public health informatics and technology program office office of surveillance, epidemiology, and...
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Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Public Health and Meaningful Use of Health IT
Nikolay Lipskiy, MD, DrPH, MBA
Standards and Interoperability Lead,CDC, Public health Informatics and Technology Program Office (PHITPO)
November 3, 2010
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Purpose
Describe participation of the CDC in development of public health IT meaningful solutions, meaningful use (MU) strategies and objectives in areas of standardization and interoperability
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Background• For decades, CDC has engaged in the development of expertise, information, and tools that
help people and communities protect their health.
• CDC has a strong commitment to support the development and deployment of standard-based public health information systems and for fostering the use and exchange of consistent information among public health partners.
• MU activities became a critical CDC component in further consolidation and improvement of state and national public health systems
• CDC actively participate in development of MU objectives and setting up priorities for population health
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Background (cont.)CDC has established the MU Advisory Group and Sub-Groups for specific topics.
The most important objectives of this Group are: 1. Develop CDC strategies:
•Addressing CDC Director’s priorities, particularly:• Excellence in surveillance, epidemiology, and laboratory
services• Strengthen support for state, tribal, local and territorial
public health• Better prevention of illness, injuries, disease, and death.• Supporting the use of health information technology to
improve the quality of health care, reducing health disparities and improving public health. Increase coordination with community resources.
• Coordinating state and community resources to support national and state bi-directional information exchange
2. Serve as the CDC Point of Contact for Meaningful Use3. Guide communication and coordination across the agency
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Background (cont.)
CDC MU Advisory Group/ Sub-Groups:
The Standards, Interoperability and Certification Sub-group (SIC SG) is charged with implementing of the Advisory Group vision on: a) Assessment and harmonization of Public Health IT standard solutions for meaningful exchange of informationb) Development and implementation of strategies and solutions for testing and certification of electronic public health records
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Meaningful Use: Public Health Opportunities and Potential
ThreatsOpportunities:
1. High visibility and additional attention to informatics
2. Additional resources3. Improvement of care coordination
and additional attention to prevention
4. Improvement of electronic data exchange
5. Potential improvement of interoperability of clinical and population electronic care data exchange
Potential Threats:
1. High interest to included in MU objectives may reduce interest to other important PH priorities
2. Funding challenges for programs that were not included in a scope of MU
3. High interest to MU certification that may reduce interest to PH certification and interoperability
4. Additional challenges in rapid implementation of standards that were not included in MU legislation
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
MU Stage 1 Public Health Objectives and Development of the “One Stop
Shop” for PH Vocabularies and Messaging Guides
Electronic Laboratory Reporting
Immunization Reporting
Syndromic Surveillance
Reporting
The PHIN VADS Vocabulary Team has started CDC-wide collaborative efforts on assessment of vocabulary-related PH capacities for addressing needs of the meaningful use objectives and maintenance and distribution of respective groups of value sets. This task includes but not limited to a gathering of business requirements from CDC programs and our partners, filling out gaps in standard code systems, binding them into structures of HL7 messages etc.
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Syndromic Surveillance Reporting
1. Facility Identifier2. Facility Name3. Facility Location4. Unique Visiting ID5. Visit Date/Time6. Unique Patient Identifier7. Medical Record #8. Age9. Age Units10. Gender11. Zip Code12. State13. County14. Race
15. Ethnicity16. Diagnosis/Injury Code17. Diagnosis Type18. Discharge Disposition19. Disposition Date/Time20. Patient Class21. Chief Complaint/Reason
for Visit22. Temperature23. Pulse Oximetry24. Date of Onset25. Report Date/Time
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Syndromic Surveillance Reporting (cont.)
The Public Health Information Network (PHIN) is in a process of development of the Syndromic Surveillance Reporting Messaging Guide
Sets of Value Sets, VADS Views, will be maintained through the PHIN VADS
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Health IT Standards and Interoperability: Potential Focus
Areas for MU Stages 2-3Data elements
EHR Data Elements/Conte
nt Standards
Public Health Reporting Measures
Quality Measures
Governance of the National
Data Exchange & Data
Exchange Standards
HIT Certification/ PH
Certification
Standards and Interoperability
Framework
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Capturing Additional Data Elements and Adding Content Standards for Public Health
ProgramsCapturing additional behavior risk factors:• drug abuse for patients 13 years old or older • alcohol use for patients 13 years old or older
Reporting laboratory results:Using LOINC codes for reporting tests and SNOMED codes for test results
Reporting family history of diseases (i.e., cancer, diabetes, hypertension, genetic disorders etc.)
Adding to reportable through EHR vital signs:• body temperature
Reporting pregnancy status
Reporting additional demographics:insurance status, current patient residence, patient address history (for 5 past years), country of birth, usual and current occupation, date of death
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Quality Measures: Working on PH MU Objectives for Stages 2-3
* People with CVD, taking Aspirin; Adequate BP control for people with hypertension; Controlling hyperlipidemia among people with high Cholesterol; Smoking cessation
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Analysis of MU Stage 1 Quality Measures
Several critical national public health priorities were not included in Stage 1. For example:
• Prevention of lower respiratory diseases
• Accidents (unintentional injuries)• Teen pregnancy prevention• Smoking cessation
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Quality Measures Workgroup Tiger Teams
•Care Coordination•Efficiency Including Underuse and Overuse•Patient Safety•Patient and Family Engagement•Methodological Issues•Population and Public Health
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Care Coordination Tiger Team’s Tasks and PH Priorities (Example)
Source : David Lansky, Co-Chair QM WG / HIT Policy Committee Presentation October 20, 2010
Incorporate
preventive care
tasks that are
related to PH
objectives
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Tiger Teams’ Population & Public Health Sub-Domains*
Healthy Lifestyle Behaviors—Longitudinal outcome measures of improvement (or lack of improvement) resulting from patient health-related behaviors.
Effective Preventive Services—Longitudinal outcome measures of improvement (or lack of improvement) resulting from the use of preventive health care.
Health Equity—Longitudinal outcome measures that evaluate the quality of health care across priority populations to track and prevent inequities and health care disparities.
* Source : David Lansky, Co-Chair QM WG / HIT Policy Committee Presentation October 20, 2010
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
HITPC Population and PH Tiger Team: Potential Stages 2-3 Candidates for
PH-related Quality Measures
Source : David Lansky, Co-Chair QM WG / HIT Policy Committee Presentation October 20, 2010
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Public Health and Meaningful Use of Health IT
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
The National Standards and Interoperability (S&I) Framework
* Documents of the FACA HIT Standards Committee meeting on 09/21/2010
S&I Mission: *
• Promote a sustainable ecosystem that drives increasing interoperability and standards adoption• Create a collaborative, coordinated, incremental standards process that is led by the industry in solving real
world problems• Leverage “government as a platform” –provide tools, coordination, and harmonization that will support
interested parties as they develop solutions to interoperability and standards adoption.
The ONC S&I Process
Public Health will work on integration of the PH domain into the national S&I Framework :• development of PH use cases• assisting ONC in a harmonization
of PH concepts• Development of implementation
specifications etc.
Public Health Informatics and Technology Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
The NIEM Model and PH Infrastructure
Base S&I Framework modeling on the 3 OMG/MDA model abstractions. •Computational Independent Model (CIM)•Platform Independent Model (PIM)•Platform Specific Model (PSM)
* Source: Documents of the FACA HIT Standards Committee meeting on 09/21/2010