Nedra Garrett, MSCenters for Disease Control & PreventionFebruary 21, 2017

Maximizing EHR Data for Public Health Reporting

The Interoperability Dream –Technology that bridges the divide between families,

clinicians, communities & public health

• Patient – collect & return useful, timely information• Provider – prompt best practices, improve work flow• Care Manager – e-referrals to community resources • Community – receipt/transfer of patient information• Reporting - structured data for -

– Clinical quality improvement – Local surveillance– Program evaluation

National Vital Statistics System

4.0 million birth records per year 2.5 death records per year50,000 fetal death records

6.5 million events processed per year

eVital Standards Initiative

Using HL7and IHE-based standards

Improving the timeliness, accuracy, and completeness of vital records data

National Standards for Vital Records Reporting

Birth and Fetal Death Reporting

HL7 V2.5.1 Birth and Fetal Death Reporting

(BFDR) IG

HL7 Clinical Document Architecture (CDA)

BFDR IG

Integrating the Healthcare Enterprise

(IHE) BFDR-E (Enhanced) Content

Profile

https://www.cdc.gov/nchs/nvss/evital/accessing_evital_standards.htm

National Standards for Vital Records Reporting

Death Reporting

HL7 V2.6 Death Reporting Vital Records Death

Reporting (VRDR) IG

HL7 Clinical Document

Architecture (CDA) VRDR IG

IHE VRDR Content Profile

Death Fast Healthcare

Interoperability Resource (FHIR)

Profiles

https://www.cdc.gov/nchs/nvss/evital/accessing_evital_standards.htm

CDC Healthy Weight (HW) and Occupational Data for Health (ODH) Electronic Health Information Initiatives

HEALTHCARE PROVIDERSPUBLIC HEALTH & 

COMMUNITY/PRACTICE GROUPS

Quality Improvement Data  Community 

Health Data

Body‐Mass Index (BMI), Physical Activity, 

Nutrition, and Work Data

• Informing & improving health programs

• Improving local surveillance

• Supporting clinical decisions

• Capturing quality weight, behavior, & work data

The Gap• EHR-based Healthy Weight clinical management and collection of Body Mass Index (BMI)

and work information are inadequate & inefficient:– EHRs are underutilized to support clinical care & functionality is insufficient

– In 2013, <10% report advanced functions such as referral to community resources

– Interoperability is poor: multiple approaches to communicate information– Multiple methods of data exchange: dual data entry & multiple interfaces

– Data extraction for research, evaluation & surveillance difficult– 2011 IOM Letter Report, Incorporating Occupational Information in Electronic Health Records.

– “Advances in incorporating occupational information in EHRs could lead to more informed clinical diagnosis and treatment plans as well as more effective policies, interventions, and prevention strategies to improve the overall health of the working population.”

– Work information “could contribute to fully realizing the meaningful use of EHRs in improving individual and population health care”.

Achieving the Dream• IHE Healthy Weight profile• HL7 v2.5.1 standard• Occupational Data for Health (ODH)

CDA template• SMART on FHIR proof-of-concept

applications

Central Cancer Registries in the US by Federal Funding Source 1992 Cancer Registry Amendment

Act, Public Law 102-515, authorized CDC to establish National Program of Cancer Registries (NPCR)

Nationally reportable disease; required by state law

Population-based longitudinal data from multiple sources on all diagnosed cancers including diagnosis, treatment and vital status data

Highly standardized data collection system

Cancer Program AccomplishmentsPhysician Electronic Health Record (EHR) Reporting:• IHE Physician Reporting to a Public Health Repository – Cancer Registry (PRPH-Ca), based on HL7

Clinical Document Architecture (CDA)• Developed HL7 CDA® Release 2 Implementation Guide: Reporting to Public Health Cancer

Registries from Ambulatory Healthcare Providers , Release 1; DSTU Release 1.1 - US Realm(“Cancer IG”)

• Meaningful Use (MU) Cancer Reporting for Eligible Professionals:– Stage 2 menu item (2014 implementation)– Stage 3 optional item (2018 implementation)– Standards (PRPH-Ca and Cancer IG) published in ONC 2014 and 2015 Certification Rules

• eMaRC Plus Physician Reporting Module– 35+ states using– Processes IHE PRPH-Ca and Cancer IG data

Cancer Program Accomplishments Electronic Pathology and Biomarker (ePath) Reporting:• IHE Anatomic Pathology Reporting to Public Health – Cancer Registry (ARPH) profile based

on HL7 2 messaging:– 46 state cancer registries receive ‘live’ ePath data– 25 laboratories reporting to state cancer registries– 40+ states use eMaRC Plus ePath Module to receive and process ePath reports

• IHE Structured Data Capture (SDC) Profile to report College of American Pathologists (CAP) Electronic Cancer Checklist (eCC) pathology and biomarker data to cancer registries

– Implemented in the California Cancer Registry• HL7 Fast Healthcare Interoperability Resources (FHIR) SDC to report cancer data to state

cancer registries

Public Health Cancer Reporting Solutions

Primary Care Provider/Specialist Physician diagnoses cancer

State Public Health Agency

Cancer Registry System

Anatomic Pathology Laboratory

IHE *SDC, IHE ARPH

IHE

*SD

C

Pathology Report indicates patient has cancer

Pathology Report indicates cancer

*NOTE: IHE SDC and RFD require a Form Manager to

maintain a repository of forms

Improving Clinical Care and Public Health with Electronic Case Reporting

A Public Health-Clinical Collaborative

Digital Bridge eCR Approach

• An interoperable, scalable, and multi-jurisdictional approach to eCR.

• Not a new technology product. The Digital Bridge approach is based on existing eCR tools and standards, and seeks to support their development and adoption.

• eCR is incorporated into the EHR as a background operation requiring little or no effort on the part of the clinical end user.

• The approach will be tested through at least five implementation sites in 2017.

• The implementation sites’ technical solution will remain EHR vendor-agnostic so that any vendor can adopt the solution and pass on this functionality to their clients.

Benefits to This Approach• A unified approach to information exchange will ease the burden and

costs for all stakeholder groups.

• Advances greater consistency across public health and health care interoperability cases.

• Lays the foundation for greater bidirectional exchange of data between health care and public health so that clinicians can be more easily informed, and collaborate with public health during outbreaks.

• Bidirectional data exchange can eventually encompass non-communicable diseases.

eCR Process (High Level)

HealthCare

DecisionSupport

(AIMS/RCKMS)

PublicHealth

Define Reporting Criteria

Provide Trigger Criteria

Import Trigger Criteria

Provide Patient Care

Match Trigger Criteria

Send Case Report

Compare to Reporting Criteria

Match Reporting Criteria

Send Case Report

Send Response

Follow-Up Activity

Process Case Report

Send Response

Envisioned eCR Architecture Using AIMS & RCKMS

Contacts:• Sandy Jones – SFJones@cdc.gov (Cancer reporting)• Michelle Williamson MWilliamson@cdc.gov (Vital Records reporting)• Genny Luensman GLuensman@cdc.gov (Occupational Health data)• Aly Goodman AGoodman@cdc.gov (Healthy Weight)• Laura Conn LConn@cdc.gov (eCR)• Ninad Mishra Nmishra@cdc.gov (STD eCR)