CAIR Interface Presentation

CCALAC NEXTGEN USER GROUP JULY 24, 2014

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Los Angeles (Region VII) California Department of Public Health 3530 Wilshire Blvd, Suite 700 Los Angeles, CA 90010 City Of Long Beach City Of Pasadena Los Angeles County Local User Support: Iris Gonzalez Phone: 213-351-7475 Fax: 213-351-2780 Email: [email protected]

y.gov

Monique Harris Phone: 213-351-7473 Fax: 213-351-2780 Email: [email protected]

unty.gov

Janet Ajao Phone: 213-351-7472 Fax: 213-351-2780 Email: [email protected]

Data Exchange Support: Eric Dansby Fax: 916-440-5967 Email: CAIRDataExchang [email protected]

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Important Contact Info

For Stage 2 MU, your contact is: Eric Dansby [email protected]

ov CAIR State Help Desk Hours: Monday - Friday 8:00AM - 5:00PM Phone: 800-578-7889 Fax: 888-436-8320 Email: [email protected]

Website: www.cairweb.org

Website Region VII: http://www.immunizelink.org/i ndex.htm

What are the requirements for Stage 2 MU?

3 1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders 2. Generate and transmit permissible prescriptions electronically (eRx) 3. Record demographic information 4. Record and chart changes in vital signs 5. Record smoking status for patients 13 years old or older 13. Use certified EHR technology to identify patient-specific education resources 14. Perform medication reconciliation 6. Use clinical decision support to improve performance on high-priority health conditions 7. Provide patients the ability to view online, download and transmit their health information 8. Provide clinical summaries for patients for each office visit 15. Provide summary of care record for each transition of care or referral 16. Submit electronic data to immunization registries 17. Use secure electronic messaging to communicate with patients on relevant health information 9. Protect electronic health information created or maintained by Certified EHR Technology 10. Incorporate clinical lab-test results into Certified EHR Technology 11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach 12. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care

Measure Specifics

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Stage 1 Objective

Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission except where prohibited and in accordance with applicable law and practice

Stage 1 Measure

Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information have the capacity to receive the information electronically)

Stage 2 Objective

Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission except where prohibited and in accordance with applicable law and practice

Stage 2 Measure

Successful ongoing submission of electronic immunization data from Certified EHR Technology to an immunization registry or immunization information system for the entire EHR reporting period

Exclusions

You do not administer immunizations to any of the populations for which data is collected by your jurisdiction’s immunization registry. You operate in a jurisdiction where no immunization registry is capable of accepting the specific standards required for your EHR. You operate in a jurisdiction where no immunization registry provides timely information on capability to receive immunization data. You operate in a jurisdiction for which no immunization registry that is capable of accepting the specific standards required by your EHR can enroll additional EPs.

Five Steps to MU Compliance

5 Register • Choose submission type • Click secure email and follow steps • •

EHR Upgrade HL7 2.5.1

SOAP messaging protocol

Pretest Test Submission

2014 90-day reporting can begin

Message Validation Ongoing Submission • Learn how to obtain the HL7 message from your EHR • Submit HL7 message to the validator to complete pre-testing • URL for submission is CAIR IMP and is different than that used for the pretest • 50 unique test messages • Monitored by CAIR for one week • CAIR automatically updates your status • CAIR recommends daily submission

Step 1: Register at http://cairweb.org/imp/

6    Registration is at the Site level and includes NPI address, contact, and other general health center information Choose submission type:    Direct from EHR Via a distinct Sending Facility (e.g. HIO, vendor/EHR data warehouse, health plan data warehouse, or other data aggregator) Act as a Sending Facility (e.g. Health Information Exchange) A secure email will contain Site credentials as well as information on the follow-up steps your Site must take to prepare for data exchange with CAIR

Step 2: Pretesting

7       Work with your EHR vendor to obtain the proper flat file, called VXU (Immunization Messages) Inform your vendor and upgrade project manager of your timeline for submitting the message. Let the vendor know you expect their timely support in resolving any error messages (days not weeks) Submit the message to the the CAIR message validation tool: https://igsstag.cdph.ca.gov/CAIRHL7WebValidator/ From what we know there is one CAIR rep to assist several regions. His preferred manner of communication is email CAIR HL7 2.5.1 is the preferred language spec found at: http://cairweb.org/images/docs/CAIR_HL7v251_Spec_for_web.pdf

You will need to resubmit until you receive an auto response from CAIR that your test message was successful

Step 3: Test Submission

8     You should use the same message format that passed the Pre-testing You then install a CDPH Client Certificate in order to use SOAP web services (required) by CAIR http://cairweb.org/images/docs/SOAPUI_Instructions.pdf

Now, submit to: http://cairweb.org/imp/ Failed test will produce an auto response with diagnostic information. As before you will need your EHR vendor’s support to trouble shoot and resolve before you can move to the next step

Step 4: Message Validation

9      You must enter message validation within the first 60 days of the reporting period There are 2 components to validation:   Proper formatting of the message Data quality Once 50 unique and successful test messages with appropriate data quality have been sent from your EHR, CAIR will move the organization from the test environment to production You must confirm message success and continue resolving errors in order to move to the next step You must receive an official notification from CAIR that you have successfully passed Message Validation

Step 5: Ongoing Submission

10       CAIR recommends daily submission of the VXU messages You must enter the Ongoing Submission step within 60 days of your reporting period or providers will fail MU Stage 2 We recommend you move into Ongoing Submission within 30 days You must correct and resubmit failed messages What is your expected frequency of submission and who is responsible to submit for all or each of your 2014 MU Stage 2 providers?

How will you work with your EHR provider for timely resolution of failed messages?

Common Issues

11       EHR interface to CAIR still under development  Does not apply to NextGen Use of SOAP protocol is not widely tested Wait time for vendor to implement interface  Not a part of the upgrade Understanding recovery steps for correcting rejected messages  E.g. CVX/ CPT codes not matching Obtaining timely vendor support for rejected messages Limited CAIR resources for our region and expectation of high volume for Q4 but especially December

Which CAIR interface product is right for you?

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NextGen Rosetta Immunization Interface E-MedApps SevaExchange Interface

    Can send HL7, HTTPS, FTP, Flat Files and other file formats Can send Real time or batch files to Registries ONC Certified Can meet stage 2 requirements

Both interfaces are sufficient for meaningful use. Perhaps consider which organization you feel is best able to meet your timeline, support needs, and budget.

     SevaXchange sends real-time updates to CAIR of immunizations Can send HL7, CCD/CCDA, XML, flat files, and custom format files ONC Certified “EHR Module Ambulatory” Can be configured to send real time or batch file messages on a custom schedule Can meet stage 2 requirements

Key points

13      Begin the process today (if you have not already done so) Registration can and should be done before your upgrade Registration is done at the site level CAIR and your vendors are the best resources for troubleshooting failed messages Leverage CCALAC for common themes and discovered solutions

Questions?

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