PMIRWG August 19, 2010 Bill Brand, MPH, CPHIE Public Health Informatics Institute

1. HITECH and Meaningful Use– Implications for Immunization Information Systems and for Public Health PMIRWG August 19, 2010 Bill Brand, MPH, CPHIE Public Health Informatics Institute

2. Overview • Overview of HITECH Act • Overview of the EHR Incentive Program (“Meaningful Use”) • Implications for IIS and for public health • Getting ready

3. The Public Health Informatics Institute Mission To improve health outcomes worldwide by transforming health practitioners' ability to effectively apply information.

4. OVERVIEW OF HITECH AND MEANINGFUL USE

5. HITECH Vision • Goal: To improve the health of Americans and the performance of the nation’s health system through health information technology (HIT) • An important component of health reform • Harness the full potential of digital technology to prevent and treat illnesses and to improve health

6. HITECH Goals • Improve quality, safety, efficiency, and reduce health disparities • Engage patients and families • Improve care coordination • Ensure adequate privacy & security protections for personal health information • Improve population and public health

7. Major HITECH Strategies • EHR Incentive Program (“Meaningful Use”) • Workforce training • State Health Information Exchange (HIE) Cooperative Agreements • Regional Extension Centers for technical assistance • Health IT policy and standards committees and workgroups • Focus is on primary and inpatient care, and small and rural providers

8. Medicare-Medicaid EHR Incentive Program $44.7B estimated incentive payments Eligible provides and hospitals must demonstrate being a meaningful user of EHR to receive payment Focuses on clinician behavior to improve care A “meaningful user” must: Use a certified EHR product Meet core objectives and at least 5 “menu” objectives Report quality measures Current rules define requirements for stage 1 of 3 A voluntary program 8

9. Examples of Core Objectives Computerize physician order entry (CPOE) Provide electronic copy of patient’s health information, upon request Record demographics Maintain active medication list Record smoking status for patients 13 years or older Exchange key clinical information among providers of care and patient-authorized entities electronically Check drug-drug and drug-allergy interaction E-Prescribing (eRx) Provide clinical summaries for patients for each office visit 9

10. Examples of Menu Objectives Incorporate clinical lab test results as structured data Generate lists of patients by specific conditions Summarize care record for each transition of care/referral Send reminders to patients per patient preference for preventive/follow up care Submit electronic data to immunization registries/systems Provide electronic syndromic surveillance data to public health agencies Provide electronic submission of reportable lab results to public health agencies 10

11. Meaningful Use – Public Health Objectives 1Unless an EP, eligible hospital or CAH has an exception for all of these objectives and measures they must complete at least one as part of their demonstration of the menu set in order to be a meaningful EHR user.

12. Future Stages • Intend to propose 2 additional Stages through future rulemaking. Future Stages will expand upon Stage 1 criteria. • Stage 1 menu set will be transitioned into core set for Stage 2 • Administrative transactions will be added • CPOE measurement will go to 60% • Will reevaluate other measures – possibly higher thresholds • Stage 3 will be further defined in next rulemaking Source: CMS

13. EHR Incentive Program Timeline • Registration for the EHR Incentive Programs begins January 2011 • For Medicare providers, attestation for the EHR Incentive Programs will begin in April 2011 • EHR incentive payments will be made 11 months after the rule is published • For Medicaid providers, States may launch their programs in January 2011 and thereafter • November 30, 2011 – Last day for eligible hospitals and CAHs to register and attest to receive an incentive payment for FFY 2011 (Medicare providers) • February 29, 2012 – Last day for EPs to register and attest to receive an incentive payment for CY 2011 (Medicare providers) • 2015 – Medicare payment adjustments begin for EPs and eligible hospitals that are not meaningful users of EHR technology** • 2016 – Last year to receive a Medicare EHR incentive payment; Last year to initiate participation in Medicaid EHR Incentive Program** • 2021 – Last year to receive Medicaid EHR incentive payment** **Statutory Source: CMS

14. FINAL RULE SPECIFICATIONS RELATED TO IIS

15. Standards Required for IZ Reporting • Messaging Standards • HL7 v2.3.1 or 2.5.1 • Implementation Guides • Implementation Guide for Immunization Data Transactions using Version 2.3.1 of the Health Level Seven (HL7) Standard Protocol Implementation Guide Version 2.2 • HL7 Version 2.5.1 Implementation Guide for Immunization Messaging • Vocabulary Standard • CVX

16. Issues with the Standards • Who gets to decide which version of HL7 will be used in a state—the IIS, the provider/hospital, the vendor, or the Medicaid program? • Use dummy data or real? • How much effort to put into checking accuracy/syntactical conformance? • What constitutes a successful test? • If a current IIS user, can any routine submission count as a test? • If ongoing submission follows, program have capacity to train and support the new users? • Need to maintain old interfaces

17. Projected Pattern of Population Health Testing Transactions/ month Providers submitting Transactions/mo Medicare EPs/Hosps Medicaid EPs/Hosps Apr 2011 Oct 2012 Jan 2013 Oct 2010 Jan 2011 Oct 2011 Jan 2012 Source, Seth Foldy, MD Timeline completion period

18. OTHER ISSUES?QUESTIONS?

19. IMPLICATIONS FOR PUBLIC HEALTH AND IIS

20. Implications for States/IISs • Increased bi-directional exchange with health care over time = increased standardized data for reuse inside PH • Healthcare will emphasize MU requirements over PH requests for data • They and their vendors will expect to send/receive data using ONC standards

21. Implications for States/IISs (cont.) • Getting ready will be a challenge for PH • Supporting old partners and their vendors in moving to new standards • Integrating new partners • Adjusting workflows/capacity to higher data volumes • Leverage Medicaid and state HIE funding to modernize public health information systems • More standards-based and interoperable

22. Implications for Public Health • Unprecedented opportunity/challenge to partner on HIE and population health improvement • Funding, policy and regulations aligned • Private and public sector buy-in • Expectations for public health capabilities around HIE will increase • Workload issues around testing and verification • Workforce readiness issues • Pressure to standardize across jurisdictions

23. The Big Implication If public health fails to perform credibly and consistently for stage I meaningful use, it will likely lose any ability to include/influence requirements for stages II and III.

24. Other Implications • Operate more as an industry, with greater standardization across jurisdictions and information systems • Align CDC/other federal funding and initiatives with HITECH priorities • Certify public health information systems • Develop organizational capacity and workforce competencies

25. Action Steps • Work closely with state Medicaid program • Appoint a senior-level Meaningful Use Coordinator • Identify protocols for processing test submissions • Coordinate with epi. on lab and syndromic reporting • Assess readiness/compliance of IIS with meaningful use requirements • Build capacity in HL7; move toward v2.5.1 • Work closely with the state HIT Coordinator • Engage in state HIE planning and operations • Share questions and lessons learned

26. Current Coordination • Joint Public Health Informatics Task Force • ASTHO, NACCHO, CSTE, APHL, NAPHSIS, NAHDO, PHDSC • Establishes joint public health informatics priorities • AIRA being invited as affiliate member • CDC • Meaningful Use Advisory Committee • CDC appointee to ONC • CDC/NCIRD interoperability initiative

27. Meaningful Use Summit • August 9 Summit on Public Health Readiness for Meaningful Use • Representatives from 7 CDC centers/offices, ASTHO, NACCHO, CSTE, APHL, ISDS, NORC • Created a joint action plan to support states to achieving readiness by April 1, 2011 • Focus is on those with the intent to be ready

28. Discussion Bill Brand: bbrand@phii.org HHS/ONC: www.healthit.hhs.gov CMS Meaningful Use FAQ site: www.cms.gov/EHRIncentivePrograms