1. Utah Digital Health Service Commission Meaningful Use Public Health Measure: Submitting electronic immunization data to USIIS by establishing an EHR-USIIS HL7 interface Nancy McConnell USIIS Program Manager 3-March-2016

2. Stage 1: Send a single test message -or- Operational interface – HL7 versions 2.3.1, 2.4, or 2.5.1 Stage 2: Operational HL7 2.5.1 interface (2013 HL7 version grandfather clause) 4Q 2015-2016, “Modified Stage 2” : active engagement toward an operational HL7 2.5.1 interface To keep in mind: Meaningful Use EHR-IIS interface intent IIS data used for patient care – Patient immunization histories consolidated across providers – Immunization forecast [clinical decision support] Improved public health – Appropriate immunization coverage – Reduce over-immunization Immunization Meaningful Use compliance

3. Meaningful Use registrations Stage 1 test message submissions USIIS Meaningful Use activities

4. Number of distinct EHR-USIIS interfaces in production: 43 Currently in Production: 558 provider facilities – Private Providers: 357 – Local Health Departments: 41 – FQHCs: 34 – Pharmacies: 126 End goal: operational EHR-USIIS HL7 interfaces

5. EHR vendor engagement – Before MU: EHR vendors non-responsive to USIIS o Utah had little influence as a low volume state – After MU: EHR vendors calling USIIS o Responding to competition and customer demands o Utah more equalized among other states Provider participation – Increasing reliance on interfaces submitting immunization data to USIIS – USIIS aficionados: no more duplicate data entry – Previous USIIS non-participants: now participating USIIS utilization – More complete immunization histories – Providers gaining understanding of and interest in their USIIS data quality – Providers learning about useful USIIS features Meaningful Use benefits

6. Meaningful Use challenges: EHR-IIS complexities

7. Meaningful Use instructions from various sources —CMS, ONC, Medicaid, EHR vendors, UDOH, USIIS, HealthInsight, etc. Complexity of EHR systems Complexity of EHR-USIIS interfaces Multiple possible points of failure Understand and undertake responsibility for data quality – In EHR system – In USIIS – Clinic workflow and staff practices impact data quality Provider Challenges

8. EHR vendor relationships – Understanding how to work with each vendor—e.g, their business models & organizational structures – USIIS ends up providing customer support for EHR systems Customer relationships – Educating customers o Interfaces are not magic o Provider control over data quality issues – Supporting large numbers of facilities – Facilitating data quality improvments Infrastructure RAS (Reliability, Availability, Serviceability) – Volume of data – Volume of bad, invalid data – Multiple possible points of failure USIIS Challenges

9. Communications – Meaningful Use – EHR vendors and systems information – EHR-USIIS interfaces information Interoperability funding Provider-EHR-USIIS Responsiveness Data quality cHIE transport challenge: EHR vendors cannot support dual transport routes—e.g., route to cHIE if customer is a cHIE member & route to USIIS if customer is not a cHIE member Gaps and Opportunities

10. Gaps and Opportunities [Sidney Harris fashion]