Health Information Technology: A State Systems Update from KDHE

Aaron Dunkel Deputy Secretary Kansas Department of Health & Environment Healthy Kansans Living in Safe and Sustainable Environments 1

Overview

• KDHE houses the state HIT Coordinator’s Office • Health Information Technology – Meaningful Use • Kansas’ Electronic Disease Surveillance System (EDSS) – Reportable Diseases Investigations – Electronic Laboratory Reporting (ELR) • Syndromic Surveillance – BioSense 2.0

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HEALTH INFORMATION TECHNOLOGY

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WHAT IS MEANINGFUL USE?

•Financial incentive to use certified EHRs •Establishes requirements for EHR products •Functionality •Standards •Security •Must show “meaningful use” •Complete and accurate information •Better access to information •Patient empowerment Healthy Kansans Living in Safe and Sustainable Environments 4

Stage 1 2011-2012 Data capture and sharing Stage 2 2014 Advance clinical processes Stage 3 2016 (postponed) Improved outcomes Meaningful use criteria focus on: Meaningful use criteria focus on: Meaningful use criteria focus on: Electronically capturing health information in a standardized format Using that information to track key clinical conditions Communicating that information for care coordination processes More rigorous health information exchange (HIE) Improving quality, safety, and efficiency, leading to improved health outcomes Increased requirements for e prescribing and incorporating lab results Decision support for national high-priority conditions Electronic transmission of patient care summaries across multiple settings Patient access to self management tools Initiating the reporting of clinical quality measures and public health information Using information to engage patients and their families in their care More patient-controlled data Access to comprehensive patient data through patient centered HIE Improving population health http://www.healthit.gov/policy-researchers-implementers/meaningful-use Healthy Kansans Living in Safe and Sustainable Environments 5

MU Stage 2 Criteria

• Eligible Providers (EP) must meet: – 17 core objectives, and – 3 menu objectives out of a list of 6 • Eligible Hospitals must meet: – 16 core objectives, and – 3 menu objectives out of a list of 6 Healthy Kansans Living in Safe and Sustainable Environments 6

Objective Immunization registry Electronic Laboratory Reporting (ELR) Syndromic Surveillance Cancer Registries Specialized Registries Ambulatory (EP) measures

Ongoing submission to Public Health Authority (core) n/a Ongoing submission to Public Health Authority (menu) Ongoing submission to Public Health Authority (menu) Ongoing submission to Public Health Authority (menu)

Hospital (EH) measures

Ongoing submission to Public Health Authority (core) Ongoing submission to Public Health Authority (core) Ongoing submission to Public Health Authority (core) n/a n/a Healthy Kansans Living in Safe and Sustainable Environments 7

Stage 2 PH Changes

1. Declaration of Readiness i.

i.

PHA declares MU2 capabilities to CMS ii.

CMS hosts website reflecting states readiness Eligible Entities (EEs) can refer to website for PHA availability When: Beginning late summer 2013 2. Registration of Intent i.

Eligible Entity (EP or EH/CAH) registers intent to KDHE KDHE hosts web page(s) to record EEs intent to attest to PH MU2 criteria ii.

When: No later than 60th day of EEs 90 day reporting period Healthy Kansans Living in Safe and Sustainable Environments 8

Stage 2 PH Changes

3. On-Boarding • Each PH MU2 criteria owner publishes an on-boarding document that EEs follow • Transport • Message format • Data quality • ELR, SS and IZ all have implementation guides that can be published • When: Following EE’s registration Healthy Kansans Living in Safe and Sustainable Environments 9

Stage 2 PH Changes

4. Acknowledgement • If MU2 PH criteria met the EE is acknowledged via a KDHE web page. Acknowledgement/PH criteria • When: Upon EE’s successful submission of reportable data to KDHE Healthy Kansans Living in Safe and Sustainable Environments 10

ELECTRONIC LABORATORY REPORTING

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Disease Reporting

• EDSS – EpiTrax – eHARS • HIV/AIDS surveillance • Report to the CDC’s National Notifiable Disease Surveillance System (NNDSS) – Morbidity and Mortality Weekly Reports (MMWR) Healthy Kansans Living in Safe and Sustainable Environments 12

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Reporting before ELR

• Laboratory reports faxed or mailed from laboratories – 2012: 23,000 CD; 10,000 TB; 50,000 Lead; 15,000 STD; 13,000 HIV • Staff manually sort out reports and enter data into EpiTrax & eHARS – 3 to 10 minutes to enter new lab report – 2012: 11,808 (CD) Healthy Kansans Living in Safe and Sustainable Environments 14

Inefficient Process

• Timeliness – Labs batched weekly – When they get to it • Cumbersome – Sorted for multiple program areas at KDHE • Limited information • Potential for error Healthy Kansans Living in Safe and Sustainable Environments 15

Reporting with ELR

• Message sent into EpiTrax staging area • Timeliness – Received 2+ days earlier • Efficiency – No processing/sorting time • Staff assign reports to new/existing cases – 1 to 5 minutes to enter – Fewer data errors Healthy Kansans Living in Safe and Sustainable Environments 16

ELR Process

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LIVE!

• ELR in EpiTrax – Accepts 2.3.1 & 2.5.1 HL7 messages • Went Live on December 4, 2012 – LabCorp • CD and STD laboratory reports • Live with blood lead labs in March 2013 Healthy Kansans Living in Safe and Sustainable Environments 18

Current Status

• National Labs in Production – Labcorp & Mayo Medical Laboratories • Hospitals in Production – Olathe Medical Center – Shawnee Mission Medical • State lab in testing stage • Three additional hospitals in testing stage • Testing ELR to eHARS Healthy Kansans Living in Safe and Sustainable Environments 19

Program Goals

• Connect Quest and ARUP • Reach out to regional laboratories • Increase the number of hospitals in Production – Working with KHIN to connect hospitals though the HIE • State lab in Production by October 2013 • Move eHARS route to production by June 2013 Healthy Kansans Living in Safe and Sustainable Environments 20

SYNDROMIC SURVEILLANCE

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Syndromic Surveillance

• “The systematic process of data collection and analysis for the purposes of detecting and characterizing outbreaks of disease in humans and animals in a timely manner" • Situational awareness • Improved health and public health outcomes • Detect and characterize public health threats Healthy Kansans Living in Safe and Sustainable Environments 22

Syndromic Surveillance • KDHE did not have a syndromic surveillance program prior to 2012

• In 2010 CDC redesigned their BioSense syndromic surveillance program to make it more versatile • BioSense 2.0 went live in November 2011 • KDHE signed data use agreement (DUA) to join in March 2012 Healthy Kansans Living in Safe and Sustainable Environments 23

BioSense 2.0

• Allows facilities to connect using BioSense 2.0 TA Team • No cost to KDHE • No development by KDHE • Allows KDHE staff time for recruiting facilities, administering data, data analysis and dissemination • Catchers mitt • All data sent to BioSense 2.0 is controlled by Kansas • Can share aggregate data as we choose with CDC or other states Healthy Kansans Living in Safe and Sustainable Environments 24

BioSense 2.0 in Kansas

• KDHE is requesting only the “ISDS Final Recommendations” minimum data set • Basic demographics, ED chief complaint, triage notes, diagnosis type, discharge disposition … • Currently doing syndromic surveillance hospitals only • Emergency Department (ED) data • De-identified • Data send real-time or batched daily • BioSense 2.0 3-year cooperative agreement with CDC to onboard hospitals Healthy Kansans Living in Safe and Sustainable Environments 25

Paths to Syndromic Surveillance

• • • KDHE is working with the Kansas Health Information Exchanges to send data to BioSense 2.0

• Allows hospitals to connect through HIE • Fewer connections directly to BioSense 2.0 for KS should help facilities get connected faster Work directly with hospitals to connect to BioSense 2.0

• Sign downstream DUA • Connect hospitals with BioSense 2.0 TA team to connect Work with Missouri data to ESSENCE then to BioSense 2.0

• KC Metro Area hospitals Healthy Kansans Living in Safe and Sustainable Environments 26

Current Status

• One hospital migrated from BioSense • KHIN facilities went live in BioSense 2.0 on November 16, 2012 – Became first state to connect through HIE directly to BioSense 2.0

– Currently 30 hospitals sending data • Two hospitals testing stage • Seven hospitals transmitting to ESSENCE – Connection to BioSense 2.0 in testing stage Healthy Kansans Living in Safe and Sustainable Environments 27

Program Goals

• Continue to onboard hospitals – 75% of Kansas hospitals by July 2014 • Establish a Kansas BioSense Governance Team – State and local health department, hospitals, HIEs, public health partners – Understand best practices, analysis needs, dissemination of public health data • User training and program integration Healthy Kansans Living in Safe and Sustainable Environments 28

Questions

Contact Information:

Aaron Dunkel Deputy Secretary Kansas Department of Health & Environment [email protected]

(785) 296-0461 Healthy Kansans Living in Safe and Sustainable Environments 29