Stage 2 Meaningful Use Immunization Message Submission

to CHIRP

Indiana State Department of HealthImmunization Program

June 17th, 2014

Stage 1 Meaningful Use Stage 2 and ongoing submission VFC Providers requirements versus Stage

2 Meaningful Use Registration Web Portal

◦Do I need to setup all of my facilities? Sending data to CHIRP – Transport Layers Troubleshooting When does Meaningful Use end? Question and Solutions

Itinerary

Meaningful use is using certified electronic health record (EHR) technology to:

Improve quality, safety, efficiency, and reduce health disparities Engage patients and family Improve care coordination, and population and public health Maintain privacy and security of patient health information Ultimately, it is hoped that the meaningful use compliance will

result in:◦ Better clinical outcomes◦ Improved population health outcomes◦ Increased transparency and efficiency◦ Empowered individuals◦ More robust research data on health systems

Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs.

Source: HealthIT.gov

Meaningful Use Defined

Source: HealthIT.gov

Core Objective – Public Health Reporting◦ Stage 1 – maybe optional◦ Stage 2 - required

Indiana State Department of Health is the Public Health Authority for the State of Indiana

Accept, validate, document provider attestments for Stage 1 and Stage 2

Where does ISDH and CHIRP fit in?

Children and Hoosier’s Immunization Registry Program

Began in September 2002 as state wide IIS Prior to CHIRP Indiana used ImmTime Over 4,000 providers and 8,000 users ~42,000 HL7 messages accepted each day Accepts HL7 2.0 through 2.5.1 VXU type

messages◦ All valid messages received will create an ACK

response Connected to all Indiana HIEs

What is CHIRP?

Life on the ISDH Meaningful Use Jargon Farm CHIRP,

CHIRP, CHIRP

MU, MU, MU

ACK, ACK, ACK

ISDH Indiana State Department of Health

PHA Public Health Authority

MU Meaningful Use

MU(X) Usually MU1 or MU2, referring to the stage of Meaningful Use

HL7 Health Level-7, a healthcare message standard developed by Health Level Seven International

VXU Vaccine Update/Add HL7 Message type, can be 2.3.1 or 2.5.1 message

VXQ Vaccine Query Message, used with 2.3.1 message

QPB Vaccine Query Message, used with 2.5.1 message

HIE Health Information Exchange

ACK Acknowledgement response for VXU message submitted

Meaningful Use Jargon

And many more…

Common terms that pop during a Meaningful Use call/email

HL7 VXU 2.3.1◦ Required fields - 8◦ VXU, VXQ and ADT

Test messages Accepted versus failed message Onetime and ongoing Additional year attestments Began in 2011

◦ First CHIRP Meaningful Use Attestment February 2011

Stage 1

HL7 VXU 2.5.1 message◦ Required fields – 42

New segments for 2.5.1◦ OBX – required and optional◦ RXR◦ NK1 and PID patient guardian

Testing requirements for Stage 2◦ Message approval prior to submitting to production◦ 30 day suggested timing by the ONC

Ongoing Submission – 90 days?◦ Does it need to be done during attestment◦ What if there is an error

Stage 2 Meaningful Use Attestment

MSH|^~\&|EMR_VENDOR|SENDING_FAC|CHIRP|OR|20140521143722.057||VXU^V04^VXU_V04|2014052115856822|P|2.5.1|||AL| PID|1||123456^^^^MR||TEST_PATIENT^CHIRP^^^^^L||200001010000|F||2131-1^Undefined Race^CDCREC|||||EN||VAR|||||UN^Unknown^99USI||||||||N PD1||||""||||U|||01^No Reminder^HL70215|N|20140521||Y^Advanced Directive Code - Y|A|20140521|20140521 PV1||||||||||MED RXA|0|1|201405211437|201405211437|03^MMR^CVX|0.5|mL^milliliter^UCUM||00^New Immunization Record^NIP001|ABC123^RABBIT^BUNNY^^^^^^TEST|1234ABC^^^CHIRP TEST FACILITY||||6622554411||AB^Abbott Laboratories^MVX|||CP|A RXR|SUBQ^^HL70162|LD^LEFT DELTOID^HL70163||^SUBCUTANEOUS OBX|1|CE|64994-7^Vaccine funding program eligibility category^LN|1|V01||||||F|||20140521|||VXC40^Eligibility captured at the immunization level^CDCPHINVS OBX|2|CE|30956-7^vaccine type^LN|2|||||||F OBX|3|TS|29768-9^Date vaccine information statement published^LN|2|20140101||||||F OBX|4|TS|29769-7^Date vaccine information statement presented^LN|2|20140521||||||

HL7 2.5.1 MU2 Sample Message

Provider registers each physical location with ISDH via Meaningful Use Portal

Providers registers each location to CHIRP via the Provider Enrollment Agreement

HL7 user account setup for testing Provider or vendor submits messages to

CHIRP review and approval◦ Recommend contacting CHIRP after submission

for review Provider moves messages into production

◦ Ongoing 90 day clock begins

Stage 2 Overall Process

New VFC policy requirement including use of VFC codes and lot numbers in HL7 message◦ 2.3.1 PV1 Codes◦ 2.5.1 OBX Codes

What fields do I need to send to make sure my lot inventory will decrement

If I am sending the new 2.5.1 MU2 message do I meet the VFC policy?◦ 2.3.1 that meet VFC requirements vs. 2.5.1

July 31st – VFC policy date

VFC and Stage 2

MU 2.5.1 Message◦ OBX segment with V0 VFC eligibility code◦ OBX segment with lot number funding source◦ RXA segment with complete lot number,

manufacturer, and administering facility (RXA.11) Existing 2.3.1 Message

◦ PV1 segment with V0 VFC eligibility code, code is located in PV1.20 placement

◦ All messages with a valid VFC code, i.e. V02 (Medicaid) will be assumed Public Supplied by CHIRP

◦ RXA segment with complete lot number, manufacturer, and administering facility (RXA.11)

What do I need to send for VFC

Only Stage 2 are required to register◦ Stage 1 is optional registration

All providers need to register Each physical location to be attested should

register◦ We do not recommend registering each provider

Providers may register for Immunization, Synrdomic, and ELR attestments

Email confirmation once registration is complete

Register for Meaningful Use

ISDH Meaningful Use Portal

Provider Group Indiana

PG Hosp Indy

PN West

PG Hosp Warsaw

PG Hosp Muncie

PG Physician’s Network

PN North

PN Indy

PN Main

PN South

PN East

Dr. JonesSmith, MDDr. Jones

Smith, MDDr. JonesSmith, MD

Specialist Team

PA RogersNP WishkaPA Rogers

NP WishkaPA RogersNP WishkaPA Rogers

NP Wishka

PG Hosp Indy

PN West

PG Hosp Warsaw

PG Hosp Muncie

PN North

PN Indy

PN Main

PN South

PN East

Providers can register for their Stage 2 Meaningful Use Attestment at anytime

ISDH recommends registering 30 days prior to the start of your 90 day attestment window

Providers must register by their 60th day of attestment time period◦ Registering later shortens the window to test and

move interface into production 90 day ongoing and 90 day attestment

window do not need to match up

When to register

How to get your data to CHIRP

Submitting from your HIE◦ HIE will act as a pass through◦ Meets Stage 2 transport layer

Connecting to CHIRP directly◦ HTTPS Post/SOAP connection

Standard created by CDC and used by most Immunization Information Systems

◦ Message sent using secured SSL certificate Sent from your EMR/EHR Cloud Vendor

◦ Uses HTTPS connection

Only connections that support bidirectional messages can be used

Transport Layers

OBX Segments◦ All administered messages should include VIS data in

OBX◦ VFC providers need to include VFC eligibility for all

administered patient records 0 through18 years of age

Historical vaccines◦ Contains fewer details but still need to meet

minimums including patient data and facility◦ When in doubt, do not submit historical data

Sending via Cloud EMR◦ Each provider needs to register and attest individually◦ Cloud EMR will only need to test initial messages

Troubleshooting and Known Issues

Stage 2 Year 1 Attestments◦ 90 day ongoing submission of data to PHA

Stage 2 Year 2 Attestments◦ 365 day ongoing submission of data to PHA

Stage 3 – 2016◦ Improving quality, safety, and efficiency, leading

to improved health outcomes◦ Decision support for national high-priority

conditions CHIRP forecast included in message response

◦ Patient access to self-management tools MyVaxIndiana

90 Days and Beyond

We (ISDH) are not the Meaningful Use Police

Accept, validate, document provider attestments for Stage 1 and Stage 2

Official documents of Meaningful Use status can be downloaded from ISDH Meaningful Use Portal

Please feel free to ask any questions

Questions and Contacts

Raymond Epps317-233-8828repps@isdh.in.gov

Cameron Minich888-227-4439caminich@isdh.in.gov

CHIRP Contacts

Meaningful Use EmailISDHMUa@isdh.in.gov

CHIRP Web pagehttps://chirp.in.gov

ISDH Meaningful Use Portal

https://gateway.isdh.in.gov/MUSSE/Default.aspx

Indiana Immunization Coalitionhttp://www.vaccinateindiana.org/

Help Links

Thank you for attending!!!