Public Health Data Standards Consortium http phdatastandards info

Public Health Data Standards Consortium http: //phdatastandards. info

2 nd Connecting Communities for Better Health Learning Forum May 25 -26, 2005, Washington DC Technical Aspects Track Developing an Incremental Pathway Towards Interoperability and Health Information Exchange Anna O. Orlova, Ph. D Executive Director, PHDSC and Johns Hopkins Bloomberg School of Public Health 1

Q 1. Special considerations of semantic interoperability for public health Clinical versus Public Health Concepts Clinical Public Health u Anthrax Dx u Anthrax epidemic u Asthma treatment u Asthma surveillance Immunization administration u Immunization stock pile Blood lead level u Level of lead exposure u u u Diabetes with ketoacidosis (250. 1) (in patient) u Diabetes with ketoacidosis (250. 1) (in population) Based on Steven Steindel’s Presentation “Perspectives on the Developing Public Health Vocabulary, Data 2 Standards and Models. ” AMIA, November 2004, Washington DC

Q 1. Special considerations of semantic interoperability for public health FROM… u. No Standards for sharing of health information between PH programs u. Multiple approaches to PH data gathering u. Ability only communicate to one PH program at a time TO… u. Standards in architecture allow data sharing/transfer u. Common approach to PH data gathering u. Communicate to PH data from outside sources u. To provide access to PH data for providers u. To coordinate clinical care and PH practices in serving the public’s health 3 Based on Steven Steindel’s Presentation. AMIA, November 2004, Washington DC

Q 1. Special considerations of semantic interoperability for public health Semantic interoperability in the past is categorization Semantic interoperability in the future is commitment to adhere to all of the standards encompassed in RHIE and global NHIN specification requirements 4

Q 2. Specific solutions from public health that could be adopted by other HIE implementers Public Health Experience with Data Integration State Health Systems u Missouri u Utah u Rhode Island u New York State 5

Missouri Health Strategic Architectures and Information Cooperative Project (MOHSAIC) Statewide Network or Web Access Real-time Link Data Merge BIRTHS: Birth Loads, Name, DOB, Sex, Race, DCN Other Birth Info HEALTH MANAGEMENT & REGULATED Medicaid Encounters DEPT. OF SOCIAL SERVICES DCN, Medicaid Enrollment, Aging EDL, Managed Care Info, FAMIS SURVEILLANCE Registration, Demographics, Scheduling, Inventory Immunization TB Family Planning Service Coordination NEOMETRICS: Metabolic & Newborn Hearing Results Audiological Assessment EPSOT/DCY Traumatic Brain Injury Eligibility I N T E G R A T E D Communicable Disease HIV/AIDS STD TB I N T E G R A T E D D A T A B A S E TL-Link Lead Private Physician Records WIC Family Care Safety Registry Bureau of Narcotics & Dangerous Drugs Lead Inspection & Abatement Child Care Licensing Accredited Training Registry Highway Patrol D A T A B A S E Laboratories 6 Ellen Wild, etal. 2004. Key Elements for Successful Integrated Health Information Systems. JPHMP, . S 36 -47

Utah’ Child Health Advanced Records Management System (CHARM) PHASE II Birth Registration Charm Agents Web Access Charm Agents Date Ware House Newborn Metabolic Screening Children With Special Health Care Needs Birth Defects CHARM SERVER Newborn Hearing Screening Security Manager Lead Screening Data Catalog Child Registration Matcher & Merger Early Intervention Women Infants Children Query Monitor Statistics Manager Utah Statewide Immunization Info System Neonatal Follow-up PHASE III Medicaid CNEC EPSOT System Child Health Insurance Program DHS-DCPS Foster Care 7 Ellen Wild, etal. 2004. Key Elements for Successful Integrated Health Information Systems. JPHMP, . S 36 -47

New York State Integrated Clinical Management System (ICMS) Hospital Draw Blood Sample DOH Blood Spot Card B MSDS Exception Reports C A Web. Server VRS Birth Certificate HIS CMS Vital Records Follow-up Hospital Data Entry WAARP Firewall INTERNET A. Establish link to EBC records Physician or Case Manager FAX Mailer B. Report missing or late blood spot cards C C. Allow mailer image viewing through browser Mailer 8 Source: Perry Smith. 2 nd Connecting Communities for Better Health Learning Forum, May 25 -26, 2005, Washington DC

Rhode Island’s KIDSNET RHIO u Newborn Metabolic Screening Registry u Newborn Hearing Screening Registry u Birth Defect Registry u Immunization Registry u Birth Registration 9

PHDSC EHR-PH System Prototype for Interoperability of Clinical and Public Health Systems, HIMSS-2005 Clinical Care Public Health Hospital of Birth ADTBirth Record Newborn Screening Test Hearing Screening State Health Department HL 7 2. 4 HL 7 3. 0 EHR-PH Info Exchange HL 7 2. 4 Test Immunization Administration HL 7 3. 0 HL 7 2. 4 J 2 EE HL 7 2. 4 External Laboratory 10 Source: Orlova, et al. HIMSS 2005, Dallas TX, February 13 -17, 2005 Newborn Screening Registry Hearing Screening Registry Immunization Registry Communicable Disease Registry

PHDSC EHR-PH System Prototype for Interoperability of Clinical and Public Health System Our Prototype Illustrates how interoperability between clinical and public health systems can be achieved with a standards-based infrastructure Is built upon existing systems in clinical care and public health programs Enables electronic data reporting from a clinical setting to multiple public health systems Enables translation of customized standards into HL 7 3. 0 messaging standard Links clinical and public health systems to provide a continues view of the patient record across the systems involved 11

Q 3. Key principles and lessons learned that could be applied elsewhere u Define the goal: The goal is not to build the data exchanges The goal is to provide information for comprehensive and coordinated care via data exchange u u Understand work processes of stakeholders and how they will be affected by data exchanges that will emerge Define how to involve stakeholders To be informed is not enough Involve them in the development and implementation not just develop for them 12