Meaningful Use and Public Health

1. Meaningful Use and Public Health April 19, 2012

2. Listen only mode • This webinar will be recorded and available on NACCHO’s website • Type your questions in the box as we go • Please complete the evaluation when you receive the link

3. Outline of Webinar • Welcome and Introductions   • What is Meaningful Use of EHRs? Why Should LHDs Care? • Overview of Stage 2 • Potential impacts on LHDs • Local-State collaboration • Opportunities for future LHD Input and Engagement for Stage 3 • Q&A

4. Speakers • Seth Foldy, Senior Advisor for the Public Health Surveillance & Informatics Program Office at the Centers for Disease Control and Prevention (CDC) • James Daniel, Public Health Coordinator for the Office of the National Coordinator for Health Information Technology (ONC)

5. CDC and Meaningful Use: Strengthening the Link Between Healthcare Providers and Public Health Seth Foldy, MD MPH FAAFP Senior Advisor Public Health Surveillance and Informatics Program Office Office of Surveillance, Epidemiology, and Laboratory Services Public Health Surveillance and Informatics Program Office

6. Changing Policy Drivers: ARRA HITECH • >$20B Medicare/Medicaid incentives to • Implement certified Electronic Health Record (EHR) technology • Use EHR to achieve objectives related to improving: • Care quality, safety and efficiency, including: • Creation of patient registries (conditions, devices, etc,) • Reporting of quality measures • Clinical decision support (automated warnings/advice) • Coordination of care • Patient and family engagement • Privacy & security • Population and Public Health (next slide) • Office of National Coordinator for HIT • $2B for information exchange, training, Beacon exemplars

7. Policy Drivers: ARRA HITECH Act • Population & public health objectives include • Electronic lab reporting of reportable results • Syndromic surveillance • Communication with immunization registries • Cancer registry reporting • 3 stages of aggressive timelines (Oct 2010, 13, 15) • New national standards impact local and state PH

8. The Early Days…

9. Today! !

10. Healthcare Meaningful Use STAGE 1 Electronic Information Exchange Public Health Births and fetal deaths Birth defects & congenital disorders Immunizations Communicable diseases Reportable test results Outbreaks Poisoning Occupational injuries Other injuries Adverse events and effects Cancer Other chronic disease reports Visits and hospitalizations (Syndromic surveillance) Quality reports Deaths and associated data

11. Healthcare Likely Meaningful Use STAGE 2 Electronic Information Exchange Public Health Births and fetal deaths Birth defects & congenital disorders Immunizations Communicable diseases Reportable test results Outbreaks Poisoning Occupational injuries Other injuries Adverse events and effects Cancer Other chronic disease reports Visits and hospitalizations (Syndromic surveillance) Quality reports Deaths and associated data HL7 2.5.1

12. Healthcare Possible Meaningful Use STAGE 3 Electronic Information Exchange Immunizations & decision support Public Health Births and fetal deaths? Birth defects & congenital disorders? Immunizations Communicable diseases? Reportable test results Outbreaks Poisoning? Occupational injuries Other injuries Adverse events and effects? Cancer Other chronic disease reports? Visits and hospitalizations Syndromic surveillance Quality reports Deaths and associated data? Items in green are being considered by S&I Framework PH Reporting Initiative – CDA?

13. Four information sources for Population Health

14. Meeting Tomorrow’s Challenges • S&I Framework Public Health Reporting Initiative http://wiki.siframework.org/Public+Health+Reporting+Initiative • Harmonized use case and value sets from several user stories • Communicable disease reports • Child health reports • Adverse event reports • Chronic disease reports • Administrative/quality reports • Possible implementation guide by Stage 3 • QueryHealth Initiative http://wiki.siframework.org/Query+Health

15. Problem Solving • Meaningful Use Technical Assistance Team • Experts in immunization, syndromic and lab reporting • Policy interpretation from ONC, CMS • Technical assistance resources • All-party conference call • ID rapid solution – OR • Log problem for longer term fix • Request the team: meaningfuluse@cdc.gov

16. More info: www.cdc.gov/ehrmeaningfuluse www.cdc.gov/phin Or drop a line to: meaningfuluse@cdc.gov Questions, Insights, Discussion

17. Public Health Surveillance and Informatics Program Office (Proposed) www.cdc.gov/osels www.cdc.gov/ehrmeaningfuluse

18. Table of Contents • Review of Stage 1 • NPRM and Stage 2 • Health Information Exchange Models • Regional Extension Centers 8/29/2014 Office of the National Coordinator for Health Information Technology 18

19. Stage 1 Meaningful Use Menu: Improve Population and Public Health Unless an EP, eligible hospital or CAH has an exception for all of these objectives and measures they must complete at least one in this group as part of their demonstration of a meaningful use to be eligible for incentives. Public health agencies may specify how to test the data submission and to which specific destination Source: Dr. Paul Kleeberg, Clinical Director, Key Health Alliance Communicate with public health agencies 19

20. Standards for Public Health Transactions in Stage 1 Meaningful Use 20

21. Stage 2 Timeline • CMS and ONC NPRM published March 7 • 60 Day Comment Period • Stage 2 Begins 2014

22. Stage 2 EP Public Health Measures • 1 EP core measure = immunizations • EPs have to pick 3 of 5 menu measures • 2 new PH Stage 2 EP menu measures- • Successful ongoing transmission of cancer case information • Successful ongoing transmission of data to a specialized registry

23. Stage 2 Public Health EP Core Measure • One PH EP measure that moved from the Stage 1 menu to the Stage 2 core: • Successful on-going submission of immunization data • Changed from testing to on-going submission

24. Stage 2 Public Health EP Menu Measures • Successful ongoing transmission of syndromic surveillance data • New • Changed from testing to on-going submission

25. Stage 2 Public Health EP Menu Measures • Successful ongoing transmission of cancer case information • New • Changed from testing to on-going submission

26. Stage 2 Public Health EP Menu Measures • Successful ongoingtransmission of data to a specialized registry • New • Changed from testing to on-going submission

27. Stage 2 Public HealthEH Measures • Three public health EH measures that moved from the menu to the core for Stage 2: • Successful ongoing transmission of immunization data • Successful ongoing submission of electronic syndromic surveillance data • Successful ongoing submission of reportable laboratory results • No public health EH measures in the menu

28. Stage 2 Public Health Measures and HIE • The on-going submission requires the provider and the public health agencies to identify an electronic process for data to move from EHRs to public health • Efficient • Automated • Secure

29. For the Stage 1 public health objectives, beginning in 2013, we also propose to add "except where prohibited" to the regulation text, because we want to encourage all EPs, eligible hospitals, and CAHs to submit electronic immunization data, even when not required by State/local law

30. Stage 2 Public Health Measures and HIE Some State Public Health Agencies are using Health Information Exchange entities to collect the EHR data from providers on their behalf In addition to accepting direct provider to public health data submission

31. Stage 2 Public Health Measures and HIE What is the means of transmission for on-going submission? Meaningful use of EHR = generate the data file and submit it Certification of EHRs = how the EHR generates the file The transport layer is what’s in between

32. States may also specify the means of transmission of the data or otherwise change the public health measure, as long as it does not require EHR functionality above and beyond that which is included in the ONC EHR certification criteria as finalized for Stage 2 of meaningful use.

33. Stage 2 Public Health Measures and HIE HIE intermediaries can just capture the data for PH; or HIE intermediaries can accept the data from EHRs and transform it into the correct version of HL7 (and are certified as an EHR module to do so)

34. Take Away Points Health Information Exchange infrastructure underpins a scalable, efficient and lower-cost mechanism for thousands of providers to interact with a small number of lower-budget public health entities Interfaces can be costly and the cost burden may fall onto the provider or public health entity- HIEs (noun) could ameliorate this issue

35. Models for HIEs to Help Public Health Data Aggregation Translation Services Transformation Services 8/29/2014 Office of the National Coordinator for Health Information Technology 35

36. Regional Extension Centers • Communication • Requirements • On-boarding process • Test and Queue • Receipt of test messages (Michigan) • Vendor negotiation • Contracts • Communication of vendor capacity

37. Public Health Implementation Flow 37

38. Resources • ONC HIT Policy Committee workgroups http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__hit_policy_committee_workgroups/1470 • Standards and Interoperability Framework • Public Health Reporting Initiative: http://wiki.siframework.org/Public+Health+Reporting+Initiative • QueryHealth Initiative http://wiki.siframework.org/Query+Health

39. Q&A • Please type your questions in the box

40. Upcoming NACCHO ePublic Health Events • Webinar Series: • Integration and Interoperability Across Public Health, Human Services, and Clinical Systems  • http://www.naccho.org/topics/infrastructure/informatics/resources/spring-2012-webinars_ephi.cfm

41. Contact Information • Vanessa Holley, MPH • Program Analyst, ePublic Health • vholley@naccho.org • (202) 507-4239