Achieving Meaningful Use IHS Resource and Patient Management

Achieving Meaningful Use: IHS Resource and Patient Management System (RPMS) Interoperability with IIS Cecile Town, Amy Groom, Cheyenne Jim IHS Immunization Program Division of Epidemiology and Disease Prevention CDC NCIRD Immunization Services Division/Program Operations Branch

Indian Health Service (IHS) 2007 U. S. Census: – AI/AN alone or in combination with other races: 4, 429, 514 (1. 5% of U. S. population) Indian Health Service (IHS) system (35 states): – Federal health care provider for eligible AI/AN – Eligibility = member of a federally recognized tribe (560+) – Services via IHS, Tribal and Urban Indian (ITU) facilities – 1. 5 million AI/AN people access IHS-funded services

Indian Health Service Administrative Regions Portland Billings Aberdeen Bemidji California Phoenix Tucson Alaska Nashville Navajo Albuquerque Oklahoma User Population: 1. 5 Million

IHS User Populations, FY 2009

IHS Electronic Health Record • Resource Patient Management System (RPMS) • Utilized by all IHS and most tribal and urban Indian health facilities • Includes immunization component – Clinical decision support (forecasting) – Coverage reports • 3 -27 month old, 2 year old, Adolescent, Influenza (all ages) report • Based on vaccines administered – Reminder/recall lists and letters

Background • In 2009, the Centers for Medicare and Medicaid Services (CMS) established interoperability measures of Electronic Health Record (EHR) meaningful use that can be demonstrated by submission of electronic immunization data to IIS.

Meaningful Use and IHS

ARRA Objectives for IHS • IHS Office of Information Technology (OIT) objectives for its ARRA funding include: – Contribute to the revitalization of the American economy • Significant expansion in the use of information technology (IT) service companies and significant purchases of hardware from U. S. based IT companies • Job creation – Deploy a certified EHR that meets the requirements of meaningful use (MU) – Implement a personal health record (PHR) tool – Upgrade the reliability, redundancy, and security of the IHS network • Ensure an adequate telemedicine infrastructure

MU and IHS • IHS is ahead of the curve with some of the Meaningful Use requirements – RPMS EHR deployment is consistent with the Meaningful Use goal of increasing EHR adoption across the U. S. – Public Health surveillance –IHS has conducted syndromic surveillance for influenza-like illness since 2009 – Electronic clinical quality reporting - since 2002 IHS has been reporting clinical quality measures with the Clinical Reporting System (CRS) – IHS has ongoing relationships with ONC and CMS

Non-RPMS Sites and MU Each EHR vendor is responsible for ensuring that its products are certified and capable of supporting Meaningful Use; IHS accepts this responsibility for the RPMS EHR – Non-RPMS sites will be dependent upon certification of their commercial-off-the-shelf (COTS) products

IHS Data Exchange Initiative A bidirectional HL 7 batch interface between RPMS & SIIS using: • IHS data exchange software (BYIM) • HL 7 Communications Bridge – HTTPS transport Benefits of Interface: – Facilities can continue to use the RPMS as their primary information source – Eliminates need for double data entry – Data can be pulled from the IIS directly into individual RPMS records – The bridge software automates the exchange, saves time, provides interface continuity

Setting • The IHS National Immunization and Information Technology Programs work closely with IIS personnel, software programmers and ITU facility staff to establish and maintain functional interfaces. • ITU clinics utilizing the IHS RPMS can use the IHS interface software to demonstrate meaningful use through submission of test immunization messages in states with an IIS that can accept HL 7 uploads.

Population • As of 2009, roughly 30% of patients served by IHS facilities were enrolled in Medicaid, and most eligible IHS providers and hospitals are expected to apply for Medicaid meaningful use incentives • By April 2011, IHS providers and hospitals will determine whether they will apply for Medicare Meaningful Use incentives in 2011

Immunization Submission Requirements, 2011: - Medicare eligible providers need to use a certified EHR to successfully send one valid HL 7 test message from their certified EHR system to a state immunization registry by 12/31/2011. - Medicaid eligible providers need only adopt, implement, or upgrade an EHR system in their first year of participation.

Qualifying for Medicare vs. Medicaid • Certain types of providers in a free-standing ambulatory care clinic may qualify for either Medicare or Medicaid (but not both). – Medicaid eligible - hospital and provider must meet patient volume requirements. Hospitals must have a 10% patient volume and most providers must have a 30% patient volume. – IHS is encouraging providers to seek Medicaid incentives where possible • Requirement less stringent this year • Incentive pays are higher: $18 K Medicare vs. $21. 25 K Medicaid for 2011

Qualifying for Medicare vs. Medicaid • Acute care hospitals may qualify for both Medicare and Medicaid incentives and critical access hospitals qualify for the Medicare incentives. – There are 42 IHS hospitals. All may seek Medicare incentives in 2011. – 19 of 42 (45%) currently export immunization data to their state IIS – 15 of 42 (36%) hospitals will be exempt – 8 of 42 (19%) hospitals are in states with pending data exchange and can attest if test messages are submitted by July 1, 2011.

IHS Data Exchange 2011 AK WA ME MT ND VT MN OR N Y WI ID CT PA IA NV IL NE KS NJ DC OH IN MO DE W V UT CO RI MI SD WY MA NH VA KY CA MD NC TN AZ OK NM SC AR MS San Diego County IIS AL States w/non. Federally Recognized Tribes or No Tribes (16) GA TX LA FL Two Way Exchange (12) Pending Exchange (5) One Way Exchange (2) ITU State, No Exchange (16) Current IHS Immunization Data Exchange Operations

Total I/T/U facilities engaged in data exchange: 63 • • AK – 13 AZ – 12 • CA – 1 • ID - 1 • LA – 1 • ME - 1 • MN – 4 • • MS - 1 MT – 8 UT - 1 WA – 10 WI - 5 WY- 1 SD – 4 (pending)

IHS MU Attestation 2011 Current Exchange, Can Attest (12) AK Exempt (12) WA ME MT ND VT MN OR N Y WI ID CT WY PA IA NV NE IL CA KS DC IN MO DE W V VA KY OK NM SC AR MS San Diego County IIS MD NC TN AZ NJ OH UT CO RI MI SD MA NH AL States w/non. Federally Recognized Tribes or No Tribes (17) GA TX LA FL Pending Exchange, Can Attest (11) Current IHS Immunization Data Exchange Operations

Results • Currently, there are 232 ITU facilities in 34 states, with 63 (27%) facilities exchanging immunization data with 14 IIS. • 2011 - RPMS will interface with 19 of 35 (54%) possible IIS. • IHS facilities can now attest for Meaningful Use in 12 states • Medicare eligible IHS providers and hospitals will be able to attest in 11 additional states in 2011 • Interface discussions are underway in half of the ‘Exempt’ states.

Lessons Learned • Processes yet to be defined: IIS and IHS • Transport driving tests in environments less ideal for production messaging • Message submission: MU vs. production – Time – Personnel • IIS Vendors developing to MU Phases

Next Steps • Continue roll-out in states with new interfaces • Initiate interfaces in states with Medicare incentive priority • Continue development of IHS interface – HL 7 2. 5. 1 – Real-time – Web services transport • Plan for 2012 Medicaid MU

Acknowledgements • Joanne Hawkins, IHS HQ MU Consultant • IHS Area Meaningful Use Coordinators & Consultants • IHS Area Immunization Coordinators • SIIS Partners