““ let's all work together to give the gift of health to our children and our nation.“...

“ “Let's all work together to give the gift of health

to our children and our nation.“Joseph H. Kanter

Public Health Data Standards Consortium http://www.phdsc.org

“

PUBLIC HEALTH DATA STANDARDS CONSORTIUM~ 2012 BUSINESS MEETING OF MEMBERS ~

November 8-9, 2012, Hyattsville, MD

2012 PHDSC Report

Anna O. Orlova, [email protected]

Executive Director

Public Health Data Standards Consortium

Baltimore, Maryland, USA

2012 PHDSC Report: Outline

Goals

Membership

Revenues

Activities

2012 PHDSC Report

Goals

PHDSC’s Mission

ImprovedHealth Information

Health Data Standards

EnhancedHealth andHealth Care



EnhancedHealth

and Health Care






EnhancedHealth

and Health Care






EnhancedHealth

and Health Care





Health IT Standards

EnhancedPopulation

Health

PHDSC is committed to bring a common

voice from the

public health community

to the national efforts of standardization of

health and healthcare information

Represent public health interests (local, state and federal agencies and research communities) in the standards development, harmonization and maintenance activities by participation in the standard development (SDOs), data content committees (DCCs), standard harmonization entities and other healthcare standardization-related effortsPromote interoperability of health-related data systems to meet the health data needs of public and private organizations, agencies and individuals Educate clinical and public health professionals about standards and systems interoperability, and vendors and clinicians about public healthEnhance membership services

2012 PHDSC Goals

Develop Implementation Strategy for the PHDSC Strategic Plan 2012-2014

We will hear reports from PHDSC Committees on Day 2

Strategic Plan was approved in March 2012

2012 PHDSC Objective

2012 PHDSC Report

Membership

Our Members Federal Agencies

Agencies for Healthcare Research and Quality (AHRQ) Centers for Disease Control and Prevention (CDC) CDC/ National Center for Health Statistics (NCHS) CDC/ National Institute for Occupational Safety & Health

(NIOSH) Health Resources and Services Administration (HRSA) National Library of Medicine (NLM)

Our Members

State and Local Agencies California Office of Statewide Health Planning and

Development Denver Public Health El Paso City Department of Public Health, Texas Minnesota Department of Health Ohio State Department of Health Texas Department of State Health Services Wisconsin Department of Health and Family Services

Our Members Professional Membership Organization

American Immunization Registry Association (AIRA)Association of Public Health Laboratories (APHL)Association of State and Territorial Health Officers

(ASTHO)Council of State and Territorial Epidemiologists (CSTE)National Association for Health Data Organization

(NAHDO)National Association of City and County Health Officers

(NACCHO)North American Association of Central Cancer Registries

(NAACCR)Texas Association of Local Health Officials

Other Professional Organizations Illinois Hospital AssociationKaiser PermanentePublic Health Informatics Institute

Our Members

Our Members

Academic Institutions INSERM (France) Johns Hopkins Bloomberg School of Public Health University of Connecticut Vanderbilt University

Our Members For-profit Organizations

Atlas Public HealthCoto PartnersCognosante (former Fox Systems)Greenway TechnologiesHLN Consulting, LLCOZ SystemsRegistry Widgets, IncScientific Technologies Corporation (STC)Software Partners, LLC

Our Members Organizations – Individual Members

American Health Information Management Association (AHIMA)

Prosocial ApplicationsResearch Triangle Institute (RTI)

2012 PHDSC Membership

2012 PHDSC Membership

Revenues

PHDSC Revenues

Membership Dues Grants Contracts Annual Meetings Services

PHDSC REVENUES: 2004-2012

Year Dues Grants Contracts

Ann. Mtgs Services Total

2004 76K 0 0 2K 0 78K

2005 82K 19K 10K 12K 0 123K

2006 81K 6K 42K 3K 0 132K

2007 115K 63K 44K 3.7K 0 225K

2008 117K 101K 40K 3.4K 0 262K

2009 106K 162K 115K 5K 3.7 392K

2010 125K 277K 0 6K 0 408K

2011 94K 456K 0 6.2K 0 556K

2012 97K 1000K 0 4.6K 0 1102K

2013* 95K 1107K 0 5K 0 1207K

2013* - Projected Revenues

PHDSC Revenues Comparison: 2004 - 2013

$$$

PHDSC Revenues Comparison – 2004-2012

2012 PHDSC Report

Activities


2012 PHDSC Goals

Data StandardsCo-Chairs: Robert Davis & Starla Ledbetter

Health Care Services Data Reporting GuideChair: Robert Davis Payer TypologyCo-Chair: Roxanne Andrews

Privacy, Security & Data SharingCo-Chairs: Vicki Hohner & David Lawton

EHR-PH Task Force & Nationwide Health Information NetworkCo-Chairs: Anna Orlova & David Ross

Communication and OutreachCo-Chairs: Noam Arzt & Sally Klein

Professional EducationCo-Chairs: Anna Bossard & David Lawton

2012 PHDSC Committees


2011 PHDSC Goals

PHDSC Projects on

Assuring Health IT Standards for Public Health

Supported through the CDC Cooperative Agreement.

Business Case: Public Health in HIT Standardization

PHDSC Business Case: HIT Standardization Phases, Products and Entities

HIT Standardizati

on Phases

Needs &

Priorities

Development &

Maintenanc

e

Selection &

Harmonization

Testing/Trial Implementati

on

Certification

Deployment

Goals

What should be

accomplished?

What are the standards?

What standards

to use?

Show what can be

accomplished

Certify standards-

based products

Deploy standards-

based products

HIT Standards and

Interoperability Framework Development

Entities

HIT Policy Committee

HIT Standards Committee

(Formerly AHIC)

SDOs(e.g.,

HL7, SNOMED (IHTSDO), LOINC,

ASC X12,NUBC, ISO

TC215)

IHE

HITSP

ONCStandards &

Interoperability Framework

NwHIN

IHE

Certification Entities(CCHIT,

Drummond Group, Inc)

Proposed

IHE & PHDSC

Deployment Workshops

Standards Documents

Use Cases (Description of the health information exchanges)

Standards

Interoperability Specifications

Technical Frameworks

Integration Profiles

Test Reports

Functional Profiles

Certification Criteria

Deployment Reports

On-going Activities ( 2008-now)

Developed methodology for public health participation in HIT standards development & harmonization.

New Activities (2010-11)Develop methodology for public health participation in HIT product testing and certification

Future ActivitiesDevelop methodology for evaluation of standard-based HIT products (HIT adoption)

Source: Fridsma D. Standards and Interoperability Framework: Principles and Processes. HIT Standards Committee. September 21, 2010. URL: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1817&parentname=CommunityPage&parentid=28&mode=2&in_hi_userid=11673&cached=true


2009 PHDSC HIT Standardization Process is fully aligned with the 2010 ONC S&I Framework

HIT Standardization and PHDSC ProjectsHIT

Standardiza-tion Phases

Needs &

Priorities

Development &

Maintenance

Selection &

Harmonization

Testing /Trial

Implemen-tation

CertificationDeploy-ment

GoalsWhat should be accomplished?


What standards

to use?

Show what can be

accomplished

Certify standards-

based products

Deploy standards-based products

Public Health

Domains Undergoing

HIT Standardiza

-tion

AHIC / MU:Biosurveillance

Immunization

ELR

Public Health Reporting

Newborn Screening

Vital Records

Biosurveillance

Immunization

PH-Lab


Newborn Screening

Vital Records

Biosurveillance

Immunization

PH-Lab


Newborn Screening

Vital Records

Admin DataOccupation

Data

PH-Lab


Hearing

Vital Records

PH-Lab


Hearing

Vital Records

PH-Lab

Hearing

ONCStandards

and Interopera-bility

Framework

PHDSC Projects

HITSP Projects

Public Health

Domains Undergoing

HIT Standardi-

zation

Case Report

Hearing

2008-2010: Implementing the Business Case through

Developing a methodology for Public Health Participation in HIT Standardization Efforts

Educating Public Health Community about Health Informatics and HIT Standards


Supported through the CDC Cooperative Agreement, 2008-now


Implementing PHDSC methodology: Public Health Participation in HIT Standardization Efforts




PHDSC Projects on HIT Standardization


HIT Policy Committee&


Project 1: Assure HIT Standards for Public Health (Business Case: Role of Public Health in National HIT Standardization)

Project 2: PHDSC Participation in Health Data Standards Development for Administrative Data Exchanges

Project 3: Public Health Functional Requirements Project

Project 4: Standards for Early Hearing Detection and Intervention (EHDI) Program

Project 5: Standards for Public Health Laboratory (PH-Lab) Data Exchange

Project 6: Clinical Document Architecture (CDA) for Public Health

Project 7: Knowledgebase for ONC S&I Public Health Reporting Initiative

Project 8: Business Process Analysis for Local Health Departments

Project 9: University-based Public Health Informatics Training

PHDSC Projects: 2011-2012Assuring Health IT Standards for Public Health

Project 1: Assure HIT Standards for Public Health (Business Case: Role of Public Health in National HIT Standardization)

Project 2: PHDSC Participation in Health Data Standards Development for Administrative Data Exchanges

Project 3: Public Health Functional Requirements Project

Project 4: Standards for Early Hearing Detection and Intervention (EHDI) Program

Project 5: Standards for Public Health Laboratory (PH-Lab) Data Exchange and Case Reporting

Project 6: University-based Public Health Informatics Training

PHDSC Projects: 2012-2013Assuring Health IT Standards for Public Health

Supported through the CDC Cooperative Agreement.

Business Case: Public Health in HIT Standardization

Implementing PHDSC Methodology on

HIT Standardization for Public Health

Phase 1: Defining Needs and Priorities for

HIT Standards for Public Health


United States

ONC S&I Public Health Reporting Initiative – Community-based Initiative Started in July 2011

International

WHO Initiative of Health Data Standardization

PHDSC and National & International Initiatives:Assuring Health IT Standards for Public Health



Phase 2: Developing



On-going Projects - Data Standards Committee Participate in standards development activities:

Maintain the Health Care Service: Data Reporting Guide.

Collaborate with AHRQ and ANSI X12 to populate USHIK with All Payer Claims Database metadata

Develop data standards harmonization GAP ASSIST on-line tool

Assure the inclusion of more clinical content in the standards to accommodate changes in billing practices to pay for quality rather than just for procedures performed – IHE White Paper on Populating Admin Datasets from EHR


On-going Projects - EHR-PH Task Force & NHIN Committee

Public Health Functional Profile of the HL7 EHR-S Functional Model Release 2 that includes

Vital Record Early Hearing Detection & Intervention (EHDI) Cancer Public Health Laboratory Birth Defects Occupational Health Adverse Event Reporting

HL7 Public Health Reporting Requirements Standard




Phase 3: Harmonizing



On-going Projects - NHIN Committee

Public Health Reporting Integration Profile Content Profiles:

Early Hearing Detection and Intervention (EHDI) Early Hearing Care Plan (EHCP) Quality Measure Execution (QME) – EHDI Cross Document Workflow - EHDI

Public Health Laboratories Cross Document Sharing – Lab Reports (XD-Lab)

Occupational Data for Health (ODH) Harmonization for data standards for ODH




Phase 4: Testing




Develop HIT Testing Methods and Tools for Public Health

Vital Records Early Hearing Detection & Intervention (EHDI) Public Health Laboratory


EHR-Public Health Interoperability Showcase Vital Record Early Hearing Detection & Intervention (EHDI) Public Health Case Reporting/Alerting

Lab Reports Case Reports


Interoperability Showcase™



Phase 5: Certifying

Standards-based HIT Solutions for

Public Health



Establish HIT Certification process for EHR data exchanges with Public Health using HL7 Public Health Functional Profile for

Early Hearing Detection & Intervention (EHDI) Public Health Laboratory




Phase 6: Deploying

Standards-based HIT Solutions in

Public Health



Conduct pilot projects on using Clinical Document Architecture (CDA) standards for public health reporting

Public Health Case Reporting Early Hearing Detection & Intervention (EHDI)


Stage I – Use HL7 CDA documents

Clinical EHRs

Stage I – Use HL7 v2.3.1 or v2.5.1 messages to electronically record, modify, retrieve, submit public health data

Syndromic Surveillance – use v2.3.1 or v2.5.1

Laboratory Results Reporting to Public Health – use v2.5.1

Reporting to Immunization Registries - use v2.3.1 or v2.5.1

Stage II – Use HL7 CDA documents

Reporting to State Cancer Registries

Reporting of Early Hearing Detection and Intervention (EHDI) Quality Measures to Public Health

HL7 Standards in Meaningful Use of HIT

CDA R2 2005

CDA R2 2005

CDA for PH Project: History of HL7

Source: Renly S, Krueger J. What’s Next? Why HL7 Messages and HL7 CDA Documents are in our Future. Presentation at the CDC PHIN Vocabulary and Messaging Community of Practice, February 21, 2012

Sarah Quaynor

I'm not understanding the relevance of this level of detail about the HL7 organizaton. I would think the history of standards use in PH Reporting would be more relevant

URL: http://www.ringholm.de/docs/04200_en.htm

They are the Continuity Care Record (CCD) standard and Clinical Document

Architecture (CDA) standards

They represent information in documents (i.e., forms)

Used “post occurrence”, i.e. once the actual process is done to provide

"snapshots" at a particular time

Contain data “as it was” when the document was originally created

Capture information and allow it to be shared

Can be superseded and corrected, but are "static documents" rather than

dynamic objects

The more passive and loosely coupled your communication process is, the

more the use of documents is applicable.

HL7 Document-based Standards: CCD/CDA

Source: Renly S, Krueger J. What’s Next? Why HL7 Messages and HL7 CDA Documents are in our Future. Presentation at the CDC PHIN Vocabulary and Messaging Community of Practice, February 21, 2012

CDA Test Result Report XML Schema

…<component> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.31"/> <id root="8b3fa370-67a5-11db-bd13-

0800200c9a66"/> <code code="33765-9"

codeSystem="2.16.840.1.113883.6.1" displayName="WBC"/>

<statusCode code="completed"/> <effectiveTime value="200003231430"/> <value xsi:type="PQ" value="6.7" unit="10+3/ul"/> <interpretationCode code="N"

codeSystem="2.16.840.1.113883.5.83"/> </observation></component>…

HL7 CDA Standard

CDA Test Result Report Human Readable

CDA for Public Health Reporting Pilot Projects

Communicable Diseases (November 2011 - May 2012)

Early Hearing Detection and Intervention(August 2012 – January 2013)

CDA for Public Health Reporting

Goal

Demonstrate ability to receive a CDA-based Public Health Case Report by a Public Health Information Systems in two jurisdictions

CDA for PH Pilot Project: Case Reporting

Header

Social History Section

Clinical Information Section

Treatment Information Section

Encounters Section

Relevant Diagnostics and Laboratory Section

Immunizations Section

HL7 CDA Standards for Public Health Case Report

Public Health Reporting Schema: DELAWARE

ProviderEHR(Core

CX360)

CDA TB

Case Report

Delaware PH Communication Server/Router

(Orion Rhapsody)

CDA TB

Case Report

Delaware Electronic Reporting

Surveillance System

(DERSS)

CDA-based Actor Diagram


CDA for Public Health Reporting

Pilot Project Communicable Diseases Early Hearing Detection & Intervention

States Participants

DE, NYS, San-Diego Co MD, MI, ND, OR, RI

State Observers CT, MA, MI, OK, SC, WA, OH FL, MA, MO,OH, PA, SC, TX

Reports TB, Pertussis Newborn Hearing Screening

Vendors AllScript (test harness)Atlas Public Health CoreSolutionsOz SystemsDE PH Communication RouterNYS UPHN

To be determined

Timeline Nov 2011 – May 2012 Aug 2012 – January 2013

CDA Pilot Project Documentation:1. PHDSC. Clinical Document Architecture (CDA) for Public Health. CDA

Pilot Project: Communicable Diseases. Report. October 2012. URL: https://wiki.phdsc.org/images/f/f1/PHDSC-CDA-for-PH-Pilot-Report-FINAL-10-12-12.pdf

2. CDA for Public Health Pilot Project: Communicable Diseases PHDSC-IBM CDC Press Release. URL: http://www-03.ibm.com/press/us/en/pressrelease/38602.wss

3. CDA for Public Health Pilot Project: Communicable Diseases Forbes on NYS Pilot. URL: http://www.forbes.com/sites/amywestervelt/2012/08/27/could-technology-help-stem-the-spread-of-whooping-cough/

4. CDA for Public Health Pilot Project: Communicable Diseases wiki pages – URL: https://wiki.phdsc.org/index.php/CDA

5. CDA EHDI Pilot Project wiki pages. URL:https://wiki.phdsc.org/index.php/EHDI

PHDSC CDA for Public Health Pilot Project



Tools for

Standards-based HIT Solutions in

Public Health


URL: https://www.projects.openhealthtools.org/sf/projects/mdht

Open Source Model Driven Health Tool - MDHT

Building CDA Public Health Reports (Templates)

Sarah Quaynor

I think it'd be better to have high level bullet points describing what MDHT project represents

Model Driven Health Tool - MDHT

The MDHT automatically generates the CDA templates, validation is built-in.

Building CDA Public Health Reports in MDHT

MDHT Library of Public HealthReports

CDA PH Case Report Templates for Selected Conditions

1.Anthrax 2.Chlamydia trachomatis genital infection (& Gonorrhea, Syphilis) 3.Coccidioidomycosis 4.Haemophilus Influenzae, invasive disease, all ages, serotypes 5.Hepatitis B, Acute (& Hepatitis C) 6.Influenza 7.Meningococcal disease, all serogroups 8.Pertussis 9.Silicosis 10.Salmonellosis (& Shigella) 11.Streptococcus pneumoniae, invasive disease 12.Toxic-shock syndrome 13.Tuberculosis 14.Tularemia 15.West Nile virus (& Lyme)

Building CDA Public Health Reports in MDHT

CDA Public Health Case Reports https://wiki.phdsc.org/index.php/PH-Lab

Header Social History Section Clinical Information Section Treatment Information Section Encounters Section Relevant Diagnostics and Laboratory

Section Immunizations Section

Example:Case Report Documentation: Pertussis Case Reports Pertussis - Data Definitions xls Pertussis - Implementation Guide pdf Pertussis - Case Report 1 (XML File) (JPG Image) 12-05/10 Pertussis - Case Report 2 w/Labs (XML File) (JPG Image) 12-05/10


PHDSC Business Case: HIT Standardization Phases, Products and Entities

HIT Standardizati

on Phases

Needs &

Priorities

Development &

Maintenanc

e

Selection &

Harmonization

Testing/Trial Implementati

on

Certification

Deployment

Goals

What should be

accomplished?


What standards

to use?

Show what can be

accomplished

Certify standards-

based products

Deploy standards-

based products

HIT Standards and

Interoperability Framework Development

Entities

HIT Policy Committee


(Formerly AHIC)

SDOs(e.g.,

HL7, SNOMED (IHTSDO), LOINC,

ASC X12,NUBC, ISO

TC215)

IHE

HITSP

ONCStandards &

Interoperability Framework

NwHIN

IHE

Certification Entities(CCHIT,

Drummond Group, Inc)

Proposed

IHE & PHDSC

Deployment Workshops

Standards Documents

Use Cases (Description of the health information exchanges)

Standards

Interoperability Specifications

Technical Frameworks

Integration Profiles

Test Reports

Functional Profiles

Certification Criteria

Deployment Reports

On-going Activities ( 2008-now)

Developed methodology for public health participation in HIT standards development & harmonization.

New Activities (2010-11)Develop methodology for public health participation in HIT product testing and certification

Future ActivitiesDevelop methodology for evaluation of standard-based HIT products (HIT adoption)

HIT Standardization and PHDSC ProjectsHIT

Standardiza-tion Phases

Needs &

Priorities

Development &

Maintenance

Selection &

Harmonization

Testing /Trial

Implemen-tation

CertificationDeploy-ment

GoalsWhat should be accomplished?


What standards

to use?

Show what can be

accomplished

Certify standards-

based products

Deploy standards-based products

Public Health

Domains Undergoing

HIT Standardiza

-tion

AHIC / MU:Biosurveillance

Immunization

ELR


Newborn Screening

Vital Records

Biosurveillance

Immunization

PH-Lab


Newborn Screening

Vital Records

Biosurveillance

Immunization

PH-Lab


Newborn Screening

Vital Records

Admin DataOccupation

Data

PH-Lab


Hearing

Vital Records

PH-Lab


Hearing

Vital Records

PH-Lab

Hearing

ONCStandards

and Interopera-bility

Framework

PHDSC Projects

HITSP Projects

Public Health

Domains Undergoing

HIT Standardi-

zation

Case Report

Hearing


Implementing PHDSC methodology: Public Health Participation in HIT Standardization Efforts




Health Information Technology Standards Web-Resource Center (http://www.phdsc.org/standards/resource-center.asp)

PHDSC Webinars: HIT Standards for Early Hearing Detection and Intervention Re-evaluation of HL7 EHR-S Functional Model from Public Health Perspectives

University-based Health Informatics Training in partnership with Johns Hopkins University

Educate Public Health and Clinical Professionals about HIT Standards

PHDSC Health Information Technology Standards Web-Resource Center(http://www.phdsc.org/standards/resource-center.asp)

Building Public Health Informatics at Hopkins

PHDSC works with Johns Hopkins to develop and deliver the following training:

Clinical Informatics Certificate Public Health Informatics Certificate Applied Health Informatics Certificate Applied Master Degree in Health Informatics Master of Health Sciences Informatics – Research

URL: http://dhsi.med.jhmi.edu/node/64


2012 PHDSC Goals

Strengthening partnerships with member organizations

Participate in Joint Public Health Informatics Task Force (JPHIT) Collaborate with PHDSC members in HIT Standardization Projects:

Agency for Healthcare Research and Quality Association of Public Health Laboratories (APHL) Atlas Public Health Centers for Disease Control & Prevention (NCHS, NCBDDD, OSELS, NIOSH) Council for State and Territorial Epidemiologists (CSTE) HLN Consulting National Association of City and County Health Officials (NACCHO) OZ Systems Registry Widgets

Enhancing Membership Services

PHDSC Web-based Resources PHDSC Quarterly Standard e-Newsletter (http://www.phdsc.org/about/communications-outreach_products.asp)

Projects Wiki Pages

Updates on Key Initiatives on HIT Standards via e-mail broadcast

Develop new marketing strategies via social media outlets (blogs, twitter, facebook and others)

Enhancing Membership Services

PHDSC in the News

Anna Orlova, PhD, Executive Director, [email protected] Alla Fridman, Project Manager, [email protected]

111 South Calvert Street Suite 2700 Baltimore MD 21202Phone: 410-385-5272 Fax: 866-637-6526 URL: www.phdsc.org

Get Involved!