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.
- 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 – Public Health Measures
For Stage 3 Meaningful Use (MU), Public Health and Clinical Data Registry Reporting fall under Objective 8. To qualify for this objective in 2018 (optional in 2017), eligible providers (EP), eligible hospitals (EH) and critical access hospitals (CAH) must demonstrate active engagement with a public health agency.
EPs attesting to Stage 3 MU (optionally in 2017 or in 2018 and beyond) have five measure options, from which they must select two:
- Measure 1 – Immunization Registry Reporting: The EP is in active engagement with a public health agency to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS).
- Measure 2 – Syndromic Surveillance Reporting: The EP is in active engagement with a public health agency to submit syndromic surveillance data from an urgent care setting.
- Measure 3 – Electronic Case Reporting: The EP is in active engagement with a public health agency to submit case reporting of reportable conditions.
- Measure 4 – Public Health Registry Reporting: The EP is in active engagement to submit data to public health registries.
- Measure 5 – Clinical Data Registry Reporting: The EP is in active engagement to submit data to a clinical data registry.
EHs and CAH attesting for Stage 3 MU (optionally in 2017 or 2018 and beyond) have six measure options from which they must select four:
- Measure 1 – Immunization Registry Reporting: The EH or CAH is in active engagement with a public health agency to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system
- Measure 2 – Syndromic Surveillance Reporting: The EH or CAH is in active engagement with a public health agency to submit syndromic surveillance data from an urgent care or emergency department setting.
- Measure 3 – Electronic Case Reporting: The EH or CAH is in active engagement with a public health agency to submit case reporting of reportable conditions.
- Measure 4 – Public Health Registry Reporting: The EH or CAH is in active engagement to submit data to public health registries.
- Measure 5 – Clinical Data Registry Reporting: The EH or CAH is in active engagement to submit data to a clinical data registry.
- Measure 6 – Electronic Reportable Laboratory Result Reporting: The EH or CAH is in active engagement with a public health agency to submit electronic reportable laboratory (ELR) results.
Measure 1- Immunization Reporting
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.
Measure 2 – Syndromic Surveillance Reporting
Massachusetts Department of Health (MDPH) is accepting syndromic surveillance data from eligible hospital emergency departments. As of January 2017, MDPH began accepting urgent care syndromic surveillance data from eligible hospitals and freestanding urgent care facilities.
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
Measure 3 – Electronic Case Reporting
The Digital Bridge is a multi-jurisdictional approach to electronic case reporting (eCR), coordinated by the CDC (http://www.digitalbridge.us/). Massachusetts is a pilot state, to test the implementation of electronic initial case reporting (eICR) of a limited dataset, and will be able to accept eICR on January 1, 2018. The eICR will conform to the HL7 standard referenced below.
Consistent with the pilot parameters of the Digital Bridge collaboration, Massachusetts will accept case reports for chlamydia, gonorrhea, zika, pertussis and salmonellosis. The specifications and processes of the eICR are still under development. Further details of how to engage with MDPH will be made available on this website in October 2017. In the meantime, please contact ELR.CDSupport@State.MA.US with any questions.
MDPH will be complying with the HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 2 - US Realm - the Electronic Initial Case Report (eICR)
Measure 4 - Public Health Registry Reporting
What was previously known as the Specialized Registry Reporting measure in Stage 2 will be split into two separate measures for Stage 3 MU. The new measures define the following registries:
• A Public Health Registry is defined as one that is administered by, or on behalf of, a local, state, territorial, or national public health agency and which collects data for public health purposes. For the purposes of Stage 3 MU, cancer case reporting for eligible professionals will fall under the Public Health Registry Reporting measure.
• A Clinical Data Registry is defined as one that records information about the health status of patients and the health care they receive over varying periods of time and is administered by, or on behalf of, other non-public health agency entities.
Public Health Registry - Cancer Registry
The Massachusetts Cancer Registry supports cancer reporting from ambulatory providers/EPs to help meet Meaningful Use (MU) objectives.
Modified Stage 2 MU: MDPH accepts Modified Stage 2 reporting during 2017. The Cancer Registry falls under Measure 3 Specialized Registry Reporting. An EHR must meet the 2014 certification criteria 170.314(f)(5) and (f)(6) in order to be CEHRT for cancer reporting. An Implementation Guide is available here: https://www.cdc.gov/phin/resources/guides/documents/implementation_guide_for_ambulatory_healthcare_provider_reporting_to_central_cancer_registries_august_2012.pdf .
Stage 3 MU: MDPH accepts Stage 3 reporting during 2017 (early adopters of Stage 3) and during 2018. The Cancer Registry falls under Measure 4 Public Health Registry Reporting. An EHR must meet the 2015 certification criteria 170.315(f)(4) in order to be CEHRT for cancer reporting. An Implementation Guide is available here: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=398 .
If you diagnose and/or treat cancer patients in an ambulatory setting in Massachusetts and would like to report cancer cases for MU, register with the Massachusetts Cancer Registry by the 60th day of your reporting period. For registration or questions, please contact the Cancer Registry’s Director, Susan Gershman, at email@example.com.
Public Health Registry - Infectious Disease Registry
The Bureau of Infectious Disease and Laboratory Sciences (BIDLS) at the Massachusetts Department of Public Health (MDPH) has implemented enhanced disease surveillance through which relevant longitudinal clinical information is submitted to MDPH.
For Stage 3 MU, the infectious disease registry is declared a public health registry and is distinct from electronic case reporting. The infectious disease registry collects an expanded dataset of relevant patient information longitudinally, whereas electronic case reporting collects the data elements currently defined as an initial case report. Data derived from electronic health records (EHRs) contribute important information and supports monitoring of public health outcomes.
Currently the only validated mechanism for sending data to the infectious disease registry is via ESP, the Electronic medical record Support for Public health (ESP), an automated software application that analyzes electronic health record (EHR) data to identify and report conditions of interest to public health. Detailed information about ESP is available at www.esphealth.org.
The process involves implementing a series of case detection algorithms embedded in ESP to identify specific diseases which are then sent securely to the infectious disease registry, the Massachusetts Virtual Epidemiologic Network (MAVEN). Currently, BIDLS only receives EHR data from systems using ESP. Providers may choose to use ESP or use alternative software (like eCW) to send MDPH reports, but in the latter case, 1) there would have to be some built in logic that could apply the case selection algorithms, 2) the methodology would need to be validated by MDPH, and 3) messages would have to be in HL7 XML format, and submitting facilities would have to take responsibility for keeping detection algorithms up-to-date and the on-going validation of data.
Bringing provider organizations on board is very resource intensive, so MDPH is prioritizing onboarding of entities under contract with BIDLS for certain infectious disease prevention, screening, and linkage to treatment programs. For entities not contracted by BIDLS, prioritization for onboarding is based on the incidence of reportable conditions seen by providers over a twelve-month period.
For Eligible Providers: if the combined numbers of cases of HIV, syphilis, gonorrhea, chlamydia, hepatitis A, B, or C and tuberculosis seen at your facility are greater than 1000 in the most recent 12 month period, please contact ELR.CDSupport@state.ma.us. You will receive Stage 3 MU credit for the Public Health Registry option if you register your intent to submit data and engage with MDPH by January 1, 2018.
If you are not contracted by BIDLS and your reporting threshold for these selected diseases is less than 1000 in a 12 month period, you are not eligible to participate. Take a screenshot of the relevant section of the MDPH Meaningful Use webpage (http://www.mass.gov/dph/meaningfuluse) to document this for exclusion.
Measure 5 – Clinical Data Registry Reporting
The Massachusetts Department of Public Health does not currently support any Clinical Data Registries for Meaningful Use purposes.
Measure 6 - 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 BIDLS ELR portal has met Stage 2 MU (2014 Rules) requirements since October 1, 2013 and will meet Stage 3 MU requirements as of January 1 2018. Hospitals currently submitting ELR data to BIDLS meet Meaningful Use requirements; no change in reporting method is required to meet the ELR objective.
The portal is able to transform messages currently sent from hospitals (in HL7 2.3.1 or SMF formats) to HL7 2.5.1 format; BIDLS 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 will be provided to all data providers upon request.
BIDLS 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 ELR.CDSupport@state.ma.us.
The Massachusetts Department of Health (MDPH) 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. For more information about the Mass HIway and how to enroll, please visit www.masshiway.net.
This information is provided by the Massachusetts Department of Public Health.