Public Health and Promoting Interoperability
Medicare’s Promoting Interoperability Incentive Program
As a part of the federally funded Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, $36 billion was budgeted for health information technology (HIT) infrastructure. Of that, $34 billion was allocated for the Medicare and Medicaid EHR Incentive Programs (CMS now refers to these programs as the Promoting Interoperability program). The goal was to provide more effective health care by encouraging eligible professionals (EP), eligible hospitals (EH) and critical access hospitals (CAH) to adopt, implement, or upgrade (AIU) to an EHR technology certified by the Office of the National Coordinator for Health Information Technology (ONC), and then to demonstrate Meaningful Use (MU) of that technology.
The American Recovery and Reinvestment Act of 2009 specifies three main components of meaningful use:
- The use of a certified EHR in a meaningful manner, such as e-prescribing.
- The use of certified EHR technology for electronic exchange of health information to improve quality of health care; and,
- The use of certified EHR technology to submit clinical quality and other measures.
Simply put, "meaningful use" means providers need to show they are using certified EHR technology in ways that can be measured significantly in quality and in quantity.
The NC Medicaid EHR Incentive Program began in 2011 and will end in 2021. EPs may receive up to $63,750 in incentive payments over six years of participation in the program. EPs may no longer receive the first-year payment of $21,250, but each subsequent payment is $8,500. Providers must have attested successfully at least once, to AIU or MU, before April 30, 2017, to be able to participate in the NC Medicaid EHR Incentive Program in program years 2017-2021.
For a list of the MU Objectives and CQMs, please see the links below:
- Stage 3 MU objectives: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/TableofContents_EP_Medicaid_2019.pdf
- 2019 CQMs: https://ecqi.healthit.gov/eligible-professional/eligible-clinician-ecqms?field_year_value=2
North Carolina’s state Division of Public Health (NC DPH) oversees objectives for the Centers for Medicaid and Medicare Services (CMS) Promoting Interoperability Program and the Merit-based Incentive Payment System (MIPS). Eligible clinicians (EC) participating in the MIPS program, and eligible hospitals (EH) and critical access hospitals (CAH) must meet the electronic Public Health reporting program objectives to qualify for incentive payments. The CMS Promoting Interoperability Program specification sheets for the 2022 calendar year for eligible hospitals, critical access hospitals, and eligible clinicians can be accessed on the Public Health and Services website.
Public Health Promoting Interoperability Objectives:
- Electronic Reportable Laboratory Results Reporting
- Syndromic Surveillance Reporting
- Immunization Registry Reporting
- Electronic Case Reporting
- Diabetes Specialized Public Health Registry Reporting
The NC Immunization Branch, a branch of DPH's Women's and Children's Health section, operates the NC Immunization Registry (NCIR). The NCIR is a secure, web-based clinical tool which is the official source for North Carolina immunization information. The NCIR takes the place of outdated handwritten charting of immunizations administered in the state. Immunization providers may access all recorded immunizations administered in North Carolina, regardless of where the immunizations were given.
Access to the NCIR via the North Carolina Identity Management (NCID) system is limited to North Carolina Immunization Program medical providers and affiliates. Access to the immunization information contained within the NCIR is meant for health care providers in the prevention and control of vaccine preventable diseases and is not intended for general public use.
The primary purposes of the NCIR are:
- To give patients, parents, health care providers, schools and child care facilities timely access to complete, accurate and relevant immunization data;
- To assist in the evaluation of a child's immunization status and identify children who need (or are past due for) immunizations;
- To assist communities in assessing their immunization coverage and identifying areas of under-immunization; and
- To fulfill federal and state immunization reporting needs.
More information on Immunization Information Systems (IIS) can be found on the CDC’s IIS webpage.
The NCIR stores immunization records that are client-specific and created by the client's health care provider or through our data feed with NC Vital Records. If you find there is an error in your child's or client's NCIR record, please contact your health care provider or Vital Records directly. The Immunization Branch cannot alter those records because we cannot confirm the identity of the client and do not provide treatment to clients in the NCIR.
Reminder on MU Stage 3 Objective 8 Measure 1 (Public Health and Clinical Data Registry Reporting: Immunization Registry Reporting)
To meet Objective 8 Measure 1 (Public Health and Clinical Data Registry Reporting: Immunization Registry Reporting), providers who administer vaccinations must be in active engagement with the North Carolina Immunization Registry (NCIR). NCIR is capable of accepting the specific standards required to meet the 2015 CEHRT definition and has declared readiness to receive immunization data, so providers can take an exclusion for this measure only if they do not administer vaccinations.
Provider who wish to participate in Program Year 2019 of the NC Medicaid EHR Incentive Program but who are not yet in active engagement with NCIR, must complete registration with NCIR within 60 days after the start of their MU reporting period. In Program Year 2019, a provider's MU reporting period must begin no later than Oct. 3, 2019 to get 90 days of MU data in calendar year 2019. This means the last day a provider may complete registration with NCIR to meet MU in Program Year 2019 is Dec. 1, 2019, with the 90-day MU reporting period being Oct. 3, 2019 through Dec. 31, 2019.
To begin registering with NCIR, providers should contact the NCIR Help Desk by phone at (877) 873-6247 or by email at email@example.com. Providers who are not already in active engagement with NCIR should begin this process now if they wish to apply for Program Year 2019 of the NC Medicaid EHR Incentive Program.
Diabetes Specialized Public Health Registry
Effective June 1, 2018, the NC Diabetes Specialized Public Health Registry is available for population health purposes. Full participants of NC HealthConnex are eligible to participate in the registry by signing the NC HealthConnex Diabetes Registry Form. Data submitted to NC HealthConnex will be included in the Diabetes Registry, as appropriate. No additional data submission from participants is required. The NC HealthConnex Diabetes Registry supports attestation for Meaningful Use Stage 3 for eligible professionals and Medicare Quality Payment Program Advancing Care Information for eligible clinicians. More information about becoming a full participant of NC HealthConnex and about the diabetes specialized registry is available on NC HIEA’s website.