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PUBLIC HEALTH ADVISORY CONCERNING FENTANYL AND FENTANYL-LACED SUBSTANCES

Public Health Reporting using Certified Electronic Health Record Technology (CEHRT)

The Tennessee Department of Health collects health information to prevent and contain outbreaks, analyze population health trends, track immunization rates, track infectious diseases, and educate and promote healthy choices for the people of Tennessee. Public health reporting incentives provided by Medicaid and Medicare Electronic Health Record (EHR) Incentive Program (aka Meaningful Use) and the Medicare Merit-based Incentive Payment System (MIPS) programs are prompting increased partnerships between TDH and health care providers capable exchanging public health information electronically.

Because of increased EHR adoption, public health reporting requirements can be more rapidly and easily reported to TDH. The process to exchange data begins when a potential trading partner registers with TDH expressing their intent to exchange data electronically using the Trading Partner Registration (TPR) system. Training is provided to help potential trading partners register – click here to see available schedule. 

Merit-based Incentive Payment System (MIPS)

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced three programs (the Medicare Electronic Health Record (EHR) Incentive Program, the Physician Quality Reporting System (PQRS), and Value-based Payment Modifier) with the Quality Payment Program.

There are two ways to take part in the Quality Payment Program:

The Advancing Care Information category of MIPS replaces the Medicare MU program and is intended to promote patient engagement and electronic exchange of information using Certified Electronic Health Record Technology (CEHRT). Advancing Care Information is 25% of the MIPS final score. The option used to submit data is based on CEHRT edition:

Option 1: Advancing Care Information Objectives and Measures

·         If you have technology certified to the 2015 Edition: or 

·         If you have a combination of technologies from 2014 and 2015 Editions that support these measures.

·         TDH is participating in the following public health reporting measures for eligible clinicians in this option:

·         Immunization Registry Reporting

·         Public Health Reporting (Cancer Case Reporting)

Option 2: 2017 Advancing Care Information Transition Objectives and Measures

·         If you have technology certified to the 2015 Edition: or 

·         If you have technology certified to the 2014 Edition: or 

·         If you have a combination of technologies from 2014 and 2015 Editions that support these measures.

TDH is participating in the following public health reporting measures for eligible clinicians in this option:

·         Immunization Registry Reporting

·         Public Health Reporting (Cancer Case Reporting)

Meaningful Use Summary

The American Recovery and Reinvestment Act of 2009 (ARRA) (Pub. L. 111–5) amended Titles XVIII and XIX of the Social Security Act (the Act) to authorize incentive payments to Eligible Professionals (EPs), Eligible Hospitals (EHs), Critical Access Hospitals (CAHs) and Medicare Advantage (MA) organizations to promote the adoption and meaningful use of Certified Electronic Health Record Technology (CEHRT).

Doctor looking at Xray

Meaningful Use (MU) is using certified EHR technology to

  • Improve quality, safety, efficiency and reduce health disparities
  • Engage patients and families in their healthcare
  • Improve care coordination
  • Improve population and public health

NOTE: The Medicare EHR Incentive Program for returning eligible professionals (EPs) ended with the 2016 reporting period.

Eligible hospitals and EPs that attest directly to a state for the state’s Medicaid EHR Incentive Program will continue to attest to the measures and objectives as finalized in the 2015 EHR Incentive Programs Final Rule (80 FR 62762 through 62955).

TDH Declaration of Readiness for Public Health Reporting 

As of July 1, 2017, TDH is declaring readiness for the following Public Health Reporting objectives and measures. MU EHR Incentive Program and MIPS/Advancing Care Information providers should check here periodically for updates to TDH’s Public Declaration of Readiness to receive data from Certified Electronic Health Record Technology (CEHRT).

Requirements and references are listed for your convenience. 

Electronic Case Reporting (eCR) is the automated generation and transmission of case reports from an electronic health record (EHR) to the public health agency’s disease surveillance system for review and action. eCR will allow healthcare providers the opportunity to report suspected cases to TDH for further investigation using an electronic health record (EHR) system rather than manually reporting on paper and waiting on lab test results to confirm a suspected case. The eCR will capture critical clinical and demographic patient data from Certified Electronic Health Record Technology (CEHRT) not otherwise included in laboratory reports. Utilizing eCR will reduce the burdensome paper-based and labor-intensive administrative process reporters face in reporting and responding to public health’s requests for additional information.

Electronic Case Reporting Measure

TDH will declare readiness for eCR in January 2018 under the Public Health Reporting Objective and begin accepting eCR in July of 2018 from pilot partners. Currently, TDH is actively developing requirements and documentation to begin pilot testing with selected trading partners. Eligible providers and eligible hospitals interested in eCR pilot testing in 2018 can email us directly at CEDS.Informatics@tn.gov for more information.

EHR Incentive Programs support the adoption and meaningful use of certified EHR technology to allow providers to exchange public health information electronically. TDH is currently accepting electronic reportable laboratory results from eligible hospitals (EHs) and eligible clinical access hospitals (CAH) only. 

The MU EHR Incentive Program requires EHs and CAHs to be in active engagement with public health to send electronic reportable laboratory results from CEHRT, except where prohibited, and in accordance with applicable law and practice.

Note: The time until live data exchange varies and depends upon the quality and speed of data exchange testing.

Send inquiries to CEDS.Informatics@tn.gov

EHR Incentive Programs support the adoption and meaningful use of certified EHR technology to allow providers to exchange public health information electronically. TDH is currently accepting syndromic surveillance data from Eligible Hospitals (EHs) with an emergency department only.

The MU EHR Incentive Program requires EHs to be in active engagement with public health to submit syndromic surveillance data from CEHRT, except where prohibited, and in accordance with applicable law and practice.

Note: The time until live data exchange varies and depends upon the quality and speed of data exchange testing. At this time, TDH is not accepting syndromic surveillance data from any eligible professionals.

Send inquiries to CEDS.Informatics@tn.gov.

EHR Incentive Programs support the adoption and meaningful use of certified EHR technology to allow providers to exchange public health information electronically. TDH is currently accepting immunization data from EPs, EHs, and CAHs. 

Modified Stage 2

Stage 3 (2017 Optional)

 

2014 CEHRT

2015 CEHRT

 

HL7 Version 2.5.1: Implementation Guide for Immunization Messaging, Release 1.4

 

HL7 Version 2.5.1: Implementation Guide for Immunization Messaging, Release 1.5 (October 2014) and Addendum (July 2015). Includes the ability to respond to bidirectional queries and the capacity to receive NDC codes.

 

The MU EHR Incentive Program and the MIPS Advancing Care Information program require EPs, ECs, EHs, and CAHs to be in active engagement with public health to submit immunization data from CEHRT except where prohibited and in accordance with applicable law and practice.

Note: The time until live data exchange varies and depends upon the quality and speed of data exchange testing.

Send inquiries to TennIIS.MU@tn.gov. Your points of contact will be Nicole Haas or Sarah Rudd. 

EHR Incentive Programs support the adoption and meaningful use of certified EHR technology to allow providers to exchange public health information electronically. TDH is currently accepting immunization data from EPs, EHs, and CAHs.

Modified Stage 2 (Specialized Registry Reporting)

Stage 3 (2017 Optional)

 

2014 CEHRT

2015 CEHRT

 

Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries, HL7 Clinical Document Architecture (CDA), (August 2012)

Cancer Case Reporting is a part of the Public Health Registry Reporting measure in stage 3 for EPs; however TDH is not participating in Cancer Case Reporting for optional Stage 3 in 2017.

 

The MU EHR Incentive Program requires EPs to be in active engagement with public health to submit data to a specialized registry from CEHRT except where prohibited and in accordance with applicable law and practice.

Note: The time until live data exchange varies and depends upon the quality and speed of data exchange testing.

Send inquiries to TNCancer.Registry@tn.gov.


TDH will declare readiness for eCR in January 2018 under the Public Health Reporting Objective and begin accepting eCR in July of 2018 from pilot partners. Currently, TDH is actively developing requirements and documentation to begin pilot testing with selected trading partners. Eligible providers and eligible hospitals interested in eCR pilot testing in 2018 can email us directly at CEDS.Informatics@tn.gov for more information.​

TDH also continues to onboard trading partners capable of implementing bidirectional immunization reporting requirements for HL7 2.5.1 following the 1.5 implementation guide now. For questions related to Immunization Registry Reporting, contact TennIIS.MU@tn.gov.

MU EHR Incentive Program and MIPS/Advancing Care Information providers should check here periodically for updates to TDH’s Public Declaration of Readiness to receive data from Certified Electronic Health Record Technology (CEHRT). For questions related to the TDH Declaration of Readiness, contact the TDH Meaningful Use Coordinator at (615) 253-8945 or MU.Health@tn.gov.  

TDH Public Health Reporting Procedures

In the MU EHR Incentive Program’s for 2015 through 2017 proposed rule 80 FR20366, CMS highlighted their intention to align with the Stage 3 proposed rule and remove the term “ongoing submission” and replace it with an "active engagement" requirement. Active engagement may be demonstrated by any of the following options:

The EP, EH or CAH registered to submit data with the PHA or, where applicable, the CDR to which the information is being submitted; registration was completed within 60 days after the start of the EHR reporting period; and the EP, eligible hospital, or CAH is awaiting an invitation from the PHA or CDR to begin testing and validation.

In Tennessee, the onboarding process to exchange data with the Tennessee Department of Health (TDH) begins when a potential trading partner registers with TDH expressing their intent to exchange data electronically.

The Trading Partner Registration (TPR) system allows potential trading partners to register for Immunization Messaging (new registrations), Cancer Case Reporting, Electronic Laboratory Reporting (ELR) and Syndromic Surveillance Messaging (Eligible Hospitals w/Emergency Room) in one location. TPR provides documentation that can be utilized for Meaningful Use attestation and allows users to view their progress from end to end through the use of milestone letters documenting on-boarding progress. Click here to download the TPR Worksheet.

Also displayed within the TPR organizational profiles are requests for actions. TDH expects the responses of potential trading partners to requests for actions to be applicable with moving the trading partner to a production status. TDH reserves the right to disengage in onboarding activates with any trading partner, at any time, due to consistent problems associated with reporting requirements, and file specifications in accordance published national standards. The trading partner’s active engagement status will be provided in the TPR system under the Interface Details tab.

Click here to see a listing of training dates and times. To receive the TPR webinar details, you must complete the registration form found at http://tn.gov/health/calendar. If the requested date/time is available, you will receive an email invitation with the conference phone number and webinar link. If you do not receive an email within 2 business days send an email to mu.health@tn.gov.

The EP, EH or CAH is in the process of testing and validating of the electronic submission of data. Providers must respond to requests from the PHA or, where applicable, the CDR within 30 days; failure to respond twice within an EHR reporting period would result in that provider not meeting the measure.

The TDH interfaces will invite the EPs, EHs or CAHs to begin submitting test messages. TDH staff will validate the messages and provide information needed to correct errors or omissions. The testing procedures and requirements will vary between TDH interfaces and will depend upon which stage of the Meaningful Use process is being completed. The testing and validation process will continue until the onboarding team states the messages have met the requirements. The trading partner’s active engagement status will be provided in the TPR system under the Interface Details tab.

The EP, eligible hospital, or CAH has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDR.

Appropriate TDH program staff will indicate that testing has been successfully completed and data is being sent to the TDH production system. TDH may communicate with those reporting electronically about data quality. The trading partner’s active engagement status will be provided in the TPR system under the Interface Details tab. 

Preferred Secure Transport Methods

Below are the currently preferred transport methods for each Public Health objective. Additional mechanisms might be available for each objective and can be discussed upon establishment. 

Interface

Secure File Transport Protocol (SFTP)

Web Services (using the TDH WSDL)

Direct Messaging

Immunization Registry

Yes

Yes

No

Electronic Laboratory Reporting

Yes

No

No

Cancer Case Reporting

Yes

No

Yes

Syndromic Surveillance (EHs w/Emergency Department)

Yes

No

No

If you have MU or MIPS questions, please contact MU.Health@tn.gov