benefits and challenges of ehr-iis real-time communication
TRANSCRIPT
Kristen Forney, MPHCitywide Immunization Registry
New York City Department of Health and Mental Hygiene
Meaningful Use and Bi-directional Exchange of Immunization Data in
New York City
Public Health Informatics Conference 2014
Citywide Immunization Registry (CIR) Background: HL7 Data Exchange
DefinitionsInteroperability StandardsInteroperability DemoBenefits for Providers Benefits for IISSupporting DataFuture DirectionsConclusion
OVERVIEW
Started in 1997Contains 70 million immunizations for 5.2 million
patientsApproximately 1800 active provider sitesReporting is mandated for patients 0-18, consent is
required for reporting immunizations given to adultsPaper reporting Online registry Flat file real-time HL7
CIR HISTORY
Real-time, bi-directional exchange through a SOAP web service
No batch file option for providersFirst facility began submitting data through the web
service in February 2011Currently 465 provider sites + 400 pharmacies
sending HL7 data through the web service; (189 provider sites are bi-directional)
CIR’S HL7 DATA EXCHANGE
Real-time Synchronous Transport- User submits an HL7 message, and
as part of that transaction/connection 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 patient’s immunization history, evaluation and decision support
EHR imports IIS data and stores it as structured data
DEFINITIONS
HL7 2.5.1Supported by 44 immunization registries as of Sep 2013Well-defined standard for immunization reporting (VXU)
and query/response (QBP/RSP)SOAP Web Services
National standard recommended by CDC’s Transport Layer Expert Panel
Supported by 30 immunization registries as of Sep 2013
INTEROPERABILITY STANDARDS
[BI-DIRECTIONAL DEMO]
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 workflowAccuracy of data within provider EHRData immediately available in IIS for use with school forms, other pre-completed formsParticularly beneficial for first-time EHR implementers
BENEFITS OF REAL-TIMEBI-DIRECTIONAL EXCHANGE
* P < 0.05; ** P <0.01; *** P < .001; **** P < .0001Stockwell, et al, 2010. http://cdc.confex.com/cdc/nic2010/recordingredirect.cgi/id/6746
COLUMBIA PRESBYTERIAN HOSPITAL
For an IIS:TimelinessCompleteness of immunization information (lot number, manufacturer, expiration date, etc)Providers have continuous interaction with the IIS
BENEFITS OF REAL-TIMEBI-DIRECTIONAL EXCHANGE
IMPROVED VFC 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 < 19 years**Data from all newly administered immunizations reported to the CIR during calendar year 2013
IMPROVED VFC ELIGIBILITY AND LOT NUMBER CAPTURE
INCREASE IN ADULT DATA CAPTURE
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
MEANINGFUL USE AND IIS
Start of MU (Jan)
INCREASE IN HL7 SITES
SHIFT IN REPORTING METHOD
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
CHALLENGES OF BI-DIRECTIONAL HL7 EXCHANGE
For IIS:Webinars (or site visits) with providers to understand how their EHR worksSet up the ability to restrict queries from specific accounts Store unique IDs sent by the EHRData quality monitoring; daily e-mails
For EHRs:Store patient’s registry ID and send in all transactionsAutomatic re-query to get decision support updatedFull sync of registry record with EHR record—critical for accurate decision support
BEST PRACTICES FOR REAL-TIME BI-DIRECTIONAL EXCHANGE
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
FUTURE DIRECTIONS- IIS COMMUNITY
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 IISIIS nationally have well-defined standards for message
content and transportPreference 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
CONCLUSIONS
Amy MetrokaVikki Papadouka
Angel ApontePaul Schaeffer
Contact Information
Kristen ForneyDirector, EHR-IIS Interoperability Project
THANK YOU!