Anna Orlova and Lori Reed-Fourquet Public Health Data Standards Consortium and eHealthSign Business...

Anna Orlova and Lori Reed-Fourquet

Public Health Data Standards Consortium and

eHealthSign

Business Process Analysis (BPA) for Public Health Systems Interoperability:

From Business Cases towards Interoperability Standards

Acknowledgements:

Public Health Data Standards Consortium (PHDSC)

National Association of City and County Health Officers (NACCHO), USA

Participants of the NACCHO Workshop on Business Process Analysis in Public Health, Salt Lake City, UT, December 2011

Centers for Disease Control and Prevention (CDC), USA

Quality, Research and Public Health Committee, Integrating the Healthcare Enterprise (IHE)

Public Health and Emergency Response Workgroup, Health Level Seven (HL7)

Structured Documents Workgroup, HL7

State Health DepartmentOrganizational Chart

Provider 1

Provider 2

Provider 3

Provider 4

Provider X

Quality Improvement

Public HealthLaboratory

Vital Statistics

Communicable Diseases

Immunization

EnvironmentalHealth

Injury Control

School Health

Chronic Care

Biosurveilance,Preparedness

Genetic Disorders

Women & Children

CDA2

IHE

X12

NCPDP

Quality Improvement

Public HealthLaboratory

Vital Statistics

Communicable Diseases

Immunization

EnvironmentalHealth

Injury Control

School Health

Chronic Care

Biosurveilance,Preparedness

Genetic Disorders

Women & Children

HL7Provider 1

Provider 2

Provider 3

Provider 4

Provider X

From Connectivity to Interoperability

Healthcare Public HealthTODAY

Healthcare Public HealthTOMORROW

Term Definition

Business Area Public health roles (objectives) in the society performed by the agency

Domain Public health program/division/office within an agency that realizes the implementation of a given business area or multiple business areas

Business Process Activities to support a particular role (objective)

Information System Functions

Functional requirements for information systems to support business processes

Case (or Public Health Case)

A health-related event (condition) that by law is of interest to a particular public health program at the local, state or federal level

Public Health Reporting An information exchange (send, recieve, retrieve) on a public health case (health-related event (condition, occurence)) that by law is of interest to a particular public health program at the local, state or federal level

Terms and Definitions

The operation of local, state and federal public health agencies under the core public health functions (assessment, policy and assurance) is focused on enabling resources and services for the public’s health protection. The public health operates under the following business areas:

•Population – Know population to serve•Resources – Know healthcare capacities and other resources to serve the population•Environment – Know the environment in your jurisdiction to prevent and control possible public’s health threat exposure to the served population•Protection – Enable protection of the public in the jurisdiction from diseases and exposure to biohazards, environmental agents and natural disasters •Wellness – Promote wellness for the served population•Direct Care – Enable access to care for underserved population and people with special needs •Agency Operation – Enable program operation to provide services to the population in need•Research – Conduct research to evaluate public health interventions and to develop new interventions

Harmonizing Public Health Operation across Various Domains/Programs

Core Public Health Functions

Public Health Business Processes

Patient-level Population level

ASSESSMENT

Case identification Outbreak identification

Case investigation Outbreak investigation

Case management Outbreak management

ASSURANCE

Case management evaluation

Outbreak management evaluation

POLICYMitigation Mitigation

Business Processes: Patient & Population Level

Information System Functions

Examples of Related IHE Profiles and Standards

Collect Data RFD, XDS, LAB TF (XD*Lab, Lab message), QRPH content (EHDI, PRPH-CA, MCH, DSC), PCC Content (LDS, XDS-MS, XPHR, IC), RPE, RDA, XD* with HL7 CDA for PH ReportingReporting Requirements (Pending HL7 work)Report Criteria Guideline ManagerPractice ManagerData Source Workflow (XDW)

Manage Data (upload, maintain, delete)

Control Access (XUA, ATNA)

Analyze Data (Statistical Algorithms), Syndromic Surveillance Algorithms (DSUB, MPQ), Retrieve Medical Knowledge QRPH-29

Integrate Data IT Infrastructure Profiles (PIX, PDQ, XDS, XDR, On-Demand Documents, XDW)

Report Data PDF, Maps, Send Distribution QRPH-30

Examples of Interoperability Standards by Information Systems Function

Public Health

Business Areas

NACCHO-PHDSC Business Process Analysis for Pubic Health: Project Findings

Public Health Business ProcessesIndividual/Population

Public Health

Business Areas



Information Systems

Functions

Public Health

Business Areas



Information Systems

Functions

Data Content

Public Health

Business Areas



Information Systems

Functions

Data Content

Population

Resources

Environment

Protection

Wellness

Direct Care

Operations

Research

Public Health

Business Areas

Case/Outbreak

IdentificationCase/

Outbreak Investigation


Information Systems

Functions

Data Content

Case/Outbreak

ManagementCase/

Outbreak Management

EvaluationMitigation

Population

Resources

Environment

Protection

Wellness

Direct Care

Operations

Research

Public Health

Business Areas

Case/Outbreak

IdentificationCase/



Information Systems

Functions

Data Content

Case/Outbreak

ManagementCase/

Outbreak Management


Collect Data

Manage Data

Integrate Data

Analyze Data

Report Data

Population

Resources

Environment

Protection

Wellness

Direct Care

Operations

Research

Public Health

Business Areas

Case/Outbreak

IdentificationCase/



Information Systems

Functions

Data Content

Case/Outbreak

ManagementCase/

Outbreak Management


Collect Data

Manage Data

Integrate Data

Analyze Data

Report Data

Guidelines

Case/Outbreak Reports

Alert & Notification

Quality Reports

Educational Materials

Lab Reports

Care Plans

Population

Resources

Environment

Protection

Wellness

Direct Care

Operations

Research

Public Health

Business Areas

Public Health Program Examples:

Early Hearing Detection & Intervention (EHDI)

andPublic Health Laboratory


Information Systems

Functions

Data Content

Public Health

Business Areas

Workflow Standards

Health IT Standards

Content Standards

Use Cases

Guiding the HIT Standardization for Public Health

Business Areas: Early Hearing Detection & Intervention

Business Areas: Public Health Laboratory

Case/Outbreak

IdentificationCase/



Information Systems

Functions

Data Content

Case/Outbreak

ManagementCase/

Outbreak Management


Collect Data

Manage Data

Integrate Data

Analyze Data

Report Data

Guidelines

Case/Outbreak Reports

Alert & Notification

Quality Reports

Educational Materials

Lab Reports

Care Plans

Population

Resources

Environment

Protection

Wellness

Direct Care

Operations

Research

Public Health

Business Areas

Newborn Hearing ScreeningWorkflow

Short-Term Care Follow-up Workflow

Case Identification

Case Investigation

Case Management

Labor & Delivery Summary

Hearing Screening

Order/Results

MS: Hearing Risk Factors

Labor & Delivery Workflow

Early Hearing Care Plan

Updated Hearing Care Plan

Newborn Care Workflow

Hearing Screening

Quality Measures

Early Hearing Detection and Intervention (EHDI) ProgramWorkflow

StandardsHealth IT Standards

Content Standards

Use Cases

Population

Resources

Environment

Protection

Wellness

Direct Care

Operations

Research

LaboratoryWorkflow

Case Management

Workflow

Case Identification

Case Investigation

Case Management

Chief ComplaintMedical

Summary

Lab order/ Results

Risk Factors

Visit to Provider

Case Management

PlanUpdatedPlan

Case InvestigationWorkflow

PH Questionnaire

Communicable Diseases Programs (Lab Data)Workflow

StandardsHealth IT Standards

Content Standards

Use Cases

Population

Resources

Environment

Protection

Wellness

Direct Care

Operations

Research

Business Processes /

Activities

Information Exchange Content by DomainExamples of

IHE Interoperability StandardsEHDI

PH-LabPreparedness (Anthrax)

Surveillance (Influenza)

CASE IDENTIFICATIONTrigger: Due for screening / Present with symptoms

Input:Notification of birthOutput: Standing order

Input: Medical SummaryOutput: Test Order

Input: Medical Summary Output: Test Order

XDS-MS/XPHR/C32 XDS/XDR/Lab-Technical Framework (TF)PIX/PDQ/QRPH29 – Retrieve medical knowledge/PCC Care Management TF

Trigger: Order test/Standing order for the test

Input: Consent (or by statute)Output:Test order



BPPCLAB TF

Trigger: Conduct test

Input: Test orderOutput:Test results



PCD-01/LAB TF/ RFD/XDR/DSUB/NAV

Business Processes, Data Content, Standards: Early Hearing Detection & Intervention & PH Labs

Information Systems (Technical Actors)

Business Actors by Domain

EHDI PH-Lab

Hospital EHR-S Birthing Facility ER, Inpatient

Ambulatory EHR-S Pediatrician Outpatient

Medical Device Hearing Screening Device

N/A

LIMS N/A Public Health LaboratoryClinical LaboratoryReference Laboratory

Public Health Information Systems (IS)

EHDI IS Condition-Specific IS

Actors and Information Systems: Early Hearing Detection & Intervention (EHDI) & PH Labs

N/A – Not applicable

Public Health Report Clinical Information

Source

Public Health Reporting Requirements, Quality Measure Requirements

Source

Public Health Report Source

Public Health Information Source Form

Filler

Public Health Report Form

Manager

Retrieve Public Health Report Form along with CCD pre-pop data [ITI-34]

Deliver pre-pop Public Health report form QRPH-yy

Public Health Report Form

Receiver

Submit Completed Public Health Report Form [ITI-35]

Public Health Reporting Decision Processing Entity

Send Distrib Msg [QRPH-30] Recv Process

Definitions (QRPH-Y1)

Public Health Report

Lab-1 Result Message XD*Lab

PCD-01 Device Result Message

ARPH

APSR

Cardiology (TBD)

XDS-MS, XPHR, LDS

Public Health Report Consumer

Initiate Public Health Reporting Process QRPH-xx

Initiate Public Health Reporting Process QRPH-xx

Retrv Medical Knowledge [QRPH-29]

Interoperability Standards Schema: Early Hearing Detection & Intervention & PH Labs

URL: http://www.phdsc.org/standards/pdfs/PHDSC_Business_Case_Public_Health_HIT-Standardization.pdf

Business Case: Public Health in HIT Standardization

http://www.phdsc.org/standards/pdfs/PHDSC_Business_Case_Public_Health_HIT-Standardization.pdf

PHDSC Business Case: HIT Standardization Phases, Products and Entities

HIT Standardizati

on Phases

Needs &

Priorities

Development &

Maintenanc

e

Selection &

Harmonization

Testing/Trial Implementati

on

Certification

Deployment

Goals

What should be

accomplished?

What are the standards?

What standards

to use?

Show what can be

accomplished

Certify standards-

based products

Deploy standards-

based products

HIT Standards and

Interoperability Framework Development

Entities

HIT Policy Committee

HIT Standards Committee

SDOs(e.g., HL7,

SNOMED (IHTSDO), LOINC,

ASC X12,NUBC, ISO

TC215)

IHE

S&I Harmonization Framework

Initiatives

IHE

Certification Entities(CCHIT,

Drummond Group, Inc)

IHE & PHDSC

Deployment Workshops

Standards Documents

Use Cases (Description of the health information exchanges)

Standards

Interoperability Specifications

Technical Frameworks

Integration Profiles

Test Reports

Functional Profiles

Certification Criteria

Deployment Reports

On-going Activities ( 2008-now)

Developed methodology for public health participation in HIT standards development & harmonization.

New Activities (2010-11) Develop methodology for public health participation in HIT product testing and certification

Future Activities Develop methodology for evaluation of standard-based HIT products (standards-based HIT products deployment)

Source: Fridsma D. Standards and Interoperability Framework: Principles and Processes. HIT Standards Committee. September 21, 2010. URL: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1817&parentname=CommunityPage&parentid=28&mode=2&in_hi_userid=11673&cached=true

Assuring Health IT Standards for Public Health

HL7 PH Functional Profile HL7 PH Reporting Requirements Standard

IHE PH Reporting Integration Profile

PH Systems Certification

ProposedPH Reporting Initiative

StandardsInteroperability Standards:

Testing & CertificationUse Cases

Interoperability Showcase™

HIT Standardization and PHDSC ProjectsHIT

Standardiza-tion Phases

Needs &

Priorities

Development &

Maintenance

Selection &

Harmonization

Testing /Trial Implemen-

tationCertification Deploy-

ment

Goals What should be accomplished?

What are the standards?

What standards

to use?

Show what can be

accomplished

Certify standards-

based products

Deploy standards-based products

Public Health

Domains Undergoing

HIT Standardiza

-tion

AHIC / MU:Biosurveillance

Immunization

ELR

Public Health Reporting

Newborn Screening

Vital Records

Biosurveillance

Immunization

PH-Lab


Newborn Screening

Vital Records

Biosurveillance

Immunization

PH-Lab


Newborn Screening

Vital Records

PH-Lab


Hearing

Vital Records

PH-Lab


Hearing

Vital Records

PH-Lab

Hearing

ONCStandards

and Interopera-bility

Framework

PHDSC Projects

HITSP Projects

Admin Data

URL: http://www.phdsc.org/standards/pdfs/PHDSC_Business_Case_Public_Health_HIT-Standardization.pdf

QUESTIONS?

http://www.phdsc.org/standards/pdfs/PHDSC_Business_Case_Public_Health_HIT-Standardization.pdf

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