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Meaningful Use and Bi-directional Exchange of Immunization Data in New York City. Kristen Forney, MPH Citywide Immunization Registry New York City Department of Health and Mental Hygiene. Public Health Informatics Conference 2014. Overview.
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Meaningful Use and Bi-directional Exchange of Immunization Data in New York City Kristen Forney, MPHCitywide Immunization Registry New York City Department of Health and Mental Hygiene Public Health Informatics Conference 2014
Overview • Citywide Immunization Registry (CIR) Background: HL7 Data Exchange • Definitions • Interoperability Standards • Interoperability Demo • Benefits for Providers • Benefits for IIS • Supporting Data • Future Directions • Conclusion
CIR history • Started in 1997 • Contains 70 million immunizations for 5.2 million patients • Approximately 1800 active provider sites • Reporting is mandated for patients 0-18, consent is required for reporting immunizations given to adults • Paper reporting Online registry Flat file real-time HL7
CIR’s HL7 Data exchange • Real-time, bi-directional exchange through a SOAP web service • No batch file option for providers • First facility began submitting data through the web service in February 2011 • Currently 465 provider sites + 400 pharmacies sending HL7 data through the web service; (189 provider sites are bi-directional)
Definitions • Real-time • Synchronous Transport- User submits an HL7 message, and as part of that transaction/connection to the IIS, the application waits for an acknowledgment response • Synchronous Processing- Upon receipt of an HL7 message, IIS processes the message and acknowledges the results of processing. Data is immediately accessible to users of the IIS. • Bi-directional • EHR sends an HL7 query message (VXQ or QBP) and receives a response containing patient’s immunization history, evaluation and decision support • EHR imports IIS data and stores it as structured data
Interoperability Standards • HL7 2.5.1 • Supported by 44 immunization registries as of Sep 2013 • Well-defined standard for immunization reporting (VXU) and query/response (QBP/RSP) • SOAP Web Services • National standard recommended by CDC’s Transport Layer Expert Panel • Supported by 30 immunization registries as of Sep 2013
Benefits of real-timebi-directional exchange For Providers: • Avoid double data entry (89 CIR facilities have moved from online registry to HL7 web service) • Accessibility of information (both immunization history and clinical decision support) within provider workflow • Accuracy of data within provider EHR • Data immediately available in IIS for use with school forms, other pre-completed forms • Particularly beneficial for first-time EHR implementers
Columbia presbyterian hospital * P < 0.05; ** P <0.01; *** P < .001; **** P < .0001 Stockwell, et al, 2010. http://cdc.confex.com/cdc/nic2010/recordingredirect.cgi/id/6746
Benefits of real-timebi-directional exchange For an IIS: • Timeliness • Completeness of immunization information (lot number, manufacturer, expiration date, etc) • Providers have continuous interaction with the IIS
Improved vfc eligibility and lot number capture Improved VFC and Lot Number Capture *Data from all newly administered immunizations reported to the CIR during calendar year 2013 for patients < 19 years **Data from all newly administered immunizations reported to the CIR during calendar year 2013
Meaningful USE and IIS CIR built HL7 web service in 2009 Stage 1: Began January 2011; Eligible providers and hospitals must perform a test of EHRs capability to send data to an IIS in HL7 format Stage 2: Began January 2014; Eligible providers and hospitals must institute ongoing reporting to an IIS in HL7 2.5.1 format
increase in HL7 sites Start of MU (Jan)
Challenges of bi-directional HL7 exchange • How can we ensure that the IIS finds and returns the correct patient? • EHR should send all possible demographic information • Exchange unique IDs (Medical record number, IIS ID) • Will the EHR display IIS data correctly? • Thorough testing with the EHR vendor • Involve providers in testing • How will the EHR de-duplicate immunizations? • EHR record and IIS record must be fully synced to ensure accurate clinical decision support
Best practices for real-time bi-directional exchange For IIS: • Webinars (or site visits) with providers to understand how their EHR works • Set up the ability to restrict queries from specific accounts • Store unique IDs sent by the EHR • Data quality monitoring; daily e-mails For EHRs: • Store patient’s registry ID and send in all transactions • Automatic re-query to get decision support updated • Full sync of registry record with EHR record—critical for accurate decision support
Future Directions- IIS Community • Advocate for MU Stage 3 to include bi-directional exchange • Reduce Variability in HL7 implementations between IIS • Find ways to partner with EHR vendors that will be mutually beneficial • Create a set of recommendations to EHR vendors for best practices
CONCLUSIONS • Meaningful Use has facilitated increased adoption of HL7 standards among practices reporting to CIR • Real-time, bi-directional exchange is feasible and scalable to a large number of facilities • Presents a number of benefits to both providers and IIS • IIS nationally have well-defined standards for message content and transport • Preference of EHR vendors in MU stages 1 and 2 has been for a unidirectional HL7 interface; inclusion of a bi-directional requirement in stage 3 would accelerate implementation of bi-directional interfaces
Thank you! Amy Metroka Vikki Papadouka Angel Aponte Paul Schaeffer Contact Information Kristen Forney Director, EHR-IIS Interoperability Project kforney@health.nyc.gov 347-396-2578