How Public Health Can Appear Inside an EHR
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Transcript of How Public Health Can Appear Inside an EHR
Public Health and The EHR
• Why would we want to be “inside”?
• How could we get “inside”?
• Who’s in control?
• Why not?
• Now what can we do?
Forms
• Why do we love them?
• We can create a form that gathers all of the data we need for a topic.
• We can change them.
• They meet the needs of the agency that needs data.
Forms
• Do providers love forms?
• Not so much.
• They are not fun to fill out.
• They take time away from doing whatever it is that providers do when they are not filling out forms.
EHR
• A place to record point-of-care data.
• Organized around a patient.
• Designed to make it easy to document and review data about a patient.
• They are becoming ubiquitous.
• This is where providers “work”.
Interoperability
• Send data from one system to another.
• Standardized processes so the sender and the receiver both know how to make the exchange.
• Standardized structured data so the receiver knows something about the data it receives.
Landscape
• Forms == data related to a topic that I need from the provider at the point-of-care.
• EHR == place where provider records point-of-care data.
• Interoperability == way to move data
Landscape
• So we just specify the data we need based on interoperability content standards;
• The EHR can then pull out the data and package it up and send it to us; and
• We receive the data and go do our job.
Landscape
• We get the data we need;
• Provider doesn’t have to spend time filling out a form;
• Life is good….
• So what is the hold up here?
Interoperability
• Send data from one system to another.
• Standardized processes so the sender and the receiver both know how to make the exchange.
• Standardized STRUCTURED data so the receiver knows something about the data it receives.
Structured Data
• Not all data in an EHR is structured.
• Not all data needed by public health forms is structured.
• So we can’t exchange reliably.
• SO JUST WRITE A NEW STANDARD.
Structured Data Standards
• The nuisance about standards is we have to agree on them or at the very least tell people what they are.
• Developing a new standard is not easy and not fast.
• THEN THEY HAVE TO BE IMPLEMENTED.
• And then if we need to change we start over.
Structured Data Standards
• It can take 1-2 years to develop a new standard (getting shorter).
• Current standards implementation backlog for many EHR systems is measured in years.
• Not everyone will implement our standard.
Back to the drawing board…
• Paper Forms
– Create the form
– Print and distribute it
– Fill it out
– Ship it back
– Transcribe the data
Back to the drawing board…
• Web forms
– Create the form
– Put it on our website
– Fill it out
– Form sends us the data the way we need it
Web Forms beat Paper Forms
• Deployment – saves trees (and dollars)
• Deployment – provider doesn’t have to keep a stash of forms (nor do we)
• Version–change in version is instantaneous
• Data - we don’t have to transcribe to get data
Web Forms: The dark side
• Even though a lot of the data we need is in the EHR as structured data providers have to re-enter those data into our form.
• Providers have to “go to” our website (giving them an excuse not to report).
What if?
• Could get benefits of web form AND
• Be able also get the data from the EHR that is structured AND
• Be “inside” the EHR so the provider doesn’t have to go to our web site.
• THAT IS RFD.
RFD
• Is a web form that appears “inside” the EHR
• Can be updated and deployed at will
• Can get the data for our program electronically
• Can “use” the structured data that is in the EHR.
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Clicks button
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Builds document with structured data
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Sends document and which form is needed
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Gets current version of form
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Reads document with structured data
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Fills in form data from document data
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Returns web form with filled in data
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Displays form for user
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Fills in remaining data
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Clicks SUBMIT
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Gets data entered and sends it to archiver
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Gets data and puts it in the archive
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Gets data entered and sends it to receiver
RFD: One step at a time
Form Filler
Form Manager
Form Receiver
User
FORM
Form Archiver
Gets data and….
RFD: Form Filler (think EHR)
• Generates standard document with structured data (they know how to do this)
• Sends that document to Form Manager along with a request for form X (easy to implement and doesn’t matter what form is being requested).
• Display web form (think browser window)
RFD: Form Filler Key Features
• Does essentially the same thing no matter what the form is.
• Once an EHR has implemented RFD it can support virtually any form and virtually any number of forms.
• Which means when we add or change a form we don’t have to wait for the EHR to implement the change.
RFD: Form Manager
• “Brains” of the process to capture the data.
• Manages the structured data associations between the EHR data and the form data.
• “Absorbs” the impact of changes. It is built to support change.
• Virtually unlimited potential for what a smart manager might do.
RFD: Form Archiver
• Pristine place to record what was entered in the form.
• Meant to be a “read only” copy.
RFD: Form Archiver
• Smart archivers can show
–What was “pre-filled” and left untouched
–What was “pre-filled” but user changed
–What was added by the user
–What the form looked like
RFD: Form Receiver
• By standard not very impressive
• Just receives the data
• This allows it to be very flexible
RFD: Form Receiver +
• Power is in what is done next with the data
– Use the data to “build” a document
– Save the data into a repository
– Restructure the data to match what the public health system is capable of
RFD: Form Receiver +
• Can be a distributor
– Can send the data to more than one “consumer”
–Meaning multiple public health programs can each get their own copy of the data in the way they need it
– Can “batch” up data or send in real time
RFD: Who is in charge here?
• Form Authority
– This is whoever will ultimately get the data
– Controls what data are in the form
– Controls what the form looks like
– Controls what the form does
RFD: Who is in charge here?
• Form Authority
– Controls how structured data from the EHR is used to “pre-fill” the form
– Controls who gets the form data
– Controls how the form data are delivered
– DOES NOT HAVE TO BE THE MANAGER TO BE IN CONTROL
RFD: Who is in charge?
• Form Filler
– Controls what forms can be selected by the user
– Controls when forms can be selected
– Controls what data are “disclosed” to “pre-fill” the form
– Controls the use of an archive
RFD: Who is in charge?
• Form Manager
– Controls which forms are supported
– Controls which user/EHR can access what form
– Otherwise it just follows instructions
RFD: Who is in charge?
• Form Receiver
– Isn’t in control of anything
– It just follows instructions
RFD: Why not…
• We know all too well why paper forms aren’t a great answer.
• We know that even web forms have their drawbacks.
• We have already explored why we cannot JUST rely on EHRs generating documents with all of the data we need YET.
RFD: Why not…
• Just build the forms into the EHR?
• Sheer numbers makes this impractical
– Number of topics that there are or might be forms for
– Number of local, state, and federal variations
– Number of different EHR systems
• Cannot rely on this until all EHRs build them
• Changes will not be instantaneous or synchronized
RFD: Why not…
• Just let the EHR pre-fill the form?
• There is nothing to preclude this.
• However, pre-filling is a type of “coupling” and that makes the system less fluid and able to accommodate change.
• It makes us dependent on development priorities of EHR vendors.
• No EHR vendor currently supports this.
So what can we do with this?
• Virtually any reporting form especially if the report is about a patient.
– Reportable conditions
– Case reports
– Follow-up reports
So what can we do with this?
• Vital Records
• Program specific data
– EHDI, CCHD
–Metabolic specimen card data
– HIV/AIDS
– Immunization
So what can we do with this?
• Adverse event reporting
• Patient safety reporting
• Quality measures reporting
So else what can we do?
• Other than public health
– Clinical research forms
– Payer/claims forms
– Augment EHRs
RFD: Use with caution
• Since RFD forms are easier to access you will get more data.
• Since RFD forms take less time to complete you will get more data.
• Since RFD forms are “in” the EHR you will get data more timely.