CCALAC NEXTGEN USER GROUPJULY 24, 2014

CAIR Interface Presentation

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Los Angeles (Region VII) California Department of Public Health3530 Wilshire Blvd, Suite 700Los Angeles, CA 90010

Local User Support: Iris GonzalezPhone: 213-351-7475 Fax: 213-351-2780Email: IriGonzalez@ph.lacounty.gov

Monique HarrisPhone: 213-351-7473 Fax: 213-351-2780Email:mharris@ph.lacounty.gov

Janet AjaoPhone: 213-351-7472 Fax: 213-351-2780Email: jajao@ph.lacounty.gov

Data Exchange Support:Eric DansbyFax: 916-440-5967Email:CAIRDataExchange@cdph.ca.gov

City Of Long BeachCity Of PasadenaLos Angeles County

Important Contact InfoFor Stage 2 MU, your contact is:

Eric Dansby

CAIRDataExchange@cdph.ca.gov

CAIR State Help Desk Hours: Monday - Friday 8:00AM - 5:00PMPhone: 800-578-7889Fax: 888-436-8320 Email: cairhelpdesk@cdph.ca.govWebsite: www.cairweb.org

Website Region VII:

http://www.immunizelink.org/index.htm

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What are the requirements for Stage 2 MU?

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1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders

10. Incorporate clinical lab-test results into Certified EHR Technology

2. Generate and transmit permissible prescriptions electronically (eRx)

11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach

3. Record demographic information 12. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care

4. Record and chart changes in vital signs 13. Use certified EHR technology to identify patient-specific education resources

5. Record smoking status for patients 13 years old or older

14. Perform medication reconciliation

6. Use clinical decision support to improve performance on high-priority health conditions

15. Provide summary of care record for each transition of care or referral

7. Provide patients the ability to view online, download and transmit their health information

16. Submit electronic data to immunization registries

8. Provide clinical summaries for patients for each office visit

17. Use secure electronic messaging to communicate with patients on relevant health information

9. Protect electronic health information created or maintained by Certified EHR Technology

Measure Specifics5

Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 MeasureCapability to submit electronic data to immunization registries or Immunization Information Systems and actual submission except where prohibited and in accordance with applicable law and practice

Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information have the capacity to receive the information electronically)

Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission except where prohibited and in accordance with applicable law and practice

Successful ongoing submission of electronic immunization data from Certified EHR Technology to an immunization registry or immunization information system for the entire EHR reporting period

ExclusionsYou do not administer immunizations to any of the populations for which data is collected by your jurisdiction’ s immunization registry. You operate in a jurisdiction where no immunization registry is capable of accepting the specific standards required for your EHR. You operate in a jurisdiction where no immunization registry provides timely information on capability to receive immunization data. You operate in a jurisdiction for which no immunization registry that is capable of accepting the specific standards required by your EHR can enroll additional EPs.

Five Steps to MU Compliance6

EHR Upgrade•HL7 2.5.1•SOAP messaging protocol

2014 90-day reporting can begin

Step 1: Register at http://cairweb.org/imp/

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Registration is at the Site level and includes NPI address, contact, and other general health center information

Choose submission type: Direct from EHR Via a distinct Sending Facility (e.g. HIO, vendor/EHR data

warehouse, health plan data warehouse, or other data aggregator) Act as a Sending Facility (e.g. Health Information Exchange)

A secure email will contain Site credentials as well as information on the follow-up steps your Site must take to prepare for data exchange with CAIR

Step 2: Pretesting8

Work with your EHR vendor to obtain the proper flat file, called VXU (Immunization Messages)

Inform your vendor and upgrade project manager of your timeline for submitting the message. Let the vendor know you expect their timely support in resolving any error messages (days not weeks)

Submit the message to the the CAIR message validation tool: https://igsstag.cdph.ca.gov/CAIRHL7WebValidator/

From what we know there is one CAIR rep to assist several regions. His preferred manner of communication is email

CAIR HL7 2.5.1 is the preferred language spec found at: http://cairweb.org/images/docs/CAIR_HL7v251_Spec_for_web.pdf

You will need to resubmit until you receive an auto response from CAIR that your test message was successful

Step 3: Test Submission9

You should use the same message format that passed the Pre-testing You then install a CDPH Client Certificate in order to use SOAP web

services (required) by CAIR http://cairweb.org/images/docs/SOAPUI_Instructions.pdf

Now, submit to: http://cairweb.org/imp/ Failed test will produce an auto response with diagnostic

information. As before you will need your EHR vendor’s support to trouble shoot and resolve before you can move to the next step

Step 4: Message Validation10

You must enter message validation within the first 60 days of the reporting period

There are 2 components to validation: Proper formatting of the message Data quality

Once 50 unique and successful test messages with appropriate data quality have been sent from your EHR, CAIR will move the organization from the test environment to production

You must confirm message success and continue resolving errors in order to move to the next step

You must receive an official notification from CAIR that you have successfully passed Message Validation

Step 5: Ongoing Submission11

CAIR recommends daily submission of the VXU messages You must enter the Ongoing Submission step within 60 days of your

reporting period or providers will fail MU Stage 2 We recommend you move into Ongoing Submission within 30 days You must correct and resubmit failed messages What is your expected frequency of submission and who is

responsible to submit for all or each of your 2014 MU Stage 2 providers?

How will you work with your EHR provider for timely resolution of failed messages?

Common Issues12

EHR interface to CAIR still under development Does not apply to NextGen

Use of SOAP protocol is not widely tested Wait time for vendor to implement interface

Not a part of the upgrade Understanding recovery steps for correcting rejected

messages E.g. CVX/ CPT codes not matching

Obtaining timely vendor support for rejected messages Limited CAIR resources for our region and expectation of

high volume for Q4 but especially December

NextGen Rosetta Immunization Interface NextGen Rosetta Immunization Interface

E-MedApps SevaExchange InterfaceE-MedApps SevaExchange Interface

Can send HL7, HTTPS, FTP, Flat Files and other file formats

Can send Real time or batch files to Registries

ONC Certified Can meet stage 2

requirements

SevaXchange sends real-time updates to CAIR of immunizations

Can send HL7, CCD/CCDA, XML, flat files, and custom format files

ONC Certified “EHR Module Ambulatory”

Can be configured to send real-time or batch file messages on a custom schedule

Can meet stage 2 requirements

Which CAIR interface product is right for you?

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Both interfaces are sufficient for meaningful use. Perhaps consider which organization you feel is best able to meet your timeline, support needs, and budget.

Key points

Begin the process today (if you have not already done so) Registration can and should be done before your upgrade Registration is done at the site level CAIR and your vendors are the best resources for

troubleshooting failed messages Leverage CCALAC for common themes and discovered

solutions

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Questions?15