Public Health Reporting Meaningful Use Stage 1 and 2

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1/14/2015 1

Public Health Reporting

Meaningful Use Stage 1 and 2

Laura Rappleye

Altarum Institute

Deputy Director, Center for Connected Health

Kristy Brown

Michigan Department of Community Health Meaningful Use Public Health Testing Support

Agenda

1.

Overview of M‐CEITA and Meaningful Use 

(MU)

2.

Stage 1 Public Health Objectives and Steps 

to Meet the Measures

3.

Stage 2 Public Health Objectives and Steps 

to Meet the Measures

4.

Questions

Who is M-CEITA?

▲ Michigan Center for Effective Information

Technology Adoption (M-CEITA)

▲ One of 62 ONC Regional Extension

Centers (REC) providing education & technical assistance to primary care providers across the country

▲ Founded as part of the HITECH Act to

accelerate the adoption, implementation, and effective use of electronic health

records (EHR), e.g. 90-days of MU

▲ Funded by ARRA of 2009 (Stimulus Plan) ▲ Purpose: support the Triple Aim by

achieving 5 overall performance goals

Meaningful Use Improve  Quality,  Safety & Efficiency Performance  Measurement Certified Technology Infrastructure Engage Patients  & Families Improve Care Coordi‐ nation Improve Population And Public Health Ensure Privacy And Security Protections Improve patient experience Improve population health Reduce costs

3

M-CEITA’s Services

Meaningful Use Support

Security Risk Assessment

Targeted Process Optimization (Lean)

Attestation/Audit Preparation

Our services are highly subsidized for qualified providers.

These Health IT services include:

Overview and Program Basics

Meaningful Use…as defined by CMS

▲

Meaningful Use is using certified electronic health record (EHR)

technology to:

– Improve quality, safety, efficiency, and reduce health disparities

– Engage patients and families

– Improve care coordination and population and public health

– Maintain privacy and security of patient health information

▲

Ultimately, it is hoped that Meaningful Use compliance will

result in:

– Better clinical outcomes

– Improved population health outcomes

– Increased transparency and efficiency

7 Stage 1 Data capture  and sharing Stage 2 Advanced clinical  processes Stage 3 Improved  outcomes

Meaningful use: Path to better

outcomes and quality

For more information on meaningful use of EHRs, visit:  http://www.cms.gov/EHRIncentivePrograms/35_Meaningful_Use.asp   Better clinical outcomes  Improved population health outcomes  Increased transparency and efficiency  Empowered individuals  More robust research data on health  systems

Stage 1 and Stage 2 MU Objective Comparison

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1/14/2015 9

Stage 1 Public Health Objectives

▲

3 of the 9 menu set are public health objectives

▲

Must select 1 public health measure

Stage 1

Menu Items 

Eligible Professional  (EP) or  Hospital? Immunizations Capability to submit electronically to registries/systems Both Syndromic Data Capability to submit electronically to public health agencies Both Reportable Laboratory Results Capability to submit electronically to public health agencies Hospitals

Stage 1 Public Health Exclusions

CMS Final Rule Exclusions

Valid Exclusion in  Michigan? An eligible professional and/or hospital does not administer  immunizations during the reporting period Yes An eligible professional who does not collect reportable  syndromic data during the reporting period Yes The public health agency/immunization registry does not  have the capacity to receive immunizations, syndromic data  and/or reportable labs NO! The public health agency/immunization registry prohibits  submission of immunizations, syndromic data and/or  reportable labs No* * Syndromic data is not accepted from the following provider types, and  therefore an exclusion is permitted: Dentists, Dental Surgeons, Podiatrists,  Optometrists/Ophthalmologists, Chiropractors, and Certified Nurse‐midwives.

Frequently Asked Question

Question What is syndromic data? Answer A set of de‐identified data collected from emergent care and  ambulatory care settings used to detect bioterrorism(anthrax),  emerging infections(foodborne illness, influenza), and naturally  occurring outbreaks. Example data collected:  Chief complaint or encounter reason  (presenting symptoms), date of onset, age, temperature,  date/time of admissions or visit Source: https://www.michiganhealthit.org/wp-content/uploads/MSSS-Submission-Guide-Inpatient-Ambulatory-Dec2013-Revision.pdf

Frequently Asked Question

Question If an eligible professional can exclude from both of the public  health measures, how should they select the 5 menu items? Answer If an EP can be excluded from both public health menu  objectives, the EP may meet the menu requirement one of two  ways: 1. Claim an exclusion from only one public health objective and  report on four additional menu objectives from outside the  public health menu set. (Only valid if EP can justifiably claim  exclusions on all other menu objectives) 2. Report on five menu objectives from outside the public  health menu set. Source: https://questions.cms.gov/faq.php?id=5005&faqId=2903

Public Health Systems Supporting Stage 1

Michigan’s Public Health Systems Immunizations Michigan Care Improvement Registry  (MCIR) Syndromic Michigan Syndromic Surveillance System  (MSSS)

Reportable Labs Michigan Disease Surveillance System  (MDSS)

Meeting the Measure(s) Stage 1, Year 1

▲

Submit One Test Before or During the Reporting Period

– Must use the standards (i.e. HL7 2.5.1) and technology the EHR is certified to use for the public health measure

– Submission of actual patient information is not required for the one test

– If the public health agency considers the one test unsuccessful, the failed test satisfies the measure

– If the test is successful, regular reporting with the entity with whom the successful test was conducted is required, in accordance with

Frequently Asked Question

Question If multiple eligible professionals (EPs) are using the same certified EHR technology across  several physical locations, can a single test or onboarding effort serve to meet the  measures of these objectives? Answer The intent of the public health objectives is to demonstrate that a provider has the full  capability to use their certified EHR technology to successfully submit data to public health  agencies in a live setting. Under changes made in the Stage 2 Final Rule, providers within the same organization that  use the same certified EHR technology and share a network for which their organization  either has operational control of or license to use can conduct one test or one single effort  to register and onboard that covers all providers in the organization. For example, if a large  group practice of EPs with multiple physical locations uses the same EHR technology and  those locations are connected using a network that the group has either operational  control of or license to use, then a single test would cover all EPs in that group to meet this  objective.

Attesting “Yes” Stage 1, Year 2

▲

Follow-Up Submission

– Regular reporting with the entity with whom the successful test was conducted is required, in accordance with applicable law and practice

– Demonstration of engagement with the public health agency meets the measure (As of 7/29/2013)

 Engagement in the form of communications showing evidence of action in year

2

 Provider needs to demonstrate:

– Another test is not beneficial to move towards follow-up submission

– Follow up submission is not possible in year 2

–

– Medicare auditors are requesting proof of engagement with the public health agencies during year 2

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Stage 2 Public Health Objectives

Stage 2 Eligible Professionals Core  or  Menu? Immunizations Capability to submit electronically to  registries/systems Core Syndromic Data Capability to submit electronically to  public health agencies Menu Cancer Case Reports Capability to identify and report to a  registry Menu Specialized Case Reports Capability to identify and report  specific cases (i.e. birth defects) to a  registry Menu Stage 2  Hospitals Core or  Menu? Immunizations Capability to submit electronically to  registries/systems Core Reportable Laboratory Results Capability to submit electronically to  public health agencies Core Syndromic Data Capability to submit electronically to  public health agencies Core New New

Stage 2 Public Health Exclusions

CMS Final Rule Exclusions Valid Exclusion in  Michigan?

An eligible professional and/or hospital does not administer immunizations during the reporting period Yes An eligible professional who does not collect reportable syndromic data, diagnose and treat cancer or  the disease associated with the specialized registry  Yes A hospital  who does not have an emergency or urgent care department for syndromic reporting Yes An EP and/or hospital operates in a jurisdiction for which no immunization registry/public health agency  or is capable of accepting the specific standards required for Certified EHR Technology at the start of  their EHR reporting period No An EP operates in a jurisdiction where no immunization registry/public health agency provides  information timely on capability to receive immunization, syndromic, reportable labs, cancer case and  specialized reports No A hospital operates in a jurisdiction where no immunization registry/public health agency provides  information timely on capability to receive immunization, syndromic  and reportable labs No An EP and/or hospital operates in a jurisdiction for which no public health agency is capable of accepting  the specific standards required by Certified EHR Technology at the start of their EHR reporting period can  enroll additional eligible hospitals or EPs.  No

Public Health Systems Supporting Stage 2

Michigan’s Public Health Systems

Immunizations Michigan Care Improvement Registry (MCIR)

Syndromic Michigan Syndromic Surveillance System (MSSS)* Reportable Labs Michigan Disease Surveillance System (MDSS) Cancer Michigan Cancer Surveillance Program (MCSP) 

cancer registry

Meeting the Measure(s)

• Submitting case information prior to Stage 2 using a 2014  ONC certified EHR AND • Continues to submit during the EPs reporting period

Scenario 1

• Registered intent within 60 days of the EPs reporting  period AND • Achieved ongoing submission during the Stage 2 reporting  period

Scenario 2

• Registered intent within 60 days of the EPs reporting  period AND • Engaged in the required testing and validation process  leading to ongoing submission

Scenario 3

• Registered intent within 60 days of the EPs reporting  period AND • Awaiting an invitation to engage in the required testing 

Scenario 4

Providers can attest YES, if they meet one of four scenarios:

Failing to Meet the Measure(s)

•Fails to register their intent by the  deadline***

Scenario 1

•Fails to participate in the onboarding process  as demonstrated by failure to respond to the  PHA written requests for action within 30 days  on two separate occasions.

Scenario 2

Providers will NOT meet the measure, if they fail to 

respond to PHA requests

What is Onboarding?

▲

The Testing and Validation Process to:

–

Ensure the provider has entered the required public health

information into the EHR

–

Ensure the EHR technology has electronically extracted the

information and formatted it to meet the certification

requirements and standards

–

Ensure the data sent is what the public health agency is

expecting before adding the data to the public health system

(Data Quality Assurance)

Public Health Meaningful Use Onboarding

Steps

1

Learn about Reporting Requirements

2

Register Intent for Ongoing Submission

3

Test and Validate for Quality Assurance

4

Establish a Transport Method

5

Send Production Reports and Monitor Data Quality

Learn about the Requirements

▲

Visit

– https://www.michiganhealthit.org/public-health/ – Public Health Meaningful Use FAQs

– Contact Information

– Implementation Guides

– Link to the Registration Site

▲

Share the implementation guides with your

Register Intent

▲

Go to MDCH’s Registration of Intent Site:

https://mimu.michiganhealthit.org/

▲

Review the tip sheets before registering

▲

Register the intent of all providers in the organization

▲

Completion of the registration is the invitation to begin testing

Frequently Asked Question

Question Do eligible professionals and/or hospitals who registered for immunization and/or  syndromic testing in Stage 1, and are actively engaged in testing and validation, need to re‐ register to continue in Stage 2? Answer No, EPs and hospitals who registered for immunization and syndromic testing during Stage  1, do not need to re‐register.  To be recorded as registered for Stage 2, providers should  send an e‐mail stating they have entered in Stage 2 and are actively engaged in testing and  validation.   Immunization e‐mail:  mu_mcirhelp@mphi.org Syndromic e‐mail:  DCHPublicHealthMU@michigan.gov

Begin the Testing and Validation Process

-Scenario 3

Submit Reports 

in Accordance 

with IG

PHA Team Evaluates 

(DQA) 

PHA Team 

Provides Feedback

Site Remediates 

Issues

Site Generates 

New Reports

▲

Visit

http://mihin.org/exchanges/

to find a qualified

organization or HIE to transport the public health electronic

reports

▲

Follow your HIEs instructions for sending ongoing public health

electronic reports

MiHIN  Qualified  HIE MiHIN  Validation

Send Production Reports

▲

Monitor the transport feed to ensure the electronic

reports/messages are submitted regularly

▲

Respond to the public health team’s requests to improve data

quality

▲

Correct data quality issues identified

▲

Keep record of the MU ongoing submission status that is

Laura Rappleye Laura.Rappleye@altarum.org Kristy Brown DCHPublicHealthMU@michigan.gov

Questions?

www.michiganhealthit.org/public-health/ www.mceita.org