Health Information Exchange in Minnesota: Frequently Asked Questions for Health and Healthcare Providers
Establishing a Sustainable Method of HIE for Meaningful Use and Beyond
Information changes rapidly and new details are always emerging; this page will continue to be updated as the knowledge base grows.
What is Meaningful Use?
Through the American Recovery and Reinvestment Act of 2009 (Recovery Act), the Centers for Medicare and Medicaid Services (CMS) is authorized to make incentive payments to eligible professionals and eligible hospitals demonstrating meaningful use of certified EHR technology. After 2015, CMS is authorized to reduce payments to Medicare providers who don’t meet the meaningful use requirements.
The main components of meaningful use are:
- The use of a certified electronic health record (EHR) in a meaningful manner to perform a number of specific transactions such as e-prescribing, recording patient information as structured data, and creating reports.
- The use of certified EHR technology for electronic exchange of health information to improve the quality and coordination of health and health care.
- The use of certified EHR technology to submit clinical quality (eMeasures) and other measures.
What are the general requirements to obtain meaningful use incentives?
The Centers for Medicare and Medicaid Services (CMS) EHR incentive programs provide a financial incentive for meaningful use of certified EHR technology. The programs are set up in three stages over the next five years and began with Stage 1 in early 2011. Each stage is progressively more complex and addresses specific requirements drawn from the main components of meaningful use.
In July 2010, CMS released the Stage 1 meaningful use final rule, which included specific objectives for professionals and hospitals. In Stage 1 of the incentive program (now through 2012) eligible health professionals and hospitals must meet a series of 15 core objectives (hospitals only need to meet 14 as electronic prescribing does not apply to them in Stage 1) and at least five of 10 menu set objectives. Examples of core objectives include using the certified EHR technology to: record patient demographics, maintain patient problem list, maintain patient medication and allergy lists, and generate and transmit electronic prescriptions.
- The first step is to adopt, implement or upgrade to certified EHR technology, which may include more than one product. Check the list of (meaningful use) certified products at http://onc-chpl.force.com/ehrcert.
- The second step is to use that technology to meet the (stage 1) meaningful use requirements. Under the Medicaid incentive program eligible hospitals and eligible professionals do not need to meet Stage 1 meaningful use requirements, but instead can apply under the adopt/implement/upgrade option.
- The third step is to apply for payment.
Eligibility criteria and requirements vary by program. Eligible professionals may apply for either the Medicare or Medicaid program; they may switch programs once before 2015. Eligible hospitals may apply for both Medicare and Medicaid incentives. Incentives are currently available for eligible professionals and eligible hospitals who achieve Stage 1 meaningful use of an EHR and adopt/implement/upgrade for Medicaid. To see who qualifies as an eligible professional under Medicare and Medicaid see the Minnesota e-Health Glossary.
For both the Medicare and Medicaid incentive programs registration begins at the CMS Registration and Attestation System website. The Minnesota Department of Human Services (DHS) is administering Minnesota’s Medicaid EHR Provider Incentive Program. On their website you can find information on eligibility, timelines, registration and helpful resources. CMS is administering Medicare EHR incentives and states are administering Medicaid EHR incentives. Information on Medicare Incentives is available on the Centers for Medicare and Medicaid Services (CMS) website.
What qualifies as demonstrating meaningful use of EHRs?
In July 2010, CMS released the meaningful use final rule, which included specific objectives for professionals and hospitals. In Stage 1 of the incentive program (through 2012) eligible health professionals and hospitals must meet a series of 15 core objectives (14 for hospitals) and at least five of 10 menu set objectives. Examples of core objectives include using the certified EHR technology to: record patient demographics, maintain patient diagnoses, maintain patient medication and allergy lists, and generate and transmit electronic prescriptions.
An important meaningful use resource for providers in Minnesota and North Dakota is REACH, the Regional Extension and Assistance Center for Health Information Technology. REACH works with providers to improve the quality and value of care they deliver through adopting and meaningfully using health information technology (HIT), specifically EHRs.
What are the benefits to using a certified EHR?
At the core of meaningful use is adopting and effectively using certified EHR technology. Beyond the meaningful use incentives, though, the benefits of adopting and using a certified EHR include the standards for interoperability between systems that are part of the certified EHR. This means, a provider using certified EHR technology would know that the health information exchanged with another provider using certified EHR technology will be understandable and useable for both sender and recipient. This does not involve the method in which the information is exchanged, however.
How can I find out if my EHR system/the system I am considering is certified?
Find a current list of certified products at http://onc-chpl.force.com/ehrcert. This site contains the authoritative, comprehensive listing of Complete EHRs and EHR Modules that have been tested and certified under the Temporary Certification Program maintained by the Office of the National Coordinator (ONC).
How does meaningful use relate to health information exchange?
The exchange of health information is a requirement to obtain the meaningful use financial incentives. Successful exchange of health information depends on the effective use of EHR technology, which is a key element of the meaningful use incentive programs.
What are the Stage 1 meaningful use options to meet the requirements for health information exchange?
Some of the core objectives as well as menu objectives options for Stage 1 involve the exchange of health information. These include:
- e-prescribing (eRx)*
- Report Clinical Quality Measures (eMeasures)*
- Perform test of health information exchange*
- Submit immunization data**
- Submit reportable lab data (eligible hospitals only)**
- Submit syndromic surveillance data**
* Core: You must complete this transaction to receive the incentive payments (e-prescribing is for eligible professionals only for the Medicaid incentives)
** Menu: You may choose one or more of these to receive the incentive payments
Public Health Reporting for Meaningful Use
What are the specific meaningful use requirements for public health reporting?
Although providers have flexibility in choosing menu set meaningful use options, one of the five must be specific to public health. The public health objectives include submitting electronic data to public health agencies on immunizations, syndromic surveillance and reportable lab results (hospitals only).
Currently, the Minnesota Department of Health is able to accept immunization data and lab results. Submitting syndromic surveillance data to the MDH is not an option for Stage 1 meaningful use incentives.How can I report these?
For details on how to report, including the recommended standards, and an overview of Stage 1 meaningful use requirements specific to public health, see the “Minnesota Public Health Reporting for Stage 1 Meaningful Use” fact sheet.
Clinical Quality Measures Reporting for Meaningful Use
What are the specific meaningful use requirements for reporting clinical quality measures (eMeasures)?
Clinical quality measures (or eMeasures) are the measures of processes, experience and/or outcomes of patient care, observations or treatments that related to one or more of the Institute of Medicine (IOM) domains of health care quality (e.g. effective, safe, efficient, patient-centered, equitable and timely).
Eligible professionals must report on six eMeasures (out of a total of 44 measures) including three core measures and three additional quality measures for Stage 1 meaningful use. In addition, eligible professionals must also submit their aggregate clinical quality measure number, denominator and exclusion data to the Center for Medicare and Medicaid Services (CMS). The meaningful use requirements for clinical quality measures includes that the reporting of those measures must be from certified electronic health record (EHR) technology.
Eligible hospitals must report on 15 different eMeasures on all patients regardless of payer type.
How can I report these?
The clinical quality measures results need to be reported from certified EHR technology to the Center for Medicare and Medicaid Services (CMS) to satisfy the criteria for meaningful use. Find more information on the electronic specifications for reporting the quality measures on the CMS website, http://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPage.
Health Information Exchange
What is health information exchange?
Health information exchange, or HIE, in Minnesota means the electronic transmission of health related information between organizations according to nationally recognized standards (Minn. Stat. §62J.498 sub. 1(f)). This means each time information is sent electronically to another provider it is done in a uniformly accepted way that meets specific standards to ensure protection of the data and privacy of the patient. It also means the information will be received in a way that is usable for the recipient.
Why is health information exchange important?
The ability to securely exchange health information is essential for transforming health care. Connecting health care providers, including clinicians and facilities, can ensure continuity and coordination of care for every Minnesotan. It can also provide opportunities to engage patients in their own health care.
Can I still exchange health information if I am not eligible for meaningful use?
The meaningful use incentives are only available to a specific subset of healthcare professionals yet the need to securely exchange health information is something all health care professionals are experiencing regardless of settings and patient populations. In Minnesota, the goal is for all healthcare settings to have interoperable electronic health records (EHR) systems in place by 2015. Implementing standards-based exchange is a good business practice internally and between your partners across the state so you are able to use the capability of your EHR system to share and provide information as well as look up and move information between your trading partners.
Health Information Exchange Oversight
What is the health information exchange oversight process in Minnesota?
The Minnesota Department of Health (MDH) is required by state law to establish an oversight process that will protect the public interest on matters pertaining to health information exchange.
The health information exchange (HIE) oversight process is intended to ensure organizations involved in HIE in Minnesota are adhering to Minnesota and nationally recognized standards and requirements that will allow Minnesota providers and hospitals to access pertinent patient health information to improve health outcomes while ensuring patients have the appropriate privacy and security protections in place.
Under the Minnesota HIE Oversight Law, a health information exchange service provider operating in Minnesota to provide exchange transactions must seek a certificate of authority to operate in this state. Two types of organizations can apply to become State-Certified Health Information Exchange Service Providers in Minnesota:
- Health Information Organization (HIO): An organization that oversees, governs, and facilitates health information exchange among health care providers that are not related health care entities as defined in Minnesota Statutes section 144.291, subdivision 2, paragraph (j), to improve coordination of patient care and the efficiency of health care delivery.
- Health Data Intermediary (HDI): An entity that provides the technical capabilities or related products and services to enable health information exchange among health care providers that are not related health care entities as defined in Minnesota Statutes section 144.291, subdivision 2, paragraph (j). This includes but is not limited to: health information service providers, electronic health record vendors, and pharmaceutical electronic data intermediaries as defined in section 62J.495.
To the extent that information is exchanged without the use of an intermediary, it is outside the scope of Minnesota’s oversight law.
Where can I find a list of current State-Certified Health Information Exchange Service Providers (HIOs and HDIs)?
Find information on the current State-Certified Health Information Exchange Service Providers at:
Am I required to use a State-Certified Health Information Exchange Service Provider in Minnesota?
Using a State-Certified HIE Service Provider is recommended but not technically required for meaningful use. However, using one does provide certain benefits not available from a non-certified organization including:
- Transparent knowledge of services offered and that the services are in accordance with national standards.
- Over time, the ability to exchange health information with other State-Certified HIE Service Providers, providing greater interoperability statewide.
- The HIE Service Provider has attested its policies and procedures are in compliance with both federal and Minnesota privacy laws, and it has confirmed it has privacy and security policies and procedures in place for protecting PHI (personal health information).
Most important, however, is to focus on choosing an HIE Service Provider, or other type of intermediary, that best suits your needs and matches your HIE priorities.
What are the benefits to using a State-Certified Health Information Exchange Service Provider in Minnesota?
Minnesota law requires organizations that facilitate the exchange of health information to seek a certificate of authority to operate in Minnesota. Certification is a process that:
- Provides an opportunity for public review of HIE service provider applications.
- Defines requirements for HIE service providers that serves the best interests of both providers and patients.
- Defines a compliance and enforcement framework to ensure certified entities conduct business in accordance with state requirements.
Health Information Exchange Options
Push – a one-directional “push” or send of the information between two known entities e.g. from a specialist to a primary care provider.
Pull – a bi-directional “pull” of the information that involves: 1) a query for information about a patient, and 2) a response with information on the location and/or the content of a patient’s records.
Knowing the type of health information exchange transactions you want to do is essential for determining your options for HIE. For example, a “push” of information can be done directly between two providers or settings, or with the use of an intermediary such as a Health Information Organization (HIO), Health Data Intermediary (HDI), or Health Information Service Provider (HISP), which is a form of an HDI. A “pull” of information requires access to record locator services (RLS) and can only be done through an HIO and potentially an HDI if the HDI maintains a RLS.
Both pushing and pulling of health information are done using nationally established standards to ensure the security of the information being exchanged and that it is in a format both the sender and recipient can understand and accept.
What is the Nationwide Health Information Network (NwHIN)?
The Nationwide Health Information Network (NwHIN) is a set of standards, services and policies that enable the secure exchange of health information over the internet. Along with over 20 federal agencies, the Office of the National Coordinator (ONC) began developing the NwHIN in 2004, and it has continued to evolve to meet changing needs and environments.
The NwHIN is a critical part of the national health IT agenda and will enable health information to follow the consumer, be available for clinical decision-making, and support appropriate use of healthcare information beyond direct patient care, so as to improve population health. Specific projects or outcomes of the NWHIN include CONNECT and the Direct Project.
CONNECT is a free, open source software solution that organizations can use to securely link their existing health IT systems into health information exchanges. The CONNECT solution enables secure and interoperable electronic health information exchanges with other NwHIN compliant organizations, including federal agencies, state, tribal and local-level health organizations, and healthcare participants in the private sector
The initial objective of CONNECT was to provide a single solution for more than 20 federal agencies to tie their health systems into the NwHIN. CONNECT acts as a gateway to the NwHIN by using the NwHIN standards and governance to ensure the information exchanged is compatible with other CONNECT sites or “nodes.” It still provides this solution for those agencies but is also usable by more agencies not necessarily part of the NwHIN exchange. Because the solution is open source it is now available for use throughout the health and healthcare industry.
CONNECT can be used to:
- Set up a health information exchange within an organization (share information between computers and other technologies having the software installed within an organization)
- Tie an organization into regional and national networks of health information exchanges using NwHIN standards (this could be to connect to the federal agencies part of the NwHIN exchange or with a different network)
Using CONNECT can be a way to “pull” information - query for information on a patient and receive a response with that information. As an exchange option, using CONNECT does meet the requirements for Stage 1 meaningful use.
(This answer adapted from http://www.connectopensource.org).
What is the Direct Project?
The Direct Project uses a set of standards, policies and services that enable simple, secure transport of health information between healthcare participants (e.g., providers, labs) who know each other and already have a relationship of trust. The Direct Project enables standards-based exchange of health information in support of core stage 1 meaningful use measures. This can include communication of summary care records, referrals, discharge summaries and other clinical documents in support of continuity of care and medication reconciliation, as well as communication of laboratory results to ordering providers. Using Direct Project protocols as an exchange option does meet the requirements for Stage 1 meaningful use (when it is done using a formatted file from a certified EHR system).
Direct protocols are one option for the secure push of health information to a known receiver and can be one piece of a more robust HIE plan. It is commonly described as secure email between two known entities; information is exchanged by way of the actual message or an attachment to the message. Health information exchange using Direct protocols can replace slow, inconvenient and expensive methods of exchange, such as sending information by fax, and provide a future path to advance electronic interoperability.How does the Direct Project help in achieving meaningful use?
The Direct Project specifies the technical protocols and services necessary to securely push content from a sender to a receiver. Direct protocols focus on the transportation and security mechanism for the content being exchanged, but do not specify the actual content itself. However, Direct-enabled products can be used by providers and organizations to transport and share different types of content specified by meaningful use – thus the combination of meaningful use-specified content and Direct Project-specified transport standards may satisfy certain Stage 1 meaningful use requirements that involve health information exchange (e.g., care summary exchange and lab results delivery).
(This answer adapted from “Direct Project FAQs,” a state health information exchange program resource by the ONC)
How do I exchange information using the Direct Protocols?
In order for the message to be sent using the Direct protocols, a user must be connected to a Health Information Service Provider (HISP), which in Minnesota falls under the definition of an HDI, or the user must be able to perform the same functions as a HISP. The HISP provides security for the message and routes it to the appropriate recipient. In some cases, HISP functionality may be embedded within an EHR system.
Both the sender and receiver must be connected to a HISP/HISP services, although they may choose a different HISP, and they must have the Direct protocols installed in order to send and receive a Direct message. Each entity, the sender and the receiver, will have a unique Direct email address that is used for this type of exchange.
(Portions of this answer adapted from “Direct Project FAQs,” a state health information exchange program resource by the ONC)
How can I exchange health information in Minnesota?
State-Certified Health Information Exchange Service Providers are one of several options in Minnesota. The decision to choose one over the other may depend on what needs to be done with the information such as push or pull/query. All state-certified HIE service provider options in Minnesota meet Stage 1 meaningful use requirements for exchange.
State-Certified HIE Service Provider Options in MN*
Exchange using a state-certified HIE service provider (facilitated exchange)
Health Information Organization (HIO)
Health Data Intermediary (HDI)
“Direct” or Direct Project exchange using direct protocols and a HISP, a form of an HDI
*To the extent that information is exchanged without the use of an intermediary, it is outside the scope of Minnesota’s oversight law.
What do Personal Health Records (PHRs) have to do with health information exchange?
The personal health record (PHR) is an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual. Individuals manage the information in the PHR, which comes from health care providers and the individual. The PHR is maintained in a secure and private environment with the individual determining rights of access. The PHR is separate from and does not replace the medical record of any provider. In some cases, a PHR may be set up to allow for exchange of secure emails between a patient and provider(s), for instance if a PHR system that supports the Direct Project specifications and offer Direct email addresses.
Is there a cost for health information exchange services?
Yes, there are costs involved in utilizing the services of an HIE service provider as well as a direct exchange process. The prices will vary based on fees determined by the service provider organizations.
Health Information Exchange Standards
What standards are recommended for the exchange of health information?
Minnesota e-health standards are essential for electronic exchange of health information and achieving interoperability. Interoperability of EHR systems in Minnesota means the ability of two or more EHR systems or components of EHR systems to exchange information electronically, securely, accurately and verifiably, when and where needed. It is comprised of “technical,” “semantic” and “process” interoperability, and the information exchanged includes transactions and standards..
Three types of standards are critical for the successful exchange of health information:
- Technical standards: what data fields are transmitted and how they are organized for transmission
- Semantic standards: the taxonomy of each code used in a data field
- Process standards: in what order do the transmissions fit into the workflow of the organization
For more detailed information, see the Minnesota –specific resources on standards including, “Guide 2: Standards Recommended to Achieve Interoperability in Minnesota: Updated 2010” and “Recommended Standards and Resources for Meaningful Use (2010 Edition).”
Key Action Steps
- Check out the Practical Guide to Understanding Health Information Exchange: Assessing Your Readiness and Selecting Health Information Exchange Options in Minnesota.
- Find out more about the Minnesota e-Health Initiative.
- The MDH Office of Health Information Technology (OHIT) provides oversight for health information exchange service providers. Find information on the current State-Certified Health Information Exchange Service Providers and read about Minnesota’s plans for supporting health information exchange.
- REACH, the Regional Extension Assistance Center for Health Information Technology, works with providers to improve the quality and value of care they deliver through adopting and meaningfully using health information technology (HIT), specifically EHRs. REACH can help with some of the key action steps including assessment through process consultation.
- The Minnesota Department of Human Services is administering the Medicaid EHR incentives program. Find information about the eligibility criteria and program information.