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ADVISORY CONCERNING ELECTRONIC CIGARETTES, THE PRACTICE OF “VAPING,” “JUULING” AND USE OF OTHER ELECTRONIC NICOTINE DELIVERY SYSTEMS OR ENDS

Public Health Reporting using Certified Electronic Health Record Technology (CEHRT)

The Tennessee Department of Health collects health information to prevent and contain outbreaks, analyze population health trends, track immunization rates, track infectious diseases, and educate and promote healthy choices for the people of Tennessee. Public health reporting incentives provided by Medicaid and Medicare Electronic Health Record (EHR) Incentive Program (aka Meaningful Use) and the Medicare Merit-based Incentive Payment System (MIPS) programs are prompting increased partnerships between TDH and health care providers capable exchanging public health information electronically.

Because of increased EHR adoption, public health reporting requirements can be easily reported to TDH using an EHR. The process to begin reporting electronically begins when a potential trading partner registers with TDH expressing their intent to exchange data electronically using the Trading Partner Registration (TPR) system. CMS requires Eligible Professionals (EPs) and Eligible Hospitals (EHs) to maintain proof of active engagement with public health. TPR manages active engagement statuses, generates emails and letters as proof of public health reporting for registered users. Training is provided to help potential trading partners register – click here to see available schedule. 

Promoting Interoperability (PI) Programs

In 2011, the Centers for Medicare & Medicaid Services (CMS) established the Medicare and Medicaid EHR Incentive Programs (now known as the Promoting Interoperability programs) to encourage clinicians, hospitals, critical access hospitals to adopt, implement, upgrade (AIU), and demonstrate meaningful use of Certified Electronic Health Record Technology (CEHRT). CMS renamed the EHR Incentive Programs to the Promoting Interoperability (PI) Programs in April 2018. This change will move the programs beyond the existing requirements of meaningful use to a new phase of EHR measurement with an increased focus on interoperability and improving patient access to health information.

 

Doctor looking at Xray

CMS allowed the state Medicaid agencies the option of using the new PI program title or to retain usage of the original program name. TennCare has opted to continue to refer to its program as the EHR Provider Incentive Payment Program. Remember, no matter which name you see or hear, it is still referring to the EHR Incentive Program which began in 2011.

Promoting Interoperability  (aka Meaningful Use) is using certified EHR technology to

  • Improve quality, safety, efficiency and reduce health disparities
  • Engage patients and families in their health care
  • Improve care coordination
  • Improve population and public health

Eligible hospitals and EPs that attest directly to a state for the state’s Medicaid EHR Incentive Program will continue to attest to the measures and objectives as finalized in the 2015 EHR Incentive Programs Final Rule (80 FR 62762 through 62955).

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TDH Declaration of Readiness for Public Health Reporting 

2015 Edition Certified Electronic Health Record Technology

Beginning in 2019, all eligible professionals (EPs), eligible hospitals (EHs), dual eligible hospitals, and critical access hospitals (CAHs) participating in EHR incentive Programs are required to use a 2015 edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interoperability Program. The 2015 Edition CEHRT functionality must be in place by the first day of the EHR reporting period and the product must be certified to the 2015 Edition criteria by the last day of the EHR reporting period. Participants must be using the 2015 Edition CEHRT functionality for the full EHR reporting period.  In many situations the product may be deployed, but pending certification.  As long as the certification is received by the last day of the reporting period, the EP will be able to meet the Stage 3 objectives and measures.

TDH Declaration of Readiness

As of July 1, 2019, TDH is declaring readiness for the  Public Health Reporting measures listed below. Participating providers should check here periodically for updates to TDH’s Public Declaration of Readiness to receive data from Certified Electronic Health Record Technology (CEHRT). For questions related to the TDH Declaration of Readiness, contact the TDH Partner Engagement Team at (615) 253-8945 or MU.Health@tn.gov.

Note: TDH will continue to support the use of both the 2014 and 2015 CEHRT for the purpose of Public Health Reporting in Tennessee.

Electronic Case Reporting (eCR) is the automated generation and transmission of case reports from an electronic health record (EHR) to the public health agency’s disease surveillance system for review and action. eCR will allow healthcare providers the opportunity to report suspected cases to TDH for further investigation using an electronic health record (EHR) system rather than manually reporting on paper and waiting on lab test results to confirm a suspected case. The eCR will capture critical clinical and demographic patient data from Certified Electronic Health Record Technology (CEHRT) not otherwise included in laboratory reports. Utilizing eCR will reduce the burdensome paper-based and labor-intensive administrative process reporters face in reporting and responding to public health’s requests for additional information.

Electronic Case Reporting Measure

TDH is developing requirements and documentation for eCR under the Public Health Exchange Objective, with plans to declare readiness in July 1st, 2019  for January of 2020. Eligible hospitals interested in eCR pilot testing can email questions to CEDS.Informatics@tn.gov for more information.

 

 

CEHRT Edition

Implementation Guide

Measure

Incentive Program

Supported  by TDH eCR

2014

 

Electronic Case Reporting

MU Modified Stage 2

 

2015

 

Electronic Case Reporting

Stage 3

 

 

X

EHR Incentive Programs support the adoption and meaningful use of certified EHR technology to allow providers to exchange public health information electronically. TDH is currently accepting electronic reportable laboratory results from eligible hospitals (EHs) and eligible critical access hospitals (CAH) only.

Electronic Reportable Laboratory Result Reporting Measure

In order to satisfy TDH’s requirements for Public Health Reporting using electronic health record technology, all potential trading partners must first register their intent to exchange data: Trading Partner Registration (TPR)

The MU EHR Incentive Program requires EHs and CAHs to be in active engagement with public health to send electronic reportable laboratory results from CEHRT, except where prohibited, and in accordance with applicable law and practice.

Note: The time until live data exchange varies and depends upon the quality and speed of data exchange testing.

Send inquiries to CEDS.Informatics@tn.gov.

CEHRT Edition

Implementation Guide

Measure

Incentive Program

Supported  by TDH ELR

2014

Hl7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 (US Realm), with Errata and Clarifications

Electronic Reportable Laboratory Result Reporting

MU Modified Stage 2

X

2015

Hl7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 (US Realm), with Errata and Clarifications

Electronic Reportable Laboratory Result Reporting

Stage 3

 

 

X

EHR Incentive Programs support the adoption and meaningful use of certified EHR technology to allow providers to exchange public health information electronically. TDH is currently accepting syndromic surveillance data from Eligible Hospitals (EHs) with an emergency department only.

Syndromic Surveillance Measure

In order to satisfy TDH’s requirements for Public Health Reporting using electronic health record technology, all potential trading partners must first register their intent to exchange data: Trading Partner Registration (TPR)

The MU EHR Incentive Program requires EHs to be in active engagement with public health to submit syndromic surveillance data from CEHRT, except where prohibited, and in accordance with applicable law and practice.

Note: The time until live data exchange varies and depends upon the quality and speed of data exchange testing. At this time, TDH is not accepting syndromic surveillance data from any eligible professionals.

Send inquiries to CEDS.Informatics@tn.gov.

EHR Incentive Programs support the adoption and meaningful use of certified EHR technology to allow providers to exchange public health information electronically. TDH is currently accepting immunization data from EPs, EHs, and CAHs.

Immunization Registry Reporting Measure

In order to satisfy TDH’s requirements for Public Health Reporting using electronic health record technology, all potential trading partners must first register their intent to exchange data: Trading Partner Registration (TPR)

The MU EHR Incentive Program and the MIPS Advancing Care Information program require EPs, ECs, EHs, and CAHs to be in active engagement with public health to submit immunization data from CEHRT except where prohibited and in accordance with applicable law and practice.

Note: The time until live data exchange varies and depends upon the quality and speed of data exchange testing.

Send inquiries to TennIIS.MU@tn.gov. Your points of contact will be Karen L. Curtis.

Cancer Case reporting using a CEHRT does not replace state mandated hospital and laboratory reporting. 

Effective July 1st, 2018, TCR will accept only new registrations from eligible clinicians for electronic data submissions with the following physician specialties:

  1. Dermatology                            
  2. Urology
  3. Gastroenterology
  4. Hematology
  5. Medical Oncology
  6. Radiation Oncology
  7. Surgical Oncology
  8. Gynecologic Oncology

See also TCR Declaration Update for more information.

Public Health Registry Reporting Measure

In order to satisfy TDH’s requirements for Public Health Reporting using electronic health record technology, all potential trading partners must first register their intent to exchange data: Trading Partner Registration (TPR)

The MU EHR Incentive Program requires EPs to be in active engagement with public health to submit data to a specialized registry from CEHRT except where prohibited and in accordance with applicable law and practice.

Note: The time until live data exchange varies and depends upon the quality and speed of data exchange testing.

Send inquiries to TNCancer.Registry@tn.gov.

TDH Public Health Reporting Procedures

In the MU EHR Incentive Program’s for 2015 through 2017 proposed rule 80 FR20366, CMS highlighted their intention to align with the Stage 3 proposed rule and remove the term “ongoing submission” and replace it with an "active engagement" requirement. Active engagement may be demonstrated by any of the following options:

The EP, EH or CAH registered to submit data with the PHA or, where applicable, the CDR to which the information is being submitted; registration was completed within 60 days after the start of the EHR reporting period; and the EP, eligible hospital, or CAH is awaiting an invitation from the PHA or CDR to begin testing and validation.

In Tennessee, the onboarding process to exchange data with the Tennessee Department of Health (TDH) begins when a potential trading partner registers with TDH expressing their intent to exchange data electronically.

The Trading Partner Registration (TPR) system allows potential trading partners to register for Immunization Messaging (new registrations), Cancer Case Reporting, Electronic Laboratory Reporting (ELR) and Syndromic Surveillance Messaging (Eligible Hospitals w/Emergency Room) in one location. TPR provides documentation that can be utilized for Meaningful Use attestation and allows users to view their progress from end to end through the use of milestone letters documenting on-boarding progress. Click here to download the TPR Worksheet.

Also displayed within the TPR organizational profiles are requests for actions. TDH expects the responses of potential trading partners to requests for actions to be applicable with moving the trading partner to a production status. TDH reserves the right to disengage in onboarding activates with any trading partner, at any time, due to consistent problems associated with reporting requirements, and file specifications in accordance published national standards. The trading partner’s active engagement status will be provided in the TPR system under the Interface Details tab.

Click here to see a listing of training dates and times. To receive the TPR webinar details, you must complete the registration form found at http://tn.gov/health/calendar. If the requested date/time is available, you will receive an email invitation with the conference phone number and webinar link. If you do not receive an email within 2 business days send an email to mu.health@tn.gov.

The EP, EH or CAH is in the process of testing and validating of the electronic submission of data. Providers must respond to requests from the PHA or, where applicable, the CDR within 30 days; failure to respond twice within an EHR reporting period would result in that provider not meeting the measure.

The TDH interfaces will invite the EPs, EHs or CAHs to begin submitting test messages. TDH staff will validate the messages and provide information needed to correct errors or omissions. The testing procedures and requirements will vary between TDH interfaces and will depend upon which stage of the Meaningful Use process is being completed. The testing and validation process will continue until the onboarding team states the messages have met the requirements. The trading partner’s active engagement status will be provided in the TPR system under the Interface Details tab.

The EP, EH, or CAH has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDR.

Appropriate TDH program staff will indicate that testing has been successfully completed and data is being sent to the TDH production system. TDH may communicate with those reporting electronically about data quality. The trading partner’s active engagement status will be provided in the TPR system under the Interface Details tab. 

Preferred Secure Transport Methods

Below are the current preferred transport methods for each of the Public Health measure. Additional mechanisms might be available and can be discussed when appropriate.  

Interface

Secure File Transport Protocol (SFTP)

Web Services (using the CDC WSDL)

Direct Messaging

Immunization Registry

Yes

Yes

No

Electronic Laboratory Reporting

Yes

No

No

Cancer Case Reporting

Yes

No

No

Syndromic Surveillance (EHs w/Emergency Department)

Yes

No

No

Note: The CDC Web Service Definition Language (WSDL) is the formally defined transport standard for transmitting immunization data via HL7 messaging. Trading partners seeking a bi-directional interface with TennIIS should contact the TennIIS Team at TennIIS.MU@tn.gov

If you have  public health reporting questions, please contact MU.Health@tn.gov