Health Project
Resume:
Minnesota e-Health Update
Monthly Call
March **, 2011
Conference Call
Sponsored by:
Minnesota e-Health Initiative
Minnesota Department of Health
Minnesota Department of Human Services
Monthly Update Calls
Purpose of the Calls:
Brief update on issues important to Minnesota Stakeholders
Provide a Q & A opportunity
Compliment other communications activities
Monthly Timing of the Calls
Usually Third Thursday of the Month from 4:00 - 4:45 p.m.
Next Call Scheduled for April 21, 2011
E-mail feedback & suggestions for improvement to
abpdid@r.postjobfree.com
2
Plan for Receiving Questions
From Conference Call Participants
All lines will be muted during the call
E-mail questions to abpdid@r.postjobfree.com at any
time during the presentation
Questions will be addressed following the presentation
Following the call:
Questions will be reviewed and staff will identify future
resource materials to be posted.
3
Reminder
We don t have all the answers but we are very
interested in hearing your questions and your
perspectives.
4
Meeting Agenda
Topic: Direct Immunization Data Exchange in
Minnesota
Minnesota Immunization Information
Connection (MIIC)
Hennepin County Medical Center (HCMC)
Comments and Questions
5
Our Speakers & Panel Members
Emily J. Emerson
Manager/IT Unit Supervisor
Minnesota Immunization Information Connection (MIIC)
Minnesota Department of Health
Kevin Larsen, MD
Chief Medical Informatics Officer
Associate Medical Director
Hennepin County Medical Center
6
Minnesota Immunization
Information Connection (MIIC):
An Update on Current Initiatives
Emily J. Emerson
MIIC Manager/IT Unit Supervisor
March 17, 2011
Topics
MIIC Overview
Direct Project Participation Update
Public Health Reporting on Immunizations
for Meaningful Use
EHR-IIS Interoperability Grant
Future Directions
8
MIIC Quick Stats
MIIC is the statewide immunization
information system; live since May 2002
MIIC contains 5.7 million clients
Over 45 million immunizations
Met Healthy People 2010 goals of 95% of
kids 0-6 enrolled
8,324 active users
Over 2,300 log-ins occur every day
9
Providers in MIIC
Provider Type # enrolled
Primary Care Clinic 803
School 780
Child Care/Headstart/Pre-school 475
Pharmacy 344
Nursing Home/ Long Term Care 271
Hospital 146
Specialty, other 126
Public Health 112
Other 103
OB/Gyn 49
College/University 37
Occupational Health 36
Tribal or IHS Clinic 30
Family Services 26
Correctional facility 23
Home Care/Hospice 22
Health Plan 21
Community Vaccinators 10
10
Data Receipt by MIIC
Direct data entry 14%
Batch file process 83%
Real-time HL7 3%
Time period 1/1/11-3/14/11
- Batch includes flat file format and
HL7 2.3.1 and 2.4.1
- New standard is 2.5.1
11
Direct Project Evolution
Initial meeting of interested stakeholders at MDH (MIIC, OHIT and
ISTM) with HISP Vendor (former Visionshare, now ABILITY) in
Sep 2010
To meet current message transport environment that MDH
supports, decision to use secure PHINMS communication
standard as destination edge protocol
Provider recruitment done by HISP vendor and Hennepin County
Medical Center (HCMC) participated in Direct pilot project
Technical details of transport protocols worked between HISP
vendor and technical teams of sender and receiver
Project went live on January 12, 2011
Currently, HCMC is sending production immunization data to the
MIIC immunization registry using direct project specifications
and using PHINMS as destination protocol, a one direction push
of data
12
Direct Project
HCMC
ABILITY, formerly MIIC
VisionShare
Source: Adapted from Direct Project site
http://wiki.directproject.org/Pilot+Project+Brief+-+VisionShare+and+Public+Health
13
Meaningful Use and Public Health
Reporting for Immunizations
State Immunization Registry (MIIC)
http://www.health.state.mn.us/divs/idepc/immunize/registry/ind
ex.html
MIIC Meaningful Use Fact Sheet
http://www.health.state.mn.us/divs/idepc/immunize/registry/hp
/mu.pdf
National standards and MIIC-specific
requirements available at
http://www.health.state.mn.us/divs/idepc/immunize/registry/h
p/mu.html#6
HL7 Specifications for MIIC
http://www.health.state.mn.us/divs/idepc/immunize/registry/h
p/hl7specs.pdf
14
Meaningful Use and Public Health
Reporting for Immunizations
Successful data submissions to MIIC include those
with all of the following characteristics:
Submitted from a certified EHR technology
Follows MIIC HL7 Version 2.3.1 specifications
Capabilities to accept HL7 2.5.1 under development and
will be ready in Summer 2011
Includes MIIC-accepted CVX codes
Sent to MIIC via a secure transport mechanism
Currently it is PHINMS, secure ftp, or direct upload into
MIIC, but other options are being explored as part of EHR-
IIS interoperability grant
Submissions using direct data entry, electronic transfer from
billing systems, and electronic transfer in flat file format do
not qualify under the meaningful use objective 15
MIIC and MN State Certified HIOs
Agreements in place between
MDH/MN-HIE and MDH-CHIC
HIO s web portal will display IZ of
patients based upon MIIC data
Plans to utilize HL7 real-time
messaging
For additional info on state certified HIOs, refer to
http://www.health.state.mn.us/e-
health/index.html
16
EHR-IIS Interoperability Grant
Minnesota Project Objectives
Project Period: September 2010 August 2012
The MDH received $1.38 million in September 2010
Implement HL7 version 2.5.1 messaging for receiving immunizations
records into MIIC
Establish a secure, more automated standard method of exchanging
HL7 messages
Upgrade MIIC s vaccine forecasting algorithm
Increase the number of electronic interfaces between EHRs and MIIC
Increase provider participation and timeliness of reporting
Enhance the capability of MIIC to meet the public health requirements
of meaningful use related to immunizations
17
Three Paths of EHR-MIIC
Integration:
Data from EHR to MIIC real time
Ability to query MIIC from within
EHR to receive immunization history
and forecast (Alternate Access)
True bi-directional exchange
18
Future Directions
Increasing provider participation and
moving to better electronic exchange
with nationally recommended
standards
Increasing timeliness and
completeness of immunization
reporting
Advanced reports such as
assessment and patient follow up
available to end users
True bi-directional exchange!
19
Acknowledgements
True Team Effort!
MDH Leadership
Marty LaVenture, Director, e-Health and Office of Health IT
Jim Golden, State Government HIT Coordinator
John Paulson, MDH Chief Information Officer
Kris Ehresmann, Director, IDEPC
Margo Roddy, IDEPC/Immunization Program Mgr
MIIC Team
Aaron Bieringer, Steve Felton, Diana Jaeger, Linda Luebchow, Priya
Rajamani, Erin Roche, Linda Stevens, Karen White, Jeff Williams
ISTM Team
Mark Hollock, Gerry Skerbitz, Keith Hammel, Spencar McCaa
HP
David Kaiser, Mike Loula
20
Questions
Emily J. Emerson
MIIC Manager/IT Unit Supervisor
Minnesota Department of Health
abpdid@r.postjobfree.com
21
Direct Project Update
Dr. Kevin Larsen, MD
Chief Medical Informatics Officer
Associate Medical Director
March 17, 2011
22
HCMC & MIIC
HCMC has been sending immunization
data to MIIC for 10+ years
Multiple formats, most recently via
encrypted secure messaging of daily
reports from our EHR (Epic)
23
Recently Epic/
MIIC Integration
HCMC and MIIC do context linking so
that a provider can launch a patients MIIC
record directly from HCMC s EMR
Vision for future is a live 2 way, HL7
interface
24
Viewing MIIC data in Epic
When the MIIC Activity is launched, Epic will send username, password, patient first name, last
name, middle initial and date of birth. There is an option to also submit the Epic MRN. MIIC uses
wildcard searching, so if MRN is in the search criteria, it would be the first item checked. If MRN
is not found (which would be the case in the majority of patients if your facility recently began
sending), then a message would return that says No matches are found even if there is other
information that will match. It is suggested to not add MRN to your search criteria until you are sure
that all Epic MRN s are loaded into MIIC. Records not found, too many
matches. Go to MIIC website to refine your
search.
https://miic.health.state.mn.us/miic
Example of Activity:
25
Proposed NHIN/Direct
Pilot Implementation
HCMC and Ability! (then VisionShare) piloted the NHIN
Direct Project protocols
Started in Jan 11
NHIN Direct HISP routing and secure messaging
services to send the immunization message to the
Minnesota Department of Health public health
department
26
Description
Phase 1
the flat file being submitted to the Public Health Department.
Phase 2
HL7 VXU messages embedded in the standard NHIN Direct
RFC5322 container. In both cases it will be S/MIME signed and
encrypted and S/MIME decrypted and verified as specified by
NHIN Direct.
27
Description
In order to help the Public Health Department at the State of
Minnesota participate with the NHIN Direct initiative, the secure
PHINMS communication standard will be used as the NHIN Direct
destination edge protocol. HCMC will be able to send immunization
messages through VisionShare s HISP using a mutually agreed
source edge protocol. This approach allows the public health
departments to leverage existing investments in PHINMS while
enabling HCMC to communicate immunization information using a
communication protocol with which they are comfortable. In short,
the two parties may securely communicate while remaining
technologically decoupled from one another. This is made by NHIN
Direct security, addressing, content packaging, and routing
standards coupled with the enabling concept of a HISP.
28
29
Implementation
Very Easy!
HCMC about 4 hours of work from
our interface team largely for testing
Smooth go-live
Excited about future opportunities
30
Frequently Asked
Questions
Q - How are vaccines handled when patient lives in Minnesota but vaccine was
administered at a Wisconsin facility, or the other way around?
A There is a weekly exchange between MIIC and WIR. This is dependant
upon the address that is in the MIIC or WIR systems.
Q Many times, the address in MIIC doesn t match the address in Epic. How
does this get updated?
A if your facility is sending an extract or reporting vaccine data to MIIC and the
patient s address is on that report, then MIIC will be updated with the correct
address at the time the report is received.
Q How do patients Opt-Out of having their vaccine information reported to
MIIC?
A Patient families are notified on the Parent Notice on checking the accuracy
of the birth record, that vaccines are reported to MIIC. If the patient/patient
family decides to Opt-Out, there is a number to contact MIIC. If they have opted
out, vaccine data will not be uploaded to MIIC from the clinic reports. More
information regarding opting out and patient notification can be found here:
http://health.minnesota.gov/divs/idepc/immunize/registry/notification.html
31
Questions?
e-mail questions to
abpdid@r.postjobfree.com
32
For More Information
Liz Cinqueonce
Deputy Director
MDH
Office of Health Information Technology
abpdid@r.postjobfree.com
Bob Johnson
MDH
Office of Health Information Technology
abpdid@r.postjobfree.com
www.health.state.mn.us/e-health
33
Contact this candidate