Transcript PHDSC ELR Meaningful Use

PHDSC session
Readiness of public health
information systems to
support Meaningful Use of
EHRs through health
information exchanges
Laboratory Reporting to
Public Health
Steven C. Macdonald PhD, MPH
Washington State Dept. of Health
Council of State & Territorial Epidemiologists
August 2009 HIT Policy
Committee recommendations
• Improve quality, safety, efficiency, &
reduce health disparities
• Engage patients and families
• Improve care coordination
• Improve population & public health
• Ensure adequate privacy & security
protections for personal health information
Readiness of public health information
systems to support Meaningful Use
• Interoperability
– Capability to receive ELR, immunization and
syndromic data
– Capability to send alerts and queries
• Capacity for data management
– Scaling up for increased volume of reports
– Increased data dissemination expectations
• Capacity for clinical decision support
– Current immunization schedules
ELR recommendations for 2011
• Hospitals objective “Capability to provide
electronic submission of reportable lab
results to public health agencies and actual
submission where it can be received”
• Performance measure “% reportable lab
results submitted electronically”
ELR Challenges
• Condition selection
• Methods for testing “Capability”
• Methods for identifying reportable lab
results which were not submitted
electronically
• Methods for monitoring hospital
compliance
Condition selection for
performance measures
• All reportable conditions separately for each
state/jurisdiction
• Roughly 70 conditions on the CSTE
Nationally Notifiable Conditions list
• Subset of the NNC list where the conditions
are reportable by labs in all 50 states
– Further subset to conditions where testing is
routinely done in hospital labs?
Methods for testing “Capability”
• Define "Capability to provide electronic
submission" for those instances where no
"actual submission" is indicated during the
defined period
– Small hospital
– Rare condition
• Development of test protocols
– Pilot before implementation?
Calculation of performance
measure
• Methods for identifying reportable lab results
which were not submitted electronically
– necessary to calculate “% reportable lab results
submitted electronically”
– hospital EHR performance test ?
• Rely on state health agencies to document the
proportion of results for reportable conditions that
came from any given hospital as ELR reports vs.
paper reports or by telephone ?
Methods for monitoring hospital
compliance
• Attestation ?
• CMS “verification” using existing auditing
mechanisms
– Audit team could examine code mapping tables (e.g.,
local code to LOINC)
– Audit team could supervise capability and performance
testing
• State laboratory quality assurance certification
bodies
HL7 Standards
• HL7 Version 2.5.1 Implementation Guide:
Electronic Laboratory Reporting To Public Health
(US Realm), Release 1
• Related standards
– HL7 Version 2.5.1 Implementation Guide: Orders and
Observations; Interoperability Laboratory Result
Reporting to EHR (US Realm), Release 1
– NAACCR Pathology Laboratory Electronic Reporting
V3.0 (HL7 V 2.5.1 Implementation Guidelines)
– HL7 Version 2.5.1 Implementation Guide:
eSurveillance; Microbiology Transactions (US Realm),
Release 1
CSTE ELR Workgroup
• Annual survey since 2004