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Stage 2 Meaningful Use Immunization Message Submission
to CHIRP
Indiana State Department of HealthImmunization Program
June 17th, 2014
Stage 1 Meaningful Use Stage 2 and ongoing submission VFC Providers requirements versus Stage
2 Meaningful Use Registration Web Portal
◦Do I need to setup all of my facilities? Sending data to CHIRP – Transport Layers Troubleshooting When does Meaningful Use end? Question and Solutions
Itinerary
Meaningful use is using certified electronic health record (EHR) technology to:
Improve quality, safety, efficiency, and reduce health disparities Engage patients and family Improve care coordination, and population and public health Maintain privacy and security of patient health information Ultimately, it is hoped that the meaningful use compliance will
result in:◦ Better clinical outcomes◦ Improved population health outcomes◦ Increased transparency and efficiency◦ Empowered individuals◦ More robust research data on health systems
Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs.
Source: HealthIT.gov
Meaningful Use Defined
Source: HealthIT.gov
Core Objective – Public Health Reporting◦ Stage 1 – maybe optional◦ Stage 2 - required
Indiana State Department of Health is the Public Health Authority for the State of Indiana
Accept, validate, document provider attestments for Stage 1 and Stage 2
Where does ISDH and CHIRP fit in?
Children and Hoosier’s Immunization Registry Program
Began in September 2002 as state wide IIS Prior to CHIRP Indiana used ImmTime Over 4,000 providers and 8,000 users ~42,000 HL7 messages accepted each day Accepts HL7 2.0 through 2.5.1 VXU type
messages◦ All valid messages received will create an ACK
response Connected to all Indiana HIEs
What is CHIRP?
Life on the ISDH Meaningful Use Jargon Farm CHIRP,
CHIRP, CHIRP
MU, MU, MU
ACK, ACK, ACK
ISDH Indiana State Department of Health
PHA Public Health Authority
MU Meaningful Use
MU(X) Usually MU1 or MU2, referring to the stage of Meaningful Use
HL7 Health Level-7, a healthcare message standard developed by Health Level Seven International
VXU Vaccine Update/Add HL7 Message type, can be 2.3.1 or 2.5.1 message
VXQ Vaccine Query Message, used with 2.3.1 message
QPB Vaccine Query Message, used with 2.5.1 message
HIE Health Information Exchange
ACK Acknowledgement response for VXU message submitted
Meaningful Use Jargon
And many more…
Common terms that pop during a Meaningful Use call/email
HL7 VXU 2.3.1◦ Required fields - 8◦ VXU, VXQ and ADT
Test messages Accepted versus failed message Onetime and ongoing Additional year attestments Began in 2011
◦ First CHIRP Meaningful Use Attestment February 2011
Stage 1
HL7 VXU 2.5.1 message◦ Required fields – 42
New segments for 2.5.1◦ OBX – required and optional◦ RXR◦ NK1 and PID patient guardian
Testing requirements for Stage 2◦ Message approval prior to submitting to production◦ 30 day suggested timing by the ONC
Ongoing Submission – 90 days?◦ Does it need to be done during attestment◦ What if there is an error
Stage 2 Meaningful Use Attestment
MSH|^~\&|EMR_VENDOR|SENDING_FAC|CHIRP|OR|20140521143722.057||VXU^V04^VXU_V04|2014052115856822|P|2.5.1|||AL| PID|1||123456^^^^MR||TEST_PATIENT^CHIRP^^^^^L||200001010000|F||2131-1^Undefined Race^CDCREC|||||EN||VAR|||||UN^Unknown^99USI||||||||N PD1||||""||||U|||01^No Reminder^HL70215|N|20140521||Y^Advanced Directive Code - Y|A|20140521|20140521 PV1||||||||||MED RXA|0|1|201405211437|201405211437|03^MMR^CVX|0.5|mL^milliliter^UCUM||00^New Immunization Record^NIP001|ABC123^RABBIT^BUNNY^^^^^^TEST|1234ABC^^^CHIRP TEST FACILITY||||6622554411||AB^Abbott Laboratories^MVX|||CP|A RXR|SUBQ^^HL70162|LD^LEFT DELTOID^HL70163||^SUBCUTANEOUS OBX|1|CE|64994-7^Vaccine funding program eligibility category^LN|1|V01||||||F|||20140521|||VXC40^Eligibility captured at the immunization level^CDCPHINVS OBX|2|CE|30956-7^vaccine type^LN|2|||||||F OBX|3|TS|29768-9^Date vaccine information statement published^LN|2|20140101||||||F OBX|4|TS|29769-7^Date vaccine information statement presented^LN|2|20140521||||||
HL7 2.5.1 MU2 Sample Message
Provider registers each physical location with ISDH via Meaningful Use Portal
Providers registers each location to CHIRP via the Provider Enrollment Agreement
HL7 user account setup for testing Provider or vendor submits messages to
CHIRP review and approval◦ Recommend contacting CHIRP after submission
for review Provider moves messages into production
◦ Ongoing 90 day clock begins
Stage 2 Overall Process
New VFC policy requirement including use of VFC codes and lot numbers in HL7 message◦ 2.3.1 PV1 Codes◦ 2.5.1 OBX Codes
What fields do I need to send to make sure my lot inventory will decrement
If I am sending the new 2.5.1 MU2 message do I meet the VFC policy?◦ 2.3.1 that meet VFC requirements vs. 2.5.1
July 31st – VFC policy date
VFC and Stage 2
MU 2.5.1 Message◦ OBX segment with V0 VFC eligibility code◦ OBX segment with lot number funding source◦ RXA segment with complete lot number,
manufacturer, and administering facility (RXA.11) Existing 2.3.1 Message
◦ PV1 segment with V0 VFC eligibility code, code is located in PV1.20 placement
◦ All messages with a valid VFC code, i.e. V02 (Medicaid) will be assumed Public Supplied by CHIRP
◦ RXA segment with complete lot number, manufacturer, and administering facility (RXA.11)
What do I need to send for VFC
Only Stage 2 are required to register◦ Stage 1 is optional registration
All providers need to register Each physical location to be attested should
register◦ We do not recommend registering each provider
Providers may register for Immunization, Synrdomic, and ELR attestments
Email confirmation once registration is complete
Register for Meaningful Use
ISDH Meaningful Use Portal
Provider Group Indiana
PG Hosp Indy
PN West
PG Hosp Warsaw
PG Hosp Muncie
PG Physician’s Network
PN North
PN Indy
PN Main
PN South
PN East
Dr. JonesSmith, MDDr. Jones
Smith, MDDr. JonesSmith, MD
Specialist Team
PA RogersNP WishkaPA Rogers
NP WishkaPA RogersNP WishkaPA Rogers
NP Wishka
PG Hosp Indy
PN West
PG Hosp Warsaw
PG Hosp Muncie
PN North
PN Indy
PN Main
PN South
PN East
Providers can register for their Stage 2 Meaningful Use Attestment at anytime
ISDH recommends registering 30 days prior to the start of your 90 day attestment window
Providers must register by their 60th day of attestment time period◦ Registering later shortens the window to test and
move interface into production 90 day ongoing and 90 day attestment
window do not need to match up
When to register
How to get your data to CHIRP
Submitting from your HIE◦ HIE will act as a pass through◦ Meets Stage 2 transport layer
Connecting to CHIRP directly◦ HTTPS Post/SOAP connection
Standard created by CDC and used by most Immunization Information Systems
◦ Message sent using secured SSL certificate Sent from your EMR/EHR Cloud Vendor
◦ Uses HTTPS connection
Only connections that support bidirectional messages can be used
Transport Layers
OBX Segments◦ All administered messages should include VIS data in
OBX◦ VFC providers need to include VFC eligibility for all
administered patient records 0 through18 years of age
Historical vaccines◦ Contains fewer details but still need to meet
minimums including patient data and facility◦ When in doubt, do not submit historical data
Sending via Cloud EMR◦ Each provider needs to register and attest individually◦ Cloud EMR will only need to test initial messages
Troubleshooting and Known Issues
Stage 2 Year 1 Attestments◦ 90 day ongoing submission of data to PHA
Stage 2 Year 2 Attestments◦ 365 day ongoing submission of data to PHA
Stage 3 – 2016◦ Improving quality, safety, and efficiency, leading
to improved health outcomes◦ Decision support for national high-priority
conditions CHIRP forecast included in message response
◦ Patient access to self-management tools MyVaxIndiana
90 Days and Beyond
We (ISDH) are not the Meaningful Use Police
Accept, validate, document provider attestments for Stage 1 and Stage 2
Official documents of Meaningful Use status can be downloaded from ISDH Meaningful Use Portal
Please feel free to ask any questions
Questions and Contacts
Raymond Epps317-233-8828repps@isdh.in.gov
Cameron Minich888-227-4439caminich@isdh.in.gov
CHIRP Contacts
Meaningful Use EmailISDHMUa@isdh.in.gov
CHIRP Web pagehttps://chirp.in.gov
ISDH Meaningful Use Portal
https://gateway.isdh.in.gov/MUSSE/Default.aspx
Indiana Immunization Coalitionhttp://www.vaccinateindiana.org/
Help Links
Thank you for attending!!!
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