Michigan Care Improvement Registry’s Experience with Interoperability and Meaningful Use Bob Swanson, MPH Director, Division of Immunization
Current HL7 Status Stage 1 MU (9237 eligible professionals and 116 hospitals) January 2011 March 2012 production for HL7 2.51 VXU 28 EHR Vendors approved to send VXU’s to MCIR These sites are listed on MCIR.org
Testing Query By Parameter 2.51 (Bi-directional) 1323 provider sites including pharmacies and hospitals submitting VXU’s through the HIE to MCIR
Current Onboarding Status 2.5 FTE’s onboarding staff (Medicaid and PPHF funds) 1 FTE for meaningful use registration (Medicaid) Over 300 onboarding sites in the que
HIE Participation Started with two connections to MCIR (IIS) HTTPS to MCIR (Temporary URL) One Qualified Organization (sub-state HIE) sending data
Now there are 5 Qualified Organizations sending data In January 2014, we discontinued using the Temporary URL all providers must register with an HIE to send VXU’s to MCIR
Lessons Learned Communication and Cooperation Regular meetings, weekly or biweekly with the partners involved Managing ACKS from the HIE’s to the providers IIS downtime (scheduled maintenance) Where’s my message? (Communication Plan) Timeliness (what does the IIS expect?) New way of doing business (letting go)
Benefits of Participating with an HIE MiHIN “throttles” the HL7 messages being sent to MCIR Michigan Health Information Network is recruiting Pharmacies ( Walmart, Walgreens, Meijers, CVS) MCIR Onboarding staff focuses on Data Quality and not transport issues Biweekly stakeholder calls provide updates on current and future enhancements with Michigan Health Information Network.
2012 Interoperability Grant Objectives Overall goals Onboard new providers Assess evidence of changes in reporting to MCIR Measure key immunization data quality metrics Unidirectional Bidirectional
Approach
Evaluation sites selected from MCIR practices across the state Goal: evaluate 200 sites Evaluate 90 days pre-/post HL7
Benefits of HL7 messaging? Improved data quality: timeliness completeness accuracy
Total Number of Doses by Time Elapsed Target List Sites (n = 200) 140,000
Total Number of Doses
120,000 100,000 80,000 60,000
40,000 20,000 0
<=1 days
2-7 days 8-14 days 15-30 days Time Elapsed Since Administration Pre-HL7
Post-HL7
>30 days
Average DQA Scores for Patients <= 18 Target List Sites (n = 200) 100 90
Average Score
80 70 60
50 40 30
20 10 0 DQA Completeness Score
DQA Accuracy Score
Pre-HL7
DQA Timeliness Score
Post-HL7
DQA Overall Score
Average DQA Scores for Patients > 18 Target List Sites (n = 200) 90 80
Average Score
70 60 50 40 30
20 10 0 DQA Completeness Score
DQA Accuracy Score
Pre-HL7
DQA Timeliness Score
Post-HL7
DQA Overall Score
Count of Records for Patients Target List Sites (n = 200) 160,000
Average Number of Records
140,000 120,000 100,000 80,000
60,000 40,000 20,000 0
Electronic Transfer Pre-HL7
Manual Entry Post-HL7
HL7 Benefits Other potential dividends: Improved registry participation more providers reporting adult vaccinations (reporting is not mandated) up-to-date contact information
October 2013
Impact Questions What are HL7 implications for assessment of vaccination status / rates? Local / state health jurisdictions national immunization surveillance and forecasting Provider AFIX assessments
Impact Questions Can HL7 reporting help improve effectiveness of reminder / recall notification? improved timeliness / completeness fewer false notifications improved contact information accuracy more successful outreach
Impact Questions Is real time surveillance feasible for flu pandemics? more sites reporting (pharmacies, etc.) more doses (adults) faster
Could it enable real time, targeted flu vaccination outreach?
Connections to the MDCH Shared Services Master Person Index Found over 14,000 duplicate patient records in MCIR
Health Provider Directory Provider Licensure/ Sanctions
Michigan HL7 Guides and Additional Information Can Be Found at www.MCIR.org
MCIR.org
