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Promoting Interoperability/Meaningful Use

Central Cancer Registry

Starting January 2019, The North Carolina Central Cancer Registry is accepting registrations and cancer data from Eligible Providers participating in the Medicare and Medicaid Promoting Interoperability Program (formerly Meaningful Use EHR Incentive Program). The North Carolina Central Cancer Registry will accept Stage 3 (2015 Edition Health IT Certification Criteria) standards including support for the HL7 Implementation Guide for CDA© Release 2: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1.

Important information for EPs intending to use the Promoting Interoperability/MU Cancer Reporting option to meet the N.C. CCR electronic reporting requirement:

Eligible Providers (EP) that manage, detect, diagnose or treat patients with reportable cancers and conditions are required to meet the N.C. CCR’s electronic reporting requirements regardless of their ability to meet the cancer reporting objective specified in the Stage 3 Meaningful Use criteria. This step must be completed before initiating a discussion with the N.C. CCR regarding availing the MU option to meet the N.C. CCR reporting requirements.

Summary of each standard setter’s role related to Promoting Interoperability/MU reporting to the N.C. CCR:

The N.C. CCR is offering the option for EPs to leverage the MU incentives and CEHRT to achieve electronic reporting to the N.C. CCR. Meeting the electronic cancer reporting objective through MU and meeting the electronic reporting through the registry’s database specified by the N.C. CCR are two separate, independent processes with separate methods of obtaining approval. It is possible to meet one requirement without meeting the other. For example, an EP may be able to meet the requirements for the cancer reporting objective specified in MU and begin receiving the Medicare and/or Medicaid EHR Incentive but not be able to meet the electronic reporting requirements of the N.C. CCR because the MU data transmission does meet the quality and content criteria established by the N.C. CCR.

Prior to initial discussion with the N.C. CCR regarding using the Promoting Interoperability/MU Cancer Reporting Option, providers must first start with step 1 of the on-boarding process above to determine their eligibility and register with CMS to participate in the Medicare and/or Medicaid EHR Incentive Programs.

Once that is accomplished, there are many more steps required before the Promoting Interoperability/MU Cancer Reporting Option can be used to meet the electronic reporting requirements specified by the N.C. CCR. To be approved to report using the Promoting Interoperability/MU Cancer Reporting Option, the EP must meet ALL of the conditions specified below:

  • Establish provider eligibility with CMS and use a certified EHR.
  • Register on the CMS website to participate in the Medicare and/or Medicaid EHR Incentive Programs.
  • Register intent to report to the N.C. CCR on the N.C. DPH MU portal.
  • Complete testing and validation with the N.C. CCR.
  • Receive a letter of approval from the N.C. CCR to begin reporting using the Promoting Interoperability/MU Cancer Reporting process. This letter will specify the Go-Live date in which the EP will be required to start reporting using HL7 CDA format.
  • Submit the completed N.C. Provider Site Responsibilities & Contact Information Form.
  • Be able to continually submit files in the approved format and content on an ongoing basis from the Go-Live date onward.

Reporting using Promoting Interoperability/MU Cancer Reporting Option must meet the data quality standards required for reporting to the N.C. CCR. Using the Clinical Document Architecture (CDA) format is required for the MU incentive but the format and content must also meet the requirements of the N.C. CCR before approval may be given. Certain fields are required in the CDA document to pass the quality assurance review. Following the successful submission of a test CDA document, EPs must also pass quality assurance testing before actual production submission can occur. It is important to note that EHR certification does not guarantee that the EHR software meets the N.C. CCR requirements. Furthermore, to ensure complete and correct data are recorded, the N.C. CCR has set high standards for data completeness, quality and timeliness. The N.C. CCR measures adherence to these standards during a data quality assessment.

Providers that are not able to meet the N.C. CCR’s reporting requirements using the Promoting Interoperability/MU Cancer Reporting Option or have not been approved by the N.C. CCR for ongoing HL7 CDA submission are required to abstract cases directly into the N.C. CCR database. Meeting the N.C. CCR’s reporting requirements are determined by the N.C. CCR, not the CMS, ONC, or the EHR vendor.

After providers, have passed the quality assurance testing process, production submission can occur. Direct data entry and cancer reporting must continue until the EP receive a Go-Live date and a written confirmation of approval to report using the HL7 CDA format. This written approval will come directly from the N.C. CCR MU team. Note that, if any time after the Go-Live date has been issued, if the submission file no longer meets the requirements for MU reporting, the approval to report through the Promoting Interoperability/MU Cancer Reporting Option will be revoked and the EP must return to abstracting cases directly into the N.C. CCR database.

Meaningful Use (MU) Cancer Reporting:

Overview:

The Medicare and Medicaid EHR Incentive Programs provide financial incentives for the "meaningful use" of certified EHR technology. To receive an EHR incentive payment, providers must show that they are “meaningfully using” their certified EHR technology by meeting certain measurement thresholds that range from recording patient information as structured data to exchanging summary care records. CMS has established these thresholds for eligible professionals, eligible hospitals, and critical access hospitals.

The Medicare and Medicaid EHR Incentive Programs include three stages with increasing requirements for participation. All providers begin participating by meeting the Stage 1 requirements for a 90-day period in their first year of meaningful use and a full year in their second year of meaningful use. After meeting the Stage 1 requirements, providers will then have to meet Stage 2 requirements for two full years. CMS has recently published a proposed rule for Stage 3 of meaningful use which focuses on the advanced use of EHR technology to promote health information exchange and improved outcomes for patients.

In October 2015, CMS released a final rule that specifies criteria that eligible professionals, eligible hospitals and CAHs must meet in order to participate in the EHR Incentive Programs in 2015 through 2017 (Modified Stage 2) and in Stage 3 in 2017 and beyond. Visit the CMS Meaningful Use page for more information and to read CMS meaningful use regulations.

Public Health Reporting Objective: The Eligible Provider (EP) is in active engagement with the public health agency to submit electronic public health data from a Certified Electronic Health Record Technology (CEHRT) except where prohibited and in accordance with applicable law and practice.

Meaningful Use Public Health Measure and Objectives:

  • Meaningful Use Stage 1 (2011-2014): Not an available measure
  • Meaningful Use Stage 2 (2014): Cancer Case Reporting
  • Meaningful Use Modified Stage 2 (2015-2017): Specialized Registry Reporting
  • Meaningful Use Stage 3 (2017-2021): Public Health Registry Reporting

Declaration of Readiness:

Meaningful Use Stage 3 – 2015 Edition CEHRT:
NC Central Cancer Registry is capable of accepting electronic cancer reports from EPs, according to the standards required to meet the 2015 Edition CEHRT definition.

Exclusions: Any EP that meets one or more of the following criteria may be excluded from this objective:

  • The EP does not diagnose or treat any disease or condition associated with or collect relevant data that is required by a specialized registry in their jurisdiction during the EHR reporting period;
  • The EP operates in a jurisdiction for which no specialized registry is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the beginning of their EHR reporting period; or
  • The EP operates in a jurisdiction where no specialized registry for which the EP is eligible has declared readiness to receive electronic registry transactions at the beginning of the EHR reporting period.

MU On-boarding Process:

There are several steps required to achieve Promoting Interoperability/MU Cancer Reporting. Click on each box below to learn more about the requirements for each step in the MU On-boarding process.

 

 
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Eligibility:

Before discussion with the N.C. CCR regarding using the Promoting Interoperability/MU Cancer Reporting Option can begin, providers must first start with the CMS website to determine their eligibility and register with CMS to participate in the Medicare and/or Medicaid EHR Incentive Programs.

Please review the eligibility criteria below and verify the physician’s eligibility status before registering:

  • Must manage, detect, diagnose or treat patients with reportable cancers and conditions.
  • Must practice in stand-alone ambulatory practices. Hospital-based EPs are not eligible for reporting to the N.C. CCR through the Promoting Interoperability/MU Cancer Reporting Option. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient or emergency room setting.
  • Must be using Certified EHR Technology. Please click on the following link, EHR Certification Criteria to find the instructions on determining if your EHR meets the criteria for cancer reporting or contact your EHR vendor for more information.

NOTE: In order to meet the cancer reporting objective measure, an Eligible Professional must use an Electronic Health Record system (EHR system) that meets standard certification criteria established by The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).

  • For Stage 3 Cancer Reporting
    • 170.315(f)(4) – Transmission to Cancer Registries

Registration:

As part of the Promoting Interoperability process, EPs are required to register their intent to submit data with the North Carolina Division of Public Health (N.C. DPH). EPs must register with N.C. DPH within 60 days of the electronic health record (EHR) reporting period.

Register Intent to Report:
To register your intent to report to the N.C. CCR, go to the N.C. DPH Meaningful Use Site for Registration of Intent and click on NCID New User Registration Page to begin the registration process.

Invitation to On-board:
EPs that meet the initial eligibility requirements and have completed the registration process will be contacted by the N.C. CCR MU team via email indicating that they can start the on-boarding process.

Among those EPs, priority is given to providers based on the provider specialty and the EHR vendor’s readiness to start cancer reporting. Specialties with a high incidence of cancer in an outpatient setting are given a higher priority such as Dermatology, Urology, Hematology, Oncology, Gastroenterology, etc. Priority is also given based on the volume of cancer cases and reporting period.

Connectivity:
The only available method of transport available at this time within the N.C. CCR is sFTP file upload. The invitation to on-board will also contain the following documents to establish the EHR test environment and connection between the N.C. CCR and the EHR:

Please contact the N.C. CCR MU team to discuss other options for transferring cancer data.

Testing and Validation:

During the Testing and Validation step, the EP generates, evaluates and addresses corrections to the electronic cancer report test messages.

The EP is responsible for:

Note: The N.C. CCR is not responsible for and does not maintain documentation on behalf of the EP to document compliance with the MU measure. The EP/EHR is responsible for retaining the confirmation messages produced during the submission process that a successful test message has been received by N.C. CCR. Also, the provider is required to continue reporting through the Registry’s database to be compliant with State Law until a MU Go Live notice has been received and signed on.

Submission Confirmation:

The submission confirmation step notifies the EP that testing and validation has been completed and the EP has been approved for production submission.

The EP is responsible for:

  • Establishing an ongoing electronic cancer data feed to the N.C. CCR.
  • Continuing to work for data validation.
  • Continuing to use the sFTP login to transmit cancer messages to the N.C. CCR.
  • Continuing to work with N.C. CCR MU team to make any additional required corrections to the test messages.
  • Maintaining on-going submission confirmation emails from the N.C. CCR for documentation of Promoting Interoperability/MU Cancer Reporting compliance.

Go-Live:

The Go-Live step is the final step in being able to use the Promoting Interoperability/MU Cancer Reporting Option to meet the electronic reporting requirements specified by the N.C. CCR. Written confirmation of approval to report using the CDA format is issued directly from the N.C. CCR MU team. This notification will specify the Go-Live date in which the EP will be required to start continuous reporting using HL7 CDA format.

The EP is responsible for:

  • Continually submitting HL7 CDA cancer data in the approved format and content on an ongoing basis from the Go-Live date forward.
  • Participating in periodic quality assurance activities.
  • Addressing and correcting any errors identified during the quality assurance check.

Quality assurance checks may be performed periodically to ensure accuracy of reporting. The N.C. CCR will contact the EP to schedule these activities. If, at any time after the Go-Live date has been issued, the submission files no longer meet the N.C. CCR’s requirements for reporting, the approval to report through the Promoting Interoperability/MU Cancer Reporting Option will be revoked and the EP must return to abstracting cases directly into the N.C. CCR database.

 

N.C. Central Cancer Registry Meaningful Use Contacts

MU Cancer Reporting Team
N.C. Department of Health and Human Services
North Carolina Central Cancer Registry – Division of Public Health
1908 Mail Service Center
Raleigh, NC 27699-1900
Courier #56-20-00
Email
919-715-7474