Promoting Interoperability

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, 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 the 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.

The strategies for demonstrating “meaningful use” of EHR systems include 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 manually report reportable disease case reports 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.

The DPH 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: Currently, the Georgia Department of  Public Health only accepts syndromic surveillance data from Eligible Hospitals, Critical Access Hospitals, and Urgent Care facilities.  Ambulatory care physician practices can be exempted from this requirement but must still register with the Georgia Department of Public Health.

The Georgia Department of Public Health supports the 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 to gather this crucial data for external users. You should be sent a welcome package by Ms. Robin Billet from GCCS, who can also be reached directly at [email protected]

The GDPH contact for the Cancer Registry is Rana Bayakly, who can be contacted at [email protected].

The Georgia Birth Defects Registry aims to initially 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 [email protected].

The purpose of the Alzheimer's registry is:

1. To collect and disseminate usable data to inform programs and services for the aging population
2. Identify 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 additional information, please contact Kimberly Erukunuakpor at [email protected].

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

About eCR

The CDC defines electronic case reporting (eCR) as the automated, real-time exchange of case report information
between electronic health records (EHRs) and public health agencies.

Traditionally, healthcare providers need to know the rules for reporting and manually report about cases or people with
conditions of public health concerns to their public health agencies via fax, phone call, or email.

The Georgia Department of Public Health uses the HL7 electronic initial case report (eICR) standards (R1.1 and R3) for electronic case reporting and to support the new CMS Promoting Interoperability regulation for eCR. We will use these standards to eventually eliminate manual reporting requirements.

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 only syndromic data from EHs and CAHs with emergency departments.

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

Facility Name
Facility address
Patient City town
Smoking status

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

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

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 Dementia (ADRD) Reporting
• Prescription Drug Monitoring Program Reporting (PDMP) - (In Progress)
• Electronic Case Reporting (eCR) - (In Progress)

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.

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.

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.

Can I claim an exclusion from meeting Public Health objectives?

GDPH does not have the authority to provide exemptions/exclusions from Promoting Interoperability objectives. That authority resides exclusively with CMS or State Medicare agencies. GDPH can help register, onboard to full sending status, and give confirmation of sending statuses for attestation with those agencies.  However, we cannot provide any letters stating that any Provider is outright exempt from any registry measure.  While GDPH cannot provide direct letters of exemption from Promoting Interoperability objectives, the guidelines do state that certain providers are automatically exempt/excluded from some objectives.

For example:

• Your facility does not do in house testing of any State Reportable Notifiable Diseases. Then you are automatically excluded from sending ELR (We cannot provide a letter for this)
• Your facility does not administer immunizations (We cannot provide a letter for this)
  • Your facility does not do in house testing of any State Reportable Notifiable Diseases. Then you are automatically excluded from sending ELR (We cannot provide a letter for this)
  • Your facility does not administer immunizations (We cannot provide a letter for this)

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.

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.

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.

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.

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.

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.

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.

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 [email protected] 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

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.

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.

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:

• Acknowledgment 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 get in touch with [email protected] with these requests.

What type of letters does GDPH provide?

Syndromic Surveillance Decline Letter:

GDPH will decline any Eligible Provider (Primary Care or non-urgent care practices) whom registers for Syndromic Surveillance. This “Notice of Decline” for Eligible Providers can be used every year by these providers to request an exemption from Syndromic Surveillance with CMS or State Medicare. Eligible Providers can register for Syndromic Surveillance if they need to be declined (Note: you do not need to be declined yearly, one letter can be used every year) or we can provide letters for attestation purposes.

How do I request needed attestation letters?

Attestation for ELR, Syndromic Surveillance and/or eCR:

We provide 3 types of letters for attestation purposes; Active Engagement- Meaning in communication with the state to set up a connection and start testing; 90-days of Continuous Sending; Or Full Year of continuous sending. If you need attestation confirmation of active engagement, 90 day or full year attestation statuses, please include the information below in an email to SendSS Support [email protected], Shakeita Davis ([email protected]), and Patrick Pitcher ([email protected]) and include:

• The dates you plan to attest for
• The Facilities or Healthcare System names you want listed in letter
• Which registries you want listed; Syndromic Surveillance, ELR and/or eCR (can be all 3)

For Immunization attestation it is suggested to take a screenshot of your facilities’ data in GRITS, to use as confirmation for this registry.

What about eCR letters?

GDPH is partnering with CDC and APHL to facilitate eCR onboarding and implementation. All onboarding will be done through APHL and CDC. If APHL or CDC is not prepared to begin onboarding your facility or LIS, then any notice of this non-readiness (including email) can be used to claim either “active engagement” or request an exemption with CMS or State Medicare. The email response from GDPH after registering can be used as proof of registration with the State. We can also provide attestation requests please see question above.