Southern Nevada Health District

Division of Community Health

Office of Public Health Informatics Cassius Lockett PhD, Director of Community Health

What is Health Informatics?

• Let us start by defining “informatics”

– Discipline focused on the acquirement, storage and use of information in a specific setting or domain

– More about managing information and people than technology

– Sometimes defined as an activity at the crossroads of people, information and technology

What informatics “is and isn’t”

Isn’t • Cross-training where basic

informational sciences meet a biomedical application domain (Nursing, Dental, Public Health, Medical, Translational, etc)

• Relentless pursuit of assisting people

• Tower of achievement – Business process

– System development

– System implementation

Is

• Scientist or clinicians tinkering with computers

• Analysis of large data sets

• Circumscribed roles related to deployment of EHR

• Profession of health information management

• Anything done using a computer

Meaningful Use Activities

Meaningful Use (MU) refers to provisions in the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act:

• Authorized incentive payments through Medicare and Medicaid to clinicians and hospitals that use electronic health records (EHRs) in a meaningful way to improve clinical care through EPs, EHs.

– Eligible Providers (Medicaid): 1) Physicians 2) Nurse Practitioner 3) Certified Nurse-midwife 4) Dentist 5) Physician Assistant in FQHC

– Eligible Providers (Medicare): 1)Doctor of Medicine or Osteopathy 2) Doctor of Optometry 3) Chiropractor 4) DDS or DDM 5) Doctor of Podiatry

• Stage 1-intended to capture data and share; Stage 2-focuses on advanced clinical processes (CDS, CPOE, etc); Stage 3-focuses on trying to improve outcomes

• MU did not incentivize Public Health to receive, process and make the data meaningful.

5

Meaningful Use Public Health Objectives

To improve public and population health (Data capturing and sharing):

All EPs and EHs must choose at least one of the public health measures to demonstrate Meaningful Use from a Menu Set (10 objectives). Stage 2 MU all three if possible.

• EPs– must choose reporting to immunization information systems or reporting syndromic surveillance to public health

• EHs– must choose reporting to immunization information systems, electronic reporting lab results to public health or reporting syndromic surveillance to public health

6

7

Meaningful Use 3 (proposed rule)

Public Health and Clinical Data Registry Reporting

Standard EPs must report on at least 3 of the first 5, while EHs

report on 4 of the 6

EP, EH, CAH select from:

Measure 1

Immunization registry HL7 2.5.1

Measure 2

Syndromic Surveillance Reporting

2) BioSense 2.0 NDPBH/SNHD

Measure 3

Case Reporting FHIR, SDC, CDA SNHD RCKMS

Measure 4

Public Health Registry CDA release 2 EPs and EHs allowed to submit only measure 5, 4

Measure 5

Clinical Data Registry EPs and EHs allowed to submit only measure 5, 4

EH, CAH only select from:

Measure 6

Electronic Reportable Laboratory Reporting

HL7-2.5.1 SNHD ELR

Office of Informatics

Mission is to manage resources, health information and technology to create actionable data to improve the health of Southern Nevada

Office of Informatics

• 4 Corner Stones (aligned with MU) 1. Reportable Disease-EpiTrax(TriSano), RCKMS

2. Electronic Laboratory Reporting- TriSano and the SNPHL LIMS increased STD volume during FYE 2014

3. Healthcare integration-Electronic Health Records, Big Data, CCD, CDA, etc

4. Situational Awareness-BioSense 2.0 (National Syndromic Surveillance Program) and Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

Office of Informatics

• EpiTrax (TriSano) 1. Reportable Disease-

RCKMS potential

2. ELC Grant focus on Electronic Laboratory Reporting

3. Result of significant increase in ELR volume during 2014 due to SNPHL LIMS connection 3488

8837

30032

83842

Total Non EHR 2013 Total Non EHR 2014 Total EHR 2013 Total EHR 2014

SNHD, Electronic Laboratory Reporting Volume from Electronic

Health Records (EHR), 2013 vs. 2014

Office of Public Health Informatics

• EpiTrax (TriSano)

1. Electronic Laboratory Reporting by Disease Category

61

136

160

798

1378

1666

14075

24894

40674

0 10000 20000 30000 40000 50000

TB

Zoonotic

VPD

Enteric

Other CD

Influenza

HIV

Hepatitis

STD

SNHD, Electronic Laboratory Reports by Disease Group, 2014

Office of Informatics

• Electronic Case Reporting: Reportable Condition Knowledge Management System (RCKMS) partnership with CSTE and CDC

1. Healthcare integration-RCKMS

• From the CSTE FOA:

– This CSTE Pilot is intended to support participation of public health agencies in a collaborative effort to represent Laboratory and Case reporting criteria in rules that can be consumed by an open source CDS and used to determine if a electronic laboratory report should be sent from the provider to public health.

RCKMS CDS FEASIBILITY MEETING On-Site Participants: February 24, 2015

Introductions

Jurisdictions Houston: Ryan Arnold, Biru Yang Illinois: Judy Kauerauf, Jennifer Vahora SNHD: Sony Varghese, C Lockett Virginia: Jeff Stover, Jane Moore, Marylyn Huitz New York State: Hwa-Gan Chang Florida: Janet Hamilton Oklahoma: Lauri Smithee PHII: Jim Jellison APHL: Eddie Gonzalez, Michelle Meigs ASTHO: Paula Soper, Marcus Rennick

Intermountain: Shan He, Darren Mann HLN: Noam Arzt, Daryl Chertcoff, Amy Moniz RCKMS Steering Committee Co-chairs: Rita Altamore (CSTE/WA DOH), Laura Conn (CDC), Catherine Staes (University of Utah) Members: Shu McGarvey (Northrop Grumman), Julie Lipstein (L3-Stratis), Denisha Abrams (Northrop Grumman) CSTE: Janet Hui, Meredith Lichtenstein

Facilitator: Jeff Benning, LIC

RCKMS Pilot Jurisdictions (Houston, SNV VA, IL, NY, NYC UT, CO, WA, DE)

PH Reporters

CDS Feasibility Demonstration Scope

Repository

Who, What, When, Where, How - Reporting Criteria

- Reporting Actions - Links

Structured Rules Logic

Hospital Labs (Intermountain)

LIMS

EHR

PH Reports

Value Sets Data Load

National, Clinical & Public Health Laboratories

LIMS

Ambulatory Care

EHR

OpenCDS - Reporting Criteria

* Green shows in-scope for Pilot

Subscription Management & Notifications

Reporting

Web Services

Syndromic Surveillance

• Syndromic surveillance is the use of pre-diagnostic information in a near real time fashion for further investigation for public health action.

• Pre-diagnostic information precedes the diagnosis for a disease.

• Pre-diagnostic conditions may include – Influenza like illness, rash, specific infection,

gastrointestinal, localized cutaneous lesion, neurological, hemorrhagic illness, severe illness/death, botulism like (sub-syndromes: descending paralysis, blurred vision, etc)

Office of Informatics

• Syndromic Surveillance 1. Situational Awareness-BioSense 2.0 (National Syndromic

Surveillance Program) and the Electronic Surveillance for the Early Notification of Community-Based Epidemics (ESSENCE)

2. Working with State to host John Hopkins University recent version of ESSENCE at SNHD

3. ESSENCE will provide granularity for producing illness related reports for example ILI (place, person, time)

Summary

• 4 Corner Stones (aligned with MU) 1. Reportable Disease-RCKMS

2. Electronic Laboratory Reporting- EpiTrax

3. Healthcare integration-Electronic Health Records, Big Data, CCD, CDA, etc

4. Situational Awareness- BioSense 2.0 and the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

Issued that Remain to be Resolved?

• Interoperability

– Semantical

– Syntactical

• Case reporting

– RCKMS

• Health Care Integration

– CDA, FHIR, etc

• CDA, FHIR, SDC other standard?

Questions?