health information technology: a state systems update from kdhe

Healthy Kansans Living in Safe and Sustainable Environments

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Health Information Technology:A State Systems Update from

KDHE

Aaron DunkelDeputy SecretaryKansas Department of Health & Environment


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Overview• KDHE houses the state HIT Coordinator’s

Office• Health Information Technology– Meaningful Use

• Kansas’ Electronic Disease Surveillance System (EDSS)– Reportable Diseases Investigations– Electronic Laboratory Reporting (ELR)

• Syndromic Surveillance– BioSense 2.0


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HEALTH INFORMATION TECHNOLOGY


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WHAT IS MEANINGFUL USE?•Financial incentive to use certified

EHRs

•Establishes requirements for EHR products• Functionality• Standards• Security

•Must show “meaningful use”• Complete and accurate information• Better access to information• Patient empowerment


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Stage 12011-2012Data capture and sharing

Stage 22014Advance clinical processes

Stage 32016 (postponed)Improved outcomes

Meaningful use criteria focus on:



Electronically capturing health information in a standardized format

More rigorous health information exchange (HIE)

Improving quality, safety, and efficiency, leading to improved health outcomes

Using that information to track key clinical conditions

Increased requirements for e-prescribing and incorporating lab results

Decision support for national high-priority conditions

Communicating that information for care coordination processes

Electronic transmission of patient care summaries across multiple settings

Patient access to self-management tools

Initiating the reporting of clinical quality measures and public health information

More patient-controlled dataAccess to comprehensive patient data through patient-centered HIE

Using information to engage patients and their families in their care

Improving population health

http://www.healthit.gov/policy-researchers-implementers/meaningful-use


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MU Stage 2 Criteria

• Eligible Providers (EP) must meet: – 17 core objectives, and – 3 menu objectives out of a list of 6

• Eligible Hospitals must meet: – 16 core objectives, and – 3 menu objectives out of a list of 6


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Objective Ambulatory (EP) measures

Hospital (EH) measures

Immunization registry

Ongoing submission to Public Health Authority (core)


Electronic Laboratory Reporting (ELR)

n/a Ongoing submission to Public Health Authority (core)

Syndromic Surveillance

Ongoing submission to Public Health Authority (menu)


Cancer Registries Ongoing submission to Public Health Authority (menu)

n/a

Specialized Registries

Ongoing submission to Public Health Authority (menu)

n/a


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Stage 2 PH Changes1. Declaration of Readiness

i. PHA declares MU2 capabilities to CMSi. CMS hosts website reflecting states readiness

Eligible Entities (EEs) can refer to website for PHA availability

ii. When: Beginning late summer 2013 2. Registration of Intent

i. Eligible Entity (EP or EH/CAH) registers intent to KDHE KDHE hosts web page(s) to record EEs intent to attest to PH MU2 criteria

ii. When: No later than 60th day of EEs 90 day reporting period


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Stage 2 PH Changes3. On-Boarding • Each PH MU2 criteria owner publishes an

on-boarding document that EEs follow• Transport • Message format • Data quality

• ELR, SS and IZ all have implementation guides that can be published

• When: Following EE’s registration


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Stage 2 PH Changes4. Acknowledgement

• If MU2 PH criteria met the EE is acknowledged via a KDHE web page. Acknowledgement/PH criteria

• When: Upon EE’s successful submission of reportable data to KDHE


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ELECTRONIC LABORATORY REPORTING


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Disease Reporting• EDSS– EpiTrax– eHARS• HIV/AIDS surveillance

• Report to the CDC’s National Notifiable Disease Surveillance System (NNDSS)–Morbidity and Mortality Weekly Reports

(MMWR)


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Reporting before ELR• Laboratory reports

faxed or mailed from laboratories– 2012: 23,000 CD;

10,000 TB; 50,000 Lead; 15,000 STD; 13,000 HIV

• Staff manually sort out reports and enter data into EpiTrax & eHARS– 3 to 10 minutes to enter

new lab report– 2012: 11,808 (CD)


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Inefficient Process• Timeliness– Labs batched

weekly– When they get to it

• Cumbersome– Sorted for multiple

program areas at KDHE

• Limited information• Potential for error


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Reporting with ELR• Message sent into

EpiTrax staging area• Timeliness

– Received 2+ days earlier• Efficiency

– No processing/sorting time• Staff assign reports

to new/existing cases– 1 to 5 minutes to enter– Fewer data errors


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ELR Process


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LIVE!• ELR in EpiTrax– Accepts 2.3.1 & 2.5.1 HL7 messages

• Went Live on December 4, 2012– LabCorp• CD and STD laboratory reports

• Live with blood lead labs in March 2013


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Current Status• National Labs in Production– Labcorp & Mayo Medical Laboratories

• Hospitals in Production– Olathe Medical Center– Shawnee Mission Medical

• State lab in testing stage• Three additional hospitals in testing

stage• Testing ELR to eHARS


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Program Goals• Connect Quest and ARUP• Reach out to regional laboratories• Increase the number of hospitals in

Production–Working with KHIN to connect hospitals

though the HIE• State lab in Production by October 2013• Move eHARS route to production by

June 2013


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SYNDROMIC SURVEILLANCE


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Syndromic Surveillance• “The systematic process of data collection

and analysis for the purposes of detecting and characterizing outbreaks of disease in humans and animals in a timely manner"

• Situational awareness• Improved health and public health

outcomes• Detect and characterize public health

threats


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Syndromic Surveillance• KDHE did not have a syndromic

surveillance program prior to 2012• In 2010 CDC redesigned their BioSense

syndromic surveillance program to make it more versatile

• BioSense 2.0 went live in November 2011• KDHE signed data use agreement (DUA) to

join in March 2012


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BioSense 2.0• Allows facilities to connect using BioSense 2.0 TA

Team • No cost to KDHE• No development by KDHE• Allows KDHE staff time for recruiting facilities,

administering data, data analysis and dissemination• Catchers mitt

• All data sent to BioSense 2.0 is controlled by Kansas• Can share aggregate data as we choose with CDC

or other states


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BioSense 2.0 in Kansas• KDHE is requesting only the “ISDS Final

Recommendations” minimum data set• Basic demographics, ED chief complaint, triage

notes, diagnosis type, discharge disposition…• Currently doing syndromic surveillance

hospitals only• Emergency Department (ED) data

• De-identified• Data send real-time or batched daily• BioSense 2.0 3-year cooperative agreement

with CDC to onboard hospitals


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Paths to Syndromic Surveillance• KDHE is working with the Kansas Health Information

Exchanges to send data to BioSense 2.0• Allows hospitals to connect through HIE• Fewer connections directly to BioSense 2.0 for KS

should help facilities get connected faster• Work directly with hospitals to connect to BioSense 2.0

• Sign downstream DUA• Connect hospitals with BioSense 2.0 TA team to connect

• Work with Missouri data to ESSENCE then to BioSense 2.0• KC Metro Area hospitals


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Current Status• One hospital migrated from BioSense • KHIN facilities went live in BioSense 2.0 on

November 16, 2012– Became first state to connect through HIE

directly to BioSense 2.0– Currently 30 hospitals sending data

• Two hospitals testing stage• Seven hospitals transmitting to ESSENCE– Connection to BioSense 2.0 in testing stage


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Program Goals• Continue to onboard hospitals– 75% of Kansas hospitals by July 2014

• Establish a Kansas BioSense Governance Team– State and local health department, hospitals, HIEs,

public health partners– Understand best practices, analysis needs,

dissemination of public health data• User training and program integration


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Questions

Contact Information:Aaron Dunkel

Deputy SecretaryKansas Department of Health & Environment

[email protected](785) 296-0461

health information technology: a state systems update from kdhe

Documents

state public health

improved health outcomesusing

sustainable environments3what

sustainable environments5http

eligible hospitals

core objectives

menu objectives

criteria eligible providers