Meaningful Use Physician Reporting: Successes and Lessons Learned

Transcription

1 Meaningful Use Physician Reporting: Successes and Lessons Learned NAACCR 2017 Annual Meeting June 2017 Wendy Blumenthal, MPH Cancer Surveillance Branch Division of Cancer Prevention and Control Centers for Disease Control and Prevention (CDC)

2 Presentation Outline Meaningful Use Status Communications Process Challenges Successes and Lessons Learned

3 Meaningful Use Cancer Reporting to Public Health Cancer Registries Status Cancer under Specialized Registry Reporting in Stage 2; Public Health Registry Reporting in Stage 3 At least 30 states are receiving EHR data from EPs for MU 39 EHR vendors (135 total products) are currently certified for the 2014 Certification cancer reporting standard 4 EHR vendors (6 total products) are currently certified for the 2015 Certification cancer reporting standard Regular meetings with 5 EHR vendors

4 CDC-Vendor-Registry Communication Process State registries receive cancer reports EHR vendor resolves issues; deploys software update Registries validate using NIST and CDA Validation Plus CDC/registries discuss issues on calls with EHR vendor Registries report issues to CDC/Request TA CDC analyzes reports and develops issue documents

5 How CDC Participates Coordinated Communications with EHR Vendors Monthly or bi-monthly calls with registries and individual 5 EHR vendors Monthly Collaboration call with state cancer registries Ad hoc communications with additional EHR vendors as needed Work collaboratively to identify solutions to specific EHR issues identified Technical Assistance Review and analysis of cancer CDA reports Detailed feedback on CDA reports to send to provider and/or EHR vendor Training on CDA, emarc Plus, and CDA Validation Plus Respond to MU questions; coordinate responses with ONC, CDC, and EHR Public Health Task Force

6 Known Challenges--Workflow Key Data Missing Key cancer data elements (histology, behavior, laterality) missing for majority of reports transmitted Defaults Defaults set by vendor in CDA when data left blank by EHR users Report Triggers Trigger for cancer reportability not fully automated or workflow is confusing; requires some user intervention Usability/Training Many issues identified determined to be user training issues/ incorrect use of EHR

7 Key Data Missing Issue Key cancer data elements (histology, behavior, laterality) missing for majority of reports transmitted EHR users are not entering key clinical cancer data Reasons Identified Picklists (e.g., for histology) are too long Physicians don t understand cancer surveillance and the vital importance of completing the data Users don t understand workflow Possible Solutions Provide EHRs with shorter, tailored picklists EHRs develop picklist filters (e.g., hierarchy for histology) Use other data elements to filter (e.g., problems) EHRs improved training materials for users Develop cancer workflow guidance for all EHRs

8 Defaults Issue Some EHRs enter default values in the CDA when EHR users leave data elements blank in the patient record Cancer Registry Response Important to receive information as it was actually recorded in the EHR to preserve the integrity of the data enable better monitoring of data quality identify training opportunities Possible Solutions EHRs should not set defaults for missing data When the elements are not recorded in the EHR, use null flavor. BUT, null flavor should be used sparingly For elements that can t be null, needs to be set as must enter by EHR EHRs should include selections in picklists for users to positively assert that information is unknown

9 Report Triggers Issue Trigger for cancer reportability not fully automated or workflow is confusing Requires some user intervention Why is this a problem? Registries don t have the resources to work with each individual provider to address Possible Solutions 2015 Certification IG has improved trigger details Develop cancer workflow guidance for all EHRs

10 Successes EHR vendors have made significant changes based on registry feedback Programming Workflow Picklists Triggers Defaults CDA Validation Plus enhancements Clearer reports to distinguish error levels (Critical, Error, Warning, Info) MU3 IG emarc enhancements Derive behavior, histology, laterality when missing Set Stage Group defaults when missing Others? Bugs identified through testing with real data Stage 3 IG Key elements required and cannot be null Better guidance for unknown/missing key elements Better reportability trigger guidance Improved Stage 3 Certification Tool CDC emphasized the critical need for content validation CDC provided significant input during development Expect better content and fewer issues/errors

11 Lessons Learned Guidance to EHR Vendors Workflow/triggers Picklists/filtering Setting defaults Required data Implementation Guide Improvements Required elements; no nulls allowed Improved trigger rules and examples Guidance on defaults Certification Tool Improvements Includes significant content validation Improved instructions to testing bodies Automated validation of context-specific test data

12 Future Solutions to Consider Should we develop more detailed guidance? Cancer workflow Picklists/filters; site-specific lists Collaboration for development and updating of single standard translation/crosswalk tables Triggers Handling unknowns /defaults Should we develop requirements for workflow certification? Immunization Registry program has developed workflow certification requirements for ONC Includes end-to-end clinical workflows for interoperability (EHR to Registry) and also some internal EHR functions reviewed by a juror

13 Exciting Alternative Solution: Structured Data Capture Gives cancer registry community more control on required data elements, workflow, picklists, and edits Easier to implement changes

14 Structured Data Capture (SDC) Conceptual Workflow 1 Sends request for form/template Form Manager CDE Library Form Library Sends requested form/template 2 Metadata Source SDC Scope Form Filler 3 Converts, populates & displays form Specified Form/Template 4 Fills, stores/transmits structured data Displayed Form John Doe xx x 5 Form Receiver State Cancer Registry Extract, Transform, & Load Data by form/template x x x x Structured Data Captured

15 Acknowledgments State Cancer Registries Lindsay Ryan Wendy Scharber

16 Thank you! CDC MU Technical Team for all MU Public Health Programs Wendy Blumenthal, CDC