1. April 19, 2012 Meaningful Use and Public Health

2. Thursday, April 19, 2012 Listen only mode This webinar will be recorded and available on NACCHOs website Type your questions in the box as we go Please complete the evaluation when you receive the link

3. Thursday, April 19, 2012 Outline of Webinar Welcome and Introductions What is Meaningful Use of EHRs? Why Should LHDs Care? Overview of Stage 2 Potential impacts on LHDs Local-State collaboration Opportunities for future LHD Input and Engagement for Stage 3 Q&A

4. Thursday, April 19, 2012 Speakers Seth Foldy, Senior Advisor for the Public Health Surveillance & Informatics Program Office at the Centers for Disease Control and Prevention (CDC) James Daniel, Public Health Coordinator for the Office of the National Coordinator for Health Information Technology (ONC)

5. Seth Foldy, MD MPH FAAFP Senior Advisor Public Health Surveillance and Informatics Program Office CDC and Meaningful Use: Strengthening the Link Between Healthcare Providers and Public Health Office of Surveillance, Epidemiology, and Laboratory Services Public Health Surveillance and Informatics Program Office

6. Changing Policy Drivers: ARRA HITECH >$20B Medicare/Medicaid incentives to Implement certified Electronic Health Record (EHR) technology Use EHR to achieve objectives related to improving: Care quality, safety and efficiency, including: o Creation of patient registries (conditions, devices, etc,) o Reporting of quality measures o Clinical decision support (automated warnings/advice) Coordination of care Patient and family engagement Privacy & security Population and Public Health (next slide) Office of National Coordinator for HIT $2B for information exchange, training, Beacon exemplars

7. Policy Drivers: ARRA HITECH Act Population & public health objectives include Electronic lab reporting of reportable results Syndromic surveillance Communication with immunization registries Cancer registry reporting 3 stages of aggressive timelines (Oct 2010, 13, 15) New national standards impact local and state PH

8. The Early Days…

9. Today!

10. Births and fetal deaths Birth defects & congenital disorders Immunizations Communicable diseases Reportable test results Outbreaks Poisoning Occupational injuries Other injuries Adverse events and effects Cancer Other chronic disease reports Visits and hospitalizations (Syndromic surveillance) Quality reports Deaths and associated data Healthcare Public Health Meaningful Use STAGE 1 Electronic Information Exchange

11. Births and fetal deaths Birth defects & congenital disorders Immunizations Communicable diseases Reportable test results Outbreaks Poisoning Occupational injuries Other injuries Adverse events and effects Cancer Other chronic disease reports Visits and hospitalizations (Syndromic surveillance) Quality reports Deaths and associated data Healthcare Public Health Likely Meaningful Use STAGE 2 Electronic Information Exchange HL7 2.5.1

12. Births and fetal deaths? Birth defects & congenital disorders? Immunizations Communicable diseases? Reportable test results Outbreaks Poisoning? Occupational injuries Other injuries Adverse events and effects? Cancer Other chronic disease reports? Visits and hospitalizations Syndromic surveillance Quality reports Deaths and associated data? Healthcare Public Health Possible Meaningful Use STAGE 3 Electronic Information Exchange Immunizations & decision support Items in green are being considered by S&I Framework PH Reporting Initiative – CDA?

13. Four information sources for Population Health Mandated PH Reporting Quality Reporting QueriesRegistries

14. Meeting Tomorrows Challenges S&I Framework Public Health Reporting Initiative http://wiki.siframework.org/Public+Health+Reporting+Initiative http://wiki.siframework.org/Public+Health+Reporting+Initiative –Harmonized use case and value sets from several user stories Communicable disease reports Child health reports Adverse event reports Chronic disease reports Administrative/quality reports Possible implementation guide by Stage 3 QueryHealth Initiative http://wiki.siframework.org/Query+Health http://wiki.siframework.org/Query+Health

15. Problem Solving Meaningful Use Technical Assistance Team Experts in immunization, syndromic and lab reporting Policy interpretation from ONC, CMS Technical assistance resources All-party conference call ID rapid solution – OR Log problem for longer term fix Request the team: meaningfuluse@cdc.gov Public Health Vendors Provider

16. QUESTIONS, INSIGHTS, DISCUSSION More info: www.cdc.gov/ehrmeaningfuluse www.cdc.gov/phin Or drop a line to: meaningfuluse@cdc.gov

17. For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.atsdr.cdc.gov Public Health Surveillance and Informatics Program Office (Proposed) www.cdc.gov/osels www.cdc.gov/ehrmeaningfuluse

18. Table of Contents Review of Stage 1 NPRM and Stage 2 Health Information Exchange Models Regional Extension Centers 2/14/2014 Office of the National Coordinator for Health Information Technology 18

19. Stage 1 Meaningful Use Menu: Improve Population and Public Health Communicate with public health agencies 1.Unless an EP, eligible hospital or CAH has an exception for all of these objectives and measures they must complete at least one in this group as part of their demonstration of a meaningful use to be eligible for incentives. 2.Public health agencies may specify how to test the data submission and to which specific destination Source: Dr. Paul Kleeberg, Clinical Director, Key Health Alliance 19

20. Standards for Public Health Transactions in Stage 1 Meaningful Use 20

21. Stage 2 Timeline CMS and ONC NPRM published March 7 60 Day Comment Period Stage 2 Begins 2014

22. Stage 2 EP Public Health Measures 1 EP core measure = immunizations EPs have to pick 3 of 5 menu measures 2 new PH Stage 2 EP menu measures- – Successful ongoing transmission of cancer case information – Successful ongoing transmission of data to a specialized registry

23. Stage 2 Public Health EP Core Measure One PH EP measure that moved from the Stage 1 menu to the Stage 2 core: – Successful on-going submission of immunization data Changed from testing to on-going submission

24. Stage 2 Public Health EP Menu Measures Successful ongoing transmission of syndromic surveillance data – New – Changed from testing to on-going submission

25. Stage 2 Public Health EP Menu Measures Successful ongoing transmission of cancer case information – New – Changed from testing to on-going submission

26. Stage 2 Public Health EP Menu Measures Successful ongoing transmission of data to a specialized registry – New – Changed from testing to on-going submission

27. Stage 2 Public Health EH Measures Three public health EH measures that moved from the menu to the core for Stage 2: – Successful ongoing transmission of immunization data – Successful ongoing submission of electronic syndromic surveillance data – Successful ongoing submission of reportable laboratory results No public health EH measures in the menu

28. Stage 2 Public Health Measures and HIE The on-going submission requires the provider and the public health agencies to identify an electronic process for data to move from EHRs to public health – Efficient – Automated – Secure

29. For the Stage 1 public health objectives, beginning in 2013, we also propose to add "except where prohibited" to the regulation text, because we want to encourage all EPs, eligible hospitals, and CAHs to submit electronic immunization data, even when not required by State/local law

30. Stage 2 Public Health Measures and HIE Some State Public Health Agencies are using Health Information Exchange entities to collect the EHR data from providers on their behalf In addition to accepting direct provider to public health data submission

31. Stage 2 Public Health Measures and HIE What is the means of transmission for on-going submission? Meaningful use of EHR = generate the data file and submit it Certification of EHRs = how the EHR generates the file The transport layer is whats in between

32. States may also specify the means of transmission of the data or otherwise change the public health measure, as long as it does not require EHR functionality above and beyond that which is included in the ONC EHR certification criteria as finalized for Stage 2 of meaningful use.

33. Stage 2 Public Health Measures and HIE HIE intermediaries can just capture the data for PH; or HIE intermediaries can accept the data from EHRs and transform it into the correct version of HL7 (and are certified as an EHR module to do so)

34. Take Away Points Health Information Exchange infrastructure underpins a scalable, efficient and lower-cost mechanism for thousands of providers to interact with a small number of lower-budget public health entities Interfaces can be costly and the cost burden may fall onto the provider or public health entity- HIEs (noun) could ameliorate this issue

35. Models for HIEs to Help Public Health Data Aggregation Translation Services Transformation Services 2/14/2014 Office of the National Coordinator for Health Information Technology 35

36. Regional Extension Centers Communication – Requirements On-boarding process – Test and Queue – Receipt of test messages (Michigan) Vendor negotiation – Contracts – Communication of vendor capacity

37. Public Health Implementation Flow The eligible providers exchange messages with public health agency (PHA) to get the correct format and values as determined by PHA Testing Follows successful testing Eligible hospitals/EP may be prioritized by PHA for validation at a later date In Queue Public health evaluation of new electronic data Comparison with paper submission or previous electronic data flows Validation D at a is co nti n u o us ly b ei n g se nt to th e P H A a n d is b ei n g m o nit or e d fo r q u ali ty as su ra nc e Production 37

38. Thursday, April 19, 2012 Resources ONC HIT Policy Committee workgroups http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__hit_policy_committ ee_workgroups/1470 http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__hit_policy_committ ee_workgroups/1470 Standards and Interoperability Framework Public Health Reporting Initiative: http://wiki.siframework.org/Public+Health+Reporting+Initiative http://wiki.siframework.org/Public+Health+Reporting+Initiative QueryHealth Initiative http://wiki.siframework.org/Query+Healthhttp://wiki.siframework.org/Query+Health

39. Thursday, April 19, 2012 Q&A Please type your questions in the box

40. Thursday, April 19, 2012 Upcoming NACCHO ePublic Health Events Webinar Series: Integration and Interoperability Across Public Health, Human Services, and Clinical Systems http://www.naccho.org/topics/infrastructure/informatics/resources/spring- 2012-webinars_ephi.cfm

41. Thursday, April 19, 2012 Contact Information Vanessa Holley, MPH Program Analyst, ePublic Health vholley@naccho.org (202) 507-4239