Making an Electronic Interface with IIS Most Useful

Making an Electronic Interface with IIS Most Useful for All Involved: Lessons Learned about Two-Way Electronic Exchange 43 rd National Immunization Conference March 31, 2009 Mike Mc. Pherson, Nichole D. Lambrecht, MSc, Sue Bowden, RN, Kristin Shore, Mike Parsons, and Susan Dickman Immunization Program Kansas Department of Health and Environment To protect the health and environment of all Kansans by promoting responsible choices.

Slide 2 Objectives n n Background and status of project Current IIS architecture Lessons learned Recommendations To protect the health and environment of all Kansans by promoting responsible choices.

Kansas IIS History n Kansas IIS (KSWeb. IZ) started summer 2005. n Imported ~414, 000 patient records from Vital Records department. n n n Slide 3 Spanned 1994 -2005 At present we average 113 patients nightly (98% of birth cohort). Provider enrollment started Aug 2005 n First tier direct entry LHDs (42 of 105 CHDs) n Legacy data was extracted and then imported. n Historically data rich source To protect the health and environment of all Kansans by promoting responsible choices.

Slide 4 HL 7 System 1 - LHD Live HL 7 System 2 – LHD Live HL 7 System 1 - LHD testing HL 7 System 2 - LHD testing Direct Entry To protect the health and environment of all Kansans by promoting responsible choices.

KSWeb. IZ Patient Data Sources Created Updated Statistics as of March 21 st, 2009. MMIS = Medicaid Management Information System To protect the health and environment of all Kansans by promoting responsible choices. Slide 5

KSWeb. IZ Vaccine Data Sources Created Updated Statistics as of March 21 st, 2009. MMIS = Medicaid Management Information System To protect the health and environment of all Kansans by promoting responsible choices. Slide 6

KSWeb. IZ Architecture n HL 7 Interface n n n Direct Entry n n n Capable of 2 -way and 1 -way HL 7 communications. Bi-directional, real-time IIS. Focus is on 2 -way – allows provider to enter data on their own system once and avoids multiple system sign-ons. Secure messaging via SOAP or POST Audit all HL 7 traffic Web-enabled user interface over SSL. Vaccine inventory module IIS n n Training registry for direct entry training, EHR testing, precertification, certification phases. High Availability Environment To protect the health and environment of all Kansans by promoting responsible choices. Slide 7

Interface Implementation Process n Pre-certification (Extract) n n Extract immunization data, run data reports, and provider cleans up reported data quality issues. Certification (Training Site) n n Slide 8 Send all immunization data to our training registry via HL 7 errors, duplicate patients, and duplicate vaccinations are addressed. Production (Live Site) n After certification data is sent to production site and is considered “live” but continuous data quality checks are run. Pre-certification Certification Production To protect the health and environment of all Kansans by promoting responsible choices.

Pre-Certification - Extract n n Reports look for atypical data (city, zip, county, race, …). Understand formats for particular fields. e. g. SSN (9 digits, not all 9 s or 0 s, or any similarity to Do. B). n e. g. LN, FN (Prefixes/Suffixes in appropriate places). n e. g. Do. B not generic (01/01/1900). n n Issues with data entry n e. g. Invalid/unknown CVX and/or CPT codes. Pre-certification Certification Production To protect the health and environment of all Kansans by promoting responsible choices. Slide 9

Slide 10 Certification Process – Training Site n Provider sends all Immunization data to training registry via HL 7. n n Compare provider data with existing registry data. Look for HL 7 ACK errors and duplicates. Share information with provider via A/D/D reports. Assuring DQ upfront saves time and effort and helps conform to a standard. Pre-certification Certification Production To protect the health and environment of all Kansans by promoting responsible choices.

Production Process – Live Site n Ongoing data quality checks. n n n De-centralized databases require continuous synchronization effort. Apply tools to deal with duplicates. Provide support for: Duplicates found by provider. n HL 7 features, bugs. n Verification. n Pre-certification Certification Production To protect the health and environment of all Kansans by promoting responsible choices. Slide 11

Lessons Learned (LL): Overall Data Quality Slide 12 n Immediate increase in duplicates. Vaccines and Patients n HL 7 exposed mass amount from MMIS and Vital Import n n Other DQ issues: Accuracy – vaccinating at the right age. n Timeliness – time between encounter and entry into the registry. n Completeness – all data being sent to us. n How error prone – HL 7 ACK errors. n To protect the health and environment of all Kansans by promoting responsible choices.

LL: Overall DQ Solution n Enforce Pre-Certification, Certification phases. n n A – HL 7 ACK Errors D – Duplicate Vaccine D – Duplicate Patient Matrices to evaluate patient & vaccine duplicates. n n Urge usage of standard formats. Ongoing A/D/D reports n n Slide 13 Manually weighted system Automated scripts to remove billing (Medicaid) and Vital duplicates. To protect the health and environment of all Kansans by promoting responsible choices.

Slide 14 LL: DQ Solution… n Regular review of DQ at the system and provider level. n n Duplicate vaccine and patient reports. Provider Profile Reports. n n n Accuracy Timeliness Completeness HL 7 usage Business rules for HL 7 – identifies ideal HL 7 traffic: n n n VXQ = VXR + VXX + QCK VXU ≤ VXQ = normal VXU > VXQ = batch or legacy upload VXU > ACK{AE|AR} VXX: VXQ >. 5 = duplicate issue? To protect the health and environment of all Kansans by promoting responsible choices.

To protect the health and environment of all Kansans by promoting responsible choices.

LL: EMR System Functionality n Update (VXU) mechanism n n n Manual - have to remember. Automated – adds complexity. Error display and/or logging n n Immediate feedback on errors. When to display? n n Missing data fields. n n Potential to impact work flow. Some data necessary for reporting. Utilization of IIS data returned. n OBX and recommender ignored. To protect the health and environment of all Kansans by promoting responsible choices. Slide 16

LL: EMR Functionality Observation VXU mechanism can create issues. n n Queue – inability to bypass or modify queue. Manual – backup to send unsent. Both – good to display last updated date. Error Display. n n n Should display ACK|AR errors immediately. Should log all errors for later referral. n n Ability to match ACK error with VXU. Utilize OBX and Recommender data. To protect the health and environment of all Kansans by promoting responsible choices. Slide 17

LL: IIS Functionality n n n Patient matching criteria Duplicate Vaccines only included same date same antigen check. Detect possible duplicates. Default date for birth dose of Hep. B. EHR handling of duplicates may differ. Missing core data (e. g. county) To protect the health and environment of all Kansans by promoting responsible choices. Slide 18

LL: IIS Functionality Solution n Patient Duplicates n n n Created filter to look for 10 day window. MMIS duplicates n n Tweaked matching algorithm to reduce duplicates. Vaccine Duplicates n n Slide 19 e. g. Hibtiter billed – Act. Hib administered Hep. B – script removes default from Vital Import Identify core data set – taking into account long term reporting needs. To protect the health and environment of all Kansans by promoting responsible choices.

Recommendations n Develop data quality policies and procedures Need to update as new data sources are added. n Develop core set of data for long-term data use. n n Push HL 7 bi-directional, real-time exchange Enforce bi-directional EHR exchange through CCHIT. n Utilize Recovery/Reinvestment funding to develop bi-directional capability. n To protect the health and environment of all Kansans by promoting responsible choices. Slide 20

Contact Information Mike Mc. Pherson KS IIS Interface Consultant Kansas Department of Health & Environment 785 -296 -1319 mmcpherson@kdheks. gov http: //kdheks. gov/immunize/webiz. html To protect the health and environment of all Kansans by promoting responsible choices.