The Electronic Health Record (EHR) Incentive Programs administered by the Centers for Medicare and Medicaid Services provide financial compensation for the "Meaningful Use" of certified EHR technology to achieve health and efficiency goals. The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use:
- The use of a certified EHR in a meaningful manner, such as e-prescribing.
- The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
- The use of certified EHR technology to submit clinical quality and other measures.
The Massachusetts Department of Public Health (MDPH) is actively working with eligible professionals (EPs) and eligible hospitals (EHs) to help them meet the required public health objectives in order to qualify for Meaningful Use incentives.
Stage 1 Meaningful Use
The final rule for Stage 1 Meaningful Use requires eligible professionals and eligible hospitals to choose at least one public health objective from the set of menu objectives, which includes electronically submitting one of the following:
- Immunization Information
- Reportable Electronic Laboratory Results (eligible hospitals only)
- Syndromic Surveillance
Stage 2 Meaningful Use
For Stage 2 Meaningful Use (2014 Rules), requirements include
- On-going submission of electronic data for immunizations in the core (mandatory) set for eligible professionals
- On-going submission of electronic data for immunizations, reportable laboratory results and syndromic surveillance in the core set for eligible hospitals
- In addition, eligible professionals have menu (optional) objectives for supporting specialized registries. MDPH will be collecting data for its Cancer Registry and for a registry collecting infectious disease case report data.
Stage 3 Meaningful Use
For Stage 3 Meaningful Use (2015 CEHRT), Public Health and Clinical Data Registry Reporting fall under Objective 8. To qualify for this objective in 2018 (optional in 2017), eligible hospitals (EH) and critical access hospitals (CAH) must meet 4 of the following measures, while eligible professionals must meet 2.
Measures included under this objective are:
- Measure 1- Immunization Registry Reporting
- Measure 2 - Syndromic Surveillance Reporting
- Measure 3 - Specialized Registry Reporting
- Measure 3- Electronic Case Reporting (For Stage 3 in 2018 only)
- Measure 4 - Electronic Reportable Laboratory Results Reporting
- Measure 4 - Public Health Registry Reporting(For Stage 3 only)
- Measure 5 - Clinical Data Registry Reporting
- Measure 6 - Electronic Reportable Laboratory Results
The Immunization Program of the MDPH launched the Massachusetts Immunization Information System (MIIS), a statewide immunization registry, in 2010. The MIIS is currently available to receive electronic messages from eligible providers for Meaningful Use purposes. The MIIS accepts electronic immunization messages (VXU) in the HL7 2.5.1 format from certified electronic health record systems. Detailed technical specifications and other information for electronically exchanging data with the MIIS are available at www.mass.gov/dph/miis via the link Information for Providers. Additional technical information is available upon request.
The state-wide Health Information Exchange (Mass HIway) will serve as the infrastructure to accept data from existing EHR systems in real time, eliminating the burden of duplicate entry into your system and into MIIS. The Mass HIway accepts HL7 version 2.5.1 messages and fulfills the applicable Meaningful Use measure. To learn about how to enroll in the Mass HIway visit: www.masshiway.net.
Please note that pursuant to M.G.L. Chapter 111, Section 24M all licensed health care providers that administer immunizations are required to report immunization data to the MIIS.
For more information, and to formally register intent to submit immunization data, please contact the MIIS Help Desk: 617-983-4335 or firstname.lastname@example.org.
Electronic Laboratory Reporting (ELR)
Electronic Laboratory Reporting is a secure, automated mechanism for the reporting of laboratory and patient information by hospitals and commercial laboratories. Automated entry of laboratory information for reportable conditions via ELR facilitates accurate and timely detection of concerning trends and saves time associated with manual data entry or paper laboratory reporting. ELR is mandated in accordance with 105 CMR 300.170 (Laboratory Findings Indicative of Infectious Disease reportable Directly to the Department by Laboratories). For more information please contact ELR.CDSupport@state.ma.us
The MDPH ELR portal meets Meaningful Use Stage 2 (2014 Rules) requirements as of October 1, 2013. Hospitals currently submitting ELR data to MDPH meet Meaningful Use requirements; no change in reporting method is required to meet the ELR objective.
MDPH is able to transform messages currently sent from hospitals (in HL7 2.3.1 or SMF formats) to HL7 2.5.1 format; MDPH also accepts HL7 2.5.1 messages. A copy of the Meaningful Use certificate and a letter stating that the hospital routinely sends electronic laboratory reports to MDPH will be provided to all data providers upon request.
MDPH offers umbrella certification for all eligible hospitals currently submitting electronic laboratory reports. These hospitals will be viewed as having formally registered intent to submit ELR for the purposes of Meaningful Use.
For more information, please contact: Sita Smith, HIE Coordinator, Office of Integrated Surveillance and Informatics, BID, MDPH (email@example.com , telephone: 617-983-6547).
Massachusetts Department of Health (MDPH) is currently accepting syndromic surveillance data from eligible hospital emergency departments only. For Stage 3 MU, MDPH will accept urgent care syndromic surveillance data from eligible hospitals and freestanding urgent care facilities beginning January 2017.
Eligible Professionals (EPs) not practicing in a freestanding urgent care facility may claim exclusion for this measure because the MDPH will only accept urgent care syndromic surveillance data from eligible hospitals and freestanding urgent care facilities. Take a screenshot of the MDPH Meaningful Use webpage (www.mass.gov/dph/meaningfuluse) for documentation of this exclusion.
Successful attestation for this measure requires registration of intent to submit syndromic data within 60 days of start of the reporting period and one of the following: 1) has achieved ongoing submission, 2) is engaged in testing and validation or 3) is awaiting invitation to begin testing and validation.
MDPH participates in the National Syndromic Surveillance Program (NSSP) and utilizes ESSENCE for aggregation and analysis of syndromic surveillance data; data are held in the Amazon Cloud. The state-wide Health Information Exchange (Mass HIway) serves as the infrastructure to aggregate and send data to the NSSP. This data transmission is in accordance with the standards set forth by the Office of the National Coordinator in order to meet Meaningful Use requirements.
Syndromic surveillance data should comply with the PHIN Messaging Guide for Syndromic Surveillance.
For programmatic information about Syndromic Surveillance and to register intent to submit Syndromic Surveillance data for Meaningful Use, please contact the Massachusetts Department of Health Syndromic Surveillance coordinator at: Syndromic@MassMail.State.MA.US
In support of physician cancer reporting and Stage 2 Meaningful Use (MU2), the Massachusetts Cancer Registry (MCR) will be implementing electronic reporting from certified electronic health record (EHR) systems. EHR reporting is designed to be secure, automated, and unobtrusive to practice operations. Successful ongoing submission to the MCR using this EHR reporting method will assist eligible professionals in receiving Medicare and Medicaid incentive funds.
Reporting will be accepted from EHR software certified by an ONC-Authorized Testing and Certification Body and will be in accordance with the Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries (August 2012). If you are interested in reporting to the MCR using a certified EHR, or have questions please Susan T. Gershman (firstname.lastname@example.org). Please check this website for future updates.
For EPs in Stage 3 during 2017, the MCR will begin accepting submissions on January 1, 2017 from 2015-certified EHR technology in accordance with the updated HL7 CDA ® Release 2 Implementation Guide: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1, DSTU Release 1.1 – US Realm. We will continue to also accept submissions from 2014-certified EHR technology during 2017. EPs in Stage 3 during 2017 have a 90-day reporting period, and those in Stage 2 have a full-year reporting period. Register for reporting to the MCR by the 60th day of your reporting period. Please contact email@example.com .
Among the menu items for achieving compliance with Meaningful Use Stage 2 requirements is the attestation of the eligible professional (EP) that they have “the capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice”. The Bureau of Infectious Disease Prevention (BID) at the Massachusetts Department of Public Health (MDPH) has implemented electronic infectious disease case reporting into a specialized registry.
If you are interested in electronically reporting notifiable infectious disease reports, the only currently validated way of sending these data is via ESP, the Electronic medical record Support for Public health (ESP) project, which is an automated software application that analyzes electronic health record (EHR) data to identify and report conditions of interest to public health. Detailed information about ESPnet is available at http://esphealth.org.
The process involves implementing a series of case detection algorithms embedded in ESP to identify specific diseases (acute hepatitides, chlamydia, gonorrhea, syphilis, and active TB) which are then sent securely to the BID Health Information Portal and to the specialized registry, the Massachusetts Virtual Epidemiologic Network (MAVEN). MAVEN may already contain laboratory results on these individuals, but the EMR contributes important additional information including diagnostic codes, symptoms, treatment, and pregnancy status.
At the moment, only systems which use ESPnet are sending BID EMR data. Providers could choose to use ESP or use alternative software (like eCW) to send us the reports, but in the latter case, 1) there would have to be some built in logic that could apply the case selection algorithms and 2) the methodology would need to be validated by MDPH and 3) messages would have to be in HL7 XML format.
Bringing provider organizations on board is very resource intensive, so MDPH has chosen to limit onboarding via a threshold based on the incidence of reportable conditions seen by providers over a twelve-month period.
For Eligible Professionals: if the combined numbers of cases of syphilis, gonorrhea, chlamydia, acute hepatitides and active tuberculosis seen at your facility are greater than 1000 in the most recent 12 month period, please contact Sita Smith at Sita.C.Smith @state.ma.us to discuss registering intent to submit case reports to the infectious disease specialized registry.
If your reporting threshold is for these selected diseases is less than 1000 in a 12 month period, you are not eligible to participate. Take a screenshot of the MDPH Meaningful Use webpage (http://www.mass.gov/dph/meaningfuluse) to document this for exclusion.
The Massachusetts Department of Health (DPH) and the Mass HIway have partnered to transition all public health data reporting to the secure, statewide health information exchange (HIE). The key goals of this are to automate the data import process, simplify the administrative process, and remove as many manual interventions on the data as possible. This can also reduce cost for providers by maintaining fewer reporting interfaces. So while there is no specific requirement in Meaningful Use to use an HIE for public health reporting, over time the only way providers will be able to transmit to the Massachusetts DPH will be over the Mass HIway. For more information about the Mass HIway and how to enroll, please visit www.masshiway.net.