Kristen Forney, MPH Citywide Immunization Registry

1
Meaningful Use and Bi-directional Exchange of
Immunization Data in New York City

• Kristen Forney, MPHCitywide Immunization
  Registry
• New York City Department of Health and Mental
  Hygiene

Public Health Informatics Conference 2014
2
Overview

• Citywide Immunization Registry (CIR) Background
  HL7 Data Exchange
• Definitions
• Interoperability Standards
• Interoperability Demo
• Benefits for Providers
• Benefits for IIS
• Supporting Data
• Future Directions
• Conclusion

3
CIR history

• Started in 1997
• Contains 70 million immunizations for 5.2 million
  patients
• Approximately 1800 active provider sites
• Reporting is mandated for patients 0-18, consent
  is required for reporting immunizations given to
  adults
• Paper reporting ? Online registry ? Flat file
• ? real-time HL7

4
CIRs HL7 Data exchange

• Real-time, bi-directional exchange through a SOAP
  web service
• No batch file option for providers
• First facility began submitting data through the
  web service in February 2011
• Currently 465 provider sites 400 pharmacies
  sending HL7 data through the web service (189
  provider sites are bi-directional)

5
Definitions

• Real-time
• Synchronous Transport- User submits an HL7
  message, and as part of that transaction/connectio
  n to the IIS, the application waits for an
  acknowledgment response
• Synchronous Processing- Upon receipt of an HL7
  message, IIS processes the message and
  acknowledges the results of processing. Data is
  immediately accessible to users of the IIS.
• Bi-directional
• EHR sends an HL7 query message (VXQ or QBP) and
  receives a response containing patients
  immunization history, evaluation and decision
  support
• EHR imports IIS data and stores it as structured
  data

6
Interoperability Standards

• HL7 2.5.1
• Supported by 44 immunization registries as of Sep
  2013
• Well-defined standard for immunization reporting
  (VXU) and query/response (QBP/RSP)
• SOAP Web Services
• National standard recommended by CDCs Transport
  Layer Expert Panel
• Supported by 30 immunization registries as of Sep
  2013

7
bi-directional demo
8
Benefits of real-timebi-directional exchange

• For Providers
• Avoid double data entry (89 CIR facilities have
  moved from online registry to HL7 web service)
• Accessibility of information (both immunization
  history and clinical decision support) within
  provider workflow
• Accuracy of data within provider EHR
• Data immediately available in IIS for use with
  school forms, other pre-completed forms
• Particularly beneficial for first-time EHR
  implementers

9
Columbia presbyterian hospital
P lt 0.05 P lt0.01 P lt .001 P lt
.0001 Stockwell, et al, 2010. http//cdc.confex.co
m/cdc/nic2010/recordingredirect.cgi/id/6746
10
Benefits of real-timebi-directional exchange

• For an IIS
• Timeliness
• Completeness of immunization information (lot
  number, manufacturer, expiration date, etc)
• Providers have continuous interaction with the
  IIS

11
Improved VFC and Lot Number Capture
Improved vfc eligibility and lot number capture
Data source Percent of immunizations with VFC status Percent of immunizations with lot number
Flat File 88.1 59.0
Online Registry 93.6 45.3
HL7 Web Service 94.1 97.4
Total 90.5 68.4
Data from all newly administered immunizations
reported to the CIR during calendar year 2013 for
patients lt 19 years Data from all newly
administered immunizations reported to the CIR
during calendar year 2013
12
Increase in adult data capture
13
Meaningful USE and IIS

• CIR built HL7 web service in 2009
• Stage 1
• Began January 2011 Eligible providers and
  hospitals must perform a test of EHRs capability
  to send data to an IIS in HL7 format
• Stage 2
• Began January 2014 Eligible providers and
  hospitals must institute ongoing reporting to an
  IIS in HL7 2.5.1 format

14
increase in HL7 sites
Start of MU (Jan)
15
shift in reporting method
16
Challenges of bi-directional HL7 exchange

• How can we ensure that the IIS finds and returns
  the correct patient?
• EHR should send all possible demographic
  information
• Exchange unique IDs (Medical record number, IIS
  ID)
• Will the EHR display IIS data correctly?
• Thorough testing with the EHR vendor
• Involve providers in testing
• How will the EHR de-duplicate immunizations?
• EHR record and IIS record must be fully synced to
  ensure accurate clinical decision support

17
Best practices for real-time bi-directional
exchange

• For IIS
• Webinars (or site visits) with providers to
  understand how their EHR works
• Set up the ability to restrict queries from
  specific accounts
• Store unique IDs sent by the EHR
• Data quality monitoring daily e-mails
• For EHRs
• Store patients registry ID and send in all
  transactions
• Automatic re-query to get decision support
  updated
• Full sync of registry record with EHR
  recordcritical for accurate decision support

18
Future Directions- IIS Community

• Advocate for MU Stage 3 to include bi-directional
  exchange
• Reduce Variability in HL7 implementations between
  IIS
• Find ways to partner with EHR vendors that will
  be mutually beneficial
• Create a set of recommendations to EHR vendors
  for best practices

19
CONCLUSIONS

• Meaningful Use has facilitated increased adoption
  of HL7 standards among practices reporting to CIR
• Real-time, bi-directional exchange is feasible
  and scalable to a large number of facilities
• Presents a number of benefits to both providers
  and IIS
• IIS nationally have well-defined standards for
  message content and transport
• Preference of EHR vendors in MU stages 1 and 2
  has been for a unidirectional HL7 interface
  inclusion of a bi-directional requirement in
  stage 3 would accelerate implementation of
  bi-directional interfaces

20
Thank you!

• Amy Metroka
• Vikki Papadouka
• Angel Aponte
• Paul Schaeffer
• Contact Information
• Kristen Forney
• Director, EHR-IIS Interoperability Project
• kforney_at_health.nyc.gov
• 347-396-2578