enhancing public health surveillance - global health … · enhancing public health surveillance....

Enhancing Public Health Surveillance

Possible Roles of Health Information Technology and

Exchange

Key Task

Develop a sustainable business model(s) for public health collaboration with HIE’s and/or the medical community.

HIE – A Major Activity

• A five-year, thirty-eight million dollar effort in three areas – WA/ID, IN, NY

• Initiated in February 08

• Coordinators– WA/ID – SAIC– IN – Regenstrief Institute– NY• Health Research Inc.• NYSDOH• NYCDOHMH

Superb Attributes for Team Success

• WA/ID– Technical expertise– Government experience – CDC and NHIN

• IN– Thirty years of HIE experience– Internationally renowned research center

• NY– Significant state funding for statewide HIE– State and local HD’s

• Public health informatics, IT and epidemiology

HIE – Key Deliverables

Minimum Biosurveillance Data Set (MBDS)*

– Expand geographic coverage

– Increase number of data elements

– Assess utility and feasibility

MDS Category # Examples:

Base Facility Elements 5 Facility: Identifier, Name, Location, # of

Facility Beds, # Licensed Beds

Daily Facility Summary Report 18

Admissions, Discharges, and Deaths in last 24 hours, Facility Status, Staffing, Ventilators

Patient Data Elements 10 DOB, Age, Gender, Zip Code, State, and

Event Date/TimeClinical Data Elements 10 Diagnosis/injury code, Chief Complaint,

TemperatureLaboratory & Infectious Disease Test Orders

3 Order Number, Test/Procedure Name and Test/Procedure Code

Laboratory & Infectious Disease Results

12 Performing Lab, Specimen Source, Results

Minimum Biosurveillance Data Set


Minimum Biosurveillance Data Set (MBDS)

Bidirectional communication*

Bidirectional Communication

LocalHD

StateHD

HIE MedicalCommunity1

Hospitals, Labs, Clinics and Others Relay Data

CDC


LocalHD

StateHD

HIE MedicalCommunity

Manage Data to Support Medical Community Needs

CDC

2

1


LocalHD

StateHD

MedicalCommunity

Relay Information That State and Local HD’s Desire

CDC 3HIE2

1


* Geocoded Interoperable Population Summary Exchange

LocalHD

StateHD


State HD Sends Information to CDC in GIPSE* Format

CDC24

1

3

Initiate AlertsRequest Additional Information Beyond GIPSE


LocalHD

StateHD


CDC2

5

1

4 3


LocalHD

StateHD


CDC23

5

1

4

6

6

AlertingRequest Detailed Patient Information


LocalHD

StateHD


CDC23

5

1

4

6

67

AlertingEnhanced HAN


Enhance case reportingAutomated case detection and reportingNatural language processing for ELR

LocalHD

StateHD


CDC23

5

1

4

6

67

8


• Minimum Biosurveillance Data Set (MBDS)

• Bidirectional communication

• Case Reporting

• Translation

– Business process

– Technology innovations

– Partnership strategies

Public Health Perspectives Possible Scenarios

• Robust HIE/Robust Health Department– Northwest Public Health Information

Exchange - biosurveillance

NW Public Health Information ExchangeNW Public Health Information Exchange

OR ID

WA

19

Self-sustaining non-profit Health Information Exchange

Connects 36 primarily independent hospitals in Eastern Washington and Northern Idaho

75% of hospitals in Eastern Washington80% of hospitals in Northern Idaho100% of hospitals in Spokane

Consolidated EHR across all hospitals

Also provides an EMR to 98 independent physician clinics

Seamlessly Connecting Clinical Care and Public Health

• Filtering Electronic Health Records (EHRs) for public health– Syndromic surveillance– Electronic laboratory

reporting– Case reporting– Hospital acquired infections– Health alerts

• Using NHIN standards to convey clinical information to public health

Supporting Automated Clinical Care and Public Health Information Sharing

Health Information Exchange

Public Health

Alerts

Summary Data

CaseReporting

LabReporting

CaseNotification

Biosurveillance

Patient Encounters sent to HIE

CreateBiosurveillance

Records

BiosurveillanceData

CO

NN

EC

T GA

TEW

AY

CO

NN

EC

T GA

TEW

AY

CO

NN

EC

T GA

TEW

AY

CO

NN

EC

T GA

TEW

AY

Biosurveillance

NationalBiosurveillance

AnalyticsPublic Health

DecisionSupport

Public Health Alerts

Healthcare Facility

StateAnalytics

Increase in Patient Encounter Coverage

2009 Q3

2008 Q4

Timeliness of Influenza Surveillance Data

Study performed by Washington State Department of Health

Influenza Surveillance Data Feed Conclusions

• NWPHIE data accurately reflects trends in ILI activity as compared to hospitalized and fatal lab-confirmed influenza cases in eastern Washington

• NWPHIE is well suited to monitor trends at the state level and community levels

• NWPHIE data is resistant to changes in workload levels and seasonal fluctuations

• NWPHIE data is more timely than ILINet provider data and traditional notifiable disease reporting


• Robust HIE/Robust Health Department– Northwest Public Health Information

Exchange - biosurveillance– Indiana Public Health/HIE collaborative –

bidirectional communication


Situational Awareness – Three Missions– Recognition of an Emergent Threat– Raise Awareness of Threat– Action in Response to Threat

Initial QuestionHow can health information exchange

(HIE) facilitate efficient and effective dissemination of information to clinicians that keeps them informed of public health threats in their communities?

DOCS4DOCS® (D4D)

Delivers laboratory and other clinical messages from one organization to the patient’s responsible provider (PCP)– Managed by the Indiana Health Information

Exchange

Delivered in three formatsFaxElectronic inbox (Web-based application)Integration with the Electronic Health Record (EHR) system

6 million messages each month to 13,000+ Database routinely updated

Results Delivery – An Illustration

Expanding D4D to Support Public Health

• Marion County Health Department (MCHD) partnered with Regenstrief and IHIE to notify physicians of important, emergent situations involving public health threats– Salmonella exposure at local restaurant

• System went live in May 2009– Utilized several times for H1N1 updates

Hospitals, IDNs

Health Information Exchange

IN

Physician Practice

Generate H1N1 Alert

Bidirectional Communication Methods

• Clinical messaging is a “push” technology– Message authored by Public Health entity– Message integrated into clinical workflow using

established systems and processes for communication

• Other methods to support bidirectional communication– Case Reporting – Pre-populate notifiable

condition reports with HIE data to increase rate of “spontaneous” reporting

– Decision Support


• Robust HIE/Robust Health Department

• Developing HIE/Robust Health Department– New York Public Health/HIE collaborative

Members of the NY Team

• Public Health Organizations– New York State Department of Health– New York City Department of Health and Mental Hygiene– New York State Association of County Health Officials

• Regional Health Information Organization Partners

– Bronx (Bx) RHIO– Brooklyn RHIO (BHIE)– New York Clinical Information Exchange (NYCLIX)– THINC RHIO, Inc.– Western NY Healthelink (WNYCIE)– Long Island Patient Information eXchange (LIPIX)

34

Data Exchange

Data Exchange

Data Visualization

Data Visualization

Direct Data Reporting

Direct Data Reporting

Universal Public Health Node (UPHN)

Statewide Health Information Network for New York (SHIN-NY)

……..

Universal Public Health Node (UPHN)

• Allows Public Health to function as a node on the Statewide Health Information Network (SHIN-NY)

• Participating RHIOs interface with the UPHN following common specifications as a standard, publishable interface

• Four primary functions will be initially developed to facilitate the data exchange between Public Health and a RHIO

Universal Public Health Node Functions

Patient Query “Find” and “Get” data from HIEs for a specific individual based on query parameters

Line List Query Request and receive patient-level data for a specific disease condition in a patient/case line list format.

Anonymize & Re-Identify

Ability to transmit MDS line list data to public health with a “pseudonymized” linker and the ability to re-identify patient data back to a specific person for epidemiologic follow-up

Analytic Query Analytic (aggregation/ summarization) queries based on pre-defined list of disease conditions and transmit counts to public health on both a scheduled and ad-hoc basis



• Developing HIE/Robust Health Department– New York Public Health/HIE collaborative

• Now, what if all of the HIE’s/RHIO’s in NY were in a developing phase? The UPHN could capture data directly from health care facilities with EMR’s.



• Developing HIE/Robust Health Department

• Developing HIE/Developing* Health Department

*Developing Health Department = Further infrastructure development needed for some surveillance activities.

Developing HIE and Health Department

• Can we conceive a possible methodology that would enable these jurisdictions to have a functional surveillance effort pending further development?

715 facilities available to provide data across 47 states32 state and 32 city/county health department can access and view data

Flu Pandemic InitiativeJanuary, 2010 – One Activity

Flu Pandemic InitiativeOptimal Coverage – One Activity

More than 1100 facilities available to provide data

Developing HIE and Health Department

• Can we conceive a possible methodology that would enable these jurisdictions to have a functional surveillance effort pending further development?

• Yes, it appears there are several possible ways to support these areas and facilitate enhanced national surveillance.

Some Final Thoughts

• Optimism• Vigilance• Industry• Perseverance

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