METHODS: WA DOH secured a partnership with Planned Parenthood of the Great Northwest and the Hawaiian Islands (PPGNHI) in grant year two. PPGNHI and WA DOH were both interested in using the existing NextGen EHR functionality at PPGNHI for eCR testing. A mutual goal for this demonstration project was to avoid custom methods of data exchange (such as a custom HL7 interface). Both continuity of care records (CCRs) and CCDs (a type of consolidated clinical data architecture (C-CDA) document) can be generated from NextGen, and it seemed straightforward to use the existing technology, yet there were challenges in extracting and securely transporting the records.
PPGNHI initially sent both test CCR and CCD files to WA DOH using an existing secure file transfer protocol (SFTP) platform. PPGNHI then had further software modules installed and enabled, and were able to generate 25 CCDs (a mix of STI cases) and send them via SFTP.
RESULTS: PPGNHI found that out-of-the-box EHR software was not able to produce or send CCDs. WA DOH and PPGNHI were further challenged because Direct transport protocol is not supported by WA HIE or WA DOH, thus the transport protocol available from the EHR system was not usable.
The CCDs are currently being analyzed by WA DOH to determine content, format, and gaps between the CCD and current STI case reports. This analysis is the next step in our iterative process to refine the sending, receiving, and analyzing of eCRs and will be reviewed in the breakout session.
CONCLUSIONS: The assumption that a clinical partner with Meaningful Use Stage 2 certified EHR technology has the necessary EHR components to generate and export data is an important consideration of public health in establishing clinical partnerships. Even for clinical partners who have a well-established EHR system, extraction and submission of data can be challenging given additional configuration required. Public health partners will be best served understanding these potential generation and transport challenges.