Meaningful Use

Medicaid Promoting Interoperability Program

The Health Information Technology for Economic and Clinical Health Act (HITECH) provides financial incentives to promote the use of electronic health records (EHR).  The U.S. Centers for Medicare and Medicaid Services has implemented incentive programs for Eligible Professionals, Eligible Hospitals and Critical Access Hospitals to adopt, implement and demonstrate meaningful use (MU) of Certified EHR Technology (CEHRT).  Included in the strategies for demonstrating “Meaningful Use” of EHR systems are objectives related to public health:

1) Submission of immunization registry data

2) Submission of syndromic surveillance data

3) Submission of reportable disease laboratory reports

4) Cancer data reporting

5) Birth Defects reporting

6) Alzheimer’s reporting

7) Prescription Drug Monitoring reporting (PDMP) – (In Progress)

8) Electronic Case Reporting (eCR) – (In Progress)

The Georgia Department of Public Health’s (DPH) State Electronic Notifiable Disease Surveillance System (SendSS) and Epidemiology Section is working with Eligible Professionals, Eligible Hospitals, and Critical Access Hospitals on these public-health related meaningful use objectives. DPH is now receiving electronic submissions of data for the purpose of Meaningful Use Attestation.

Objectvie Eligible Professional (EP)* Eligible Hospital (EH) and Critical Access Hospital (CAH)*

Public Health Reporting Measures

Immunization Registry Data Yes Yes
Syndromic Surveillance Data Yes** Yes
Electronic Laboratory Reports N/A Yes

 

Specialized Registry/Public Health Registries

Objective Description Eligible Professional (EP)* Eligible Hospital (EH) and Critical Access Hospital (CAH)*
Cancer Reporting   Yes Yes
Birth Defects Reporting https://dph.georgia.gov/birth-defects-reporting Yes Yes
Alzheimer's Disease and Related Dementia (ADRD) Reporting https://dph.georgia.gov/alzheimers-registry Yes Yes

Prescription Drug Monitoring Program (PDMP)

(In Progress)

https://dph.georgia.gov/pdmp Yes Yes

Electronic Case Reporting (eCR)

(In Progress)

  Yes Yes

**Urgent care providers will report under Syndromic Surveillance.  Non-urgent care providers may claim Syndromic Surveillance Reporting as a public health option.

Quality Payment Program and MU measures for exchanging data with public health agencies have been established at the national level.  The on-boarding processes are identical.

 

Meaningful Use Stage 1

Concluded at the end of fiscal year 2013 (9/30/13) for Eligible Hospitals, or calendar year 2014 (12/31/14) for Eligible Professionals.

Meaningful Use Stage 2

Began on 10/1/13 for Eligible Hospitals and 1/1/14 for Eligible Professionals. See the Centers for Medicare and Medicaid Services website for specific Stage 2 timelines and criteria located at https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html.  The focus for Meaningful Use Stage 2 is establishing ongoing data communication between eligible professionals, laboratory or hospital EHR systems and Public Health.  This stage implements the testing process performed in Stage 1.

Immunization Reporting

The Georgia Department of Public Health’s Georgia GRITS (Registry of Immunization Transactions and Services) consolidates a Georgia resident’s immunization records into a complete, accurate and definitive immunization record. GRITS is Georgia’s immunization registry/information system. Currently, GRITS receives data from hospital systems, health care plans, vital records offices, local health departments, private providers, Medicaid, and schools. GRITS provides individuals, families and health professionals with tools needed to make sound medical decisions.

Objectives and Measures for Submission of Immunization Information:

  • Objective for Eligible Professionals, Eligible Hospitals/Critical Access Hospitals: Capability to submit electronic data to GRITS and actual submission, except where prohibited and in accordance with applicable law and practice.
  • Measure for Eligible Professionals, Eligible Hospitals/Critical Access Hospitals: Ongoing submission of electronic immunization data from Certified EHR Technology to GRITS for the EHR reporting period.

Laboratory Results Reporting

Included in the strategies for demonstrating “meaningful use” of EHR systems is the submission of electronic data on reportable laboratory results to public health agencies. Laboratory reporting of reportable diseases and conditions enables timely public health intervention, including epidemiologic investigations, implementation of control measures, and treatment of susceptible contacts.  The electronic reporting of reportable disease laboratory results meets Georgia’s notifiable disease reporting requirements. Messaging from hospital laboratories meets the meaningful use objective.

For laboratory results reporting in Stage 2, submission of the following core-set items apply:

  • Eligible Hospital/Critical Access Hospital Objective: Ongoing submission of electronic reportable laboratory results from a Certified EHR Technology to SendSS for the EHR reporting period.
  • Eligible Hospital/Critical Access Hospital Measure: Ongoing submission of electronic reportable laboratory results from a Certified EHR Technology to SendSS for the EHR reporting period.

Note: Sending Electronic Lab Reports or Reportable Lab Results, does not end the need to report reportable disease case reports manually through the State Electronic Notifiable Disease Surveillance System (SendSS).  ELR/RLR is a meaningful use measure with a financial incentive, however reporting reportable disease cases is a state requirement that does not go away by going live with production ELR sending to GDPH.

Syndromic Surveillance

The GDPH Epidemiology Section uses Syndromic Surveillance to aid in event detection and monitor community health trends. Pre-diagnostic, “chief complaints” from patients are used to identify patterns of illness. For example, Syndromic Surveillance is used to monitor seasonal trends such as influenza-like illness to help identify possible outbreaks and other issues of public health concern. Data is transmitted from participating facilities to SendSS daily. The data are grouped into syndromes and statistical algorithms are applied to identify unusual temporal and geographic patterns that might indicate situations of public health concern. Transmission includes limited patient-identifying information. SendSS uses technical and administrative measures to ensure the security of the data and protect the confidentiality of the submitted information.

  • Eligible Hospital/Critical Access Hospital Objective: Ongoing submission of syndromic surveillance data from a Certified EHR Technology to SendSS for the EHR reporting period.
  • Eligible Hospital/Critical Access Hospital Measure: Ongoing submission of syndromic surveillance data from a Certified EHR Technology to SendSS for the EHR reporting period.
  • Eligible Professional: At this time Georgia Departmetn of  Public Health only accepts syndromic surveillance data from Eligible Hospitals, Critical Access Hospitals and Urgent Care facilities.  Ambulatory care physician practices can receive an exemption for this requirement, but must still register with Georgia Departmetn of Public Health.

Cancer

The Georgia Department of Public Health supports submission of cancer data from eligible professionals (Eps) under meaningful use.  Providers who choose cancer reporting as their public health option must complete the registration and onboarding process, and demonstrate ongoing submission.

Georgia DPH works in conjunction with the Georgia Center for Cancer Statistics (GCCS) at Emory University in order to gather this crucial data for external users. You should be sent a welcome package by Ms. Judy Andrews from GCCS sometime after this email, who can also be reached directly at jandr04@emory.edu.

The GDPH contact for the Cancer Registry is Rana Bayakly who can be contacted at Rana.Bayakly@dph.ga.gov.

Birth Defects

The Georgia Birth Defects Registry aims to initally capture population-level baseline rates of 41 birth defects and ensure affected children and their families are referred to early intervention services.  As described on Georgia's Notifiable Disease List, birth defects are a reportable condition in Georgia.  This includes fetal deaths of at least 20 weeks gestation and children up to six years of age with birth defects.

For additional information, please contact: birthdefects@dph.ga.gov.

Alzheimer's Disease and Related Dementia (ADRD)

The purpose of the Alzheimer's registry is:

  1. To collect and disseminate usable data to inform programs and services for the againg population
  2. Identiy epidemiological trends
  3. Bring awareness at the state level to issues that affect health aging
  4. Inform stakeholders for planning and for future registry needs

For addtional information, please contact Reynolds Morrison at Reynolds.Morrison@dph.ga.gov.

Prescription Drug Monitoring Program (PDMP)

The Georgia Prescription Drug Monitoring Program (PDMP) is an electronic database used to monitor the prescribing and dispensing of controlled substances. The PDMP can help eliminate duplicative prescribing and overprescribing of controlled substances and provide a prescriber or pharmacist with critical information regarding a patient’s controlled substance prescription history and protect patients at risk of abuse.

Electronic Case Reporting (eCR)

Electronic Case Reporting (eCR) is the generation and transmission of case reports from an electronic health record (EHR) to public health for review and  action.

 

Meaningful Use Stage 3 

The EHR reporting period for providers attesting to Stage 3 in 2017 will be 90 days, whereas providers who choose to attest to Modified Stage 2 in 2017 will have a full calendar year EHR reporting period.

See the Centers for Medicare and Medicaid Services website for up-to-date information on the EHR Incentive Programs.

 

Syndromic Surveillance

For Eligible Professionals (EPs): DPH is ready to receive syndromic data from EPs practicing in urgent care settings only. Syndromic Surveillance is not an option for Non Urgent care providers.

For Eligible Hospitals (EHs) and Critical Access Hospitals (CAHs): DPH is ready to receive syndromic data from EHs and CAHs with emergency departments only.

Certification under 2015 Edition Certified Electronic Health Record Technology (CEHRT) calls for the testing of the ability to message inpatient data (in addition to emergency department or outpatient) for syndromic surveillance purposes; under 2014 Edition this was not a requirement. Under 2015 Edition CEHRT, SyS should also provide additional facility and patient demographic information, including:

Facility name
Facility address
Patient City town
Smoking status

Laboratory Reports Reporting

There are no changes to the HL7 implementation guide used for Electronic Laboratory Reporting. Despite no changes, there will be a need to revalidate if a hospital updates or purchases new certified software.

To register for Meaningful Use, click here: http://phip.ga.gov/mureg.html
 

Once your online registration has been received, DPH will then contact you to provide specific information about the next steps and answer your questions.

 

FAQs

1. What data is the Georgia Department of Public Health (GDPH) accepting under Electronic Health Record (EHR) incentive programs?

DPH currently has the capability to electronically receive the following data for meaningful use:

Immunization Data
Syndromic Surveillance
Electronic Laboratory Results
Cancer Reporting
Birth Defects Reporting
Alzheimer’s Disease and Related Demetia (ADRD) Reporting
Prescription Drug Monitoring Program Reporting (PDMP) - (In Progress)
Electronic Case Reporting (eCR) - (In Progress)

2. I previously registered to do public health reporting. Do I need to re-register?

Once you register, you do not need to register again in future years, if you have made no changes to public health reporting options previously selected.  If you are an Eligible Provider and were previously declined for Syndromic Surveillance you do not need to re-register.  You must re-register if you wish to pursue a new reporting option or have previously exited the onboarding process without completing it.

3. Our clinic has several practicing providers. Does each provider need to register?

No. A clinic may complete a single registration on behalf of all providers that primarily practice at the clinic. The clinic or healthcare organization is responsible for tracking the list of individual providers for whom the registration applies.

4. How should an eligible provider (EP) who works at multiple sites register?

Only register for the physical location where you work the majority of the time, using the Meaningful Use Registration Form. You may list other sites where you practice in the “Additional Facilities, Comments, Questions and/or Concerns” field of the registration form but this is not required.

5. Can I claim an exclusion from meeting Public Health objectives?

There are circumstances where you may qualify for an exemption from one or more Public Health objectives. These may include the following circumstances:

You do not administer immunizations.
Public health is not accepting syndromic surveillance data from your practice. 

**Urgent care providers will report under Syndromic Surveillance.  Non-urgent care providers may claim Syndromic Surveillance Reporting as a public health option.

6. I am a vendor representing several clinics (or facilities). Do we need to complete the onboarding process for each clinic or facility that we represent?

Yes. The onboarding process must be completed by (or on behalf of) each legal entity attesting for Meaningful Use.

7. Our healthcare organization consists of multiple clinics and/or hospitals. Does each of our clinics and/or hospitals need to complete the onboarding process?

If all data for your organization is centralized AND messages will be generated centrally for all entities in your organization, you only need to complete the registration onboarding process once. If this is not the case, each facility will have to complete the entire registration onboarding process independently.

8. Our clinic has several eligible providers. Does each provider need to complete the onboarding process?

No. A clinic may complete the onboarding process on behalf of all providers that primarily practice at the clinic.

9. How do I submit my data and set up a secure data transport?

Once your registration has been received and logged, a DPH representative will contact you with additional information specific to your facility to set up for a secure data transport.

10. What kind of supporting documentation is needed for audits?

Providers who receive an incentive payment for the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program potentially may be subject to an audit. It is the provider's responsibility to maintain documentation that fully supports the meaningful use and clinical quality measure data submitted during attestation. To ensure you are prepared for a potential audit, save any electronic or paper documentation that supports your attestation. An audit may include a review of any of the documentation needed to support the information that was entered in the attestation.

We suggest all eligible professionals (EPs) and eligible hospitals (EHs) refer to the CMS EHR Incentive Programs in 2015 through 2017 Supporting Documentation for Audits for a complete guide to preparing and maintaining documentation for audits.

CMS suggested documentation includes:

Dated screenshots from the EHR system that document successful submission to the registry or public health agency. Should include evidence to support that it was generated for that provider's system (e.g., identified by National Provider Identifier (NPI), CMS Certification Number (CCN), provider name, practice name, etc.).
A dated record of successful electronic transmission (e.g., screenshot from another system, etc.). Should include evidence to support that it was generated for that provider (e.g., identified by National Provider Identifier (NPI), CMS Certification Number (CCN), provider name, practice name, etc.).
Letter or email from registry or public health agency confirming receipt of submitted data, including the date of the submission and name of sending and receiving parties.

11. Which entities in Georgia should submit syndromic surveillance messages?

DPH supports submission of syndromic surveillance data from eligible hospitals and eligible professionals in alignment with activities related to Meaningful Use or other EHR incentive programs. Some eligible professionals may qualify for an exclusion from syndromic surveillance reporting.  Only urgent care Eps should submit data for syndromic surveillance.

12. What are the current standards and guidelines for submitting syndromic surveillance data in Georgia?

Upon registration, you will receive a copy of the Georgia Messaging Guide for Syndromic Surveillance for guidance on formatting syndromic surveillance messages.

13. We have generated some test syndromic surveillance messages. Can we verify that the messages look okay before we promote to our live, production system?

Upon request, DPH will review sample messages for basic adherence to structural requirements and expected value sets. Contact Meaningfuluse.support@dph.ga.gov to coordinate a review of some sample messages.

The National Institute of Standards and Technology (NIST) has created a syndromic surveillance validation tool. This tool allows for both context-free validation (i.e., only message structure is verified) and context-based validation (i.e., structure and limited content are verified).

Please keep in mind that the NIST tools do not check messages for compliance with Georgia-specific guidance.

NIST HL7v2 Syndromic Surveillance Test Suite: https://hl7v2-ss-r2-testing.nist.gov

15. How long will our facility remain in the validation queue?

There are a large number of facilities in the validation queue. DPH is unable to provide time estimates for how long a facility will remain in the queue. Facilities are being prioritized on a number of factors including facility type, type(s) of care provided, size, time since initial registration of intent, time since regular data feed was established, and level of engagement.

16. How long will validation take?

DPH is unable to provide estimates on the length of time required to complete the validation process. The length of time will largely be dependent on how quickly a facility is able to resolve the issues identified by DPH. DPH encourages facilities to begin investigation of issues as quickly as possible as there is often a delay if vendor assistance is required to address one or more issues.

17. Will we be notified by the Georgia Department of Public Health that we have completed the necessary onboarding steps required for attestation?

DPH will provide the following documentation of your facility's engagement upon request:

Acknowledgement of registration
Invitation to onboard or qualification for exclusion (if not accepting data from your facility)
Messaging specification guidelines

 

Due to limited resources for onboarding, DPH will not be providing additional documentation of engagement. Please gather evidence such as email exchanges, meeting invites, message acknowledgements, and transport logs to show your facility is actively engaged with public health. In the event of an audit, additional documentation may be provided by DPH. Please contact Meaningfuluse.support@dph.ga.gov with these requests.

Add information on uncovered reporting periods

Please include, facility, type of attestation, time period covered.

 

 Additional Resources

For more information regarding Meaningful Use, please visit the following websites:

Centers for Medicare & Medicaid Services Website regarding Electronic Health Records Incentive Programs

 https://www.cms.gov/Regulation-and-Guideance/Legislation/EHRIncentivePro...

Centers for Disease Control and Prevention website regarding Meaningful Use

https://www.cdc.gov/ehrmeaningful use/

MACRA Quality Payment Programs

https://www.cms.gov/Medicare/Quality-Payment-Program/Quality-Payment-Program.html

 

Contact Information

Meaningfuluse.support@dph.ga.gov