Review of Population and Public Health Objectives Stage 3 MU

1. Review of Population and Public Health Objectives Stage 3 MU Arthur Davidson, MD, MSPH Meaningful Use Workgroup December 20, 2013

2. Agenda • Progress with Meaningful Use Measures for Public Health • Evidence of PH Efforts with Standards • Cancer • HAI (need notes) • Updates on Current Measures: Immunization & ELR (Jim can give someone info for slides) • Future of PH – Aligning future measures w/S&I Framework • SDC • HeD • DAF • Progress • CSTE Pilots • RCKMS • Big pic diagram (Shu)

3. Hospital 1st v. 2nd v. 3rd yearPH Menu Objective Performance Source: CMS Presentation – Rob Anthony, December 4, 2013

4. Update on Current Measures: - Immunization, ELR, SS • Immunization • New guide provides improvements • Progress with providers is better • ONC test criteria are making interoperability better • PH moving toward accepting data coming form certified products • Next version (Feb 2014) of IG will include bi-directional w/ History and forecast back to provider • Electronic Laboratory Reporting (ELR) • New version of IG is available to HL7 members and includes many improvements • Syndromic Surveillance (SS) • Successful centralized infrastructure utilizing BioSense • http://www.hl7.org/dstucomments/showdetail.cfm?dstuid=104

6. Electronic Laboratory Reporting (ELR) – Pattern of Adherence to Standards • Public Health has consistently made efforts to abide by standards and in turn minimize impact on clinical partners • Proof of PH’s commitment to build on standards and processes used for other use cases,. • ELR Release 1 (HL7 Version 2.5.1: ORU^R01)1was built on the HISTP Lab-to-EHR Implementation Guide • ELR Release 2 is the current profile for Electronic Laboratory Reporting to Public Health (MU Stage 1 and 2). • Public health has demonstrated readiness for standards and will credibly achieve that for Stage 3. http://www.odh.ohio.gov/~/media/ODH/ASSETS/Files/opi/infectious%20disease%20surveillance/v251_IG_LB_LABRPTPH_R1_INFORM_2010FEB.ashx

8. Key Principle for PH Stage 3 MU • Adhere to Standards and Interoperability Framework Components Whenever Feasible

9. Cancer Reporting • Stage 3 MU Cancer Implementation Guide (IG) should move to consolidated clinical document architecture (c-CDA) because: • EHR vendors are required to use this format for Transition of Care documents in Stage 2 MU • eliminates burden of supporting two different formats for cancer reporting • c-CDA has harmonized and improved templates across multiple sources • cancer program is ready to move to this new standard

10. Cancer c-CDA: Next Steps • Align Cancer IG sections with c-CDA sections (high level completed) • Add a new document-level template c-CDA R2: "Ambulatory Healthcare Provider Cancer Event Report” • Add Cancer Diagnosis Section to c-CDA • Perform Gap and Overlap analysis of entries, data elements, attributes, and value sets • Put new document through HL7 ballot process Timeline • High level gap analysis performed in November 2013 • Detailed gap/overlap analysis work starting in January 2014 • Ballot in May 2014

11. PH c-CDA Progression 2012 2013 2014+ Pertussis (NY State) EHDI (N. Dakota) Cancer Registry Pertussis (San Diego) EHDI (Oregon) Tuberculosis (Delaware)

12. Electronic Healthcare Associated Infection (HAI) Detection and Reporting: Supporting Patient Safety CDC Reporting system publishes facility-specific HAI data • Specifications: • eMeasures • Decision rules • Computer code Healthcare Reporting system provides protocol and algorithm Public Health Publicly Reported HAI data Executable expressions of detection and case reporting algorithms Reporting protocol for HAI CMS • CDA transmission: • Manual upload • Automated send NHSN CDC Programs HeD Electronic HAI Report Clinical Document Architecture (CDA) • Electronic • systems: • EHR • Pharmacy • ADT • Lab Additional rules applied to populate full HAI report HAI detection rules applied to patient-specific data Healthcare Facility

13. Progress : What’s been completed CDA/SDC for Public Health Pilot Projects Public Health Reporting Architecture Continuity of Care Document (CCD) (pre-population data) Public Health Infrastructure Or Health Information Exchange (HIE) CDA-based Case Reports: Tuberculossis Pertussis Newborn Hearing Screening Outcome Report Provider Public Health Electronic Health Record System Information Systems: Surveillance Systems EHDI System Public Health Information Systems Delaware Electronic Reporting Surveillance System (DERSS) New Your State Universal Public Health Node (UPHN) San Diego County (Atlas Public Health) Oregon EHDI System (Filemaker) North Dakota EHDI System (OZ Systems) EHR Vendors Core Solutions Connexin Allscripts (Test Harness) Epic 2012 (Test Harness) Public Health Infrastructure (Orion Rhapsody) HIE (OZ Systems) • Request Form • 2. Provide pre-population data Form Manager Form Manager Form Filler 3. Pre-populated Report Form Form Receiver Form Receiver 4. Populated Report Form Content Creator Content Creator • Send–Receive • CDA Report Content Consumer 13 Sources: Communicable Disease CDA Pilot Project Report. 2012. URL: https://wiki.phdsc.org/index.php/CDA EHDI CDA Pilot Project Report. 2013. URL: https://wiki.phdsc.org/index.php/EHDI-Pilot

14. Communicable Disease Reporting – CDA/SDC Pilot in NYC and WI Current Progress (as December 2, 2013) – Finalize Testing in Vendor Environment • Key Outcomes • Shift in tradition al public health case report (PHCR) use case • Leverage existing standard (i.e., CCD -> cCDA) • Light-weight service for EMR vendors to connect to various jurisdiction reporting end-points • Minimize development in EMR System • Extensibility/ portability to other EMR vendors • State and LHD can configure forms based on reporting and business needs specific to jurisdiction Electronic Medical Record (EMR) Vendor Test Environ-ment (i.e., EPIC) NYC and WI Public Health Infrastructure Continuity of Care Document (CCD) Reporting Module/Form Manager • Parse • Retrieve Form • Pre-populate web form 4. Send URL with pre-populated web form Electronic Disease Surveillance System 5. Physician/ICP submits addition information directly to system Next Steps – Identify, Recruit, and Implement in Hospital using EPIC EMR System State/Local Surveillance System

15. Structured Data Capture • - Tiger Team and Selected Pilots • Public Health Tiger Team • Community based effort to identify, develop, and implement SDC Public Health Pilots • Public Health Pilots • EHDI • Cancer Reporting • Case Reporting http://wiki.siframework.org/Public+Health+Tiger+Team+Meeting+Archives 15

17. Health eDecisions - Use Cases • Use Case 1: standard format for sharing CDS knowledge artifacts • Rules, order sets and documentation templates • Goal: CDS knowledge authored in standard format can be imported and used in any EHR system • Use Case 2: standard interface for accessing CDS Web services • Goal: CDS capability encapsulated using standard interface can be integrated with any EHR system 17

18. Health eDecisions– Use Case 1 (CDS Artifact Sharing) Use Case 1 Focuses on three artifact types: Event Condition Action Rules Order Sets Documentation Templates 18

19. Health eDecision - Use Case 1: Pilot Partnerships 19 RCKMS: Reportable Condition Knowledge Management System

20. RCKMS Long term Scope Reportable Condition Knowledge Management System (RCKMS) Public Health State, Local, Territorial Agencies PH Reports Authoring Framework PH Reporters (Clinicians) Query/View Hospital Labs Database Who, What, When, Where, How Subscription Management Including Notifications LIMS Web Service EHR Other Web Services Ambulatory Care Structured Output Generator (3) Open CDS Local National, Clinical & Public Health Laboratories LIMS EHR DSS Web Service (2) Open CDS HeD HeD Compliant format - Triggering Criteria - Reporting Actions - Links (1) Health eDecision (Hed) • Output file Options • HeD file download • OpenCDS in Cloud • OpenCDS Locally Deployed 20

21. S&I Data Access Framework Use Cases 21

22. Data Access Framework- examples

23. Improving population and public health: Stage 3 Priorities Target Outcome Goals MU Outcome Goals Stage 3 Functionality Goals MU Outcome Goals Stage 1 + 2 Functional Objectives • Efficient and timely completion of case reports • Efficient and timely means of defining and reporting on patient populations to drive clinical care and identify areas for improvement • Shared information with public health agencies or specialty societies • Bidirectional public health data exchange • Providers know the health status of their patient population • Public health officials know the health status of their jurisdiction • Providers and specialty societies can track and manage domain specific events related to practice and devices • Providers and public health officials share information to improve individual and population health • Patient lists • Sharing immunization data • Cancer and specialty registry • Electronic lab reporting • Submission of electronic syndromic surveillance data 23

24. Improving population and public health: Case Reports Functionality Needed to Achieve Goals Stage 3 Functionality Goals • Efficient and timely completion of case reports • Efficient and timely means of defining and reporting on patient populations to drive clinical care and identify areas for improvement • Shared information with public health agencies or specialty societies • Bidirectional public health data exchange • CEHRT uses external data to prompt the end-user when criteria are met for case reporting. The date and time of prompt is available for audit. Standardized (e.g., consolidated CDA) case reports are submitted to the state/local jurisdiction and the data/time of submission is available for audit. • Recommended as certification criteria only 24

25. Improving population and public health: Registries Functionality Needed to Achieve Goals Stage 3 Functionality Goals • Efficient and timely completion of case reports • Efficient and timely means of defining and reporting on patient populations to drive clinical care and identify areas for improvement • Shared information with public health agencies or specialty societies • Bidirectional public health data exchange • EPs/EHs use CEHRT to electronically submit standardized (i.e., data elements, structure and transport mechanisms), commonly formatted reports to two registries (e.g., local/state health departments, professional or other aggregating resources) • EP/EH Registries examples: cancer, children with special needs, and/or early hearing detection and intervention or external entities that maintain the registry (e.g., hypertension, diabetes, body mass index, devices, and/or other diagnoses/conditions) that could include accountable care organization, public health agency, professional society, or specialty community. EHs Only: health-care associated infections 25

26. Improving population and public health: Immunization history Functionality Needed to Achieve Goals Stage 3 Functionality Goals • Eligible Professionals, Hospitals, and CAHs receive a patient’s immunization history supplied by an immunization registry or immunization information system, allowing healthcare professionals to use structured historical immunization information in the clinical workflow • Recommended CEHRT Functionality • Ability to receive and present a standard set of structured, externally-generated immunization history and capture the act and date of review within the EP/EH practice • Efficient and timely completion of case reports • Efficient and timely means of defining and reporting on patient populations to drive clinical care and identify areas for improvement • Shared information with public health agencies or specialty societies • Bidirectional public health data exchange 26

27. Improving population and public health: Electronic lab reporting Functionality Needed to Achieve Goals Stage 3 Functionality Goals • Efficient and timely completion of case reports • Efficient and timely means of defining and reporting on patient populations to drive clinical care and identify areas for improvement • Shared information with public health agencies or specialty societies • Bidirectional public health data exchange No Change from Stage 2 EH Objective: Capability to submit electronic reportable laboratory results to public health agencies, except where prohibited, and in accordance with applicable law and practiceMeasure: Successful ongoing submission of electronic reportable laboratory results from Certified EHR Technology to public health agencies for the entire EHR reporting period. 27

28. Improving population and public health: Syndromic Surveillance Functionality Needed to Achieve Goals Stage 3 Functionality Goals • Efficient and timely completion of case reports • Efficient and timely means of defining and reporting on patient populations to drive clinical care and identify areas for improvement • Shared information with public health agencies or specialty societies • Bidirectional public health data exchange No Change from Stage 2 EP MENU Objective: Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practiceEH Objective: Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice EP/EH Measure: Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period 28

29. Former Objective Details Proposed Merged Registry Objective(404, 405, 407 - EH objective) EH Objective:   Capability to electronically submit standardized (i.e., data elements, structure and transport mechanisms), commonly formatted reports to two registries (e.g., local/state health departments, professional or other aggregating resources) from the Certified EHR Technology, except where prohibited, and in accordance with applicable law and practice. This objective is in addition to and does not replace prior requirements for submission to an immunization registry. Measure: Documentation (or registry acknowledgement) of ongoing successful electronic transmission of standardized reports from the CEHRT to two registries (either mandated or voluntary)).  Attestation of submission for at least 10% of all patients who meet registry inclusion criteria during the entire EHR reporting period as authorized, and in accordance with applicable State law and practice. Registries include: cancer, health-care associated infections, children with special needs, and/or early hearing detection and intervention or external entities that maintain the registry (e.g., hypertension, diabetes, body mass index, devices, and/or other diagnoses/conditions) that could include accountable care organization, public health agency, professional society, or specialty community) should maintain the registry Certification criteria: EHR is able to build and then send a standardized report (e.g., standard message format) to an external mandated or voluntary registry, maintain an audit of those reports, and track total number of reports sent.

30. Former Objective Details Case reports – 402B Certification ONLY