State and Local Health Department - Frequently Asked Questions
The following Frequently Asked Questions answer questions on meaningful use relevant to state and local health departments.
What are the various modes of technical assistance available to state/local health departments from CDC to help with the implementation of Meaningful Use?
Currently the CDC is working to define the types of technical assistance that are needed by state and local health departments. Possibilities include providing direct technical assistance, availability of a help desk, and developing guides and toolkits on the implementation of Meaningful Use. States that have immediate needs should contact their PHIN technical assistance designee.
CDC, via a letter from Dr. Tom Frieden to each state health office, has requested each state/large local health department identify a Public Health Meaningful Use coordinator. What is the role of a Meaningful Use Coordinator within a state health department?
The Public Health Meaningful Use Coordinator is encouraged to be an executive level staff person to lead and coordinate a state’s public health agency's response to the meaningful use requirements, and to participate with other coordinators across the country in jointly advancing public health readiness for this challenge. This role includes:
- Making timely decisions, such as which relevant state public health information systems will need to be readied for the EHR Incentive Programs and the meaningful use requirements.
- Defining the process for local public health systems to test the submission of meaningful use data directly from providers and accept the data where successful.
- Working with your state Medicaid agency to ensure that public health perspectives are considered in how Medicaid will implement the EHR Incentive Program in your state, including public health IT system infrastructure assessments and enhancements. Medicaid Agencies might have fiscal resources available to contribute toward this effort.
- Serving as a public health liaison to your state’s Health IT Coordinator and to the State Medicaid Director, if they are not in your same agency.
- Serving as a public health liaison to your state’s Health Information Exchange governance and planning activities.
- Serving as a central point of contact for information and assistance by the Centers for Disease Control and Prevention (CDC) and the Joint Public Health Informatics Taskforce (JPHIT).
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What funding is available to help states implement Meaningful Use?
The following links provide information on funding opportunities to help states implement Meaningful Use:
- Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) building and strengthening epidemiology, laboratory and health information systems capacity in state and local health departments
- "Recovery Act" Standard and Reusable Solutions for Hospital Laboratory Submission of Reportable Lab Results to Public Health Cooperative Agreement Program
- American Recovery and Reinvestment Act of 2009, State Grants to Promote Health Information Technology (Health Information
- American Recovery and Reinvestment Act (ARRA)Funding Announcement for Enhancing the Interoperability of Electronic Health Records (EHR) and Immunization Information Systems (IIS)
- Health Information Exchange Challenge Program Funding Opportunity Announcement
- American Recovery and Reinvestment Act of 2009, Health Information Technology Extension Program: Regional Centers
- National Public Health Improvement Initiative
Please see the following link for additional information:
Does a modular approach that includes an Health Information Exchange (HIE) as one of its certified components meet meaningful use requirements?
A modular approach is where a hospital meets the meaningful use requirements utilizing a combination of systems is certainly an acceptable way for the hospital to meet the public health menu set option of electronic laboratory reporting (ELR).
In some cases, some of the Logical Observation Identifiers Names and Codes (LOINC)/Systematized Nomenclature of Medicine (SNOMED) and 2.5.1 transformations are taking place within the HIE Infrastructure in a particular state. In order for the hospitals to meet meaningful use, the hospitals will need electronic health record (EHR) technology that is certified as being capable of performing ELR according to the adopted certification criterion. To have this requisite functionality specified by the certification criterion it is likely that a hospital would need to get the service certified in conjunction with their Laboratory Infrastructure and Support (LIS) (since the service only provides a portion of the capability specified in the required certification criterion). Alternatively, the hospital could seek to acquire a certified complete EHR or certified EHR module designed by an EHR technology developer (vendor) that would also meet the capabilities required by the certification criterion. More information about the various options for certification can be found on the Office of the National Coordinator for Health Information Technology (ONC) website. To reiterate, this approach could allow hospitals to meet meaningful use as long the hospitals certify their system in conjunction with the functionality residing in the HIE services.
Is APHL also doing work on updating condition mappings to LOINC and SNOMED that overlaps the work being done to update the Reportable Condition Mapping Tables (RCMT)?
APHL has done work under the Public Health Laboratory Interoperability Project (PHLIP) to harmonize LOINC and SNOMED codes across 14 of the National Notifiable Diseases (NNDs). APHL has not done any work around notifiable conditions mapping.
The Joint CSTE/CDC ELR Task Force is currently updating the Reportable Condition Mapping Tables (RCMTs). These include LOINC-to-condition and SNOMED-to-condition mappings for nationally notifiable conditions (NNCs). The RCMTs will gradually be extended to include non-NNC, jurisdictionally reportable conditions that have associated laboratory tests. The updated RCMTs will be available via PHIN VADS in June 2011.
Do certification bodies certify correctness of data sent to public health?
No, certification is done based on certification criteria. Public health jurisdictions will need to validate correctness of data based on their on-boarding process.
We have a hospital whose lab is capable of sending an HL7 2.5.1 ELR message but we are only capable of receiving an HL7 2.3.1 message. Does the hospital meet the MU requirements for results reporting?
If the hospital has a certified EHR or EHR module that reports electronic laboratory results in the specified format, but the public health agency cannot recieve the data in that format, the eligible hospital can attest that the public health agency does not have the capacity to receive that message. The hospital will still receive the meaningful use incentive.
If a public health jurisdiction doesn’t have the capacity to accept a 2.5.1 MU ELR message, but the hospital can send them from their certified EHR or modular LIS system then does the hospital still qualify to receive the incentive?
If the public health agency doesn’t have the capacity to receive the messages in the format specified by the meaningful use standards and certification rule, the eligible hospital would attest that the public health agency doesn’t have that capability. The hospital would still receive the incentive payment.
Is there a tool we can use to obtain LOINC and SNOMED codes associated with nationally notifiable conditions? With non-nationally notifiable conditions (conditions reportable only to specific jurisdictions)?
The Joint CSTE/CDC ELR Task Force is currently updating the Reportable Condition Mapping Table (RCMT). These include LOINC-to-condition and SNOMED-to-condition mappings for nationally notifiable conditions (NNCs). The RCMT will gradually be extended to include non-NNC, jurisdictionally reportable conditions that have associated laboratory tests. RCMT can be accessed via PHINVADS at https://phinvads.cdc.gov/vads/SearchVocab.action
What software can be used as a rules engine to tell laboratories and hospitals what they need to report?
The certification does not require or prohibit a rules engine for identifying reportable laboratory results for the jurisdiction. If EHR and component modules are certified, the eligible hospitals will need to work with the public health agency to determine if the ELR message meets the jurisdictional reporting requirements.
How can a CDC ARRA funded immunization registry grantee use the funds to connect to an HIE?
Health Information Exchanges (HIEs) can play an important role in Immunization Registry (IR) data exchange. Currently, there are many ways in which providers can report data to an IR and the HIE can also complement existing methods. From an IR perspective, a single interface with an HIE that provides electronic exchange of immunization information with multiple provider EHRs is considered equivalent to establishing individual interfaces with the same number of EHRs, so long as full exchange functionality is achieved in either case. Full exchange functionality is defined as the needed format, performance and quality control mechanism that are needed to fully support an immunization program. Typically the exchange of the immunization data is needed for important purposes such as vaccine ordering, inventory control, and tracking vaccine administration. These and other functions with their exchanges are currently going on with providers today. An HIE may be able to improve the efficiencies and network exchange of information and IR functionality, but the core functions that the IR provides to the Immunization Program must be maintained. The performance, quantity of data, and most importantly, functionality of the exchange should not be compromised for the vaccine provider community. The immunization program needs to be able to support vaccine ordering, inventory control, dose administration tracking, coverage data, and other functional data needs. The IR function is not just a repository for data; it is a dynamic and ever-growing public health program tool.
CDC fully supports the use of the HIE in this exchange as one potentially efficient approach to exchanging immunization data with practice EHRs. Ideally, with an HIE or any new technology initiative, these exchange should be improved over time. However, individual states and their HIE will have to jointly collaborate to understand how best accomplish this based on a mutual understanding of both the HIE and IR maturity, functionality, and capacity.
What resources available to support jurisdictional health departments in meeting meaningful use?
Resources available to jurisdictional health departments can be found at the following links: