Achieving Meaningful Use: Public Health

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

3. Meaningful Use Requirements

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 summariesacross unaffiliated organizations.

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.

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

7. MIIC Interoperability Status

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)

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

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

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…

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

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

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

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

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

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!

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, PriyaRajamani, Erin Roche, Linda Stevens, Karen White, Jeff Williams ISTM Team: Mark Hollock, Gerry Skerbitz, Keith Hammel, SpencarMcCaa HP: David Kaiser, Mike Loula

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

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

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

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

23. Immunization Reporting “App”

24. E-Mail Interface

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

26. PHR (w/ HL7 VXU Support)

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

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

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

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