Post on 13-Feb-2016
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Centers for Disease Control and Prevention (CDC)
Electronic Public Health Data Exchange: Right Time, Right Place
Presenter: John Eichwald, MAMarch 4, 2013
CDC Programs Represented TodayMeaningful Use Public Health Technical AssistancePublic Health Reporting InitiativeCancer RegistriesEarly Hearing Detection and InterventionVital RecordsImmunization Information SystemsPHIN Vocabulary ServicesNational Healthcare Safety NetworkPublic Health Clinical Decision Support
Supporting Meaningful Use Implementation by CDC Programs and Jurisdictional Public
Health AgenciesMeaningful Use Public Health Technical Assistance (TA) Team
Assist in resolving issues and problems preventing successful achievement of the Meaningful Use public health objectives
Provide focused policy and technical expertise Identify successful methods used to resolve similar issues Rapidly resolve misunderstandings and simple problems Document and learn from the real problems occurring the
field
Team’s Purpose and Goals
MU TA Team Support: Request Statistics
26%
14%
28%
2%
4%
26%
Technical Assistance Requests Categories
ImmunizationReportable Lab ResultsSyndromic Surveil-lanceCancer Multiple Public Health MeasuresOther (Transport, Pol-icy, General, etc.)
Technical Assistance Requests Categories
Categories # %SS 52 28%Other (Transport, Policy, General, etc.)
47 26%
IIS 47 26%ELR 26 14%ALL 8 4%CANCER 3 2%Total 183
Technical Assistance Requests # %Requests received via the Meaningful Use Mailbox
117 64 %
Requests received via HITRC’s Burning Issues Workgroup
10 5 %
Requests received via other channels
56 31 %
Total Requests 183Total Closed 175 96 %Total Open (In Process)
8 4 %
Technical Assistance RequestTotals
meaningfuluse@cdc.gov
Supporting Harmonization of Electronic Data Exchange through the Public Health Reporting
Initiative (PHRI)In 2012 CDC actively participated in the Office of National Coordinator (ONC) Standard and Interoperability (S&I) PHRI.PHRI Goal : Harmonize HIT standards and implementation guides for interoperable communication between clinical care and public health for public health reporting
Minimize unnecessary modification of EHRs and their certification by harmonizing with other ONC-certification criteria and other S&I Framework activities
Develop implementation guides to maximize future extensibility and re-usability for multiple public health domains
Minimize impact on established Stage 1 MU public health reporting objectives while potentially simplifying such reporting in the future
Develop implementation guides while accounting for the needs of subsequent inter-jurisdictional communication (e.g., transfer of cases between jurisdictions and national notification requirements) and population-level reporting.
Facilitate future certification of public health information systems that are interoperable with ONC-certified EHRs
Step Description Outputs/Artifacts
Functional RequirementsAnalysis
• Document implementation requirements per Domain / User Stories
Documented functional requirements, including data classes
Data Harmonization and Modeling
• Collect User Story Data Elements• Achieve consensus regarding
common core data elements across user story domains
• Update Federal Health Architecture Data Model with inclusion of classes for public health
Public Health Data Harmonization Profile
Harmonizing Data Exchange Implementation Guides
• Access the structure and content of the Consolidated Clinical Data Architecture (C-CDA) Implementation Guide (IG)
• Reconcile PHRI common core data elements with C-CDA and 2009 HL7 Public Health Case Reporting IG
PHRI C-CDA library of templates
2012 PHRI: Processes and Results
Time Period
Numberof New Registries
1930 21940 21960 61970 141980 141990-1995
5
1996-2000
8
2001+ 2From: NAACCR CINA: 2001-2005
The US Requires Reporting of Cancer to the National Cancer Programs
Cancer Program Accomplishments Electronic Health Record (EHR) reporting to
central cancer registries (CCRs) Cancer Reporting is a new menu item for Eligible
Professionals (EPs) for Meaningful Use (MU) Stage 2 (2014 implementation)
Development of Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries (“Cancer IG”), based on IHE Physician Reporting to a Public Health Repository – Cancer Registry (PRPH-Ca)
Two Comparative Effectiveness Research (CER) projects pilot testing provider EHR cancer reporting (KY and MO)
Electronic pathology reporting (ePath) to CCRs Based on IHE Anatomic Pathology Reporting to Public
Health – Cancer Registry (ARPH) profile 42 states are live with ePath reporting 7 anatomic pathology laboratories reporting to CCRs 30 states use eMaRC Plus, CDC-developed software tool,
for receiving and processing ePath reports
Cancer and Meaningful Use CMS Meaningful Use Stage 2 Final Rule,
August 2012: “Capability to identify and report cancer cases to a
State cancer registry “ ONC 2014 Edition EHR Certification Criteria
Final Rule: Requires use of Implementation Guide for Ambulatory
Healthcare Provider Reporting to Central Cancer Registries (“Cancer IG”) for EHRs to create and transmit cancer reports to cancer registries
Change proposal approved in December 2012 to align IHE PRPH-Ca profile with the Cancer IG. Both use HL7 Clinical Document Architecture (CDA).
CDC-developed software tool, eMaRC Plus, is freely available to all states for receiving and processing CDA reports
Sets stage for other public health (case) reporting
For more information, please contact the Meaningful Use Public Health Technical Assistance Team
Early Hearing Detection and Intervention Information System (EHDI-IS)
• CDC’s EHDI Team, as part of the National Center on Birth Defects and
Developmental Disabilities , supports state and territorial EHDI programs
working to advance surveillance capability and interoperable data
systems.
• Newborn screening can potentially capture the entire newborn
population, providing one of the first meaningful interoperability
opportunities in an individual’s healthcare lifespan
• EHDI provides an opportunity to establish bi-directional information
exchange between clinical care and public health in a relatively simple
and feasible way
EHDI Standards-based Information Exchange
IHE Newborn Admission Notification Information
(NANI)
HL7 EHDI Messaging Data Standard Trial Use (DSTU)
IHE Early Hearing Care Plan
(EHCP)
CQM EHDIClinical Quality Measure
(CMS 31v1/NQF 1354)
IHE Quality Measure
Execution(QME-EH)
IHE EHDI Cross-enterprise
WorkflowDocument
Labor & Delivery
Newborn Screening
State EHDI Program
Medical Home
Federal Reporting
CareTasks
&States
e-MeasureDefinition
Specialist
HL7 v2
HL7 v2 HL7 CDA R2
HL7 HQMF
HL7 QRDA
Us Case 5Vital Registration and Care Coordination for Newborn
Hearing Screening
Care Theme: Maternal & Newborn Health
Use Case 16
Interoperability ShowcaseIn collaboration with IHE
• Background
– The National Vital Statistics System (NVSS) provides essential data on all U.S. births and deaths
• Over six million vital events are reported annually• Information collected includes a wide range of demographic, medical, and geographic data
derived from 4 million birth certificates and from about 2.4 million death certificates and fetal death reports
• Events are registered by 57 registration areas: 50 states, 2 cities, and 5 U.S. territories• Vital statistics data are widely used to monitor and improve the nation’s health, e.g., track and
explain trends in cesarean delivery, preterm and low birth weight births, causes of infant death and disparities in health among populations groups
– Detailed data on all events are transmitted to the Center for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS)
• Much of the information collected for birth and death certificates and fetal death reports are captured in hospital medical records
• Vital statistics and standards communities have collaborated to build upon more than a century’s effort in standardization to encourage EHRs to capture medical and health information in a format consistent with the vital statistics requirements
GOAL is to improve the timeliness, accuracy, and completeness of vital records data
Electronic Health Record (EHR) and Vital Record (VR) Systems Information Exchange
Electronic Health Record (EHR) and Vital Record (VR) Systems Information Exchange
Capturing birth and death data in electronic health record systems
Electronic exchange using HL7and IHE-based standards
Improving the timeliness, accuracy, andcompleteness of vital records data
Electronic Health Record (EHR) and Vital Record (VR) Systems Information Exchange
Document Transaction Status
HL7 Version 3 Domain Analysis Model: Vital Records, Release 1 (R1) Domain Analysis Model
Published and freely available during pilot period that began February 2012
HL7 EHR-System Functional Model (EHR-S FM) Vital Records Functional Profile, R1 EHR-S Functional Profile
Published and freely available during pilot period that began February 2012
HL7 EHR-S FM Public Health Functional Profile R1 EHR-S Functional ProfilePublished and freely available during pilot period that began February 2012
HL7 Version 2.5.1 Implementation Guide (IG): Vital Records Death Reporting, R1 –Draft Standard for Trial Use (DSTU)
Death related information from a clinical setting to the vital records electronic registration system
Available for download and comments on the HL7 DSTU Commenting Site
HL7 Version 3 CDA R2 IG: Reporting Death Information from the EHR to Vital Records, R1 (DSTU)
Death related information from a clinical setting to the vital records electronic registration system
Balloted in HL7 May 2012 ballot cycle. Goal to publish as DSTU in early 2013
HL7 Version 2.51 IG: Reporting Birth & Fetal Death Information from the EHR to Vital Records, R1 (DSTU)
Live birth and fetal death related information from a clinical setting to the vital records electronic registration system
Balloted in HL7 Jan. 2012 ballot cycle. Goal to publish as DSTU in early 2013
HL7 Version 3 CDA R2 IG: Reporting Birth & Fetal Death Information from the EHR to Vital Records R1 (DSTU)
Live birth and fetal death related information from a clinical setting to the vital records electronic registration system
Balloted in HL7 Sept. 2012 ballot cycle. Goal to publish as DSTU in early 2013
Integrating the Healthcare Enterprise (IHE) Birth and Fetal Death Reporting (BFDR) Content Profile
Defines the EHR content that may be used to pre-populate and transmit birth and fetal death information to vital records systems for vital registration purposes
IHE published for trial implementation August 2012
Integrating the Healthcare Enterprise (IHE) Vital Records Death Reporting (VRDR) Content Profile
Defines the EHR content that may be used to pre-populate and transmit death information to vital records systems for vital registration purposes
Under development. Goal to publish by fall 2013
Special thanks to those who collaborated with us during the IHE 2013 Connectathon interoperability testing to support the Vital Records and EHDI standards development
work
Thank You!!!!!
Immunization Interoperability:2012 Successes Indicators
CDC provided funding to eligible state/city/local Immunization Information Systems (IIS) to enhance EHR-IIS interoperability using HL7
96% of IIS or their designee are now able to send and receive HL7 2.3.1 and/or HL7 2.5.1 messages
Simple Object Access Protocol (SOAP) web services for immunization data transport according to CDC Expert Panel’s recommended Web Services Definition Language (WSDL) implemented by more than 43% of IIS
Published HL7 Version 2.5.1 Implementation Guide for Immunization Messages, Release 1.4 Worked with NIST to develop certification testing for MU2
based on the Implementation Guide New effort to use MU2 testing with IIS to improve conformance
Release of 2D Barcode on Vaccines and Vaccine Information Statements (VIS) Pilot testing underway in 10 states and ~220 provider sites 2D Barcoded Vaccines
• Current: Havrix, Pediatric DT, Menactra, Adacel, Fluzone, IPOL
• Release Soon: Daptacel, Tenivac, Pentacel 12/25 VIS have 2D barcodes: edition date & type of VIS
CDSi (Clinical Decision Support for Immunizations) Released Logic Specification – computable and consistent
representation of childhood vaccine recommendations and schedules
Resources include logic tables, business rules, supporting data For use in clinical EMR and IIS
Immunization Interoperability: 2012 Successes Indicators (cont.)
Vocabulary Access and Distribution System (VADS): A Web-Based PH Enterprise Vocabulary System
In 2004, CDC developed a web-based enterprise vocabulary system called the Public Health Information Network Vocabulary Access and Distribution System (PHIN VADS) for accessing, searching, and distributing HL7 messaging value sets used within the PHIN and NHIN.
Provides all the vocabulary metadata needed for HL7 messaging. Promotes sharing and reusing of the value sets. Hosts multiple versions of value sets that allow implementers to have access
to the current, past and the future versions of value sets and value set collections
Provides web services (API) that allows HL7 interface engines, medical and public health
applications to obtain the value sets as well as validate the vocabulary present in HL7 messages.
Provides detailed code system metadata for value set concepts such as context, hierarchy, synonyms and alternate codes. This will facilitate the implementation of value sets and improve the quality of local vocabulary mapping to standards.
PHIN VADS can be accessed at a public web site - http://phinvads.cdc.gov CDC Vocabulary and Messaging team manages the PHIN VADS.
VADS: Developing a Sustainable Approach for Supporting Partners
Electronic Reporting to the National Healthcare Safety Network (NHSN) via Clinical Document Architecture (CDA)
NHSN and CDA Capability • Currently accepting CDA files for:
Central line associated bloodstream infection (CLABSI) Catheter associated urinary tract infection (CAUTI) Surgical site infection (SSI) Multi-drug Resistant Organism and C. dfficile laboratory
identified (LabID) events Central line insertion practices (CLIP) Dialysis events Antimicrobial use
• Approximately 500 hospitals are reporting to NHSN via CDA – over 5000 hospitals report to NHSN
Public Health Clinical Decision Support (CDS)
Decision Support Providing public health alerts/guidelines to providers in EHR
systems• GE, Alliance of Chicago & Lehigh Valley
Working with CDC programs to deliver public health information at the point of care for screening, diagnostic evaluation, treatment & education
• HIV/STD & Million Hearts programs CDS Partnerships
CDS Consortium, Federal CDS Collaboratory, ONC Health eDecisions S&I Initiative
Development of Geospatial Community Health Record Engaging HD in Memphis & Methodist Le Bonheur Hospital
Dashboard of health indicators e.g. obesity, heart disease & stroke Working with Million Hearts program & others in OSELS
Managing Emerging Events:Public Health EHR Alerting Flow
FB Outbreak Identified
States/CDC monitoring
public health discover
foodborne outbreak
SymptomsLocationsEvent InformationGuidance e.g. Consumption history
message sits on a standalone knowledge repository
FB Message Created
Us Case 5
Visit the CDC Public Health Use Case Interoperability
DemonstrationsUse Case #3 – Biosurveillance Monitoring and Detection: “Updating and Leveraging National Healthcare Registries in Care Delivery”
Use Case #4: Immunizations Registry Updating and Utilization - “Updating and Leveraging National Healthcare Registries in Care Delivery”
Use Case #7 – “Cancer Care Coordination and Ambulatory Care Reporting to a Central Cancer Registry”
Use Case #16: Maternal & Newborn Health – “Birth Event Reporting and Care Coordination for Newborn Hearing Screening”
Interoperability ShowcaseIn collaboration with IHE
Thank YouContacts:• CDC Standards & Interoperability: Nikolay Lipskiy,
NLipskiy@cdc.gov• Cancer Reporting: Wendy Blumenthal, WBlumenthal@cdc.gov• Early Hearing Detection and Intervention: John Eichwald, JE
ichwald@cdc.gov• Vital Records Standards: Michelle Williamson,
MWilliamson@cdc.gov• Immunization Information Systems: Warren Williams,
WWilliams1@cdc.gov• PHIN VADS: Roochi Sharma, RSharma@cdc.gov
• Email: phinvs@cdc.gov• Online Forum: http://www.phconnect.org/group/phinvads
• National Healthcare Safety Network: Daniel Pollock, DPollock@cdc.gov
• Clinical Decision Support: Nedra Garrett, NGarrett@cdc.gov
The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention
For more CDC information please contactTelephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.atsdr.cdc.gov