The Public Health Laboratory Perspective: readiness to support “meaningful use”

PHDSC Annual Meeting November 12th 2009

Mary Shaffran, MPASenior Director, Public Health Programs

Association of Public Health Laboratories

Analysis, Answer, Action

APHL’s NEW Mission Statement

“To promote the role of public health laboratories in shaping national and global health objectives, and to promote policies, programs, and technologies which assure continuous improvement in the quality of laboratory practice and health outcomes.”

Analysis, Answer, Action

*Meaningful use general objectives (2011, 2013, and 2015)• Improve quality, safety, and efficiency–Capture Data in coded format• Incorporate lab test results into EHR

• Engage patients• Improve care coordination• Reduce health disparities through public &

population health data-sharing• Ensure privacy and security

*Health Information Technology Policy Committee June 16th 2009

Analysis, Answer, Action

The PHL e-health domain

Test Order / Result (ETOR) and Lab Result to local EHR/EMRTest Order / Result (ETOR) and Lab Result to local EHR/EMR

RHIO etc..RHIO etc..

Analysis, Answer, Action

Flavors of Electronic Messaging

• Electronic Lab Reporting (ELR):• Reportable disease related result from labs

to state EPI & NND related results to CDC• Electronic Case Reporting (ECR):

• Reportable disease related patient information from physician to state EPI (includes lab results) – NND related de-identified cases on to CDC (from state EPI)

• Electronic Laboratory Messaging (ELM):• Lab electronic data exchange between

partners• test requests and results to submitter (local)• test requests and results to submitter intra

state for:– COOP, Surge, Reference tests

• Reportable disease related results to state and federal EPI

Analysis, Answer, Action

As we wait for a “definitive” definition…..

“The concept of meaningful use is simple and inspiring, but we recognize that it becomes significantly more complex at a policy and regulatory level. As a result, we expect that any formal definition of “meaningful use” must include specific activities health care providers need to undertake to qualify for incentives from the federal government.”

10.01.09 Quote from a Message from Dr. David Blumenthal, National Coordinator for Health Information Technology-http://healthit.hhs.decenturl.com/healthitmessage

Analysis, Answer, Action

And see the problems that are arising

“We’re not going to be able to make a lot of

progress on any higher level ambitions until we can get our arms around some of the nitty-gritty details, like the exchange of lab results and greater standardization” – Micky Tripathi, co-chairman, Health IT Policy Committee

Experts call for widening scope of lab test exchange http://govhealthit.com/newsitem.aspx?nid=72229

Analysis, Answer, Action

PHL: Putting their House in Order-

• Increasing data exchange capacity & expertise• Taking control of their vocabularies-• Reviewing and tracking pertinent federal

standards development• Working with LIMS vendors-– Defining the best solutions to meet data exchange

• Participating in the Public Health Laboratory interoperability project (PHLIP)- 22 states, CDC-CCID & CDC-NCPHI working collaboratively

Analysis, Answer, Action

PHLIP includes components related to:• laboratory data vocabulary • messaging • security and architecture • building community and collaboration around

the critical issue of laboratory data messaging

PHLIP- advancing lab data exchange

Analysis, Answer, Action

PHLIP Current Use Cases

PHLIP TECHNICAL ARCHTECTURE

Route not Read (RnR) Hubs

• Direct Send: Currently in place (will transition to RnR Hub when Phase 3 is complete)

• Phase 1: Implement RnR Hubs in FL and NE

• Phase 2: Develop Hub-to-Hub Interoperability

• Phase 3: CDC develop capability to exchange messages with RnR Hubs

Status:• Direct Send: In Production (used for H1N1 and seasonal

surveillance)• Phase1: In Production• Phase 2: In Production• Phase 3: Available- not yet in full production- CDC can poll the

hubs.

PHL 1

PHL 2

RnR Hub FL

RnR Hub NE

PHL 3

PHL nCDC

Looking Forward to Our Future..

THE FUTURE OF DATA EXCHANGE TO SUPPORT CLINICAL CARE

Analysis, Answer, Action

• Release PHLIP harmonized lab order and result terminology

• Forge stronger collaborations with private sector

• Work with the ONC NHINConnect technical staff and the CDC to establish the mechanism for the RnR hubs to be used as a pilot for NHIN architecture for the PHL to Clinical Lab use case.

Future of PHLIP- ETOR with clinical partners

PHLIP in Action- H1N1 responseWhat’s in a Name?

A pig by any other name….

Influenza A unsubtypeableNovel Influenza A H1N1

Swine Influenza VirusInfluenza A H1N1 swine-like

Novel Influenza A H1N1 swine-likeInfluenza A H1, porcine

swine-origin influenza virusSwine-origin Influenza A (H1N1)

SO-IVFlu A/SW H1

………………………………………

Analysis, Answer, Action

The result..

• PHLIP Outbreak Response • States utilizing PHLIP• Impact on daily operations

• PHLIP Role• Lead in determining LOINC and SNOMED codes for

new Influenza assays• Collaborating with ELR, LIMSi, and other partners

to harmonize data elements..

Analysis, Answer, Action

Recommendations-

• Evidence that we NEED clear direction on test names and procedures AS the test protocols are developed. – a terminologist should participate at the outset in the

naming of new tests and determination of the results

• Assays should go to FDA with standardized codes already submitted…messaging cannot be an afterthought!

Analysis, Answer, Action

Obstacles for PH to address if they are to remain relevant in HIT

• State/Local Relationships – not working well together

• Public Health has to be perfect over practical• Funding problems have decimated Public

Health Departments, especially knowledgeable informatics workforce– Siloed funding is a huge obstacle

Analysis, Answer, Action

THANK YOU For More Information

Contactphlip@aphl.org