Tag Archives: immunization information system

Provider Backlash Threatens to Gut MU Public Health Objectives

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The chorus of health care provider complaints about growing federal HIT requirements, from Meaningful Use (MU) to switching to ICD-10 diagnosis codes threatens to claim some public health victims.  On February 19 the Meaningful Use workgroup of the US HIT Policy Committee (HITPC) responded to the latter’s pressure to reduce the number of Stage 3 MU objectives by voting to delete electronic reporting of reportable lab results (ELR), syndromic surveillance (SS), and reducing requirements for reporting to public health registries.  They declined to endorse a new objective for clinical case reporting of reportable conditions, but appear posed to recommend continuing reporting to immunization information systems (IIS, often called immunization registries) and adding the capability for EHRs to upload immunization histories from an IIS.

Ironically, ELR and SS were common (but far from universal) even before Meaningful Use. An impediment to rapid expansion of ELR to new hospitals was the need to convert in-house lab codes to LOINC (but this is now MU-required for in-hospital lab reporting anyway).  Meanwhile, providers that had happily submitted HL7 Admission, Discharge and Transfer (ADT) messages for SS in the past were confronted by more complex message requirements in Meaningful Use rules.  Some providers questioned why they should spend time and money sending standardized data when many public health jurisdictions could not accept it electronically.   Thus these efforts resemble half-built bridges, with those on neither shore willing to invest enough to finally meet in the middle.

The MU Workgroup decisions reflect a narrowing of HITPC focus from simultaneously meeting five large social goals (one being improving public and population health) to enabling “transformation of care” as envisioned in medical homes and accountable care organizations.

Some providers might enjoy short-term savings by avoiding MU standardized reporting, but then face ongoing costs and retarded outbreak response associated with inefficient manual reporting.  Of course such cost-efficacy depends on health department adoption of standardized electronic reporting.  Progress was reported in 2013 with 95% of jurisdictions receiving some ELR, and the share of 20 million annual reports received electronically rising 62% from 54% in 2012. That represents 1,600,000 fewer manual reports yearly and 1,600,000 more communicable illnesses addressed more quickly and efficiently, just in the earliest stages of MU.

Public health advocates are typically best represented at the MU workgroup level, so greater effort is required to modify HITPC recommendations and proposed rules changes. The MU Workgroup will return to the discussion (unclear how final are the recommendations at this point) on  March 4 and it seems likely HITPC will take up the topic March 11.  Interested parties can tune in.  Health.e.volution has learned the Joint Public Health Informatics Task Force of public health associations is crafting a strategy, so concerned agencies and individuals can contact their association to get involved.

Dear NPR: There IS a treatment for that diagnosis: electronic health records and immunizations

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NPR’s All Things Considered yesterday described “growing pains” in health information technology (HIT) by saying many doctors in Colorado had to enter immunization records twice: first into their Electronic Health Record (EHR) system, and then into the state’s immunization registry.   According to the story, many doctors fail to do both

In fact, immunization registries, the Centers for Disease Control and Prevention, the HHS Office of the National Coordinator for HIT, and the Centers for Medicare and Medicaid Services (CMS) have worked together to implement solutions for this problem.*  The federal EHR Incentive Program (better known as “Meaningful Use”) includes an objective for EHR systems to upload shot records into immunization registries, eliminating the “double entry” problem.  The Colorado registry has implemented the necessary standards, and instructions for doing so are published on the same website cited in the NPR story.

This process is still not simple.  But the needed standardization is further improved in Stage 2 of Meaningful Use, scheduled to begin in October 2013.  And in October 2015 federally-certified EHRs could be required to download immunization records and alerts for clinicians about which vaccines a patient lacks.   Such automated data and reminders are needed to accelerate the completeness of childhood immunization which remains subpar.

I appreciate NPR’s attention to this challenging issue.  But while various difficulties affect the transition to electronic health records, NPR inadvertently selected a success story to illustrate the problems.

*Full disclosure: I was among those involved in this collaboration.