dean lampman, mpa, dtm

Tarrant County Voices for Health

What changes will occur over the next 10 years impacting the local

economy?

Dean Lampman, MPA, DTM Regional Surveillance Coordinator

Southwest Center for Advanced Public Health Practice (APC) Tarrant County Public Health

Technological Forces of Change: The Ascendance of Health Informatics

Prepared and presented by

Dean Lampman, MBA, DTM

October 31, 2012 2

Agenda

3

What is biosurveillance?

Meaningful use & heath information

exchanges: an overview

MU & HIEs: opportunities & threats

A call to action

Technological Forces: The Ascendance of Health Informatics

Biosurveillance

4

• Captures healthcare data

• Best if it’s in near real-time

• Algorithms used to classify data

• Free text and/or ICD9 codes

• Cast in syndromes and medical subgroups

• Analyzes all categories for anomalies

• Temporal or spatial / check vs. expected values

• Automated reports, alerts for anomalies

Technological Forces: The Ascendance of Health Informatics

Benefits

Technological Forces: The Ascendance of Health Informatics 5

• Yield recognition (via alerts) of:

• Symptoms w/ unusual / unexpected event

• Unexpected # of illnesses, syndromes

• Illness or syndromes in an unusual population

• Eases collaboration and problem solving

Window of opportunity

• Initial detection (identify event rapidly)

• Quantification (how many folks are ill?)

• Localization (where is the event happening?)

• Investigation (demographics, etiology, conveyance)

• Subsequent detection (identify more cases)

• Outbreak management (confirm, track cases)

• Countermeasures (isolation, vaccination)

• Target (illness, deaths recede)


Scope of North Texas network

• Connected nearly 60 hospitals in 49-county region

– All Tarrant County acute-care facilities

• Near real-time automated EMS data

– Data from 40K transports annually

• OTC medication data analyzed

– From 90 percent of pharmacies

• School health surveillance portal

• Law enforcement / first responder alerting system


People and organizations who:

• Share resources effectively, efficiently

• Achieve separate but related solutions

• Partners, resources, practices

Public heath community of practice


Issues we continuously address:

1. Data types [< or = meaningful use]

2. Technical standards for connection

3. Data quality, accessibility

4. Response protocols

5. Cost-effectiveness

6. Scalability, replicabilty

7. A community of practice

What the work requires


“It’s not rocket science … but it’s not trivial.”

Agenda





A call to action

11 Technological Forces: The Ascendance of Health Informatics

Meaningful use overview

• Laws offer $17 billion for EHR incentives

– Established via HITECH Act (2009)

– Administered by CMS

• References three criteria stages:


Achieving meaningful use

Must

• Be Eligible Professional (EP) or a critical access hospital

• Use certified electronic health record (EHR)

• Meet criteria for incentives in each stage

Cumulative (5 yr) incentive for EPs:

• $44,000 under Medicare

• $63,750 under Medicaid


Data capture, sharing

Electronic capture of health information

Communicate info for care coordination

Implement clinical decision support tools • Ease disease, medication management

• Use EHRs to engage patients, families

Report public health information

Report clinical quality measures


Options for public health sharing

Opt. 1: Submit data to

immunization registry

Opt. 2: Submit syndromic

surveillance data

Goal: improve population, public health

Method: Communicate w/ PH agencies

Measure: Perform 1 test to show capability to

submit data, if public health can take it.


Stage 1 MU data elements

1. Facility identifier

2. Facility / visit type

3. Report date / time

4. Unique patient ID

5. Unique visiting ID

6. Diagnosis type

7. Age

8. Age units

9. Gender

10. Zip Code

11. County

12. Race

13. Ethnicity

14. Visit date / time

15. Chief Complaint

16. Diagnosis / injury cause code

17. Discharge disposition


Health information exchanges


HIEs can run on either a public or private cloud or private network

In HIEs, health data can flow in a complex array of directions and authorized users can gather and use it in many ways

Other data providers

Agenda





A call to action


Providers

efficiency

info access

collaboration


Opportunities Threats

costs

accountability

competition

“The EHR has decreased the time ancillary staff spends on issues that

used to involve paper and increased the time the physician spends on

the same issues … it is, so far, a money-losing proposition.”

-- Ted Wojno, MD, Emory Clinic

Public health

relevance

info access

collaboration



expectations

accountability

costs

“The ability to monitor [laboratory] test orders could be one of the

earliest indicators of a change in health conditions or as means to

detect outbreaks of new disease.”

-- Steven Hinrichs, Nebraska Health Dept.

Consumers

info access

choices

convenience



accountability

costs & taxes

data privacy

“We can't successfully implement [healthcare] reforms without an

underlying healthcare IT infrastructure to connect our fragmented

system and report on how providers are performing.”

-- Consumer Partnership for eHealth

Agenda





A call to action


Call to action


Stay informed

Get involved

Protect your health

Talk to your doctor

“This [meaningful use] will translate

to the kind of better provider-patient

relationships and more patient-

centered care that providers and

patients both want.”

Consumer Partnership for eHealth

Technological Forces of Change: The Ascendance of Health Informatics

Prepared and presented by

Dean Lampman, MBA, DTM

October 31, 2012 24

dean lampman, mpa, dtm

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