Although meaningful use visionaries are hoping to advance the cause of robust public health registries as part of the program's Stage 3, widespread, seamless public health data exchange still has a ways to go.

Among several meaningful use Stage 3 issues discussed by stakeholders charged with advising the Health IT Policy Committee, advanced case reporting to both public health agencies and specialized disease registries is striking some as overly ambitious and potentially impractical.

The Meaningful Use Workgroup is trying to align Stage 1 and 2 objectives and Stage 3 requirement recommendations with Stage 3 goals, such as for case reporting -- "efficient and timely means of defining and reporting on patient populations to identify areas for improvement," and data sharing with public health agencies.

Workgroup members, such as Art Davidson, MD, informatics director at the Denver Public Health Department, are looking to use meaningful use Stage 3 to move public health reporting forward, with potential case reporting to a greater variety of registries, including for cancer, children with special needs, chronic diseases, relying on an EHR that’s able to build and send standardized reports to external mandated or voluntary registry and maintain an audit of them.

"A big question is can public health agencies accommodate this?" said Paul Tang, MD, chief information and technology officer at the Palo Alto Medical Foundation, and chair of the Meaningful Use Workgroup.

Some could but others probably couldn’t without encountering standardization problems.

"The field is not solidified on how to collect data," Davidson said. There are 50-plus public health jurisdictions across the country managing data with standards different than the International Society for Disease Surveillance standards that the ONC is suggesting, he noted.

Davidson said members of the Health IT Standards Committee were working on modelling a way to coalesce all of the jurisdictions together on a site that provider EHRs could use to customize case reporting at the regional level. Essentially agencies would list their jurisdiction and related standards on an external site that an agency like the Centers for Disease Control and Prevention could possibility host.

As Tang pointed out, that host site doesn’t exist now. "Seems like a heavy lift," Tang said. "I think for Stage 3 it’s premature."

"I understand that this is a push or a heavy left," Davidson said, but he added that there’s been support for advancing case reporting among standards and interoperability stakeholders. "I would at least like to hear back from the Standards Committee."

Some eligible physicians may soon be encountering the lack of aligned standards for some disease registries in meaningful use Stage 2, which added two new public health menu objectives, reporting to a cancer registry and reporting to a specialized registry.

Eventually, those registries are going to have to be able accommodate more reporting. "This could be the nudge for those registries to standardize," said Neil Calman, MD, president of the Institute for Family Health and chair of the family and community health department at the Mount Sinai medical school.

Davidson is checking with members of the HIT Standards Committee, and the workgroup will be taking up this and other issues during meetings in November, before making recommendations to the Health IT Policy Committee on Dec. 4.

This story first appeared on Government Health IT here.