February 22, 2011 Interoperability and Public Health CDC Efforts to Move Public Health IT...

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DIPPC Health Communications What they doand can do?

February 22, 2011Interoperability and Public Health

CDC Efforts to Move Public Health IT Interoperability Towards Meaningful Implementation

Background CDC is a unique federal government structure with the purpose of protecting the Nations health and equity. CDC also plays a vital role in Collaborating to create the expertise, information, and tools that people and communities need to protect their health through health promotion, prevention of disease, injury and disability, and preparedness for new health threats. (http://www.cdc.gov/about/organization/mission.htm)

In 2010 CDC continued improvement of informatics initiatives and services that were consistent with the CDCs Vision for the 21st Century: Health ProtectionHealth Equity. Many of CDCs activities rely on collaboration between public health and the healthcare community, especially in the areas of:Health monitoring;Detection and investigation of health problems;Conduction of research; and Development and implementation of health policies and prevention strategies.

In 2010 the National Center for Public Health Informatics (NCPHI) was reorganized into the new Office of Surveillance, Epidemiology and Laboratory Services (OSELS) that includes the Public Health Informatics and Technology Program Office (PHITPO).

The PHITPO focus areas include:

Helping public health programs benefit from major changes in health informatics created by the HITECH Act. Exploring the use of electronic health records, electronic personal health records and health information exchange for prevention and public health. Increasing workforce competence in public health informatics through training, technical assistance and conferences. Improving interoperability and reducing cost of public health information systems through shared planning, standards, policies and services (like messaging and directory systems). Focusing public health informatics funding, design and acquisition practices on users and their public health objectives Applied research and evaluation of public health information technologies.

Background (cont.) 2010 CDC Informatics InitiativesEHR Meaningful Use Advisory Group

This advisory body of CDC leaders is providing strategic planning to advance the exchange of information from EHRs to include syndromic surveillance, immunization registries, and electronic laboratory reporting between laboratories and the health departments.

CSTE and CDC Joint Electronic Laboratory Reporting (ELR) Taskforce This Taskforce was established to work on the following tasks:Building on work with large national labs to ensure full implementation of ELR; Working effectively with LIMS and EHR vendors to support the adoption and use of interoperable standards-based systems;Addressing legal and policy issues at state and local levels;Using effective means to ensure ELR implementation (e.g., resources through CDC cooperative agreements, shaping guidance, providing technical assistance, monitoring progress);Identifying additional resources, as needed, for national ELR implementation; and Identifying and addressing unresolved issues regarding standards (e.g., message structure, content, vocabulary) and architecture.Release of Several Key Data Requirements and Guides

HL7 Version 2.5.1: Implementation Guide for Immunization Messaging, Release 1.1.Core EHR Data Requirements for Syndromic Surveillance, Preliminary Recommendations

Electronic Health Record (EHR) and Vital Record (VR) Systems Information ExchangeThe National Vital Statistics System provides essential data on births and deaths within the U.S.

Current birth and death registration processes are characterized by: Higher expectations of data quality and timeliness by stakeholders and the public;Separate, costly reengineering projects in various jurisdictions;Limited integration among internal vital records systems and with other stakeholder systems; A need for a standards-based, uniform, and systematic approach to collecting and exchanging data from vital records. CDC/NCHS Vital Records Standards InitiativesHealth Level Seven (HL7) Vital Records Domain Analysis Model (VR DAM)identifies and describes the activities and data required for processing birth, death and fetal death records in compliance with the U.S. Standard Certificates of Birth and Death, and the U.S. Standard Report of Fetal Death

HL7 Electronic Health Record System (EHR-S) Vital Records Functional Profile (VRFP)defines the functional requirements needed to capture vital records data at the point of contact or care with a patient CDC/NCHS Vital Records Standards Initiatives (cont.)Healthcare Information Technology Standards Panel (HITSP) C-170 Vital Records Pre-populate Component Document specified data sets that may be pre-populated from an EHR to a VR system

Integrating the Healthcare Enterprise (IHE) Maternal Child Health (MCH) Profilealigned the HITSP C170 Component document with the IHE MCH Profileprovides a technical framework for developing interoperable systems that will support transmitting EHR systems data to VR systems

CDC/NCHS Vital Records Standards Initiatives (cont.)Future activities to support VR Standards will:

Focus on identifying required VR data exchanges and the potential for developing technical messaging and document requirements to support vital registration

Include state pilot tests to determine interoperability between EHR and Vital Records Systems based on FY 2011 fundingNational Program of Cancer RegistriesAlmost two million cancers are diagnosed each year in the United States.

Cancer surveillance serves as the foundation for a national comprehensive strategy to reduce illness and death from cancer. Such surveillance is the indispensable tool that enables public health professionals at all levels to better understand and tackle the cancer burden while advancing clinical, epidemiologic, and health services research. UICC: International Union against Cancer

There are 241 cancer surveillance systems (registries) on 6 continents participating in the International Association of Cancer Registries (part of the World Health Organization).

Time PeriodNumberof New Registries1930219402196061970141980141990-199551996-200082001+2From: NAACCR CINA: 2001-2005The US requires reporting of cancer to the national cancer programsStandards and Systems UsedIHE Retrieve Form for Data Capture (RFD)IHE Shared Value Set (SVS)IHE Audit Trail and Node Authentication (ATNA)IHE Cross Enterprise Document Sharing (XDS)HITSP C76: Case Report Pre-populate ComponentHITSP TP50: Retrieve Form for Data Capture Transaction PackageHITSP T66: Retrieve Value Set TransactionSupporting Infrastructure Form Filler, Forms Manager, Form Archiver, Form Receiver, Security11IHE Profiles for Cancer Reporting from EHRs to Public HealthAnatomic Pathology Reporting to Public Health Cancer Registry (ARPH)Demonstrate standardized collection and transmissionDemonstrate methods to electronically receive and process reports Identify data elements to be reported from the pathology laboratoryUse existing terminology, data elements, and secure data exchange standardsPhysician Reporting to a Public Health Repository Cancer Registry (PRPH-Ca)Demonstrate mechanism to identify cancer casesIdentify data elements to be reported from the EMRDemonstrate use of standards vocabulary from PHINVADS (IHE SVS)Use existing terminology, data elements, and secure data exchange standards

Report required information on all new cancer patientsReport treatment and cancer status on all existing cancer patientsReport referrals to other clinicians, treatment centers, facilities and/or hospitals;Anatomic Pathology Reporting to Public Health Repositories (ARPH):Demonstrates standardized collection and transmissionDemonstrates methods to electronically receive and process reports Facilitates adoption of a uniform method for report transmission and processingClinician Reporting to a Public Health Repository (CRPH):Demonstrates a mechanism to identify cancer patients for which reporting is requiredIdentifies data elements to be retrieved from the EMR and transmitted to the cancer registryDemonstrates the use of a Shared Value Set (PHINVADS) transaction by Content Creator and the Content Consumer. Uses existing terminology, data elements, and secure data exchange standards that have been approved by national standard setting organizations such as HITSP

Clinic/Physician Office (CPO)

InfrastructureState Public Health AgencyPublic Health Cancer Registry SystemPublic Health Cancer Reporting SolutionsAnatomic Pathology LaboratoryIHE ARPHIHE RFD, PRPH-CaIHE RFD, SVS


Decision Support ToolPathology Report indicates patient has cancerPathology Report indicates patient has cancerIHE PRPH-Ca (RFD) Patient presents with symptoms and cancer is diagnosedCPO transmits patient data to Public Health Cancer RegistryIHE PRPH-Ca (XDS)Does not identify/solve any IHE profile gaps/overlaps Uses EXISTING IHE constructs.Demonstrates IHEs position that its end products can be re-used.Standards & SystemsIHE Request Form for Data Capture (RFD)IHE Clinical Research Data Capture (CRD)HITSP C76: Case Report Pre-populate ComponentHITSP TP50: Retrieve Forms for Data Capture Transaction PackageHITSP T66: Retrieve Value Set TransactionSupporting Infrastructure: PHIN VADS for reportability criteria and standardizing data element valuesForm Filler, Form Manager, Form Archiver, Form ReceiverSecurity

Immunization: Meaningful Use Final RuleFinal rule specifies use of either V2.3.1 IG or V2.5.1 IGCDC recommends use of V2.5.1 IGMore tightly constrainedImproved clarity and query capabilitiesIIS is eager and ready to move to V2.5.1Immunization: Interopera