Fewer than one-third of healthcare providers polled for the newest HIMSS Analytics Essentials Brief are currently pursuing precision medicine initiatives – with the majority who don't saying that limitations in funding, technology or expertise are holding them back. But that's poised to change very soon.

Indeed, the places where genetic, environmental and lifestyle factors are factored into clinical treatment and disease prevention tend to be research-based organizations such as academic medical centers (35 percent), multi-hospital health systems (25 percent) or larger providers with more than 500 beds (41 percent).

But the promise of precision medicine is too tantalizing to stay so segmented, and HIMSS Analytics sees the trend shaping IT solutions in four key ways in the near future.

The report, which polled 137 professionals at AMCs, health systems and standalone hospital, sees opportunities for precision medicine integration to shape technology offerings on four main fronts.

Electronic health records. Integration of genetic and environmental health data with EHRs – and easy availability and usability in clinical settings – is key to precision medicine's growth. The HIMSS report shows that, as genomics, proteomics and metabolomics become essential components in crafting treatment plans, technology vendors will need to show they can help harness that data and incorporate it into clinicians' workflows.

Indeed, 60 percent of the respondents to the online survey cited integration of clinical data systems as the biggest hurdle to their precision medicine efforts.

[Special report: Precision medicine: Analytics, data science and EHRs in the new age]

Population health management platforms. With two-thirds of healthcare organizations focusing their efforts (to varying degrees) on pop health initiatives, technology systems that do better collecting and analyzing of genomic and environmental data could help providers with their preventative medicine and chronic disease management projects, according to the study.

Clinical analytics tools. HIMSS Analytics LOGIC intelligence tool shows current provider market penetration for analytics technology exceeding 40 percent. As precision medicine efforts increase in prevalence, that number should steadily rise, with clinical and business intelligence tools growing in sophistication.

Vendor partnerships with professional organizations. "Large academic medical centers and professional societies are already benefiting from partnerships with IT start-up companies focused on precision medicine," writes HIMSS Analytics' Director of Research Brendan FitzGerald. "Not only does the adoption of these specific platforms help further the advances in precision medicine, but these relationships foster the competitive environments that will help drive innovation to new heights."

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Those hospitals still not meaningfully using certified electronic health record technology will be subject to a payment adjustment starting Oct. 1, 2016, the Centers for Medicare and Medicaid Services announced Friday.

The adjustment takes the form of a reduced applicable increase to their Inpatient Prospective Payment System rate, according to CMS. It's tied to the reporting period of specific fiscal years.

The good news is that 98 percent of eligible hospitals and critical access hospitals nationwide have by now successfully demonstrated either Stage 1 or Stage 2 meaningful use.

For those that still haven't, hospital payment adjustments by reporting year are as follows: a 25 percent decrease for 2015 (2013 reporting period); a 50 percent decrease for 2016 (2014 reporting period); a 75 percent decrease for 2017 and beyond (2015 reporting period).

CMS does offer hardship exceptions for hospitals not demonstrating meaningful use, each granted on a case-by-case basis.

Reasons may include 2014 EHR vendor issues (either a technology provider wasn't able to gain 2014 certification or the hospital was unable to attest to MU due to certification delays); infrastructure (hospitals must show they're in an area without sufficient internet access or broadband); unforeseen circumstances (a natural disaster or other unforeseeable barrier); or recent eligibility (EHs with new CMS Certification Numbers can apply for an exception for one full cost reporting period).

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In this CIO Spotlight, Harun Rashid, CIO of Children's Hospital of Pittsburgh of UPMC, describes the how new patient engagement initiatives at his organization are helping patients, their parents and care teams improve care plans together.

The Los Angeles County Department of Health Services, the second largest U.S municipal system, is growing its population health management platform with Cerner’s HealtheIntent technology.

Cerner’s platform is designed to enable thousands of LACDHS clinicians to make more informed decisions by providing a comprehensive profile of an individual and the entire population, company executives said. The profile can be used to identify gaps in care and analyze population and enterprise data through use of Cerner's registries – HealtheRegistries and HealtheEDW, – scorecards and enterprise data warehouse technology. 

[Also: John Muir Health aligns IT and care management to bolster population health]

"Our goal is to improve the health of the community that DHS serves, moving it to the highest standard possible," LACDHS chief medical information officer Robert Bart, MD, said in a statement.

Cerner executives describe HealtheIntent as a source-agnostic, near real-time population health management platform designed to aggregate and normalize data from multiple sources.

“You need to be able to have a system powerful enough to aggregate all that data and make sense of it and then give proper information back to the clinician,” Cerner President Zane Burke told Healthcare IT News in a recent interview. “The business problems we’re trying to solve – our clients are trying to solve – they’re much bigger than they were just a few years ago.”

To that end, HealtheIntent takes data from the disparate sources, he said, runs all the algorithms and the semantic matching against the data to help provide intelligence back into the workflow to the client.

“We have fundamentally architected HeatheIntent to sit above the EMR,” Burke added.

This deal makes the health system Cerner’s 100th HealtheIntent client. LACDHS is working in collaboration with the California PRIME Project on the project. 

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Email the writer: bernie.monegain@himssmedia.com

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Imprivata Cortext, the secure communications tool, now supports speech recognition via Nuance's Dragon Medical One cloud platform, enabling providers to more efficiently input clinical information, including orders.

The combination of Dragon Medical and Imprivata Cortext includes a speaker-adaptive engine, custom vocabularies, auto-texts and templates, built-in visualization and feedback, voice navigation and correction.

"Physicians spend 43 percent of their workday on documentation and they are increasingly frustrated with how it cuts into their time," said Peter Mahoney, Nuance's general manager of clinical documentation in a statement.

As clinical staff use EHRs at workstations and on mobile devices, it allows doctors to dictate medical terminology at more than 150 words per minute.

"By assuring that complex medical terminology is recognized quickly and accurately, and communicated securely from anywhere, speech to text functionality greatly improves clinician productivity and therefore benefits patients and the entire healthcare enterprise," Imprivata general manager Ed Gaudet added.

The integration comes in the wake of The Joint Commission's recent relaxation of rules around texting orders, provided that clinicians meet certain security requirements.

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Cerner has opened Healthe at Cerner Center at its Manyata campus in Bangalore, India – giving more than 2,200 associates access to the clinic, which offers routine screenings, physical exams, lab and pharmacy delivery services and the diagnosis and treatment of acute and chronic illnesses.

It will be the first time Cerner's Millennium electronic health record will be used in a patient care environment in India, company executives noted.

"We're committed to providing convenient, holistic health and care offerings, focused on prevention and education, so our associates can lead their healthiest lives," Julie Wilson, executive vice president and chief people officer at Cerner, said in a statement.

The clinic provides primary and urgent care, along with wellness programs designed to help members manage their health.

"This is our living lab where we are bringing health care providers and technology together to actively manage the health of our associates," said Rama Nadimpalli, senior vice president and general manager, Cerner India, in a statement. "What we learn here about consumer-driven care will be available to other healthcare organizations around the world."

[Also: Cerner, 3M team up for population health management integration]

Clinicians from Manipal Hospital will staff the Healthe Clinic. The two organizations have collaborated since 2011, and Manipal Hospital has provided on-site nutritionist services for Cerner India the past two years.

The Healthe Fitness Center also offers associates full-service fitness programming with personalized health education and coaching provided by Zela Health Clubs fitness experts.

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Roanoke, Virginia-based Carilion Clinic will put predictive analytics technology from PeraHealth to work spotting hospital patients who might be at risk.
 
The clinical surveillance tool is based on PeraHealth' Rothman Index, which uses a graphical display to show patient data from electronic health records, helping predict mortality and readmission risk. It draws upon vital sign, lab and nursing assessment data and translates it into a score that's shown in color-coded graphs.

[Also: Health Catalyst: Hospitals hungry for predictive analytics but only 30 percent use the tech today]

The technology will be integrated into Carilion Roanoke Memorial Hospital's Epic EHR, where patient data will be computed in real-time - starting with admission and tracked across the episode of care - enabling clinicians to better visualize patients' condition.

Hospital staff will also use the PeraHealth tool for remote monitoring, to determine when to discharge patients, prioritize bedside visits and nursing assignment, improve clinical documentation, maximize bed management and more, officials said.

"At Carilion, we are committed to improving the health of the communities we serve, and advanced analytics play a vital role in helping us do so," said Carilion Clinic Chief Medical Informatics Officer Stephen Morgan, MD. "We believe the Rothman Index will help our providers and nurses identify at-risk patients earlier, promoting more timely intervention and better outcomes."

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Texas Health Resources has gone live with a health information exchange connecting the regions of North, South and West Texas, joining 32 other healthcare organizations in the Lone Star State.

The HIE, called HASA (Healthcare Access San Antonio), has more than 2 million patient records and encrypted data on more than 8.5 million patient encounters.

"It’s all about having the right information at the right time to make well-informed clinical decisions for the patient," said Joey Sudomir chief information officer at Texas Health Resources, in a statement. "Focusing on an individual’s health and well-being to deliver quality care is paramount, and through our collaborative effort with HASA, we’ll be able to do that beyond North Texas."

HASA officials are working to build out an advanced public HIE infrastructure, and said linking with THR is a big step in those efforts.

"Texas Health, physicians on the medical staff, along with Texas Health Physician Group, represent such a large part of the North Texas market – both in terms of the number of lives that they improve and the number of hospitals throughout the area," said Jim Hoag, market lead for HASA’s North Texas area. "They are critical to the coordination and delivery of healthcare and closing gaps in care through the public HIE."

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VERONA, WISCONSIN— Epic Systems founder Judy Faulkner told Healthcare IT News in a recent interview at the company’s headquarters that the EHR giant invests 50 percent of its operating expenses on research and development.

She pointed out that three rival health IT companies spend less, with Allscripts coming in at 34 percent, Cerner at 19 percent and athenahealth at 10 percent—numbers that Healthcare IT News verified in SEC filings.

As a private company, Epic does not have to file an income statement as the publically traded companies like her competitors are required to do. So Faulkner cut to the chase. “I know what we spend,” she said.

A 50 percent R&D total would not only outpace Epic’s direct competitors in the EHR realm, but it would also surpass many big name public technology companies including Amazon, Apple and Google — at least when measured as a percentage of operating expenses.

[Inside Epic: A look into Epic's EHR design and usability teams]

Healthcare IT News checked the three public companies’ 2015 income reports and found they spend billions on research and development, in fact, but none allocate as high a percentage as Faulkner maintains she invests for Epic.

At more than $12 billion invested in R&D in 2015, Google comes the closest with an R&D investment that equals 45 percent of the $27,465 billion it spends on total operating expenses.

Apple, meanwhile, dedicated more than $8 billion, or 36 percent of operating expenses, while Amazon invested nearly $12 billion accounting for 18 percent of its annual operating expenses.

Why spend 50 percent of operating expenses on Epic R&D?

“When we know we have to build a new system, I put people on it, and they start building it,” Faulkner said.

Another major reason Epic has been able to concentrate money, time and effort on developing new products is that it creates every component from scratch, Faulkner said.

In contrast to many cutting-edge IT vendors, Faulkner has avoided the growing pains of acquiring and trying to integrate new companies to obtain their technologies.

“Here, it’s totally about building new things,” she said. “We don’t have to spend a chunk of our R&D money trying to incorporate other stuff.”

Sumit Rana, Epic’s senior vice president of R&D, cited Epic’s myChart portal as one example of a technology that grew out of the company’s research and development.

Back in 1999 patients had no access to their own records, test results, or appointments, and many doctors viewed that information as theirs rather than belonging to patients.

“It was new technology,” Rana said. “But it was also a very disruptive and very uncomfortable thing.”

[Inside Epic: Judy Faulkner refutes rivals' claims about Epic EHR being closed]

Faulkner maintained that Epic, which she founded in 1979, has always been on the cutting edge – accusations of customers being trapped in a closed EHR system notwithstanding.

Faulkner listed Epic’s own Care Everywhere network used to exchange records Epic-to-Epic and its interoperability work with the Sequoia Project’s Carequality in exchanging records with non-Epic systems as examples of the innovation her company can achieve by spending so much on R&D.

Rana, meanwhile, pointed to the Epic MyChart patient portal and the Limerick app that sends doctors alerts when test results are ready via the Apple Watch.

Faulkner also recalled Epic’s early days when developers incorporated a graphical user interface into an early version of Epic’s electronic health record software, asserting Epic was the first EHR with a GUI.

At the time, she said, there were line-by-line character-based EHRs – particularly in inpatient settings.

“I'm the only CEO founder among our major competitors who's technical,” she added. “So this is my sweet spot.” 

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OpenNotes has enlisted 10 experts from across the healthcare industry to serve as founding members of the OpenNotes Advisory Board.

These professional advocates for patient engagement and experts in quality improvement are meant to help OpenNotes continue its nationwide growth as it convinces more physicians and other health care providers to share their clinical notes with patients.

"What these individuals have already achieved is very impressive, and we have no doubt they'll be invaluable guides for us as OpenNotes expands," said Open Notes co-founder Tom Delbanco, MD, in a statement. "Their thoughts and ideas will be enormously important in helping us achieve our goal of spreading OpenNotes access to 50 million patients over the next three years."

[Also: OpenNotes hits 10 million patient milestone]

The founding members of the OpenNotes Advisory Board:

• Lisa Cooper, MD, the Fries Professor of Medicine at Johns Hopkins Hospital and Medical School and head of its Center for Population Health and Health Disparities.
• Dave deBronkart, known as "e-Patient Dave," a cancer survivor and leading advocate for patient engagement.
• James Guest, former President and CEO of Consumer Reports.
• John Halamka, MD, Harvard Medical School professor and chief information officer of the Boston's Beth Israel Deaconess System.
• Susan R. Mende, senior program officer at the Robert Wood Johnson Foundation and a specialist in healthcare delivery system reform.
• Jeffrey Rayport, a Harvard Business School professor who specializes in applications of digital, social, and mobile media.
• Elaine Ryan, vice president for governmental affairs at AARP.
• Jill Shah, founder and former CEO of Jill's List, an online network of patients, practitioners and other healthcare stakeholders.
• Kate Walsh, president and CEO of Boston Medical Center, a specialist the needs of the underserved.
• Mark Wietecha, president and CEO of the Children's Hospital Association, which represents more than 200 children's hospitals and major pediatric programs.

"This is an outstanding group of innovators," said OpenNotes Executive Director Cait DesRoches. "They have decades of experience in patient care, health information technology, and advocating for the most vulnerable."

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The Pop Health Forum 2016 convened in Chicago this week. Keynoters, speakers and panelists took the stage to address a range of topics such as defining population health's role in public health, leveraging new payment models, assuming risk and making the most of strategic resources — as well some basics: the blocking and tackling of infrastructure and technology.

Monday morning'a keynote speaker, Michael Dulin, MD, director of the University of North Carolina Charlotte’s academy for population health innovation, kicked things off with a look at the intertwined relationship between public health and population health management techniques.

Dulin’s message: The care delivery system must be redesigned from the ground up, based on data, if population health is going to thrive. ⇒ Read the full article.

The care delivery system is not the only aspect of today’s healthcare industry that speakers questioned. Another: the technological underpinnings of hospitals, practices and medical groups – even large integrated delivery networks.

IT infrastructure for population health must include analytics, care coordination, telehealth and smartphone apps as well as patient engagement tools. Adrian Zai. MD, clinical director of population informatics at Mass. General, said all of those need to be integrated. And that’s just a start, tech-wise. Read the reality check on how today's IT fares for population health. ⇒ Read the full article.

Within the discussion of technology, Citius Tech vice president Jeffrey Springer cautioned executives and health IT professionals to avoid chasing bright shiny objects in the name of population health – instead ending up with difficult-to-mange morass of systems that do not serve patients well at all. ⇒ Read the full article.

It’s no secret that engaging patients is difficult, of course. But Northwell Health’s Director of Digital Intervention Frederick Muench offered a contrarian take on developing technologies that people actually use to improve health: Start with the patient, figure out existing barriers and then plug in technologies that will help overcome those. ⇒ Read the full article. 

Patient engagement is critical to population health — as it is to the Triple Aim. Even though engagement has not, to date, been part of the Triple Aim to improve patient care that leads to healthier populations and reduces costs, population health consultant made the bold prediction that without incorporating patient education and engagement as a core component, the Triple Aim will never bend the cost curve. Not today, not even 50 years from now. ⇒ Read the full article.

Among the success stories that providers shared on stage is that of Advocate Health Care using telemedicine in its intensive care unit to slash ICU stays by 352 days between 2014 and 2015, which saved $300,000 while reducing ventilator days by 331 in that same time period saved $400,000. ⇒ Read the full article.

Healthcare IT News also interviewed speakers leading up to the event about the challenges of understanding data, critical steps to a successful population health framework, savvy engagement of the C-suite in population health initiatives, as well as looks at how health systems such as John Muir Medical Center aligned IT and care management to advance its programs, Geisinger joined forces with KeyHIE to boost clinician productivity an hour a day and Centura Health found success teaming up with Dispatch Health to conduct medical concierge services via the latter’s mobile app. ⇒ Read the roundup.  

Helpful advice for planning to purchase a population health platform:

⇒ Experts explain what to look for when choosing a population health platform
⇒ Comparison chart of 8 population health products 
⇒ An in-depth look at 8 population health software programs

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More than 1,300 health centers across the U.S. and its territories will be given $87 million for information technology enhancements, Health and Human Services Secretary Sylvia M. Burwell announced Sept. 15.

The funding is earmarked as part of the Affordable Care Act's Community Health Center Fund, which was recently extended with bipartisan support as part of MACRA. It's the first significant investment since 2009 directly awarded to health centers to support the purchase of information technology.

All purchases or upgrades of electronic health record systems made with the funding must be certified by the Office of the National Coordinator for Health IT.

The money is meant to to support health IT enhancements aimed at speeding these providers' shift toward value-based care, through better data exchange, clinical decision support, patient engagement and more, according to HHS.

[Also: HHS awards $36 million to boost IT uptake at health center networks]

"These awards will allow health centers to deliver higher quality of care to patients and spend health care dollars in a smarter way," said Jim Macrae, Health Resources and Services Administration Acting Administrator, in a statement.

"Health centers across the country are instrumental in providing high-quality, comprehensive primary health care to millions of people," added Burwell. "This investment will help unlock health care data and put it to work, improving health outcomes and building a better health care system for the American people."

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With all the changes happening to meaningful use, quality measurement and MACRA in 2016, I've been asked many questions by many organizations to help them plan for the future.

As I've said many times, one of the great challenges we have is that the 2015 Edition final rule has an enormous scope extending beyond meaningful use with the notion that it can be coupled to every government healthcare IT program.

Standards needs to be based on requirements and specific use cases with little optionality, so creating a broadly scoped rule before the use cases are known just doesn't work. Although it is my hope that the tight coupling of the 2015 Edition final rule to various programs will be eliminated eventually,  it is important to understand what certifications are needed for what programs in 2016, 2017 and 2018.

For example, all current BIDMC systems are certified to the 2014 Edition. Will we be able to participate in government programs in 2016 using the 2014 Edition Certification? Yes! Will we be able to participate in government programs in 2017 using the 2014 Edition Certification? Yes! Only in 2018 will we have to be certified to the 2015 Edition and we can all hope that the certification concept is revised before then.

Here's an example of the actual language in regulations illustrating certification requirements. Please find below rule text excerpts and citations to the Hospital Inpatient Quality Reporting Program's EHR certification requirements for electronic clinical quality measures reporting.

For the CY 2016 reporting period (FY 2018 payment update), use the 2014 or 2015 edition:

From the FY 2016 IPPS final rule (80 FR 49705-6):
"In the FY 2016 IPPS/LTCH PPS proposed rule (80 FR 24587), we proposed to continue the requirement for hospitals to use CEHRT 2014 Edition when submitting electronic clinical quality measures for the CY 2016/FY 2018 payment determination. However, in response to comment suggesting that hospitals be allowed to report using either the 2014 or 2015 edition of CEHRT, we are finalizing a modification to our proposal such that, for CY 2016/ FY 2018 payment determination reporting of electronic clinical quality measures, hospitals can report using either the 2014 or 2015 edition of CEHRT."

For the CY 2017 reporting period (FY 2019 payment update), use the 2014 or 2015 Edition:

From the FY 2017 IPPS final rule (81 FR 57170):
"After consideration of the public comments we received, we are finalizing that hospitals must report using EHR technology certified to either the 2014 or 2015 Edition for the CY 2017 reporting period/FY 2019 payment determination (not subsequent years) as proposed.  We also refer readers to section VIII.A.10.d.(5) of the preamble of this final rule, in which we finalize alignment of this policy in the Medicare and Medicaid EHR Incentive Programs."

For the CY 2018 reporting period (FY 2020 payment update), use the 2015 Edition:

From the FY 2017 IPPS final rule (81 FR 57171):
"After consideration of the public comments we received, we are finalizing the required use of EHR technology certified to the 2015 Edition for the CY 2018 reporting period/FY 2020 payment determination and subsequent years as proposed. We also refer readers to section VIII.A.10.d.(5) of the preamble of this final rule, in which we finalize alignment of policies in the Medicare and Medicaid EHR Incentive Programs."

I hope providers and developers find this useful.  In the next few years, we can hope that the entire QRDA quality reporting standard is replaced by a FHIR implementation guide or at the very least, the need to use QRDA Category 1 (individual patient data submissions) is eliminated.

Nebraska Medicine, a two-hospital system that implemented its Epic EHR three years ago, will roll out Epic’s population health platform Healthy Planet. The platform will serve 1,100 physicians using different electronic health record systems.

The goal in implementing the technology, Nebraska Medicine executives said, is to help private practice physicians work more collaboratively across the state to improve care, reduce costs, benefit from group purchasing agreements and participate in new federal incentive programs.

Nebraska Medicine, a Stage 7 facility on the HIMSS Analytics EMRAM scale, has 661 licensed hospital beds in Omaha and Bellevue, Neb. and nearly 40 specialty and primary care clinics in Omaha and the surrounding area.

Pop Health Forum 2016: What speakers said and panelists debated at the event

“Healthy Planet will be the engine that makes it possible to better predict patient needs, intervene earlier and work together to improve outcomes,” Brian Lancaster, executive director of Nebraska Medicine’s Information Management Division, said in a statement. “We considered platforms from multiple vendors, but in the end Epic’s platform is powering the largest and most successful population health programs in the country, and that’s what we want for Nebraska.”

The platform will support Nebraska Medicine’s clinically integrated network called Nebraska Health Partners.

"Improving care is no longer about what one physician can do, it’s about what we can do as a community of caregivers with better technology,” Michael Ash, MD, said in a statement. Ash is chief transformation officer at Nebraska Medicine and assistant professor for the University of Nebraska Medical Center, Nebraska Medicine’s academic partner.

Healthy Planet is expected to enable Nebraska Health Partners to gather patient information across multiple data sources, including EHRs, claims, pharmacies and satisfaction surveys. Also, the data enables them to perform sophisticated analytics work and provide care providers with a more complete view of the patient as well as better decision support.

Nebraska Medicine executives said real-time information sharing and analytics will be especially important when participating in new federal incentive programs like the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-Based Incentive Payment System (MIPS). 

Helpful advice for planning to purchase a population health platform:

⇒ Experts explain what to look for when choosing a population health platform
⇒ Comparison chart of 8 population health products 
⇒ An in-depth look at 8 population health software programs

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After an almost three-week shutdown of computer systems due to a following a crippling cyberattack that the system first revealed in late August, Appalachian Regional Healthcare system is back online, officials said.

ARH said on their website that operations are "returning to normal" at ARH facilities in Kentucky and West Virginia, with computerized clinical and electronic communication systems coming back to full function.

"At this time, all ARH hospitals, home health, retail pharmacies and various clinics are back online," the system said.

The system had been working on an emergency operations plan in which all patient-care, registration, medication, imaging and laboratory services were being handled manually. Critical patients were being assessed to determine whether they should be transferred to another facility.

Computers had been shut down early on in the attack in order to prevent further spread of the virus throughout ARH's system.

"At this time, ARH presently has no reason to believe that the protected health information or any financial information of its patients or employees has been accessed," the system said.

The cyberattack is under investigation by federal authorities. ARH said they have been asked not to discuss specifics surrounding the cyberattack. 

Helpful advice on planning your purchase of IDS and IPS tools:

• How to know if your intrusion detection and prevention solution meets HIPAA compliance rules
• 3 key factors to plan your budget for an intrusion protection system 
• What to watch: IDS and IPS features to consider when comparing different vendors products 

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The Centers for Medicare and Medicaid Services is launching a central data repository for public health agency and clinical data registry reporting.

The database, set to be completed by 2017, will help practices and hospitals meet meaningful use requirements for public health reporting, pointing them toward agencies and registries able to accept electronic public health data.

[Also: CDC: Electronic quality data a boon to public health reporting]

To join the repository, those organizations must report on their readiness to receive electronic data by October 31. Further, qualified entities need to identify the public health measures the organization reports, such as immunization registry, specialized registry reporting, electronic case reporting and syndromic surveillance reporting.

Registries can use the CMS input form to join the repository, which also declares its readiness to receive public health reporting, according to officials.

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