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Public Health Reporting
2014 Meaningful Use
July 23, 2014
DeeAnne McCallin, CalHIPSO
Alex Horowitz, Intrepid Ascent
Along with representatives from
CAIR and CalREDIE
Helping California Clinicians Transform Healt h Care
What do I have to do to meet
the Public Health (PH)
Meaningful Use (MU)
measures in 2014?
CalHIPSO is continuing to provide incentive
program and technical services through
December 31, 2014 to both current and new
members. Meeting MU is challenging, let
CalHIPSO provide you with free assistance in
meeting the first year of Stage 1 MU. Limited
availability, contact us for a FREE consult.
Visit www.CalHIPSO.org
[email protected]
510.302.3364
Disclaimer
• The information included in this presentation
follow the Meaningful Use EHR Incentive
Program as finalized in the Stage 1 Final Rule
& the Stage 2 Final Rule
• As there is a Notice of Proposed Rule Making,
the above rules are subject to change later
this year
4
Step 1
Know the Measures &
the MU Stage
Determine MU Stage By Site
– If all EPs at a site are still in Stage 1,
follow Stage 1 guidance
– If 1 or more EP that works at the site are
scheduled to attest to Stage 2, follow
Stage 2 guidance for all EPs
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If Stage 1…then…
1
2014 Stage 1 PH Measures
• Menu Set Measures
• Must select at least 1 of 2
– Immunization Registries Data
Submission http://w w w.cms.gov /Regulations-and-
Guidance/Legislation/EHRI ncentivePrograms/downloads/9_Immunization_Registries_Data_
Submission.pdf
– Syndromic Surveillance Data
Submission http://w w w.cms.gov /Regulations-and-
Guidance/Legislation/EHRI ncentivePrograms/downloads/10_Syndromic_Surveillance_Dat
a_SubmissionEP.pdf
8
Stage 1 IZ Requirement
• Performed at least one test of
certified EHR technology’s
capacity to submit electronic
data to immunization registries
and follow up submission if the
test is successful
9
2014 Change to
Menu
Exclusions
– https://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Downloads/st
age1changestipsheet.pdf
– Beginning in 2014, EPs, eligible hospitals, and
CAHs will no longer be permitted to count an
exclusion toward the minimum of 5 menu
objectives on which they must report if there
are other menu objectives which they can
select.
– In other words, a provider cannot select a
menu objective and claim an exclusion for it
if there are other menu objectives they can
meet.
10
IZ Stage 1- some details
• If multiple EPs are using the same
certified EHR technology in a shared
physical setting, testing would only
have to occur once for a given
certified EHR technology.
1X
11
IZ Stage 1- some details continued
• An unsuccessful test to submit electronic data to
immunization registries or immunization information
systems will be considered valid and would satisfy
this objective.
• If the test is successful, then the EP should institute
regular reporting with the entity with whom the
successful test was conducted.
12
Stage 1 Syndromic
Surveillance Requirement
• Performed at least one test of certified EHR
technology’s capacity to provide
electronic syndromic surveillance data to
public health agencies and follow-up
submission if the test is successful.
• If the local public health jurisdiction that a
provider submits to (county PH department)
cannot accept data electronically, the
provider must choose the IZ menu measure.
13
If Stage 2…then…
2
2014 Stage 2 PH EP Measures
• Core Item #16, Immunization Registries (IZ)
Capability to submit electronic data to immunization registries or
immunization information systems
• Menu Items:
– Syndromic Surveillance
– Cancer Registries
– Specialized Registries
MU Measure Table of Contents for more details on each PH measure
http://w w w.cms.gov /Regulations-andGuidance/Legislation/EHRI ncentivePrograms/Downloads/Stage2_MeaningfulUseSpecSheet_TableContents_EPs.pdf
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Stage 2 Meaningful Use
Improve Population and Public Health
Objective
Ambulatory Measure
Hospital measure
Immunizatio n
Registries
Ongoing Submission to
Public Health Authority
(Core)
N/A
Ongoing Submission to Public Health
Authority (Core)
Syndromic
Surveillance
Ongoing Submission to
Public Health Authority
(Menu)
Ongoing Submission to Public Health
Authority (Core)
Cancer
Registries
Ongoing Submission to
Public Health Authority
(Menu)
N/A
Specialized
Registry
Ongoing Submission to
Public Health Authority or
National Specialty Society
(Menu)
N/A
Reportable Lab
Results (ELR)
Ongoing Submission to Public Health
Authority (Core)
16
1
Menu Exclusions – applicable
to Stage 2 as well…
– https://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/stage1ch
angestipsheet.pdf
– Beginning in 2014, EPs, eligible hospitals, and
CAHs will no longer be permitted to count an
exclusion toward the minimum of 5 menu
objectives on which they must report if there
are other menu objectives which they can
select.
– In other words, a provider cannot select a
menu objective and claim an exclusion for it
if there are other menu objectives they can
meet.
17
Step 2
Know Where to Submit Data
How many CA Electronic
Registries are there?
– 10 Immunization Registries, with four
distinct data submitting processes
– 58 Registries for Syndromic Surveillance
Data
– One Statewide Registry for Cancer Data
– One Statewide Registry for Reportable
Lab (ELR) data (CalREDIE)
– No registries that meet the “Specialized
Registry” menu measure requirements
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California Immunization Registries
• Reporting processes differ depending on county.
• Go to the CDPH HIE Gateway website at
http://hie.cdph.ca.gov/ and choose ‘Immunization
Reporting’
• Enter your county and follow the county-specific
instructions under ‘Immunization Reporting’ in the PH
MU Capacity Matrix.
• Following registration, you will receive instructions on
how to report.
20
The Public Health MU
Capacity Matrix
http://hie.cdph.ca.gov/lhj-matrix.html
21
California Immunization
Registries
• For most of California, submit to CAIR via the
CDPH HIE Gateway. These are the “CAIR 7”
• Imperial and San Diego counties operate
their own registries and Solano has a
separate submission service
• The San Joaquin Region uses a registry
called RIDE (aka MyHealthyFutures)
– Includes Alpine, Amador, Calaveras,
Mariposa, Merced, San Joaquin,
Stanislaus, and Tuolumne counties
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CDPH – Health Information
Exchange Gateway
http://hie.cdph.ca.gov/
When you have assembled
all this necessary information
and are ready to begin
Gateway registration, click
below * on the type of public
health data you wish to
submit and proceed with
registration.
* Note: The images to the right
will be seen below when you are
on the Gateway’s website
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Syndromic Surveillance Registries
• Each county is responsible for operating its own
registry
• Each county has different processes…reach
out to your local public health department
directly!
• Some counties cannot or do not accept data
Contact Your Local
Public Health Department
24
ELR and Cancer Registries
• There is one registry for Cancer and one
for Reportable Labs (CalREDIE)
• Both registries accept data through the
CDPH HIE Gateway no matter where
you are in California!
• You must register separately for these
registries, even if you are already
submitting IZ data to the Gateway
25
Future Registries
• Currently no way for EPs or Hospitals to
meet the “Specialized Registry”
requirement in California
• CDPH plans to integrate the BloodLead registry into the CDPH HIE
Gateway next year (2015)
26
Step 3
Know How To Test and
Submit Data
 Stage 1 Year 1
 Stage 1 Year 2 +
 Stage 2
Information on IZ Stage 1
General instructions for data submission are
on the CAIR 5 Steps to Data Exchange
http://cairweb.org/data-exchange-tech-support
28
Find your reporting
instructions
•
Register based on county and follow
reporting instructions for your registry
o
See Capacity Matrix (represented on a
previous slide)
http://hie.cdph.ca.gov/lhj-matrix.html
• Many will find they are in one of the CAIR
7 regions and will be directed to the
Gateway/Iz Portal
29
CDPH Gateway
Welcome to the Health Information
Exchange Gateway
The California Department of Public
Health (CDPH) exchanges data with
many stakeholders, including
providers, hospitals, laboratories, local
health jurisdictions and federal
agencies. …
http://hie.cdph.ca.gov/
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Stage 1 First Year CAIR 7
If you are in a CAIR 7 county, register at the
CDPH Gateway…
 Register at http://hie.cdph.ca.gov/
 Stage 1 and Stage 2 registrations are on the
same site
 Specific Stage 1 instructions are not on the
website, you will, however, see information on
Stage 2…don’t worry!...
 …continue on, your goal right now is an email
containing specific instructions…
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Stage 1 – Year 2 or Further
1. If you already registered and tested with
CAIR for Stage 1 in previous years, you
need to test again in 2014!
2. Log In to the CDPH gateway, do not create
a new account
– Contact CDPH support if you have forgotten your
login or don’t know if your site already has one!
(855) 281-4996 for support or e-mail [email protected]
3. If you failed your test last year, CAIR will
expect efforts to improve the outcome this
year
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Registering with the Gateway
1. You will always be asked to indicate your
site’s 90-day reporting period and your
intended MU Stage and Year (in case of
Stage 1 Year 2 OR Stage 2 etc.)
 This will determine when CAIR sends reminder
emails to your site (the 90 day period)
 This will also determine which instructions you
receive by email (Stage 1 or Stage 2)
2. You will receive email instructions on
“Next Steps”, these can be acted upon
right away, even before your reporting
period!
33
CAIR Next Steps – New Users
After your registration, you will receive an
email your credentials (ID, password) and a
link that will take to you to “Next Steps” to
complete your registration
34
Differences S1 Y1 vs S1 Y2+:
CAIR 7
• For S1 Y1, you always need to create a
new Gateway Account
• For S1 Y2+, you only need to create a
new account if you have not
submitted before, otherwise log into
your existing account
• S1 Y2+ submitters are expected to
improve on previous failed tests
35
CDPH - How to meet Iz
Stage 2 in 2014
1. If you registered at the CDPH Gateway (48 of 58
counties), you were asked to identify your 90day stage 2 reporting period.
2. In stage 2, ‘ongoing data submission’ is the
requirement although active message testing
and validation during the 90-day reporting
period also qualifies.
3. A series of email reminders will be sent if test
messages are not received during this period,
and will include an option to change/ delay
your 90-day reporting period.
36
IZ Stage 1 and 2
with Other Registries
• All other registries have paper-based
registration processes, use the CDPH
Capacity Matrix to find these forms
• A similar pattern of emailed instructions sent
once registration forms are received will
occur
• Generally, two-months notice is a good
policy with the other registries
37
Electronic Lab Data
CDPH Gateway for ELR
http://hie.cdph.ca.gov/
39
Who Sends Reportable Labs
Does your facility operate a laboratory
that achieves results for reportable
conditions found in CCR Title 17 Section
2505 Summary?
ELR Specific Support
Phone: (916) 650-6885
Email: [email protected]
40
ELR Vs CMR Reporting
ELR Submitters
• Register with the CDPH HIE Gateway and receive all appropriate credentials
and instructions
• For more information about ELR:
http://www.cdph.ca.gov/data/informatics/tech/Pages/CalREDIEELR.aspx
• Electronic Laboratory Reporting is used by laboratories to report laboratory
testing results suggestive of diseases of public health importance as
mandated by title 17 section 2505
CMR Submitters
• Contact your local health department for information on how to use the
CalREDIE Provider Portal
• For more information about provider portal:
http://www.cdph.ca.gov/data/informatics/tech/Documents/Provider_Portal_
FactSheet.pdf
• Confidential Morbidity Report is used by health care providers to report a
suspect or known case of diseases or conditions of public health importance
as mandated by title 17 section 2500
41
ELR Participation
• To learn more about CalREDIE ELR system
requirements and testing process visit:
http://www.cdph.ca.gov/data/informatics/t
ech/Pages/CalREDIEELR.aspx
• For a step by step guide of the onboarding
process, download the Electronic
Laboratory Reporting Checklist:
http://hie.cdph.ca.gov/ELR_Checklist_32014_Final.pdf
42
Let’s get technical
Stage 1 Technical Details
• Stage 1 requires a “Test” of data submission.
• For 48 of 58 counties (the CAIR 7), SOAP
transport is required for testing/data
submission.
– The other registries have more options.
• For general info and link to free SOAP UI tool,
go to http://cairweb.org/data-exchangetech-support
– Can be used to satisfy testing requirements, but
will require time and effort to set up.
44
Stage 2 Technical Details
• Stage 2 requires continuous submission of
data.
• The free SOAP application that can be used
for testing with CDPH WILL NOT SUFFICE for
continuous submission.
• Your EHR vendor will need to be contacted
to implement SOAP for Stage 2.
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Public Health
Domain
Exchange Standards
Vocabulary Standards
Immunization
Registries
(IIS)
Standard - HL7 2.5.1
• HL7 2.5.1 Implementation Guide for Immunization
Messaging Release 1.4 - Approved 7/15
HL7 Standard Code Set CVX -Vaccines Administered,
updates through July
11, 2012
Reportable
Lab Results
(ELR)
Standard - HL7 2.5.1
• HL7 Version 2.5.1 Implementation Guide: Electronic
Laboratory Reporting to Public Health, Release 1 with
Errata and Clarifications - Approved 7/15
SNOMED-CT and Logical
Observation Identifiers
Names and Codes (LOINC®)
Database version
2.40
Syndromic
Surveillance
Standard - HL7 2.5.1
• PHIN Messaging Guide for Syndromic Surveillance:
Emergency Department and Urgent Care Release 1.1
August 2012 (Required for Inpatient and optional for
ambulatory) - Approved 7/15
Note: Ambulatory / In-patient Guide under development
Cancer
Registries
CDA
• Implementation Guide for Ambulatory Healthcare
Provider Reporting to Central Cancer Registries, August
2012
IHTSDO SNOMED CT®
International Release July
2012 and US Extension to
SNOMED CT® March 2012
Release and LOINC
Specialized
Registries
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Technical Requirements: IZ
Stage 1 and Stage 2 2014
• Data formats must be in HL7 2.5.1 for IZ.
Certified EHRs must comply with this
standard and should not charge extra!
• Data transport for the CDPH gateway uses
SOAP web-services. EHR vendors are not
required to support this standard and may
charge for it.
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Technical Requirements: IZ
Stage 1 and Stage 2 2014
• San Diego County also uses SOAP for data
transport. To submit to San Diego,
organizations need to join the San Diego
Regional HIE.
• RIDE, Imperial, and Solano counties should
be contacted directly for their tech specs.
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Technical Requirements: Non-IZ
Stage 1 and Stage 2 2014
• Reportable Lab Data requires SOAP data
transport
• Syndromic Surveillance Tech Specs will vary
by county
• The Cancer registry requires SOAP data
transport
– It is also the only registry that requires CDA
documents instead of HL7 Data!
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So do I have to Implement SOAP?
Stage 1 and Stage 2 2014
• It is the responsibility of providers attempting
to meet MU to at least attempt to work with
the registries.
• Providers cannot take an exception to the
Public Health measures unless a good faith
effort is made to work with the registries.
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“HUB” Submitters
• The CDPH HIE Gateway, RIDE and SD
accept data from HUB Submitters
– Includes Community and Enterprise HIEs, and
Hosted EHRs (such as Athena and Quest
Care360).
– If you are part of an HIE, or have a Hosted EHR,
contact your HIE or EHR vendor first!
• HUBs must be pre-registered with the
Gateway to submit data.
• Some HUBs may require ONC CERT.
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What’s next
• CalREDIE Submitter Checklist:
http://hie.cdph.ca.gov/ELR_Checklist_32014_Final.pdf
• FAQs from the presentation will be posted to
CalHIPSO’s website within 5 business days
• CalHIPSO members will receive a direct email
Need More Help Figuring This Out?
Enroll in CalHIPSO’s services today.
52
Questions?
CalHIPSO REC:
[email protected]
e-mail CDPH at
[email protected]
Meaningful Use (CDC)
[email protected]
Intrepid Ascent
[email protected]
[email protected]