Electronic Physician Reporting to the Kentucky Cancer RegistryDavid Rust, MS Software Developer

Sheena Batts, CTR CER Project Manager

September 17, 2012NAACCR Physician Reporting Workgroup

Overview

•Special Project Objectives•Strategic Approach•Making Contact with Providers•Collaborating with EHR Vendors•Transmission •Current Status•Challenges

Comparative Effectiveness Research (CER): KY Special Project 3 (SP3)•Objective

▫Increase completeness of cancer treatment data captured by the Kentucky Cancer Registry

•Goal▫Implement direct EHR reporting from

oncology providers in Kentucky by September 2013

Key Relationships

• Kentucky Regional Extension Center (KY-REC)▫Leverage MU incentives and infrastructures to

achieve direct electronic reporting

• Kentucky Health Information Exchange (KHIE)▫Provide secure electronic network infrastructure

• CDC▫Partner with CDC to develop and evaluate necessary

software tools to process the EHR clinical event messages

Regional Extension Centers

•Funded to assist healthcare providers quickly adopt meaningful use of EHRs

•Provide direct technical assistance to establish EHRs

•Offer training, information and guidance

•Facilitate Meaningful Use attestation

Kentucky Regional Extension Center

• KCR contracted with KY-REC to recruit providers

• Target medical and radiation oncology providers in Kentucky

• KY-REC obtains a signed Provider Agreement

• KY-REC critical in recruitment of providers to report electronically to KCR

• KY-REC works closely with the KHIE implementation specialist

Health Information Exchange

•Funded by grants through State HIE Exchange Cooperative Agreement Program

•Funded in all states, DC, and several territories

•Provide technical infrastructure for secure exchange of health information

Kentucky Health Information Exchange•KCR has a signed agreement with KHIE to

utilize service

•Provide implementation specialist on-site to oncology providers

•Information technology services may be sub-contracted by the state HIE

Identifying ideal providers• Obtained updated list of Kentucky Licensed Physicians

▫Sorted by specialty▫Removed retired and hospital based physicians

• Identified group practices by address

• Start with large practices▫ MU Certified EHR in place

• Identify legal ownership of the medical record

Contacting Practices• Developed Participation Agreement

• Developed survey instrument▫ Interest in meeting Meaningful Use ▫ Current medical record status▫ Interest in electronic reporting to KCR

• Contacted practices by phone ▫ Identify Administrator /Manager ▫ Any general information▫ Current software vendor▫ Sent return envelope with survey

• A KCR Participation Agreement was sent to those indicating interest in the project

Provider Participation

•Referrals to KY-REC and KHIE are sent upon receipt of a signed participation agreement

•Benefits of participation▫KY-REC services provided at no charge▫Meets KCR physician reporting

requirement▫Total automation of reporting (time factor)▫Reduce therapy and follow-up requests

from hospital registries

Collaborating with EHR Vendors•Providers with MU certified EHR systems

were selected

•When the REC Provider Agreement is signed, KCR obtains permission from the participating provider/practice to contact their EHR vendor

•KCR establishes communication with the EHR software vendor to discuss logistics and development of CDA document

Pilot Vendor

• Early 2012 the first vendor was recruited to develop the Ambulatory Healthcare Provider Reporting to Central Cancer Registries CDA document in Team Chart Concept(TCC) EHR

EMR because you want to, not because you have to.

At Ulrich Medical Concepts, we are proud to have worked with the Kentucky Cancer Registry to develop an electronic cancer registry system.

Our software, Team Chart Concept (TCC) is an integrated practice management, electronic medical records system in use in the following states:

Kentucky IndianaTennessee West VirginiaIllinois VirginiaMissouri Ohio

For more information, please contact Sandra Ulrich, VP Sales & Marketing.

www.ulrichmedicalconcepts.com

www.correctek.com

www.revenuesol.com

Phone 270-744-0404

Transaction Models

•KCR accepts any secure method of transaction and any type of data format▫Transactions: sftp, email, web service,

etc…▫Format: raw text, HL7 2.x, CDA, etc…

Transaction Models…• KCR’s Ideal Model and Data Format

▫ Provider sees patient and generates a cancer diagnosis code▫ This triggers the EHR to:

Create the CDA document Encodes and compresses document Wrap in HL7 message Encrypts and sends through KHIE web service

▫ KHIE’s BizTalk Server relays this message to the KCR’s PHIN-MS server

▫ The message is then stored in the PHIN-MS database▫ The CDA document is pulled from the HL7 message, decoded

and decompressed▫ eMaRC Plus polls the database, notices a new CDA, store and

displays CDA for review and export in NAACCR file format

KHIE

Kentucky Cancer Registry

PHIN-MS

Receive

Queue

eMaRC Database

KHIE sends encrypted

messages to KCR

PHIN-MS decrypts message and stores in

PHIN-MS database

eMaRC polls CDA document batches automatically from

PHIN-MS

eMaRC stores and displays

CDA documents for review

Files are exported in

NAACCR format

BizTalk

EHR

Healthcare Provider

Healthcare Provider

completes documentation

on patient

KHIE Web ServiceEHR notices cancer

diagnosis trigger, CDA document is constructed,

compressed, encoded, and wrapped in an

HL7 message

The message is encrypted and

submitted through the KHIE

Webservice

A program pulls, decodes, and

decompresses the CDA document from the HL7

message

Message Format• Currently, Ulrich Medical Concepts, Inc. has a

CDA document complete for transmitting

• KHIE had an established method for receiving HL7 2.5.1 messages

• The CDA document is compressed (gzipped), Base-64 encoded, and inserted into OBX-5 of HL7 2.5.1

• Message is then encrypted, and submitted using the KHIE web service

Placement of CDA in HL7 2.5.1 Message

MSH|^~\&|ACS|ACS|KCR PHINMS KCR|20110818214317||MDM^T02|00011|P|2.5.1||||||EVN|T02|20110818214317PID|1||KYMC|KYMC|HOODY^JONE-KY11^^^L|||||1 TEST AVE^^TEST CITY^KY^46035||||PV1|1|NOBX|1|ED|48769-4^Continuity of Care Panel^LN^CCD|| CDA MESSAGE ||||||F

Current Status• Ulrich Medical Concepts, Inc. is refining the cancer section of the CDA

messages with the assistance of CDC

• KCR has received multiple HL7 wrapped CDA test messages from the vendor through the transaction model

• KCR has received CDA messages from the provider through the transaction model

• KCR is currently working with a large oncology specific EHR vendor

• Provider Participation▫ 41 signed providers-Medical Oncology, Radiation Oncology and Dermatology▫ KCR goal: Have 60 signed providers

• KCR received Pioneer Award from the Governor’s Office of Health Information Technology

Challenges

•Ownership of medical record ▫Quickly transitioning practices

•Software vendors have not distributed the certified version of product to the provider▫Cancer Reporting is part of Stage 2 MU

•Revisions to KCR Central Registry (CPDMS)▫Procedures for creating partial records in

progress

Questions?