2023 CMS Promoting Interoperability Requirements for ELR and eCR Reporting
Hello all,
CMS’s Promoting Interoperability Programs released 2023 requirements for eligible hospitals and critical access hospitals, including changes to eCR and ELR reporting. CMS and CDC have asked CSTE to gather any questions from the community, and they will work to provide answers.
Do you have any questions or comments regarding the Eligible Hospitals and Critical Access Hospitals Objectives and Measures for the 2023 EHR Reporting Period? The specific requirements can be found on the CMS website. Please also see “Public Health & Clinical Data Exchange Objective” in the document “Medicare Promoting Interoperability Program Objectives & Measures”)
Do you have any questions or comments regarding the Eligible Hospitals and Critical Access Hospitals Objectives and Measures for the 2023 EHR Reporting Period? The specific requirements can be found on the CMS website. Please also see “Public Health & Clinical Data Exchange Objective” in the document “Medicare Promoting Interoperability Program Objectives & Measures”)
Please submit any questions or feedback by October 14th.
Thank you!
From my perspective (PA), I see this as you wrote it. However, I do not believe it should be up to the state staff to interpret and define CMS rules etc. for a facility. If your state is actively trying to onboard, that is a difference from PA as we are not doing so, but are being 'given' eCRs via the AIMS onboarding process, which we have virtually no role in.
I will never verbally or in writing tell a provider/facility that they are or are not in compliance and that they need to figure it out and work it out with CMS. I do not want the responsibility for a mis-interpretation or any fault falling on myself or our team.
Mark
Appreciate the quick responses and glad we are on the same page. I would just like an official response from CMS since it is so difficult to get them to respond.
Alaska recently had a health care facility ask us for a letter of exclusion for electronic case reporting. It seems like exclusions are between CMS and facilities. We can point a facility to the list of exclusions, but we are not keeping a registry of facilities claiming exclusions, nor are we signing off that they qualify for exclusions. We just keep track of facilities that have submitted letters of engagement for eCR. I want to make sure that this is the correct approach. I may have missed it on CMS' website, but my feedback would be more clear guidance regarding what is involved with asking for an exclusion (so we can point facilities there).
Thanks!
Morrow
We do have some rules associated with how long you can stay in pre-production and validation. Those become effective in 2024, so that anybody who is in Option 1 in 2024 should be in Option 2 by 2025. And another taste of how we do an annual rulemaking, last year when we did our annual rulemaking, we did adopt a new measure, the Antimicrobial Use and Resistance or AUR Surveillance Measure.
We do propose it for 2023, but we got a lot of pushback from commenters, and so we delayed the requirement until the 2024 reporting period. So, this is just a taste of what that additional requirement will be for next year
I will warn you that last year in rulemaking, we did establish 180-day reporting period, consecutive day reporting period for 2024, so that is coming."
I interpret this to mean we need to have all our hospitals who want to onboard, completed in Production for ELR (which takes us the longest to onboard now with about 9-month duration) by end of June 2025 in order for them to meet the 180-day rule. The EH/CAH may be able to file for an exemption if the PHA is unable to get them onboarded on time due to staff/systems constraints at the PHA, though that is between CMS and the EH/CAH. Currently, we do provide a letter when asked as what stage they are in and the date on which they entered that stage.
Speaking for just the ELR/eCR impacts, my and my staff's interpretation was the same as Michelle's.
As I've brought up before in other discussions/forums, these new CMS rules will severely negatively impact us at the PHA level.
1. We have been publishing a MU/Promoting Interoperability letter to our website since Stage 1, starting with Immunization. In that letter we clearly state the requirements and refer labs/hospitals/facilities (aka reporters) to the CMS website. We make it very clear that we do not provide attestation or proof of exemption - each reporter must request that from CMS. We only verify what stage the reporters are in - for ELR/eCR by email on request.
2. I had a longer rant here, but the short version is that we only were able to get new staff onboard in our informatics program in 2022 with COVID funding so we could go from a 3 person + 1 IT shop to now a 9-person shop (including me) to meet all of the required ELC and other funding activities including eCR and ELR. And that is still not enough staff to do all of the things we should be doing, including data modernization. I think we in our communities appreciate the time and effort involved to support surveillance systems, ELR, eCR, and messaging to CDC, but I'm not sure others outside of us really do. And most of the time, delays are not because of our staff work but due to the facilities or for us central IT not being able to deliver on time.
My concern about these new CMS rules is that we have to meet timelines we won't be able to fulfill. And we are already being hounded by HCOs without a stage 5 system to enroll in eCR. Maybe others think that these providers/hospitals being able to file an exemption with CMS will fly, but I don't think that was the intent by CMS. I feel like public health has been put into a potentially untenable position, especially when we (PHAs) only really received funding to increase staff, update positions, etc. because of COVID funds (and I realize that some states can't even hire full time staff) that even with supplemental funds from ELC (who have done their best to get us funds) those only extend to July 31, 2027 (or Nov 31, 2027 if you get to us PH Infrastructure funds).
Thanks for listening!
I wholly agree that CMS has no clue about what is involved in onboarding. CMS can make up whatever rules they want for facilities but have no right to dictate to the state PHA how and what we do and when. The 'exemption' should be used by a facility cover them when they cannot get onboard with their state by fantasy date X.
How many states are actually consuming and processing eCR data into their production systems? How many consume the 99.9% garbage into their system? Anyone cleaning the data to what we actually want and can use?
As for CDC/ELC: I will also say that CDC and ELC are becoming more clueless in their grant requirement writing and that the policy people just refuse to hear the state staff on what can be done and by when. This lack of attention is then spread top down from CDC through the state "leadership" to where IT is expected to meet fancy policy and grant goals that are just not achievable in these fantastical time lines. I will short-rant the "thank you so much-isms" we get from the ridiculous quarterly meeting team.... If you have been on these calls, no more need be said.
Throwing money and contractors at the problem is not the answer. Policy people, from state programs to CDC need to accept that as a fact in the vast majority of cases. By the time we take on and train contractors, we could have done the work ourselves and then the contractors leave anyway and all that time and effort to train them goes out the door only for us to have to start over again. Priorities changing every other week just does not help and either.
We are also thinking in terms of requiring HCOs to check in yearly for eCR - at a minimum to verify the list of facilities that are covered under their umbrella - but potentially to set up an ability to raise the bar for production over time (from sending COVID, to sending all conditions, to sending particular data that would allow us to stop the current faxing processes...). So the criterio for "production" with eCR might evolve??
I would like CMS to provide the states with templates for us to use with the appropriate language outlining that we are only confirming receipt of data and the status of the trading partner (active engagement options).
I would also like them to define what their fiscal year is with dates, as it's not clearly outlined in the documentation. Does calendar year = fiscal year.
CMS should also clarify the precise data flows that qualify for sending. I have had several hospitals ask if a lab sending on their behalf qualifies them to meet active engagement for PI. In my opinion, it does not, but I pointed them to CMS Help Desk and told them to clarify with them.
Finally, are the hospitals supposed to report the AUR data directly to CDC or is there an expectation that PHA's receive and route this data to CDC?
To address people's concerns about timelines for PHA's to onboard, etc. It looks like there is language to accommodate for a PHA's inability to onboard due to limited resources (see highlighted/italics below).
Definition of Terms
Active Engagement: Means that the eligible hospital or CAH is in the process of moving towards sending "production data" to a PHA or clinical data registry (CDR), or is sending production data to a PHA or CDR.
Active Engagement Option 1: Pre-production and Validation: The eligible hospital or CAH registered to submit data with the PHA or, where applicable, the CDR to which the information is being submitted; registration was completed within 60 days after the start of the EHR reporting period; and the eligible hospital or CAH is awaiting an invitation from the PHA or CDR to begin testing and validation. Then, the eligible hospital or CAH begins the process of testing and validation of the electronic submission of data.
Eligible hospitals or CAHs must respond to requests from the PHA or, where applicable, the CDR within 30 days; failure to respond twice within an EHR reporting period would result in that eligible hospital or CAH not meeting the measure.
Note: This option allows eligible hospitals or CAHs to meet the measure when the PHA or the CDR has limited resources to initiate the testing and validation process. Eligible hospitals or CAHs that have registered in previous years do not need to submit an additional registration to meet this requirement for each EHR reporting period.
Active Engagement Option 2: Validated Data Production: The eligible hospital or CAH has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDR.
Production Data: Refers to data generated through clinical processes involving patient care, and it is used to distinguish between data and “test data” which may be submitted for the purposes of enrolling in and testing electronic data transfers.
Health IT Lead
Texas Department of State Health Services
Steve.Eichner@dshs.Texas.gov
Since we just went live in PRODUCTION with our first HCO for eCR last week (COVID only), I believe exclusion #3 would pertain for HCO's who are live with AIMS and eCR but not yet live at the PHA level. I would like clarity on that from CMS, in case it's requested for those registered for eCR.
I think we are in a situation similar to the past Stage 1 and Stage 2 where we need a lot more clarity and guidance.
The Public Health Promoting Interoperability Task Force, which was very active prior to the COVID-19 PHE had developed a pretty far-reaching set of materials, including templated letters for registration of intent, invitations for onboarding/testing, etc. During one of CDC's website reorganizations, the information went into the CDC archives.
I can probably reconstruct/reconstitute most of it.
CMS uses the calendar year (January 1-December 31) for the timeframes for Promoting Interoperability. Under a 90 day reporting period window, October 4th begins the last 90 day period of the calendar year (the period must be over in the calendar year). In the 180 day schema, the last day is in early July.
As to a hospital "offshoring" laboratory results reporting to a third-party lab service, while that may meet state/local laws requiring reporting (and, potentially, some jurisdictions may require reporting from both the ordering hospital and the performing laboratory, the Promoting Interoperability requirements are a bit different (and it is not the PHA's responsibility to interpret the PI regulations). Currently, the PI regulations focus on the EH, CAH, or EC sending data from their information systems, not third party systems (it has been understood that an EH, CAH, or EC could contract with parties to operate the technology and/or use an external entity to convert data into the required message type, using CEHRT, for transmission to public health agencies. The rationale for using Certified Electronic Health Record Technology (CEHRT) to generate the message is that the certification process is intended to validate that the technology is capable of generating messages in the specified format. If the PHA is capable of receiving data in the specified format, it should then be easier for the PHA to ingest the message.
In these kinds of scenarios, the EH/CAH/EC is still the entity attesting to CMS.
I am happy to provide any information I know!
Steve
Steve Eichner
Health Information Technology Lead
Texas Department of State Health Services
steve.eichner@dshs.texas.gov<mailto:steve.eichner@dshs.texas.gov>; www.dshs.texas.gov<http://www.dshs.texas.gov/>
Phone: 512.221.5632
Steve Eichner
Health IT Lead
Texas Department of State Health Services
Steve.Eichner@dshs.Texas.gov
I would be grateful for any template from the task force archives to help states keep the same language regarding measures and attestation. Distinction for EP vs EH/CAH is very helpful.
Just an additional note: tracking of this requires a chunk of staff time, even with templates etc. I try to minimize what my staff need to do for this as much as possible. I need their time dedicated to onboarding and QA not responding to emails re: attestation/exclusions. We refer to our letter a lot. However, I see that now staff are getting into looking up if a vendor EHR is in stage 5/general availability especially for eCR. I think we should/could refer those to CDC?
Thanks for letting us highjack this basecamp a bit. Let me try to move this to CSTE Connect under ELDRS. Thanks!
To address your comment on receiving inquiries on whether an EHR/HIT vendor product is in Stage 5/General Availability (G.A.) for eCR, you can refer them to CDC (eCR@cdc.gov) if needed, or you can now send them to CDC's publicly available eCR website that lists the EHR/HIT products in G.A. for eCR (https://www.cdc.gov/ecr/getting-started.html). Though please note, updates may be slower to the public site than to the eCR Knowledge Management Confluence page with this info (https://aphlinformatics.atlassian.net/wiki/spaces/EKM/pages/1300660274/What+is+the+status+of+EHR+Health+IT+products+to+support+eCR, account required).
Please join us for the December 1st CSTE Surveillance Practice and Implementation Subcommittee (SPIS) Call where we will be joined by representatives from CDC/ONC/CMS who will be available to answer questions related to Promoting Interoperability requirements for eligible clinicians, eligible hospitals and critical access hospitals. Call details are below, and I will send out a reminder to the ELR WG community prior to the call.
Call details:
Friday, December 1st from 1:30-3pm ET
Join Zoom Meeting
https://zoom.us/j/98136263193?pwd=ZEE5L1ljSnBsbFNNZ3I5L1RQdm9BZz09
Meeting ID: 981 3626 3193
Passcode: 683816
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