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Johns Hopkins Schoo. I of Medicine Division of Health Sciences Informatics March 23, 2007 Johns Hopkins Schoo. I of Medicine Division of Health Sciences Informatics March 23, 2007 Nationwide Health Information Network Update Anna O. Orlova, Ph. D [email protected] edu Public Health Data Standards Consortium & Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland, USA

Towards a Nationwide Health Information Network (NHIN) Where Should We Be in 2014 n Towards a Nationwide Health Information Network (NHIN) Where Should We Be in 2014 n Building a NHIN ¨ ¨ ¨ NHIN-2004 NHIN-2005 -2006 NHIN-2007

US National HIT Strategic Plan On July 21, 2004 the Department of Health and US National HIT Strategic Plan On July 21, 2004 the Department of Health and Human Services (DHHS) announced the decade of health information technology for “delivering consumer–centric and information-rich health care. ” The vision is to build a National* Health Information Network (NHIN) of regional health information exchanges formed by health care providers who will utilize electronic health record systems. * Original term “National” has been changed on “Nationwide” in January 2006 Thompson TG and Brailer DJ. The Decade of Heath Information Technology to Deliver Consumer-centric and Information-rich Health Care. Framework for Strategic Action. US DHHS, July 21, 2004.

DHHS’ Framework for Health Information Technology: Building a NHIN will be based on: u. DHHS’ Framework for Health Information Technology: Building a NHIN will be based on: u. Electronic Health Record Systems (EHRS) that will enable u. Regional Health Information Exchanges (RHIEs) organized via u. Regional Health Information Organizations (RHIOs) Thompson TG and Brailer DJ. The Decade of Heath Information Technology to Deliver Consumer-centric and Information-rich Health Care. Framework for Strategic Action. US DHHS, July 21, 2004.

President’s Strategic Framework for HIT President’s Strategic Framework for HIT

US Nationwide Health Information Network Provider Record Laboratory Results Specialist Records Returned Requests for US Nationwide Health Information Network Provider Record Laboratory Results Specialist Records Returned Requests for Records Another RHIO Authorized RHIO Inquiry Patient data to other RHIO Index of where patients Temporary Aggregate have records Patient History RHIO Source: Jennie Harvell. The Decade of Health Information Technology – Framework for Strategic Actions. MMIS Conference, September 2004

US Health Information Network - 2014 Source: Dr. Peter Elkin, Mayo Clinic, MN US Health Information Network - 2014 Source: Dr. Peter Elkin, Mayo Clinic, MN

Source: Dr. Peter Elkin, Mayo Clinic, MN, 2006 RHIOs as NHIN Components Source: Dr. Peter Elkin, Mayo Clinic, MN, 2006 RHIOs as NHIN Components

Nationwide Health Information Network (NHIN) Emerging data shows the value that standardized health information Nationwide Health Information Network (NHIN) Emerging data shows the value that standardized health information exchange will provide to all stakeholders: ¨Healthcare purchasers and payers ¨Hospitals and other healthcare providers ¨Laboratories ¨Practicing clinicians ¨Public health Source: John Glaser, Janet Marchibroda, Jim Schuping. CCBH. Washington, D. C. December 6 -7, 2004 URL: www. ehealthinitiative. com

Building a NHIN Building a NHIN

Building a NHIN On November 15, 2004 Office of National Coordinator for Health Information Building a NHIN On November 15, 2004 Office of National Coordinator for Health Information Technology (ONC), Department of Health and Human Services (DHHS), released THE REQUEST FOR INFORMATION (RFI) on the Development and Adoption of a “National” Health Information Network Over 500 responses from various healthcare stakeholders has been submitted. URL: http: //www. dhhs. gov

Public Health Data Standards Consortium PHDSC RESPONSE TO THE RFI on the Development and Public Health Data Standards Consortium PHDSC RESPONSE TO THE RFI on the Development and Adoption of a “National” Health Information Network was submitted to DHHS on January 18, 2005 URL: http: //phdatastandards. info or http: //www. phdsc. org

PHDSC Model: PHDSC Model for Electronic Health Record-based Data Exchange RHIO EHR-PH Info Exchange PHDSC Model: PHDSC Model for Electronic Health Record-based Data Exchange RHIO EHR-PH Info Exchange

NHIN Development Process In October 2005 DHHS Office of National Coordinator (ONC) awarded several NHIN Development Process In October 2005 DHHS Office of National Coordinator (ONC) awarded several NHIN contracts ($65 M) as follows: n n Standards Harmonization EHR Certification NHIN Architecture Prototypes Health Information Security and Privacy URL: http: //www. hhs. gov/healthit/ahic. html

DHHS NHIN Contracts Standards Harmonization - Harmonize the health care and technology standards used DHHS NHIN Contracts Standards Harmonization - Harmonize the health care and technology standards used in health information interchange to address gaps and conflicts in current standards n EHR Certification - Set forth certification criteria for the many electronic health care record products and technologies currently available on the market n NHIN Prototypes - Develop and evaluate prototypes for the network architecture to assess the feasibility of developing a national health information network prototype n Privacy - Address privacy and security policy questions affecting the exchange of health information. Work resulting from each of these projects will be used by HHS to develop and refine the business case for establishing the network. n

A public-private “Community” was established to serve as the focal point for America’s health A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability The Certificatio n Commissio n for Healthcare Information Technology (CCHIT) The Health Information Security and Privacy Collaborati on (HISPC) American Health Information Community (Community) Healthcare Information Technology Standards Panel (HITSP) Nationwid e Health Information Network (NHIN) Architectur e Projects The Community is a federally-chartered commission that provides input and recommendations to DHHS on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected in a smooth, market-led way.

NHIN Development Process The Community is chartered for two years, with the option to NHIN Development Process The Community is chartered for two years, with the option to renew and duration of no more than five years. The DHHS intends for the Community to be succeeded within five years by a privatesector health information community initiative that, among other things, would set additional needed standards, certify new health information technology, and provide long-term governance for health care transformation. * AHIC URL: www. hhs. gov/healthit/ahiccharter. pdf

A public-private “Community” was established to serve as the focal point for America’s health A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability The Certification Commission for Healthcare Information Technology American Health (CCHIT) The Health Information Security and Privacy Collaboration (HISPC) Information Community (Community) Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network (NHIN) Architecture Projects

Discussion Document Standards Harmonization Technical Committees Update Report to the Healthcare Information Technology Standards Discussion Document Standards Harmonization Technical Committees Update Report to the Healthcare Information Technology Standards Panel Contract HHSP 23320054103 EC HITSP includes 206 member organizations: 17 SDOs (8%) 161 Non-SDOs (79%) 18 Govt. bodies (8%) 10 Consumer groups (5%) Arlington, VA September 20, 2006

HITSP Standards Categories 1. 2. 3. 4. 5. 6. 7. Data Standards (vocabularies and HITSP Standards Categories 1. 2. 3. 4. 5. 6. 7. Data Standards (vocabularies and terminologies) Information Content Standards (RIMs) Information Exchange Standards Identifiers Standards Privacy and Security Standards Functional Standards Other HITSP definition

HITSP Framework for Interoperability Specification Development n HITSP receives Use Cases and Harmonization Requests HITSP Framework for Interoperability Specification Development n HITSP receives Use Cases and Harmonization Requests from external sources, such as Community and ONC. n The Use Case or Request defines scenarios, business actors, and business and functional/interoperability requirements. n HITSP develops Interoperability Specifications supporting the Use Cases: technical actors, transactions, content and terminology. Source: HITSP Meeting, Arlington VA, September 20, 2006

HITSP Framework for Interoperability Specification Development n HITSP identifies constructs which are logical groupings HITSP Framework for Interoperability Specification Development n HITSP identifies constructs which are logical groupings of base standards that work together, such as message and terminology. n These constructs can be reused like building blocks. n While reuse is a HITSP goal, it is established in the context of a use case and its functional/interoperability requirements. n HITSP constructs are version controlled and, if reused, will be uniquely identified. Source: HITSP Meeting, Arlington VA, September 20, 2006

The standards harmonization process is a series of steps taken by industry stakeholders Harmonization The standards harmonization process is a series of steps taken by industry stakeholders Harmonization Process Steps Receive Request I II IV V VI VIII armonization Identification Gaps, Standards Construction Interoperability Requirements Duplications Inspection Request of Candidate of Specification Selection Analysis and Test Standards Interoperability Release Overlaps Specification and Resolution Dissemination IX Program Management Begin Support Source: HITSP Meeting, Arlington VA, September 20, 2006

HITSP Framework Source: HITSP Meeting, Arlington VA, September 20, 2006 HITSP Framework Source: HITSP Meeting, Arlington VA, September 20, 2006

Standard Harmonization Process The Community identified 3 breakthrough areas for the NHIN development process Standard Harmonization Process The Community identified 3 breakthrough areas for the NHIN development process in 2006: n n n Biosurveillance Consumer Empowerment Electronic Health Record * AHIC URL: www. hhs. gov/healthit/ahiccharter. pdf

Consumer Empowerment Use Case Allow consumers to establish and manage permissions access rights and Consumer Empowerment Use Case Allow consumers to establish and manage permissions access rights and informed consent for authorized and secure exchange, viewing, and querying of their linked patient registration summaries and medication histories between designated caregivers and other health professionals. Source: HITSP Meeting, Arlington VA, September 20, 2006

Electronic Health Record Use Case Allow ordering clinicians to electronically access laboratory results, and Electronic Health Record Use Case Allow ordering clinicians to electronically access laboratory results, and allow nonordering authorized clinicians to electronically access historical and other laboratory results for clinical care. Source: HITSP Meeting, Arlington VA, September 20, 2006

Biosurveillance Use Case Transmit essential ambulatory care and emergency department visit, resource utilization, and Biosurveillance Use Case Transmit essential ambulatory care and emergency department visit, resource utilization, and lab result data from electronically enabled health care delivery and public health systems in standardized anonymized format to authorized Public Health Agencies with less than one day lag time. Source: HITSP Meeting, Arlington VA, September 20, 2006

Event Detection EHRS Neighboring Jurisdictions Hospital State Public Health Surveillance System 1 - Report/retrieve Event Detection EHRS Neighboring Jurisdictions Hospital State Public Health Surveillance System 1 - Report/retrieve symptoms, diagnosis & medication prescription data from EMRs Ambulatory Care 4 – Order pathogen test 2 – Data mining of EMR notes 3 – Notify on increased number of cases & recommend to order pathogen test 5 – Report test results 7 – Report on the positive case electronically & by phone Local Public Health Surveillance System DHHS 6 – Report positive test result electronically & by phone Media Laboratory Pharmacy Response Team P U B L I C

Biosurveillance Technical Committee Recommendations Biosurveillance Technical Committee Recommendations

Biosurveillance AHIC-ONC BIO Consolidated Use Case Patient-level data to Public Health Message-based Submission HITSP Biosurveillance AHIC-ONC BIO Consolidated Use Case Patient-level data to Public Health Message-based Submission HITSP Biosurveillance – Patient-level and Resource Utilization Interoperability Specification Transaction Package Consumer/Patient Id X-ref Transaction Pseudonymize Message-based Scenario Component Encounter Msg Lab Report Message Radiology Msg Terminology Standards HCPCS HL 7 V 3 CPT HL 7 V 2. 5 CCC SNOMED-CT ICD 9/10 LOINC NCCLS UCUM UB-92 URL FIPS 5 -2 HAVE Base Std HL 7 V 2. 5 ADT^xxx Base Std HL 7 V 2. 5 ORU^R 01 IHE XDS IHE PIX PDQ Component Base Std HL 7 QBP^Q 23 RSP^K 23 Anonymize Component Lab Terminology Base Std LOINC SNOMEDCT Base Std ISO DTS/ 25237 HIPAA DICOM Base Std ISO 15000 eb. RS 2. 1/3. 0 Base Std HL 7 V 2. 5

Biosurveillance AHIC-ONC BIO Consolidated Use Case Patient-Level Data to Public Health Document-based Submission HITSP Biosurveillance AHIC-ONC BIO Consolidated Use Case Patient-Level Data to Public Health Document-based Submission HITSP Biosurveillance – Patient-level and Resource Utilization Interoperability Specification Transaction Package Consumer/Patient Id X-ref Transaction Package Manage Sharing of Docs Document-based Scenario Transaction Notif of Doc Availability IHE XDS-I Base Std HL 7 QBP^Q 23 RSP^K 23 Transaction Pseudonymize IHE NAV IHE XDS IHE PIX PDQ Component Lab Report Document Component Anonymize Component Lab Terminology Base Std DICOM Base Std LOINC SNOMEDCT IHE XDS-MS Base Std HL 7 CDA r 2 IHE XDS-LAB Terminology Standards HCPCS HL 7 V 3 CPT HL 7 V 2. 5 CCC SNOMED-CT ICD 9/10 LOINC NCCLS UCUM UB-92 URL FIPS 5 -2 HAVE Base Std ISO DTS/ 25237 HIPAA DICOM Base Std ISO 15000 eb. RS 2. 1/3. 0 Base Std HL 7 V 2. 5

A public-private “Community” was established to serve as the focal point for America’s health A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability The Certification Commission for Healthcare Information Technology American Health (CCHIT) The Health Information Security and Privacy Collaboration (HISPC) Information Community (Community) Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network (NHIN) Architecture Projects

Health Information Security and Privacy Collaborative (HISPC) RTI International coordinates assessment of health information Health Information Security and Privacy Collaborative (HISPC) RTI International coordinates assessment of health information exchange among states In May 2006, RTI established the National Health Information Security and Privacy Collaboration (HISPC) by announcing the 34 states and U. S. territories who signed agreements to join this project. The project is a national collaboration created to address privacy and security policy questions affecting the exchange of health information. The project is being managed by RTI in cooperation with the National Governors Association under a contract from the Department of Health and Human Services (HHS), Agency for Healthcare Research and Quality. RTI's project team includes multidisciplinary experts in privacy and security law and in health care management together with state and territorial governments. URL: http: //www. rti. org/page. cfm? nav=7&objectid=6 D 0 A 81 F 4 -6 A 6 D-44 A 5 -BD 5 E 14 B 2 A 7077 ED 6

Health Information Security and Privacy Collaborative (HISPC) Review of State Findings 34 states and Health Information Security and Privacy Collaborative (HISPC) Review of State Findings 34 states and U. S. territories signed agreements to join HISPC project Source: Walter G. Suarez. Advancing State Approaches Towards Solutions and Implementation. Health Information Security and Privacy Collaborative. Regional Meeting, November 17, 2006 – Boston, MA

Health Information Security and Privacy Collaborative (HISPC) - Scenarios Purposes of Health Information Exchange Health Information Security and Privacy Collaborative (HISPC) - Scenarios Purposes of Health Information Exchange Relevant Scenarios Treatment Scenarios 1 -4 Payment Scenario 5 RHIO Scenario 6 Research Scenario 7 Law Enforcement Scenario 8 Prescription Drug Use/Benefit Scenarios 9 and 10 Healthcare Operations/Marketing Scenarios 11 and 12 Bioterrorism Scenario 13 Employee Health Scenario 14 Public Health Scenarios 15 -17 State Government Oversight Scenario 18

Nine Domains of Privacy and Security 1. 2. 3. 4. 5. 6. 7. 8. Nine Domains of Privacy and Security 1. 2. 3. 4. 5. 6. 7. 8. 9. User and entity authentication to verify that a person or entity seeking access to electronic personal health information is who they claim to be. Information authorization and access controls to allow access only to people or software programs that have been granted access rights to electronic personal health information. Patient and provider identification to match identities across multiple information systems and locate electronic personal health information across enterprises. Information transmission security or exchange protocols (i. e. , encryption, etc. ) for information that is being exchanged over an electronic communications network. Information protections so that electronic personal health information cannot be improperly modified. Information audits that record and monitor the activities of health information systems. Administrative or physical security safeguards required to implement a comprehensive security platform for health IT. State law restrictions about information types and classes, and the solutions by which electronic personal health information can be viewed and exchanged. Information use and disclosure policies that arise as health care entities share clinical health information electronically.

Health Information Security and Privacy Collaborative (HISPC) – Design Nov. - Dec. 06 March Health Information Security and Privacy Collaborative (HISPC) – Design Nov. - Dec. 06 March 2007

Review of State Findings: Variation Analysis Source: Walter G. Suarez. Health Information Security and Review of State Findings: Variation Analysis Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA

Review of State Findings Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Review of State Findings Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA

Review of State Findings Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Review of State Findings Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA

Review of State Findings Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Review of State Findings Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA

A public-private “Community” was established to serve as the focal point for America’s health A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability The Certification Commission for Healthcare Information Technology American Health (CCHIT) The Health Information Security and Privacy Collaboration (HISPC) Information Community (Community) Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network (NHIN) Architecture Projects

A public-private “Community” was established to serve as the focal point for America’s health A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability The Certification Commission for Healthcare Information Technology American Health (CCHIT) The Health Information Security and Privacy Collaboration (HISPC) Information Community (Community) Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network (NHIN) Architecture Projects

Role of Public Health in a NHIN NEXT STEPS Role of Public Health in a NHIN NEXT STEPS

Providers and Software Developers Working Together to Deliver Interoperable Health Information Systems in the Providers and Software Developers Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings WWW. IHE. NET

Integrating the Healthcare Enterprise (IHE) Overview Presented by Dan Russler, M. D. , IHE Integrating the Healthcare Enterprise (IHE) Overview Presented by Dan Russler, M. D. , IHE PCC Co-chair IHE Workshop – June 19, 2006

Why IHE? n n n 1970’s—Mainframe Era--$100, 000 per interface 1990’s—HL 7 2. x--$10, Why IHE? n n n 1970’s—Mainframe Era--$100, 000 per interface 1990’s—HL 7 2. x--$10, 000 per interface 2000’s—IHE Implementation Profiles— Cheaper than a new phone line! How? IHE Eliminates Options Found in Published Standards

Who is IHE? n IHE is a joint initiative among: ¨ American College of Who is IHE? n IHE is a joint initiative among: ¨ American College of Cardiology (ACC) ¨ Radiological Society of North America (RSNA) ¨ Healthcare Information Management Systems Society (HIMSS) ¨ GMSIH, HPRIM, JAHIS (laboratory) ¨ American Society of Ophthalmology ¨ American College of Physicians (ACP) College of Clinical Engineering (ACCE) ¨ And many more…. Began in 1997 in Radiology (RSNA) and IT (HIMSS) International effort: IHE- Europe and IHE-Asia Additional sponsors for Cardiology including ASE, ESC, ASNC, SCA&I, HRS and more ¨ American n

IHE 2006 – Nine Active Domains Over 100 vendors involved world-wide, 5 Technical Frameworks IHE 2006 – Nine Active Domains Over 100 vendors involved world-wide, 5 Technical Frameworks 37 Integration Profiles, Testing at Connectathons Demonstrations at major conferences world-wide 15 Active national chapters on 4 continents

IHE Standards-Based Integration Solutions Professional Societies Sponsorship Healthcare Providers & Software Developers Healthcare IT IHE Standards-Based Integration Solutions Professional Societies Sponsorship Healthcare Providers & Software Developers Healthcare IT Standards General IT Standards HL 7, DICOM, etc. Internet, ISO, etc. IHE Process Interoperable Healthcare IT Solution Specifications Healthcare IT Interoperable IHE Integration Profile Specifications Healthcare IT Solution Interoperable IHE Integration Profile Specifications Solution IHE Integration Profile

IHE in 2006 – 18 Month Development Cycles • First Cycle: • • • IHE in 2006 – 18 Month Development Cycles • First Cycle: • • • Planning Committee Proposals: Technical Committee Drafts: Public Comment Due: Trial Implementation Version: Mesa Tool Test Results Due: IHE Connectathon: HIMSS Demo: Participant Comments Due: Final Implementation Version: November, 2005* June, 2006* July 2006 August 2006 December 2006 January 2007 February 2007 March 2007 June 2007

IHE Technical Frameworks Detailed standards implementation guides IHE Technical Frameworks Detailed standards implementation guides

HIMSS IHE Interoperability Showcase February 2006 Participants Leadership Level Blue Ware Cerner GE Healthcare HIMSS IHE Interoperability Showcase February 2006 Participants Leadership Level Blue Ware Cerner GE Healthcare +IDX IBM Initiate Systems Inter. Systems Mi. Sys Healthcare Quovadx Siemens Supporter Level: Acuo Bond Carefx Dairyland EMC Identrus Intel Mediserve Implementer Level Allscripts Canon Cap. Med Cardiac Science CGI-AMS Compass. Care CPSI Dictaphone DR Systems Eastman Kodak Eclipsys Epic Systems HIPAAT Medkey Motion Comp. Picis Pulse HX Technologies INFINITT Technology Kryptiq Mc. Kesson Med. Access Plus Medical Informatics Medi. Notes MNI National Institute of Sci & Tech Next. Gen Healthcare Philips Medical Sc. Image Witt Biomedical DMP–French Natl. Personal EHR American Coll. of Clinical Eng. Health Level 7 HTP IEEE Catholic Healthcare West Midmark Diagostics Group US Dept of Defense HIMSS RHIO Federation US Dept of Veterans Affairs Liberty Alliance Organizational participant:

IHE Connectathon, January 2006 • 300+ participants, 120+ systems • 60+ systems developers • IHE Connectathon, January 2006 • 300+ participants, 120+ systems • 60+ systems developers • Four Domains: Cardiology, IT Infrastructure, Patient Care Coordination, Radiology • 2800+ monitored test cases

IHE Integration Profiles for Health Info Nets What is available and has been added IHE Integration Profiles for Health Info Nets What is available and has been added in 2005 and is for 2006 Clinical and PHR Content Emergency Referrals PHR Extracts/Updates Format of the Document Content and associated coded Content ECG Report. Documentvocabulary Format of the Document and associated coded vocabulary Lab Results. Document Content Document Format of the Content Scanned Documents and associated coded vocabulary Format of the Document Content Imaging Information and associated coded Content Format of the Document vocabulary Medical Summary Format of the Document Content ( associated coded vocabulary and Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Health Data Exchange Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Cross-enterprise Document Point-Point Interchange Media-CD/USB & e-mail push Security Basic Patients Privacy Consents Establish Consents & Enable Access Control Document Digital Signature Patient Id Mgt Patient Demographics Query Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Attesting “true-copy and origin Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Other Request Form for Data Capture External form with custom import/export scripting Consistent Time Coordinate time across networked systems Notification of Document Availability Notification of a remote provider/ health enterprise

HITSP Biosurveillance AHIC-ONC BIO Consolidated Use Case Patient-Level Data to Public Health Document-based Submission HITSP Biosurveillance AHIC-ONC BIO Consolidated Use Case Patient-Level Data to Public Health Document-based Submission Biosurveillance – Patient-level and Resource Utilization Interoperability Specification Transaction Package Consumer/Patient Id X-ref Transaction Package Manage Sharing of Docs Document-based Scenario Transaction Notif of Doc Availability IHE XDS-I Base Std HL 7 QBP^Q 23 RSP^K 23 Transaction Pseudonymize IHE NAV IHE XDS IHE PIX PDQ Component Lab Report Document Component Anonymize Component Lab Terminology Base Std DICOM Base Std LOINC SNOMEDCT IHE XDS-MS Base Std HL 7 CDA r 2 IHE XDS-LAB Terminology Standards HCPCS HL 7 V 3 CPT HL 7 V 2. 5 CCC SNOMED-CT ICD 9/10 LOINC NCCLS UCUM UB-92 URL FIPS 5 -2 HAVE Base Std ISO DTS/ 25237 HIPAA DICOM Base Std ISO 15000 eb. RS 2. 1/3. 0 Base Std HL 7 V 2. 5

Providers and Software Developers Working Together to Deliver Interoperable Health Information Systems in the Providers and Software Developers Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings PHDSC was Invited to Sponsor Public Health

TEN: Public Health IHE 2006 – Nine Active Domains Over 100 vendors involved world-wide, TEN: Public Health IHE 2006 – Nine Active Domains Over 100 vendors involved world-wide, 5 Technical Frameworks 37 Integration Profiles, Testing at Connectathons Demonstrations at major conferences world-wide 15 Active national chapters on 4 continents

PHDSC was Invited to Sponsor Public Health Domain at IHE Public Health Efforts at PHDSC was Invited to Sponsor Public Health Domain at IHE Public Health Efforts at IHE – due July 2007 White Paper on Public Health PHDSC-sponsored n White Paper on Quality Siemens-sponsored n White Paper on Aggregate Data Retrieval from Document. Sharing Resource Siemens- and Oracle-sponsored n Profile Proposal on Laboratory Data Exchanges IBM-sponsored n

IHE White Paper on Public Health: Goal To describe the organization and functions of IHE White Paper on Public Health: Goal To describe the organization and functions of public health in the US in order to inform the development of the IHE integration profiles for interoperable clinical and public health information systems.

Knowledge Management in Public Health WHAT IS PUBLIC HEALTH? Knowledge Management in Public Health WHAT IS PUBLIC HEALTH?

State Health Department Organizational Chart State Health Department Organizational Chart

Clinical-Public Health Paper-based Health Data Exchanges Genetic Disorders Provider 1 Provider 2 Communicable Diseases Clinical-Public Health Paper-based Health Data Exchanges Genetic Disorders Provider 1 Provider 2 Communicable Diseases Immunization Vital Records Provider 3 Provider 4 Injury Control School Health Chronic Care Provider X Biosurveilance, BT, Preparedness HEDIS On average 49% of cases got reported (CDC, 2006).

EHR-PH System Prototype for Interoperability Public Health Clinical Care in 21 st Century Health EHR-PH System Prototype for Interoperability Public Health Clinical Care in 21 st Century Health Care System Surveillance Hospital of Birth ADTBirth Record Newborn Screening Test Hearing Screening Test Immunization Administration State Health Department HL 7 2. 4 HL 7 3. 0 Newborn Screening Registry HL 7 3. 0 EHR-PH Info Exchange HL 7 3. 0 HL 7 2. 4 Immunization Registry HL 7 2. 4 HL 7 3. 0 HL 7 2. 4 J 2 EE External Laboratory Hearing Screening Registry HTB J 2 EE Communicable Disease Registry Wrtwertghghgghhghg Wrtwrtghghgh Wtrwtrghgg Wrtwertghghgghhghg Wrtwrtghghghghgh Aadkalfjkaldkfjalkdjflajh Wtrwtrghgg jkhjkhjkhk Wrtwrtghghgh flkdjghghghgh Aadkalfjkaldkfjalkdjflajk flkdjghghghghg fhjfghjfh Healthcare Transaction Viewer HTB – Health Transaction Base Source: Orlova, et al. HIMSS 2005, Dallas TX, February 13 -17, 2005 and AMIA, Washington DC, November, 2005

WHERE TO START? WE NEED TO HARMONIZE: DATA FORMS WORKFLOW POLICIES WHERE TO START? WE NEED TO HARMONIZE: DATA FORMS WORKFLOW POLICIES

WHERE TO START? WE NEED TO HARMONIZE: DATA FORMS WORKFLOW POLICIES WHERE TO START? WE NEED TO HARMONIZE: DATA FORMS WORKFLOW POLICIES

EHR-PH Data Exchange: Clinical & Public Health Systems EHR Forms NBS Genetic Disorders CDA EHR-PH Data Exchange: Clinical & Public Health Systems EHR Forms NBS Genetic Disorders CDA 2 Provider 1 Provider 2 IHE LAB TB, STD. …… Communicable Diseases Immunization VR Provider 3 IR Vital Records ECIC Injury Control Provider 4 NCPDP SH CVD, Asthma Diabetes Provider X X 12 BT HEDIS School Health Chronic Care Biosurveilance, BT, Preparedness, Syndromic Surveillance HEDIS

WHERE TO START? WE NEED TO HARMONIZE: DATA FORMS WORKFLOW POLICIES WHERE TO START? WE NEED TO HARMONIZE: DATA FORMS WORKFLOW POLICIES

Event Detection EHRS Neighboring Jurisdictions Hospital State Public Health Surveillance System 1 - Report/retrieve Event Detection EHRS Neighboring Jurisdictions Hospital State Public Health Surveillance System 1 - Report/retrieve symptoms, diagnosis & medication prescription data from EMRs Ambulatory Care 4 – Order pathogen test 2 – Data mining of EMR notes 3 – Notify on increased number of cases & recommend to order pathogen test 5 – Report test results 7 – Report on the positive case electronically & by phone Local Public Health Surveillance System DHHS 6 – Report positive test result electronically & by phone Media Laboratory Pharmacy Response Team P U B L I C

Event Monitoring Neighboring Jurisdictions EHRS 3 - Monitor ER visits & hospitalizations data from Event Monitoring Neighboring Jurisdictions EHRS 3 - Monitor ER visits & hospitalizations data from EMRs 1 – Send health alert 2 - Monitor newly diagnosed cases & vaccination data from EMRs Ambulatory Care 4 – Order pathogen test State Public Health Surveillance System 9 – Send updates on the event 6 – Send order to activate emergency vaccination Local Public Health Surveillance System 5 – Report test results 7 – Order/ Supply vaccine Lab Hospital 8 – Monitor vaccine supplies Pharmacy 10 – Send health alert to the public DHHS Media Response Team P U B L I C

Event Management EHRS Neighboring Jurisdictions 3 - Monitor ER visits, hospitalizations data from EMRs Event Management EHRS Neighboring Jurisdictions 3 - Monitor ER visits, hospitalizations data from EMRs & utilization data 1 – Send Outbreak updates 2 - Monitor newly diagnosed cases & vaccination data from EMRs Ambulatory Care 4 – Order pathogen test State Public Health Surveillance System 9 – Send outbreak updates 6 – Send Rapid Flu Test Kits 10 – Send outbreak updates to the public Local Public Health Surveillance System 5 – Report test results 9 – Activate coordinated response 7 – Deliver vaccine Lab Hospital 8 – Monitor vaccine supplies Pharmacy Response Team DHHS Media P U B L I C

Cardiovascular Disease (CVD) Surveillance Payor Hospital EHRS 1 – Conduct Routine Check-ups 4 – Cardiovascular Disease (CVD) Surveillance Payor Hospital EHRS 1 – Conduct Routine Check-ups 4 – Prescribe Medication and Treatment Plan Ambulatory Care 9 - Monitor ER visits, hospitalizations data from EMRs & utilization data 11 – Send reports 12– Conduct Surveys (BRFSS) 5 – Monitor Treatment 2 – Order cholesterol test 3 – Report test results 7 – Report Data to Schools State Public Health Surveillance System Local CVD Surveillance System 10 – Conduct Health Education DHHS 6 – Fill Prescription 8– Coordinate Care Media Laboratory Pharmacy School P U B L I C

Hospital Asthma Surveillance Payor EHRS 1 – Conduct Routine Check-ups 4 – Prescribe Medication Hospital Asthma Surveillance Payor EHRS 1 – Conduct Routine Check-ups 4 – Prescribe Medication and Treatment Plan Ambulatory Care 9 - Monitor ER visits, hospitalizations data from EMRs & utilization data 11 – Send reports 5 – Monitor Treatment 2 – Order allergen test 3 – Report test results 7 – Report Data to Schools State Public Health Surveillance System 12– Conduct Surveys (BRFSS) Local Asthma Surveillance System 10 – Conduct Health Education DHHS 6 – Fill Prescription 8– Coordinate Care Media Laboratory Pharmacy School P U B L I C

WHERE TO START? WE NEED TO HARMONIZE: DATA FORMS WORKFLOW POLICIES WHERE TO START? WE NEED TO HARMONIZE: DATA FORMS WORKFLOW POLICIES

Examples of Notifiable/Reportable Conditions by Selected States Notifaible/Reportable Diseases (in alphabetical order) CDC CA Examples of Notifiable/Reportable Conditions by Selected States Notifaible/Reportable Diseases (in alphabetical order) CDC CA FL IN MA MD MN NC MD Lab MD Lab a a - a a a Alcohol Related Birth Defects - - - - Amebiasis - a - - - a a a - - Anaplasmosis - - - a - - Anisakiasis - a - - - Animal bites - - - a - - Animal bites for which rabies prophylaxis is given, - - - a - - - - - Anthrax a a a a Arboviral neuroinvasive and neuroinvasive diseases, all a - - a a a a a California group - - - - Eastern equine encephalitis virus - - - - a a - - - Acquired Immunodeficiency Syndrome (AIDS)

WHERE TO START? SELECT PUBLIC HEALTH DOMAINS TO BEGIN WITH WHERE TO START? SELECT PUBLIC HEALTH DOMAINS TO BEGIN WITH

Vision for Public Health Surveillance via NHIN Percent of Children Tested for Lead with Vision for Public Health Surveillance via NHIN Percent of Children Tested for Lead with BLL>10 µg/d. L in the USA Source: Eileen Koski. Quest Diagnostics. PHIN-2004, May, Atlanta GA