BACKGROUND: The HITECH Act (2009) was passed to encourage the adoption and support of certified electronic health records (CEHRT) technology to facilitate meaningful and measurable care, as well as securely exchange data to public health authorities. In response, the Centers for Medicare & Medicaid Services (CMS) developed incentive programs, referred to as Meaningful Use (MU). We share our perspectives and lessons learned while implementing three (3) public health measures to meet MU within a large jurisdiction.
METHODS: HHD actively participates in ELR and SyS to assist providers in meeting requirements for meaningful use (MU). Current endeavors are to fully implement MU modified Stage 2 and planning of Stage 3 functions, specifically (1) electronic lab reporting (ELR), (2) syndromic surveillance (SyS), and (3) electronic case reporting (eCR).
ELR:
In 2016, HHD received over 160,000 ELR transmissions in near real time. To date, HHD has successfully on-boarded four large medical systems in the Houston jurisdiction and is currently in the process of on-boarding two additional hospital systems. To facilitate the on-boarding process, HHD developed a toolkit for hospitals consisting of standard protocols and procedures, and estimated timelines.
Syndromic Surveillance:
HHD manages SyS for 19 counties in the Texas Gulf Coast region. Data transmission requires coordination with county, state, and federal partners. Currently, HHD is transitioning the syndromic surveillance system from Houston RODS to Houston ESSENCE. HHD leads and collaborates with the Syndromic Surveillance Consortium of Southeast Texas and Tarrant County Public Health Department.
Electronic case reporting:
eCR is an option to meet MU Stage 3. The goal of eCR is to securely exchange confidential case reports, using the HL7 Consolidated Clinical Document Architecture (C-CDA) R2 message structure, for reportable conditions from EHRs to public health authorities, on the Public Health Community Platform (PHCP). HHD is participating as one of the first sites to pilot eCR and Reportable Conditions Knowledge Management System (RCKMS is a component within the PHCP).
RESULTS: HHD generated toolkits which contain reports, templates, and documents that are essential in assisting providers in ELR MU measures. These activities will be duplicated for SyS and eCR projects to facilitate transition for providers as they adopt MU standards.
CONCLUSIONS: Collaboration is an essential component to implementing meaningful use, particularly establishing agreements between the hospital and public health entities regarding data usage and transfer. Having interface engineering capacity is important as message structures can affect the results of the validation or project success.