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Kristen Forney, MPH Citywide Immunization Registry New York City Department of Health and Mental Hygiene Meaningful Use and Bi-directional Exchange of.

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Presentation on theme: "Kristen Forney, MPH Citywide Immunization Registry New York City Department of Health and Mental Hygiene Meaningful Use and Bi-directional Exchange of."— Presentation transcript:

1 Kristen Forney, MPH Citywide Immunization Registry New York City Department of Health and Mental Hygiene Meaningful Use and Bi-directional Exchange of Immunization Data in New York City Public Health Informatics Conference 2014

2  Citywide Immunization Registry (CIR) Background: HL7 Data Exchange  Definitions  Interoperability Standards  Interoperability Demo  Benefits for Providers  Benefits for IIS  Supporting Data  Future Directions  Conclusion OVERVIEW

3  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 HISTORY

4  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 pharmacies sending HL7 data through the web service; (189 provider sites are bi-directional) CIR’S HL7 DATA EXCHANGE

5  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 DEFINITIONS

6  HL  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 INTEROPERABILITY STANDARDS

7 [BI-DIRECTIONAL DEMO]

8 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 BENEFITS OF REAL-TIME BI-DIRECTIONAL EXCHANGE

9 * P < 0.05; ** P <0.01; *** P <.001; **** P <.0001 Stockwell, et al, COLUMBIA PRESBYTERIAN HOSPITAL

10 For an IIS:  Timeliness  Completeness of immunization information (lot number, manufacturer, expiration date, etc)  Providers have continuous interaction with the IIS BENEFITS OF REAL-TIME BI-DIRECTIONAL EXCHANGE

11 IMPROVED VFC AND LOT NUMBER CAPTURE Data source Percent of immunizations with VFC status* Percent of immunizations with lot number** Flat File Online Registry HL7 Web Service Total *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 IMPROVED VFC ELIGIBILITY AND LOT NUMBER CAPTURE

12 INCREASE IN ADULT DATA CAPTURE

13 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 HL format MEANINGFUL USE AND IIS

14 Start of MU (Jan) INCREASE IN HL7 SITES

15 SHIFT IN REPORTING METHOD

16  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 CHALLENGES OF BI-DIRECTIONAL HL7 EXCHANGE

17 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 s 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 BEST PRACTICES FOR REAL-TIME BI-DIRECTIONAL EXCHANGE

18  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 FUTURE DIRECTIONS- IIS COMMUNITY

19  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 CONCLUSIONS

20 Amy Metroka Vikki Papadouka Angel Aponte Paul Schaeffer Contact Information Kristen Forney Director, EHR-IIS Interoperability Project THANK YOU!


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