Presentation - HIMSS Interoperability Showcases

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Centers for Disease Control and Prevention
(CDC)

Electronic
Public Health Data Exchange:
Right Time, Right Place

Presenter: John
Eichwald, MA

March 4, 2013

CDC Programs Represented Today

Meaningful Use Public Health
Technical Assistance

Public Health Reporting Initiative

Cancer Registries

Early Hearing Detection and Intervention

Vital Records

Immunization Information Systems

PHIN
Vocabulary
Services

National Healthcare Safety
Network

Public Health Clinical Decision Support

Supporting Meaningful Use Implementation by CDC
Programs and Jurisdictional Public Health Agencies

Meaningful Use Public Health Technical Assistance (TA) Team

Assist in resolving issues and problems preventing successful achievement
of the Meaningful Use public health objectives


Provide
focused policy and technical expertise


Identify successful methods used to resolve similar issues


Rapidly resolve misunderstandings and simple problems


Document and learn from the real problems occurring the field

Team’s Purpose and Goals

MU TA Team Support:

Request
Statistics

26%

14%

28%

2%

4%

26%

Technical Assistance Requests

Categories

Immunization
Reportable Lab Results
Syndromic Surveillance
Cancer
Multiple Public Health
Measures
Other (Transport,
Policy, General, etc.)
Technical

Assistance Requests Categories

Categories

#

%

SS

52

28%

Other

(Transport, Policy,
General, etc.)

47

26%

IIS

47

26%

ELR

26

14%

ALL

8

4%

CANCER

3

2%

Total

183

Technical

Assistance
Requests

#

%

Requests received via the
Meaningful Use Mailbox

117

64 %

Requests received via

HITRC’s

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R %

Requests received

via other
channels

56

31 %

Total Requests

183

Total Closed

175

96 %

Total Open

(In Process)

8

4 %

Technical Assistance
Request

Totals

meaningfuluse@cdc.gov

Supporting Harmonization of Electronic Data Exchange
through the Public Health Reporting Initiative (PHRI)

In 2012 CDC actively participated in the Office of National Coordinator (ONC)
Standard and Interoperability (S&I) PHRI.

PHRI Goal :
Harmonize HIT standards and implementation guides for
interoperable communication between clinical care and public health for public
health
reporting



Minimize unnecessary modification of EHRs and their certification by harmonizing
with other ONC
-
certification criteria and other S&I Framework activities


Develop implementation guides to maximize future extensibility and re
-
usability for
multiple public health domains


Minimize impact on established Stage 1 MU public health reporting objectives while
potentially simplifying such reporting in the future


Develop implementation guides while accounting for the needs of subsequent inter
-
jurisdictional communication (e.g., transfer of cases between jurisdictions and
national notification requirements) and population
-
level reporting
.


Facilitate future certification of public health information systems that are
interoperable with ONC
-
certified EHRs

Step

Description

Outputs/Artifacts

Functional

Requirements

Analysis


Document implementation

requirements
per Domain / User Stories

Documented functional
requirements, including
data classes

Data
Harmonization
and Modeling


Collect User Story Data Elements


Achieve consensus regarding common
core data elements across user story
domains


Update Federal Health Architecture Data
Model with inclusion of classes for public
health


Public Health Data
Harmonization Profile

Harmonizing

Data Exchange
Implementation
Guides


Access the structure and content of the
Consolidated Clinical Data Architecture
(C
-
CDA) Implementation Guide (IG)


Reconcile

PHRI common core data
elements with C
-
CDA and 2009 HL7
Public Health Case Reporting IG

PHRI C
-
CDA library of
templates

2012 PHRI: Processes and Results

Time
Period

Number

of New
Registries

1930

2

1940

2

1960

6

1970

14

1980

14

1990
-
1995

5

1996
-
2000

8

2001+

2

From: NAACCR CINA:


2001
-
2005

The US Requires Reporting of Cancer to
t
he
National Cancer Programs

Cancer Program Accomplishments


Electronic Health Record (EHR) reporting to central
cancer
registries (CCRs)


Cancer Reporting is a new menu item for Eligible Professionals
(EPs) for Meaningful Use (MU) Stage 2 (2014 implementation)


Development of
Implementation Guide for Ambulatory
Healthcare Provider Reporting to Central Cancer Registries
(“Cancer IG
”),
based on IHE Physician Reporting to a Public
Health Repository


Cancer Registry (PRPH
-
Ca)


Two
Comparative Effectiveness Research (CER) projects pilot
testing provider EHR cancer
reporting (KY and MO)


Electronic pathology reporting (ePath) to CCRs


Based on IHE Anatomic Pathology Reporting to Public Health


Cancer Registry (ARPH) profile


42
states are live with ePath reporting


7
anatomic pathology laboratories reporting to CCRs


30
states use eMaRC Plus, CDC
-
developed software tool, for
receiving and processing ePath reports



Cancer and Meaningful Use


CMS Meaningful Use Stage 2 Final Rule, August 2012:


“Capability
to identify and report cancer cases to a State
cancer registry



ONC 2014 Edition EHR Certification
Criteria Final Rule:


Requires
use of
Implementation Guide for Ambulatory Healthcare
Provider Reporting to Central Cancer
Registries

(“Cancer IG”) for
EHRs to create and transmit cancer reports to cancer registries


Change proposal approved in December 2012 to align
IHE PRPH
-
Ca

profile with the Cancer IG. Both use HL7
Clinical Document Architecture (CDA).


CDC
-
developed software tool, eMaRC Plus, is freely
available
to all states for receiving
and
processing
CDA reports


Sets
stage for other public health (case)
reporting


For more information, please contact the
Meaningful
Use Public Health Technical Assistance
Team

Early Hearing Detection and Intervention
Information System (EHDI
-
IS)


CDC’s EHDI Team, as part of the National Center on Birth Defects and
Developmental Disabilities , supports state and territorial EHDI programs
working to advance surveillance capability and interoperable data
systems.


Newborn
screening can potentially capture the entire newborn
population,

providing
one of the first meaningful interoperability
opportunities in an individual’s healthcare lifespan


EHDI provides
an opportunity to establish bi
-
directional information
exchange between clinical care and public health in a relatively simple
and feasible way

EHDI Standards
-
based Information Exchange

IHE Newborn Admission
Notification Information
(NANI)

HL7 EHDI Messaging Data
Standard Trial Use (DSTU)

IHE Early Hearing
Care Plan

(EHCP)

CQM EHDI

Clinical Quality Measure

(CMS 31v1/NQF
1354
)

IHE

Quality Measure
Execution

(QME
-
EH)

IHE EHDI

Cross
-
enterprise
Workflow

Document

Labor & Delivery

Newborn Screening

State EHDI Program

Medical Home

Federal Reporting

Care

Tasks

&

States

e
-
Measure

Definition

Specialist

HL7 v2

HL7 v2

HL7

CDA R2

HL7 HQMF

HL7

QRDA

Us Case 5

Vital Registration and Care Coordination
for Newborn Hearing
Screening


Care Theme: Maternal & Newborn Health

Use Case 16

Interoperability Showcase

In collaboration with IHE


Background



The
National Vital Statistics System (NVSS) provides essential data on
all U.S
. births
and
deaths


Over
six million vital events are reported
annually


Information
collected includes a wide range of demographic, medical, and geographic
data derived from
4
million birth certificates and from about 2.4 million death certificates
and fetal death
reports


Events
are registered by 57 registration areas: 50 states, 2 cities, and 5 U.S.
territories


Vital statistics data are widely used to monitor and improve the nation’s health, e.g.,
track

and
explain trends in cesarean delivery, preterm and low birth weight births, causes
of infant death and disparities in health among populations
groups





Detailed data on all events are transmitted to the Center for Disease Control and
Prevention’s (CDC) National Center for Health Statistics (NCHS)


Much of the information collected for birth and death certificates and fetal death reports
are captured in hospital medical records


Vital
statistics and standards communities have collaborated to build upon more than a
century’s effort in standardization to encourage
EHRs
to capture medical and health
information in a format consistent with the vital statistics
requirements


GOAL

is to improve the timeliness, accuracy, and completeness of vital
records data

Electronic Health Record (EHR) and Vital
Record (VR) Systems Information Exchange

Capturing birth and death data in
electronic health
record systems

Electronic exchange
using HL7

and IHE
-
based
standards

Improving the timeliness, accuracy, and

completeness of vital records data

Document

Transaction

Status

HL7 Version 3 Domain Analysis Model: Vital Records,
Release 1


(R1)

Domain Analysis Model

Published and freely available during
pilot period that began February 2012

HL7
EHR
-
System Functional Model (EHR
-
S

FM)

Vital
Records Functional Profile,
R1


EHR
-
S Functional Profile

Published and freely available during
pilot period that began February 2012

HL7 EHR
-
S FM Public Health Functional Profile
R1


EHR
-
S Functional Profile

Published and freely available during
pilot period that began February 2012

HL7 Version 2.5.1 Implementation
Guide (IG):
Vital Records
Death Reporting,
R1

Draft Standard for Trial Use

(DSTU)


Death related information from a clinical setting to the
vital records electronic registration system

Available for download and comments
on the HL7 DSTU Commenting Site

HL7 Version 3 CDA R2
IG:
Reporting Death Information
from the EHR to Vital Records,
R1 (DSTU)

Death related information from a clinical setting to the
vital records electronic registration system

Balloted in HL7 May 2012 ballot cycle.
Goal to publish as DSTU in early 2013

HL7 Version
2.51

IG
:
Reporting Birth & Fetal Death
Information from the EHR to Vital Records, R1
(DSTU)

Live birth and fetal death related information from a
clinical setting to the vital records electronic
registration system

Balloted in HL7
Jan. 2012
ballot cycle.
Goal to publish as DSTU in early 2013

HL7 Version 3 CDA R2
IG:
Reporting Birth & Fetal Death
Information from the EHR to Vital Records
R1 (DSTU)


Live birth and fetal death related information from a
clinical setting to the vital records electronic
registration system

Balloted in HL7
Sept. 2012
ballot
cycle. Goal to publish as DSTU in
early 2013

Integrating the Healthcare Enterprise (IHE) Birth and Fetal
Death Reporting (BFDR)


Content Profile

Defines the EHR content that may be used to pre
-
populate and transmit birth and fetal death
information to vital records systems for vital
registration purposes

IHE published for trial implementation
August 2012

Integrating the Healthcare Enterprise (IHE) Vital Records
Death Reporting (VRDR)

Content Profile



Defines the EHR content that may be used to pre
-
populate and transmit death information to vital
records systems for vital registration purposes

Under development. Goal to publish
by fall 2013

Special thanks to those who collaborated with us
during the IHE 2013 Connectathon interoperability
testing to support the Vital Records and EHDI
standards development work


Thank You!!!!!

Immunization
Interoperability:

2012 Successes Indicators


CDC provided funding to eligible state/city/local Immunization Information
Systems (IIS) to enhance EHR
-
IIS interoperability using HL7


96% of
IIS
or their designee are now able to send and receive HL7
2.3.1
and/or HL7 2.5.1 messages


Simple Object Access Protocol

(
SOAP) web services for immunization data
transport according to CDC Expert Panel’s recommended
Web Services
Definition
Language (WSDL)
implemented by more than 43% of
IIS


Published
HL7 Version 2.5.1 Implementation Guide for Immunization
Messages, Release 1.4


Worked with NIST to develop certification testing for MU2 based on the
Implementation Guide


New effort to use MU2 testing with IIS to improve conformance





Release of 2D Barcode on Vaccines and Vaccine Information
Statements (VIS)


Pilot testing underway in 10 states and ~220 provider sites


2D Barcoded Vaccines


Current: Havrix, Pediatric DT, Menactra, Adacel, Fluzone, IPOL


Release Soon: Daptacel, Tenivac, Pentacel


12/25 VIS have 2D barcodes: edition date & type of VIS


CDSi (Clinical Decision Support for Immunizations)


Released Logic
S
pecification


computable and consistent
representation of childhood vaccine recommendations and schedules


Resources include logic tables, business rules, supporting data


For use in clinical EMR and IIS


Immunization
Interoperability: 2012
Successes Indicators (cont.)

Vocabulary
Access and Distribution
System
(VADS): A Web
-
Based PH Enterprise
Vocabulary System


In 2004, CDC developed a web
-
based enterprise vocabulary system called the Public
Health Information Network Vocabulary Access and Distribution System (
PHIN VADS
) for
accessing, searching, and distributing HL7 messaging value sets used within the PHIN
and NHIN.


Provides all the vocabulary metadata needed for HL7 messaging.


Promotes sharing and reusing of the value sets.


Hosts multiple versions of value sets that allow implementers to have access to the
current, past and the future versions of value sets and value set collections


Provides web services (API) that allows HL7 interface engines, medical and public health



applications to obtain the value sets as well as validate the vocabulary present in HL7
messages.


Provides detailed code system metadata for value set concepts such as context,
hierarchy, synonyms and alternate codes. This will facilitate the implementation of value
sets and improve the quality of local vocabulary mapping to standards.


PHIN VADS can be accessed at a public web site
-

http://phinvads.cdc.gov



CDC Vocabulary and Messaging team manages the PHIN VADS.

VADS: Developing a Sustainable
Approach for Supporting Partners

Electronic Reporting to the National Healthcare
Safety Network (NHSN) via Clinical Document
Architecture (CDA)


NHSN and CDA Capability



Currently accepting CDA files for:


Central line associated bloodstream infection (CLABSI)


Catheter associated urinary tract infection (CAUTI)



Surgical site infection (SSI)


Multi
-
drug Resistant Organism and C. dfficile laboratory
identified (LabID) events


Central line insertion practices (CLIP)


Dialysis events


Antimicrobial use


Approximately 500 hospitals are reporting to NHSN via
CDA


over
5000 hospitals report to NHSN


Public Health Clinical Decision Support (CDS)


Decision Support


Providing public health alerts/guidelines to providers in EHR
systems


GE, Alliance of Chicago & Lehigh Valley


Working with CDC programs to deliver public health information at
the point of care for screening, diagnostic evaluation, treatment &
education


HIV/STD & Million Hearts programs


CDS Partnerships


CDS Consortium, Federal CDS
Collaboratory
, ONC Health
eDecisions

S&I Initiative


Development of Geospatial Community Health Record


Engaging HD in Memphis & Methodist Le Bonheur Hospital
Dashboard
of health
indicators e.g. obesity, heart disease & stroke


Working with Million Hearts program & others in OSELS






Managing Emerging
Events:

Public
Health EHR Alerting Flow

FB Outbreak
Identified

States/CDC
monitoring
public health
discover
foodborne
outbreak

Symptoms

Locations

Event Information

Guidance e.g.

Consumption history

message
sits on a
standalone
knowledge
repository

FB
Message
Created

Us Case 5

Visit the CDC Public Health Use Case
Interoperability Demonstrations


Use Case #3


Biosurveillance

Monitoring and Detection:
“Updating and Leveraging National Healthcare Registries
in Care Delivery”

Use Case #4: Immunizations Registry Updating and Utilization
-

“Updating and Leveraging National Healthcare
Registries in Care Delivery”

Use Case #7


“Cancer Care Coordination and Ambulatory
Care Reporting to a Central Cancer Registry”

Use Case #16: Maternal & Newborn Health


“Birth Event
Reporting and Care Coordination for Newborn Hearing
Screening”

Interoperability Showcase

In collaboration with IHE

Thank You

Contacts:


CDC Standards & Interoperability:
Nikolay Lipskiy,
NLipskiy@cdc.gov


Cancer Reporting:
Wendy Blumenthal,
WBlumenthal@cdc.gov


Early Hearing Detection and Intervention:
John Eichwald,
JE
ichwald@cdc.gov


Vital Records Standards:
Michelle Williamson,
MWilliamson@cdc.gov


Immunization Information Systems
: Warren Williams,
WWilliams1@cdc.gov


PHIN VADS:
Roochi
Sharma,
RSharma@cdc.gov


Email:
phinvs@cdc.gov


Online Forum:
http://www.phconnect.org/group/phinvads


National Healthcare Safety
Network
:

Daniel Pollock,
DPollock@cdc.gov



Clinical Decision Support:
Nedra Garrett,
NGarrett@cdc.gov







The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the

views of the Centers for Disease Control and Prevention


For more
CDC information please contact

Telephone
, 1
-
800
-
CDC
-
INFO (232
-
4636)/TTY: 1
-
888
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6348

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-
mail: cdcinfo@cdc.gov Web: www.atsdr.cdc.gov