Electronic Physician Reporting to the Kentucky Cancer Registry

1. Electronic Physician Reporting to the Kentucky Cancer Registry David Rust, MS Software Developer Sheena Batts, CTR CER Project Manager September 17, 2012 NAACCR Physician Reporting Workgroup

2. Overview • Special Project Objectives • Strategic Approach • Making Contact with Providers • Collaborating with EHR Vendors • Transmission • Current Status • Challenges

3. Comparative Effectiveness Research (CER): KY Special Project 3 (SP3) • Objective • Increase completeness of cancer treatment data captured by the Kentucky Cancer Registry • Goal • Implement direct EHR reporting from oncology providers in Kentucky by September 2013

4. Key Relationships • Kentucky Regional Extension Center (KY-REC) • Leverage MU incentives and infrastructures to achieve direct electronic reporting • Kentucky Health Information Exchange (KHIE) • Provide secure electronic network infrastructure • CDC • Partner with CDC to develop and evaluate necessary software tools to process the EHR clinical event messages

5. Regional Extension Centers • Funded to assist healthcare providers quickly adopt meaningful use of EHRs • Provide direct technical assistance to establish EHRs • Offer training, information and guidance • Facilitate Meaningful Use attestation

6. Kentucky Regional Extension Center • KCR contracted with KY-REC to recruit providers • Target medical and radiation oncology providers in Kentucky • KY-REC obtains a signed Provider Agreement • KY-REC critical in recruitment of providers to report electronically to KCR • KY-REC works closely with the KHIE implementation specialist

7. Health Information Exchange • Funded by grants through State HIE Exchange Cooperative Agreement Program • Funded in all states, DC, and several territories • Provide technical infrastructure for secure exchange of health information

8. Kentucky Health Information Exchange • KCR has a signed agreement with KHIE to utilize service • Provide implementation specialist on-site to oncology providers • Information technology services may be sub-contracted by the state HIE

9. Identifying ideal providers • Obtained updated list of Kentucky Licensed Physicians • Sorted by specialty • Removed retired and hospital based physicians • Identified group practices by address • Start with large practices • MU Certified EHR in place • Identify legal ownership of the medical record

10. Contacting Practices • Developed Participation Agreement • Developed survey instrument • Interest in meeting Meaningful Use • Current medical record status • Interest in electronic reporting to KCR • Contacted practices by phone • Identify Administrator /Manager • Any general information • Current software vendor • Sent return envelope with survey • A KCR Participation Agreement was sent to those indicating interest in the project

11. Provider Participation • Referrals to KY-REC and KHIE are sent upon receipt of a signed participation agreement • Benefits of participation • KY-REC services provided at no charge • Meets KCR physician reporting requirement • Total automation of reporting (time factor) • Reduce therapy and follow-up requests from hospital registries

12. Collaborating with EHR Vendors • Providers with MU certified EHR systems were selected • When the REC Provider Agreement is signed, KCR obtains permission from the participating provider/practiceto contact their EHR vendor • KCR establishes communication with the EHR software vendor to discuss logistics and development of CDA document

13. Pilot Vendor • Early 2012 the first vendor was recruited to develop the Ambulatory Healthcare Provider Reporting to Central Cancer Registries CDA document in Team Chart Concept(TCC) EHR

14. EMR because you want to, not because you have to. At Ulrich Medical Concepts, we are proud to have worked with the Kentucky Cancer Registry to develop an electronic cancer registry system. Our software, Team Chart Concept (TCC) is an integrated practice management, electronic medical records system in use in the following states: Kentucky Indiana Tennessee West Virginia Illinois Virginia Missouri Ohio For more information, please contact Sandra Ulrich, VP Sales & Marketing. www.ulrichmedicalconcepts.com www.correctek.com www.revenuesol.com Phone 270-744-0404

15. Transaction Models • KCR accepts any secure method of transaction and any type of data format • Transactions: sftp, email, web service, etc… • Format: raw text, HL7 2.x, CDA, etc…

16. Transaction Models… • KCR’s Ideal Model and Data Format • Provider sees patient and generates a cancer diagnosis code • This triggers the EHR to: • Create the CDA document • Encodes and compresses document • Wrap in HL7 message • Encrypts and sends through KHIE web service • KHIE’s BizTalk Server relays this message to the KCR’s PHIN-MS server • The message is then stored in the PHIN-MS database • The CDA document is pulled from the HL7 message, decoded and decompressed • eMaRC Plus polls the database, notices a new CDA, store and displays CDA for review and export in NAACCR file format

17. The message is encrypted and submitted through the KHIE Webservice Healthcare Provider EHR KHIE KHIE Web Service Healthcare Provider completes documentation on patient KHIE sends encrypted messages to KCR EHR notices cancer diagnosis trigger, CDA document is constructed, compressed, encoded, and wrapped in an HL7 message BizTalk PHIN-MS decrypts message and stores in PHIN-MS database PHIN-MS Kentucky Cancer Registry eMaRC stores and displays CDA documents for review Files are exported in NAACCR format Receive Queue A program pulls, decodes, and decompresses the CDA document from the HL7 message eMaRC polls CDA document batches automatically from PHIN-MS eMaRC Database

18. Message Format • Currently, Ulrich Medical Concepts, Inc. has a CDA document complete for transmitting • KHIE had an established method for receiving HL7 2.5.1 messages • The CDA document is compressed (gzipped), Base-64 encoded, and inserted into OBX-5 of HL7 2.5.1 • Message is then encrypted, and submitted using the KHIE web service

19. Placement of CDA in HL7 2.5.1 Message MSH|^~\&|ACS|ACS|KCR PHINMS KCR|20110818214317||MDM^T02|00011|P|2.5.1|||||| EVN|T02|20110818214317 PID|1||KYMC|KYMC|HOODY^JONE-KY11^^^L|||||1 TEST AVE^^TEST CITY^KY^46035|||| PV1|1|N OBX|1|ED|48769-4^Continuity of Care Panel^LN^CCD|| CDA MESSAGE ||||||F

20. Current Status • Ulrich Medical Concepts, Inc. is refining the cancer section of the CDA messages with the assistance of CDC • KCR has received multiple HL7 wrapped CDA test messages from the vendor through the transaction model • KCR has received CDA messages from the provider through the transaction model • KCR is currently working with a large oncology specific EHR vendor • Provider Participation • 41 signed providers-Medical Oncology, Radiation Oncology and Dermatology • KCR goal: Have 60 signed providers • KCR received Pioneer Award from the Governor’s Office of Health Information Technology

21. Challenges • Ownership of medical record • Quickly transitioning practices • Software vendors have not distributed the certified version of product to the provider • Cancer Reporting is part of Stage 2 MU • Revisions to KCR Central Registry (CPDMS) • Procedures for creating partial records in progress

22. Questions?