Interfaces/Electronic Transmissions

I have an engine that is owned and maintained by my IT staff. Can I configure the interfaces required for Meaningful Use or do I have to purchase an Evident-configured interface?

The universal feeds do not include the internal mapping and/or translations utilized to meet the implementation guidelines/criteria outlined in the Meaningful Use objectives and therefore cannot be used for Meaningful Use attestation.

How far in advance do I need to place orders for required interfaces?

Orders need to be placed as soon as possible. The minimum lead time for all interface orders is 90 days. Interfaces must be purchased in production prior to the start of the Meaningful Use reporting period.

Why is a separate interface order needed for each AR?

Interfaces are configured on an AR basis – meaning the company, all directories/sub-directories and associated setup for the HIS functionality must be in place and then the interface configuration in Linux, in the software tables and in the Interface Management System (IMS) can be set up. Each company has an ARID and a FACID which drive the interface configuration as all HL7 messages must contain these identifiers to ensure the data in the message is routed appropriately. Interface setup/configuration/maintenance and support all starts with an order as we have to schedule and allocate the appropriate resources to make the interface work, as well as ensure documentation reflects what is set up and expected to be supported/managed with software updates and changes.

My facility utilizes a separate product for patient access to our website for accounting needs and well-being instructions. Can the Thrive Patient Portal be linked to this portal product for the View/Download/Transmit objective that Evident plans to implement through the portal?

No, the email triggers, statistic tracking, etc. require use of the Thrive Patient Portal to meet the View, Download & Transmit objective.

If my public health agency is unable to accept the reporting data in an HL7 v2.5.1 message, or requires validation of multiple transmissions before allowing my facility to move to a production status, can Evident provide a letter of exclusion for that objective?

Only the public health agencies or an authorized entity of the state can provide exemption or exclusion status. This documentation must be stored with the rest of your attestation information for audit purposes. It is also recommended that the facility provide a copy of the exclusion to Evident for audit/tracking purposes.

We participate in a Regional Health Information Organization (RHIO) and they have the ability to submit public health reporting data for the RHIO participants. Can I use the interface to the RHIO to satisfy all the public health reporting objectives?

A Health Information Exchange (HIE) or Regional Health Information Organization (RHIO) is not required to certify for Meaningful Use and may not meet the federal requirements that are included in the Meaningful Use audits. Keep in mind that the interface is typically developed per the HIE/RHIO specifications, not the federal guidelines. Given this, Evident recommends that you confirm with the RHIO/HIE, and with the state to whom the reportable data is sent, that use of the HIE/RHIO for attestation to the public health reporting objectives will comply with federal regulations and standards and ensure you pass an Meaningful Use audit should one be issued for your facility.

Do I have to have an interface for Quality Measures in Stage 2 of Meaningful Use?

No – Initially, CMS indicated plans to require electronic submissions for Clinical Quality Measure (CQM) data but no specifications were provided and the electronic submission requirement was later retracted. The current process for submitting Quality Measures remains acceptable. More information is available on the CMS website.

How can I make sure the Syndromic Surveillance interface includes all the required data for public health reporting?

Syndromic Surveillance interfaces typically send demographic data as well as the patient’s chief complaint. It is Evident’s recommendation that each facility transition the chief complaint field in the Census tab to a required field, thereby ensuring it’s included with every registration.

Do third party vendors that send data to the Thrive System have to be Meaningful Use certified?

No, the third party systems do not have to be certified since the Thrive EHR is the certified product for attestation. However, if Thrive is using data received from a third party system to meet interoperability requirements, all data elements and formatting must comply with the implementation guidelines needed to attest. For instance, in order for Thrive to transmit lab results to the public health agencies in the manner outlined in the implementation guide, ie: structured and with LOINC/SNOMED-CT, that information must be received from any laboratory vendor that sends results to the HIS.

I have a third party vendor that sends data to Evident in HL7 v2.3 and this data will be included in what is transmitted for public health reporting. Does that vendor have to start sending the data in HL7 v2.5.1 or can we up-convert the current data stream to meet the criteria that requires HL7 v2.5.1 for interfaces?

Technically, yes. We can convert HL7 v2.3 to v2.5.1 but all of the required data elements must be included in the v2.3 message for it to be successfully updated to the public health agency.

Do all of my “public health” interfaces have to be successful ongoing submissions to my public health agency for Meaningful Use Stage 2?

Yes, all public health interfaces must be successful ongoing submissions from the certified EHR to the registry for the entire reporting period. (Note: some exclusions apply). If your state is exempt, your state will need to provide your facility with a letter of exemption.

How are immunizations sent to the state registry? Is this interface performed automatically, or does the staff need to select a certain option when charting?

Transmission depends on the public health agency. Some states utilize Public Health Information Network Messaging System (PHIN-MS), File Trasnfer Protocol (FTP) or batch transmissions and others that require real-time updates – all via an HL7 v2.5.1 message. For immunization reporting, the software is designed with logic that automatically generates a message in the background so charting of immunizations is all that the staff need to do to initiate. There is setup in the software at the item level to ensure administration charting includes lot number and expiration date.

With the increased demand for EHR integration, what is Evident doing to facilitate this process between third party systems and the Thrive system?

Evident is doing everything we can to encourage interoperability opportunities, to accelerate development and to deploy our piece of the integration progression in a timely manner. Every interface requires the coordination of three different organizations: Evident (the EHR vendor), the third party vendor and the facility, along with the various timelines of each group. In addition, it is the responsibility of the facility to validate every interface. While it may only take a week or two to actually deploy the interface, the testing and validation process can take much longer.

Do I have to purchase a separate interface for immunizations if the clinic runs as a department of the hospital?

No, clinics that are considered to be departments of the hospital (housed within the hospital AR) are not required to purchase an additional immunization interface. Separate interface orders are needed for each additional clinic AR.

Where can I find a list of public health agencies and immunization registries to submit my data as required by the public health objectives for the Medicare and Medicaid EHR Incentive Programs?

For information and/or instructions on where to submit your public health-related data, please contact your local or state public health agencies and immunization registries.

When a patient is registered in Thrive and upon inquiry they respond that they have not received any immunizations since their last visit, should I document that no vaccine was administered in the immunizations menu?

No. If the patient has not had any vaccines administered since their last visit, no new entry should be added to the immunization entry menu. Each entry made in this menu creates a record that is subsequently sent to your immunization registry via the public health interface. Each record should contain the vaccine that was received by the patient, or an explanation as to why the patient did not receive a vaccination. For example, CVX code 998 is utilized in the CPSI software to document that no vaccine was administered due to evidence of immunity. Evidence of immunity indicates that a person has plausible evidence that they have already developed immunity to a particular disease and further immunization against the disease is not likely to provide benefit. When a user selects "No vaccine administered" (CVX 998) in immunization entry, the Evidence of Immunity field should be addressed to attach an applicable SNOMED code and description to indicate that a patient is immune to a specific disease.

In summary, if the patient has not received any vaccines at any other facility since their last visit at your facility, no entry should be made in the immunization entry menu.

My hospital has an interface with a third party clinic vendor where orders are sent to the hospital and the results are returned to the physician’s clinic. We plan to use this for the ‘Incorporate Clinical Lab Tests’ objective. Does the physician in the clinic have to sign the orders in Thrive for these orders to meet Meaningful Use requirements and/or legal signature requirements on orders?

No, the Meaningful Use criteria surrounding this objective do not specify inclusion of the physician signature in the order message. Additionally, 42 CFR 410 indicates documentation by the treating physician (i.e.: in the summary of care/progress note) that he/she intended for the test to be performed will satisfy the authorization requirement without the need for the signature of the ordering physician. The industry standard on electronic orders is to include the ordering physician in the HL7 transaction as acceptable authorization for the test to be performed.

If my interface for public health reporting is ‘on hold’ or ‘in the queue’ with the state agency, what exclusion option do I select for my Stage 2 attestation?

You should only select an exclusion option if your state agency has provided your facility with a letter of exclusion/exemption. If your facility has completed the state-required registration/onboarding and are waiting to begin implementation, you should select ‘Yes’ to attest. Keep in mind that the attestation requirements included with the public health reporting objectives include registration with intent to initiate ongoing submissions within 60 days of the start of the reporting period as well as the full/ongoing submissions.