WA DOH Meaningful Use: Public Health Reporting

Travis Kushner, MPA Public Health Data Exchange and Meaningful Use

Coordinator WA Department of Health

January 12, 2016

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Housekeeping Items

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Qualis Health • A leading national population health

management organization • The Medicare Quality Innovation Network - Quality

Improvement Organization (QIN-QIO) for Idaho and Washington

The QIO Program • One of the largest federal programs dedicated to

improving health quality at the local level

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Speakers Travis Kushner is the Public Health Data Exchange and Meaningful Use Coordinator at the Department of Health.

Chris Baumgartner is Director of the Prescription Monitoring Program at the Department of Health.

Johna Peterson is an Electronic Reporting Consultant for the Washington State Cancer Registry.

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Speakers

Natasha Close is a surveillance epidemiologist in the Office of Communicable Disease Epidemiology.

Karen Meranda joined the Washington State Department of Health Office of Immunization and Child Profile (OICP) in April 2010 as a member of the Vaccine Management team.

Judy Sweet is the Sr. Project Manager & Technology Coordinator for the Department of Health’s Office of Immunization and Child Profile.

WA DOH Meaningful Use: Public Health Reporting

Public Health Objectives 10 objectives for eligible professionals including one public health reporting objective (with flexible options for measure selection) Washington State Department of Health is accepting the following MU data:

– Immunization Information – Cancer Reports (Specialized Registry) – Prescription Data (Specialized Registry) – Syndromic Surveillance – Electronic Lab Reporting (Hospitals Only)

Summary for Providers

Eligible Professionals An Eligible Professional (EP) scheduled to be in Stage 1 in 2015 must meet 1 measure and an EP scheduled to be in Stage 2 in 2015 must meet 2 measures. All EPs must meet 2 measures in 2016 and 2017.

DOH MU Website

Updated content: www.doh.wa.gov/HealthIT – Eligibility criteria – Registration instructions – Submitting data – Specific program information – Transport options – FAQ

Registration • Complete the registration of intent • Multiple clinics (supplemental enrollment spreadsheet) • Registration submission will be acknowledged by each program for which

you register • Register your intent at least once for each public health objective.

– Once your register you do not need to register again in future years, unless you’ve received an exclusion, exited or failed the onboarding process.

• A clinic may complete a single registration on behalf of all providers that primarily practice at that clinic

Active Engagement

Must demonstrate ‘Active Engagement’ to meet Public Health Reporting measures 3 ways to satisfy 1. Via Registration – The EP is registered and awaiting invitation to begin

onboarding 2. Via Testing and validation phase – Actively working with DOH and

responding to any requests within 30 days 3. Via Production – Ongoing submission of real-live, validated data

Reminder: Providers are responsible for documenting active engagement with public health

Reporting Guidelines • Moving from fiscal year to calendar year reporting beginning in 2015 • 90-day reporting period • Current CEHRT edition is 2014

– EPs may use EHR technology certified to the 2014 Edition for an EHR reporting period in 2015;

– 2014/2015 Edition required in reporting years 2016 and 2017 – 2015 Edition for a reporting period in 2018 and subsequent years.

Immunization

Every age. Every vaccination.

Immunization

Washington State Immunization Information System (WAIIS) • A statewide, lifetime immunization registry that tracks immunization

records for people of all ages • Providers participating in the WA State Childhood Vaccine program also

use the WAIIS for ordering state-supplied vaccines, managing vaccine inventory, running reports, and improving workflow

Immunization

WAIIS Enrollment • To participate as an eligible hospital or eligible provider you must have an

Information Sharing Agreement with the WAIIS. • In order to enroll in the WA IIS, you must have a licensed healthcare

provider on staff, do business in Washington State, and provide immunization services.

Immunization

MU Registration • Each provider or hospital must submit an individual registration. • Organizations with multiple clinics should submit one registration for all

the facilities enrolled under that organization in the IIS. • Organizations already submitting immunization information to the WAIIS

via an HL7 interface, still need to register intent to submit data for meaningful use.

• Organizations that do not administer immunizations may qualify for an exclusion and should not register an intent to submit immunization data.

Immunization

Interface project wait list and prioritization process • Organizations are added to our interface project wait list after they

register. • Organizations remain on the wait list until we have the appropriate staff

available to begin an interface project. • We are prioritizing interface work with providers participating in the

Childhood Vaccine Program, providers that administer high-volumes of vaccine, hospitals and pharmacies at this time.

• We have about 300 providers on the wait list. • As of 12/31/2015 we have 197 production interfaces and we’re receiving

data from 1,339 facilities.

Immunization

Onboarding process • We follow the same process for all interface projects, not just for

meaningful use. • Onboarding may take as little as 6 to 8 weeks, or it may take several

months. • Failure to respond to action requests may affect meaningful use

onboarding status. We may suspend a project if the provider or vendor fails to respond to action requests.

• When a project is suspended, the organization is returned to the bottom of the interface project wait list.

Immunization

Connectivity • The current standard for uni- and bi-directional interfaces is HL7 version

2.5.1, Release 1.5 • Message transport is via https or software bridge assisted transport • OneHealthPort (HIE) will be available as an additional transport method

later in 2016

The Washington State Cancer Registry

• The Washington State Cancer Registry collects and disseminates high quality data for use by public health agencies, health care providers, voluntary organizations, researchers, and academic institutions in order to assist in efforts to prevent and control cancer in Washington State.

• An average of 34,000-36,000 new cases are reported to the Washington State Cancer Registry each year.

• Cancers diagnosed and treated in physician’s offices and non-hospital treatment centers are under-reported throughout the United States.

• The Washington State Cancer Registry is eager to onboard and work with EP’s to submit their data for Meaningful Use.

Cancer Reporting for Eligible Professionals Meaningful Use

Stage 2 (Modified) Meaningful Use:

Cancer Reporting is no longer a separate Stage 2 measure • Cancer case reporting is now considered part of the specialized registry

reporting measure for the Public Health Reporting objective.

Modified Stage 2 • Public Health Objective 10 – Measure 3, Specialized Registry Reporting

• Eligible Professionals who were previously planning to attest to the cancer case reporting objective may count that action toward specialized registry reporting.

• Specialized Registry Reporting: The Eligible Professional is in active engagement to submit data to a specialized registry.

Cancer Reporting for Eligible Professionals Meaningful Use

Cancer Case Reporting Requirements • Certified 2014 or 2015 edition EHR

– EHR product MUST be certified for BOTH cancer reporting criteria: (f)(5) Cancer Case Information AND (f)(6) Transmission to Cancer Registries.

• Messages must be in CDA R2 format.

• Provider must collect and transmit data listed as “required” in the implementation guide.

Cancer Reporting for Eligible Professionals

• Providers are encouraged to do the “pre-testing” step of the onboarding process.

• Once providers are ready to test with Public Health, they can send a test message that doesn’t contain PHI for initial validation.

• Once this is reviewed, they will get a copy of the validation report and will be asked to address any errors in their messages. When the provider is ready, they can send an error-free message via the HIE or PHINMS.

• Providers will be moved into production as testing is completed. • Public Health will perform periodic quality checks on production data

to ensure the information being transmitted is still within standard.

Prescription Monitoring Program

Unintentional Prescription Opioid Overdose Deaths Washington 1995-2014

Source: Washington State Department of Health, Death Certificates

The PMP Solution- “An Overview”

• A PMP is a program designed to improve patient safety and protect public health with the goal of reducing overdose deaths, hospitalizations, and other related prescription drug abuse issues.

1. Records for dispensing of controlled substances are submitted to a central database by pharmacies and other dispensers.

2. Health providers and other authorized users are able to register for access, and once approved, can view information through a secure web portal.

3. PMP information helps providers avoid duplicative prescribing and dangerous drug interactions; and helps to identify substance abuse or pain management issues.

Key PMP Benefits for Providers • CHECK for misuse, multiple prescribers (coordinate care)

• CHECK for drug interactions or other harm

• USE reports for compliance with treatment contracts

• CHECK history of transactions linked to DEA number – fraudulent scripts and monthly reporting

Prescription Monitoring Program

PMP & Meaningful Use Stage 2 & 3 Meaningful Use Approval: WA DOH has approved the PMP as an official “other specialized registry” in compliance with stage 2 & 3 meaningful use

• Listed as an EP Public Health Measure-Specialized Registry

• For MU Registration we do accept group registrations (a health system can register multiple sites at once)

• Professionals need to have an active account with the PMP in order for requests to process

• Onboard with OHP using the NCPDP 10.6 transactions (it should be part of your medication reconciliation module already)

Syndromic Surveillance

Syndromic surveillance is a…

near real-time, population-based,

all-hazards

…surveillance system.

Syndromic Surveillance: Role in Public Health

Monitor: • Trends in illness and injury in the

population • Progression of outbreaks • Effect of natural events (e.g.,

wildfires, extreme heat, extreme cold)

Detect: • Events of public health concern

during large gatherings • Cases of notifiable conditions

Evaluate: • Rumors

Influenza-like illness trends

Syndromic Surveillance & Meaningful Use

Key points to keep in mind

5 Step Onboarding Process

1. Registration 2. Message structure validation 3. Connectivity 4. Message content validation 5. Production

1. Registration/Eligibility

Providers who practice at a clinic, or are affiliated with a multi-clinic network, that provides at least one of the following types of care: • Urgent, acute, or walk-in care • Primary care, defined as:

– General practice – Family medicine – Pediatric medicine – Internal medicine – OB/GYN (non-surgical) – Women’s Health – Geriatric medicine

• Infectious disease specialty care • Environmental health specialty care • Occupational health specialty care

1. Registration/Eligibility cont.

1. Select providers/clinics that meet the eligibility criteria may still qualify for an exclusion

• Determined by the department after reviewing registration of intent

1. Multi-clinic networks that have at least one clinic that meets the eligibility criteria DO NOT have to filter out specialty providers

• Details can be discussed during onboarding process

2. Message structure validation

• Expect 1st file within 24 hours of a patient visit

• Expect updated information be sent as it becomes available

3. Connectivity

3 options: 1. Washington State Health Information Exchange (encouraged) 2. Secure File Transport 3. Public Health Information Network Messaging System (PHINMS)

4. Message Content Validation

• Large number of facilities currently in queue – Prioritizing hospitals, emergency departments, large clinic networks,

urgent care clinics

• Submission of at least 1 week’s worth of real patient data required to be put in the queue

• Do not validate single messages or test data • Include data on every patient visit, NOT select conditions or

diagnoses

5. Production

DOH MU Contact Info

General Meaningful Use: meaningfuluse@doh.wa.gov

Immunization Information Systems: IISMeaningfulUse@doh.wa.gov – Karen Meranda, IIS Exchange Coordinator

Cancer Registry Reporting: MUCancer@doh.wa.gov – Johna Peterson, Electronic Reporting Consultant

Prescription Review: prescriptionmonitoring@doh.wa.gov – Chris Baumgartner, Program Director

– Gary Garrety, Operations Manager

Syndromic Surveillance: syndromic.surveillance@doh.wa.gov – Natasha Close, Surveillance Epidemiologist

Electronic Lab Reporting: elr@doh.wa.gov

EHR Attestation

For questions regarding your application, you can always contact our HIT (Health Information Technology) team at HealthIT@hca.wa.gov. If you need help with your User ID, Password or Domain, and you are the EHR System Administrator please contact our Security Department at ProviderOneSecurity@hca.wa.gov

EHR Attestation After successfully completing your CMS Registration @ https://ehrincentives.cms.gov/hitech/login.action, you will need to apply for the EHR incentive payment with Washington State. Log into ProviderOne using the logon information you received for the provider with the Domain, Username, and Password. You will receive the above information from us in an automated email. If you do not receive them, within 3 days of submitting your CMS Registration, please contact our Security Department at provideronesecurity@hca.wa.gov from the email address that is listed as your contact on your CMS Registration. Link for ProviderOne: https://www.waproviderone.org Please visit our HIT/EHR Website for User Guides and White Papers guiding you through the attestation process @ http://www.hca.wa.gov/HealthIT/Pages/ehr_overview.aspx

Questions Received 1. We have many questions surrounding this measure and the maximums, can we go through the maximums in detail?

2. What if a provider coming from somewhere else has maximized the options your practice has available?

3. If you do the math it would appear you would exceed maximums before 2021? What registries is WA state planning on supporting?

4. Is there a comprehensive list (beyond the ones administered by WA DOH) of registries which count for MU?

5. What if you’re a part of a group and attesting but are say an Optometrist who does no immunizations or syndromic, or cancer etc, can you attest with these because your group is even if you don’t practice that type of medicine?

Public Health Objectives

2015 2016-2017 2017 2018-2021*

Stage 1 Stage 2 All EPs Optional Stage 3 Stage 3*

Immunization Information

Must pick 1 of 4

Must pick 2 of 4

Must pick 2 of 4 Must pick 3

of 5 Must pick 3 of 6

Syndromic Surveillance

Specialized Registry – Cancer Reporting

Specialized Registry – Prescription Review

Clinical Data Registry N/A N/A N/A

Case Reporting of Reportable Conditions N/A N/A N/A N/A

• The Stage 3 requirements are optional in 2017. Providers who choose to begin Stage 3 in 2017 will have a 90-day reporting period. All providers will be required to comply with Stage 3 requirements beginning in 2018 using EHR technology certified to the 2015 Edition. Objectives and measures for Stage 3 include increased thresholds, advanced use of health information exchange functionality, and an overall focus on continuous quality improvement.

Questions Received

Objective 8: Public Health and Clinical Data Registry Reporting

Clinics: EP maximum times it can count

Measure 1: Immunization Registry Reporting

1

Measure 2: Syndromic Surveillance Reporting

1

Measure 3: Case Reporting (e.g. to WDRS)

1

Measure 4: Public Health Registry Reporting

3x* (e.g. WSCR, PMP)

Measure 5: Clinical Data Registry Reporting

3x* (e.g. HCA’s Link4Health)

Measure 6: Electronic Laboratory Results Reporting

N/A

* Clinic EPs and Hospitals (EHs and CAHs) may choose to report to more than one registry to meet the total number of measures required to meet the objective For MU in 2015-2017, EPs would be required to choose from Measure 1-5, required to attest to any combination of two measures. Registry measure may count more than once if more than one registry is available . Exclusions do not count, still need to meet the ones available to them

Question Received 6. What are the options for registries for MU in the state of Washington?

7. How is DOH onboarding?

8. What is the criteria for onboarding for syndromic surveillance? Are they any types of specialties that are automatically exempt?

9. How does an organization know if they qualify for syndromic or specialized registry exclusions?

10. If an organization registered their intent in 2014 or 2015 and they received a letter from the DOH that they are at capacity and can claim the exclusion, with the new rule stating that registering intent meets option 1 of active engagement, can they claim yes for the measure because they registered their intent, regardless of what the letter says?

11. What are the submission requirements? Must the data be sent via an HL7 interface or does a manual upload of HL7 messages twice a month meet the requirements?

12. Because CMS does not allow DOH to determine if the EP/EH is excluded or not, because in order to meet the objective they must meet the CMS criteria, will DOH be changing the letter they are sending out to EP/EH who register their intent?

13. What happens if a vendor won’t work with DOH after the EP/EH registers their intent and the EP/EH has been invited to begin the next step? This is out of the control of the EP/EH.

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Q & A

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For survey: https://www.surveymonkey.com/r/H562Z28

For more information:

www.Medicare.QualisHealth.org/pin

This material was prepared by Qualis Health, the Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. WA-HITC-QH-2099-01-16.

Contact Lisa Packard, MS

Quality Improvement Consultant lisap@qualishealth.org

206-288-2565