One of the strongest use cases for statewide health information exchanges involves easing reporting to public health agencies, and at the same time helping providers meet meaningful use requirements. The HIE can provide a single conduit for providers to meet many reporting obligations. In Massachusetts, progress is underway on connecting providers’ EHRs to the Mass HIway.
Last week I saw a nice presentation by Sita C. Smith, health information coordinator for the Bureau of Infectious Disease at the Massachusetts Department of Public Health (MDPH). She described progress and challenges faced in both converting previous reporting methods to the HIE or starting new ones from scratch. She also talked about three reporting programs that go beyond meaningful use requirements.
Here are some notes I took during her presentation:
• Immunization:
Using the HIway to connect to the Massachusetts Immunization Information System (MIIS) is expected to improve record submission process through electronic submission of immunizations. Providers are able to submit immunization data directly from their EHR rather than via manual entry into a web interface. “We were collecting immunization data for the registry before the HIway. Now it is going through the HIE. The pathway is very similar. If you are a hospital submitting data, it absolutely makes sense to send all your data through a single pipe to the state instead of using multiple methods of communication,” Smith said. The node is in production. There are seven organizations actively submitting data now, and 10 are in test mode. Up to 100 organizations still are waiting to connect. A lot of work has been done to standardize interfaces between the HIway and the variety of EHRs in use, she said.
• Syndromic Surveillance
Syndromic surveillance data collection, a meaningful use Stage 2 objective, is new to MDPH, Smith said, and no providers are in production yet. The state has decided it will limit reporting to hospital emergency departments only. The objective is to electronically submit chief complaint data from hospital emergency departments to identify possible clusters. The data comes through the HIway to BioSense, a data repository sponsored by the CDC. No providers are in production yet, but she said they would soon have three or four in production. There are 70 eligible hospital emergency departments, and 52 have registered their intent, and 36 are testing. Again, non-hospital data is excluded. Eligible hospitals may still attest for MU Stage 2. The Department of Public Health issued a letter to providers stating that they have met the attestation requirements if they are engaged in testing or are awaiting an invitation to begin testing/validation.
• Electronic Lab Reporting
Seventy-one hospitals in the state already submit lab reports electronically. But before the ELR data was sent to a health information web portal, which was certified for meaningful use, she said. “The HIway offers an effective alternative way of submitting data,” Smith said. So far, Beth Israel Deaconess Medical Center is the only hospital using the HIway, but she added that it would make sense to consolidate reporting in one place eventually.
• Massachusetts Cancer Registry
“The cancer registry is really interesting because it has been collecting cancer registry data reports from hospitals for a very long time,” Smith noted, but the non-hospital reports are the ones they have a difficulty getting a handle on. “This is where the HIway comes into its own,” she said. There have been ways for big organizations to transmit data in the past, but it has been extremely difficult to get data from primary-care providers and other clinics that tend to do cancer reporting. They send data in lots of many different formats and there is lots of manual intervention and pre-processing. “It has been an unsatisfactory solution in terms of getting data from non-hospital providers. Use of the HIway can fix that,” she said. “The cancer registry is very excited about this. The HIway offers a solution that wasn’t there before.” The node is live now.
• Specialized Registries
This is the one MDPH that does not use the HIway at all yet. MDPH has designated its disease surveillance and case management system (MAVEN) as a specialized registry. Two organizations (Atrius Health and Cambridge Health Alliance) are currently submitting data directly from their EHRs. “You have to have algorithms that go into the EHR and extract data,” she noted.
Then Smith talked about three HIway nodes that, although not part of meaningful use, she called very exciting:
• Intake Enrollment and Assessment Transfer Service
This is about collecting information about people in opiod treatment services. Previously the process was complex, with e-mails, manual uploading, etc. It is really straightforward to send through the HIway, she said. “These are nontraditional providers and this makes something that was very difficult before feasible.” The node is live and in production. Seven substance abuse treatment organizations representing 45 service organizations are eligible to use it. “There have been challenges with their software vendors connecting to the HIway, but it is on its way,” she said.
• Childhood Lead Poisoning Prevention Program (CLPP)
“This is a brilliant illustration of all the different formats and ways in which lead data comes into their database, and how much more simplified it can potentially be,” Smith said. I think this is exactly what health information exchanges should be about.” Benefits include automation of manual processes done by epidemiology staff, reducing the rate of errors. Sixty providers are submitting lead data through CLPPP. The HIway node is in progress right now.
• E-Referrals
The final node Smith talked about involves e-Referalls. The objective is to build a system that supports HIE data exchange in the form of e-Referrals from healthcare provider organizations to their affiliated community-based organizations. “This completely bypasses the state. It is about organizations sending data to each other,” she said. An example would be the YMCA or Tobacco Quit Line working with community organizations. They currently use paper or faxes and will now be able to securely send data to each other. “That is going to be amazing,” she said.
Overall, she said she hoped that she had made it clear that this is the wave of the future. “There have been challenges. They apply to all states and all HIEs,” Smith added. A lot have to do with legacy systems already in place and trust issues. “I absolutely do think HIEs will enhance and improve our ability to do what we do better at reduced cost. It is about increasing the utility of the data we collect.”
