Category Archives: Meaningful Use

Electronic Laboratory Reporting and the Public Health Workforce

Roland Gamache, PhD, MBA
Senior Director, Informatics
NACCHO

An informative article in this month’s Online Journal of Public Health Informatics, “Estimating Increased Electronic Laboratory Reporting Volumes for Meaningful Use: Implications for the Public Health Workforce,” shows the value electronic laboratory results reporting can bring to the public’s health. The article also describes how electronic reporting can capture the large portion of communicable disease cases that go unreported to better contain the spread of those diseases, confirming the efforts of the Office of the National Coordinator for Health IT (ONC) and the impact of Meaningful Use activities towards achieving these goals.

More complete reporting through Electronic Laboratory Reporting (ELR) allows better prioritization of case investigation by public health, with increased focus on high priority/high impact diseases that pose the greatest threat to a community. This information allows health departments to investigate these events more rapidly and more efficiently, therefore preventing disease. According to Joseph Gibson, PhD, a co-author of this paper, “Without ELR, public health has been like a physician who only gets half of the test results ordered to determine how to treat a patient.”

Public health departments can better protect their community’s health because this information will provide public health practitioners with a more complete picture of the unmet need in the community. This level of information will allow agencies to prioritize their resources more efficiently and effectively.

ELR makes the act of understanding the disease burden in the community more efficient while requiring less time for hospitals and labs to provide information to public health departments.

Additional lab reports are an important part of case investigations. More complete case reporting creates a better picture of actual diseases circulating in a community. An influx in lab reports or more thorough case reports do not hinder case investigations, but strengthens them because they create a better picture of actual diseases that are circulating in the community, and also allows for a larger data bank that can be used for future public health studies.

Nor does ELR increase the amount of disease in a community; it just provides more information about the notifiable diseases. The resources needed by public health required to respond to these diseases are just better understood because this information is reported more often to health departments. If we do not have a clear picture of what is going on in the community, how can public health departments do their job and protect the community?

The National Association of County and City Health Officials and the Association of State and Territorial Health Officials have documented the resource constraints in health departments as highlighted in the article. However, health departments are working with local, state and federal partners to build capacity so they can capitalize on the type of data flow that is envisioned in the scenarios described by this article.

Similarly, ELR has increased efficiency for lab reporting, helping to ensure that electronic case submissions can increase efficiency. Case reports submitted by clinicians with complete information will reduce the burden on public health.

In summary, ELR will improve the health status of the community by allowing health departments to more effectively and efficiently deploy its resources to improve their investigations about the spread of disease in their jurisdictions.

Public Health Informatics Virtual Event on July 16-18, 2013 – Call for Abstracts!

Connect with colleagues at your own convenience!

ph informatics virtual event

This virtual event provides the opportunity to learn and discuss the latest initiatives in public health informatics with attendees from all over the country and internationally. Call for abstracts is now open and will continue until May 31, 2013. This year’s theme is “Strengthening Public Health – Health Care Collaboration.” Abstract submissions are encouraged in the following areas:

1)  Informatics policy and practice: virtual sessions will focus on national and international policy issues and their implications for public health informatics programs; applied informatics projects for programmatic support; and new initiatives

Examples might include:

  • ICD-10 CM/PCS –deadline for implementations 10/1/2014
  • Meaningful Use & Electronic Health Records
  • Interstate data exchange
  • Data exchange to support ACOs

2)  Research & Innovation: virtual sessions will focus on informatics research and technological innovation to public health and clinical settings.

Examples might include:

  • Applying analytics to new and existing data sources
  • Leveraging Big Data for population and public health
  • Learning health systems to support integration of primary care and public health
  • Novel technologies for population and public health education and communication (mobile, web, social media)

3)  Supporting Public Health Evidence Based through Informatics Practice: virtual sessions will focus on strengthening public health through knowledge sharing, evaluation, visualization and reporting.

Examples might include:

  • Evaluation methodologies and findings
  • Decision support for population health Health status and performance management dashboards
  • Community Health Assessments as part of the community health improvement process
  • Return on Investment (ROI) and Value of Information (VOI) analyses for informatics programs and systems

If any of the items above relate to your area of work, do not miss the opportunity to submit an abstract!

Help us get the word out and share this blog post with your colleagues and friends! And if you’re ready to submit an abstract go straight ahead here.

Meeting sponsors include CDC, NACCHO, and ASTHO.

Guidance for Public Health Agencies Preparing for Stage 2 Meaningful Use

If you hadn’t considered taking a look at what Stage 2 of Meaningful Use has to offer to public health, there is no better time than now. Earlier this week, the Stage 2 Meaningful Use Public Health Reporting Requirements Task Force published a guidance for public health agencies (PHAs) preparing for Stage 2 Meaningful Use (MU).

InteroperabilityAt Stage 2 it’s all about achieving interoperability through common standards among diverse systems and organizations exchanging information.

On September 4, 2012, the Stage 2 Meaningful Use “Final Rules” was published in the Federal Register, requiring local and state Public Health Agencies (PHAs) to ramp-up their MU capabilities and establish new processes to receive the relevant public health data from Eligible Professionals (EPs) and Eligible Hospitals (EHs).

Two important things to highlight for Stage 2 of Meaningful Use:

1) Ongoing submission of electronic data for immunizations is in the core (i.e., mandatory) set for Eligible Professionals and on-going submission of electronic data for immunizations, reportable laboratory results, and syndromic surveillance are in the core set for Eligible Hospitals.

2) EPs have menu (i.e., optional) objectives for reporting syndromic surveillance data, for reporting to cancer registries, and other specialized registries (e.g., birth defects registries, chronic disease registries, traumatic injury registries).

While supporting Stage 2 MU objectives is neither a requirement nor an obligation for PHAs, it is however encouraged. These objectives represent tremendous opportunities for PHAs to improve their surveillance capabilities. Under the Stage 2 MU regulations for the public health objectives, it is suggested that PHAs perform four (4) new administrative tasks to fully support Stage 2.

The Figure listed below (from the Readiness Guidance document), shows these four administrative tasks and the timeline to develop them (prior to the state of Stage 2, 10/01/2013 for EHs and 01/01/2014 for EPs):

Four New Administrative Tasks for PHAs to support MU2

Top Reasons to Read this Document:

  1. Understand the requirements and terminology from the LHD perspective
  2. As a reminder that you need to get up to speed with your state’s MU Stage 2 plans
  3. You will likely be getting questions from your providers very soon

The Task Force developing the Stage 2 MU Public Health Reporting Requirements consists of representatives from the public health community including: NACCHO, ASTHO, ISDS, CSTE, PHII, NAACCR, State PHAs, AIRA, ONC, CDC, and others.

This is the first of many documents that will be developed by this Task Force. Please consider following the efforts of this group.

For more guidance on meaningful use, visit our website and review the resources: http://www.naccho.org/topics/infrastructure/informatics/resources/meaningful-use.cfm.

Getting ready for Stage 2 MU PH Reporting Requirements by the Meaningful Use Public Health Task Force

The Stage 2 Meaningful Use (MU) “Final Rules” published in the Federal Register on September 4, 2012, required local and state Public Health Agencies (PHAs) to ramp-up their MU capabilities and establish new processes to receive the relevant MU-compliant public health data from eligible providers, prior to the start of Stage 2 MU (10/01/2013 for EHs and 01/01/2014 for EPs). In Stage 2 MU, the capability to submit electronic data for immunizations is in the core or mandatory set for Eligible Professionals (EPs) and the capability to submit electronic data for immunizations, reportable laboratory results, and syndromic surveillance is in the core set for Eligible Hospitals (EHs). In addition, two new public health objectives for EPs have been added to the menu or options set – the capability to report cancer cases to a cancer registry and specific cases to a specialized registry (e.g., birth defects registries, chronic disease registries, traumatic injury registries). PHAs preparing for Stage 2 MU will require guidance to implement the new objectives and processes, such as:

  • Contributing their PHA’s MU capacity information to the proposed Centers for Medicare & Medicaid (CMS) centralized PHA capacity repository (declaration process),
  • Supporting providers (EPs and EHs) for registration of their intent to submit data for a MU objective,
  • On-boarding and accepting ongoing data submission from providers; and,
  • Providing an acknowledgement or a written communication (which may be in electronic format) from the PHA confirming a provider’s registration and achievement of ongoing submission.

The Centers for Disease Control & Prevention (CDC) has facilitated the establishment of the Stage 2 MU Public Health Reporting Requirements Task Force with representatives from the public health community; including: NACCHO, ASTHO, JPHIT, ISDS, CSTE, PHII, NAACCR, State PHAs, AIRA, ONC, CDC, and others. This task force is currently working to frame deliverables that will identify key concepts, task flows and guidance for PHAs to implement the Public Health objectives and associated new business processes required for Stage 2 MU. The task force has already provided recommendations and requirements to CMS for the establishment of the centralized PHA capacity repository which will provide EPs and EHs information on jurisdictional capacity to accept electronic data for Stage 2 MU public health objectives. The task force is developing guidance for PHAs to facilitate the registration of intent by providers, on-boarding and ongoing submission, and the ability to provide acknowledgements to providers. The task force is also developing guidance related to transport protocols for the electronic submission of meaningful use data to PHAs. The task force has created a specialized registry work group to provide guidance on how public health agencies can leverage the specialized registry meaningful use objective to obtain case information on mandated public health reporting information such as birth defects, traumatic injuries, hearing and vision and other public health surveillance information.

The consensus guidance and recommendations developed by this collaborative Public Health task force, currently scheduled to be available by April 2013, will be shared widely with state and local PHAs. PHAs across the nation will be able to adopt this guidance according to their jurisdictional needs to implement the new objectives and processes required for Stage 2 MU. For more information on this task force please visit http://www.phconnect.org/group/ph-reporting-task-force, and if interested in providing meaningful contributions to this work, please email meaningfuluse@cdc.gov