency your Cancer Registry will
require to have data provided to them
◦ Evaluate
l
options ffor sending
d
d
data to the
h Registry
 HL7 Interface?
 Direct Messaging?
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Specialized registries could include:
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Early hearing
g detection and intervention
Children with special needs
Diabetes
Brain injury
Parkinson’s
Outpatient surgical procedure
Emergency
g
y medical services
Congenital diseases
Birth defects
Trauma registry
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John Gorman, Project Manager, NeHII
◦ Phone: 402.770.0103
◦ Email:
E il [email protected]
j
@ hii
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Michelle Hood, NESIIS, HIE and Meaningful Use Coordinator
◦ Phone: 402-471-3727
◦ Email: [email protected]
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