Mass. offers a REC success story
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There are now 2,540 providers (and counting) enrolled in the state’s REC, out of 6,700 providers eligible for REC services, said Adetosoye, speaking at the “Heath IT: Improving Healthcare and the Economy” conference on May 10.
Forty-five percent of those providers work in the ONC’s priority setting of small practices (one to 10 providers); 10 percent work in public hospitals and 29 percent work in community health centers. And 114 providers are at go-live with e-prescribing and can generate electronic reports, aligned with state plans for meaningful use, she said.
“This is the prototype REC that you’re looking for.”
MeHI deserves accolades for going beyond MU to support additional quality programs coming from the federal level, said Adetosoye. “This isn’t easy. You need someone who’s going to walk you through the menu of core objectives, can explain the [patient-centered medical home] model, who can explain indemnification for Stage 2/3 meaningful use. The REC should be your trust advisor.”
Now, the hard part
The Massachusetts REC has made solid progress getting providers on board with EHR adoption, but there are some challenges ahead in getting data into federal and state public health systems, said James Daniel, MPH, public health coordinator at the ONC, during the presentation.
Eligible providers must choose one public health reporting option from the menu: either submitting electronic data to immunization registries or systems, or providing electronic syndromic surveillance data to public health agencies. Eligible hospitals have a third option: providing electronic lab results reporting to a public health agency.
The problem is that most states aren’t ready to accept ambulatory syndromic surveillance data, “so immunization registry [reporting] is really the only option for [most] states,” said Daniel. Some cities, including Boston, are accepting ambulatory data for syndromic surveillance, he added.
Massachusetts is ready to accept e-lab reporting as well as immunization registry data, according to Daniel.
For elecronic lab reporting, 80 conditions are reportable in Massachusetts, and hospitals must be able to pull these data on all of those and send them in the appropriate format—HL7 2.5.1. This presents another issue because most hospitals in the state use HL7 2.3.1 for exchange. Plans are under way to upgrade hospitals from HL7 2.3.1 to HL7 2.5.1 messages this summer to continue to meet meaningful use, Daniel said.
Similarly, the state has historically accepted syndromic surveillance data in CSV file format, but that doesn’t meet meaningful use criteria right now. Proposed national standards for hospital-based electronic data exchange are slated to be published next week, said Daniel, with a comment period to follow.
As for the immunization registry, providers must send a unidirectional message from their EHR to the state Department of Public Health that contains demographic information and information about the immunization. “That’s not great for the provider: You don’t get information back about the full [immunization] history, you don’t get any information about what shots are needed in future,” he said.
To obtain more comprehensive immunization information, Massachusetts providers can log in to a state portal. “We’re hoping to work with [other] RECs and communities of practice to find the best way to handle this,” said Daniel.
Creating a message is only one half of compliance—sending it is the other half, he added. “The ONC hasn’t set standards on transport mechanisms, that’s up to the states. And each state has slightly different way that they want to receive that information.”
The Massachusetts HIE is working to adopt the Direct framework as an information exchange mechansim. In addition, the ONC is working with the state’s REC to make sure providers and vendors have information on the Massachusetts immunization information system, how to get data into the system and how to access to the portal for other functions, said Daniel.
“We’re looking to work with data aggregators … or maybe we can start to develop regional or vendor-based data aggregators to send data to the Department of Public Health. So it’s the not responsibility of the provider,” he concluded.