Download 2010 PHDSC EHR-PH Task Force Practice of Public

Public Health Data Standards Consortium
http://www.phdsc.org
The Consortium is a unique entity made up of federal, state
and local agencies, professional associations, academia, health
IT vendors and individuals that collectively represent the
interests of public health in the health IT standardization.
PHDSC Ad Hoc Task Force on
Electronic Health Record-Public Health
(EHR-PH)
http://www.phdsc.org/health_info/ehr-task-force.asp
2004 PHDSC EHR-PH Task Force
Goal: To provide a public health perspective to the
evaluation of the HL7 EHR-S Functional Model
Objectives:
■ Bring the state and local public health agencies and
public health research community’s perspectives into
the on-going efforts to develop the HL7 Functional
Model for the EHR-S
■ Demonstrate the benefits of an organized interaction
between the public health and clinical health care
2004 PHDSC EHR-PH Task Force
WHITE PAPER
“Electronic Health Record: Public Health Perspectives”
http://www.phdsc.org/health_info/pdfs/PHDSC_EHRPH_WhitePaper2004.pdf
Purpose:
■ To communicate to the public health community a need for
broader involvement in the national effort to standardize
clinical and public health data and information systems
■ To describe public health perspectives on the EHR
2010 PHDSC EHR-PH Task Force
Re-evaluation of HL7 EHR-S FM V1.1 from
Public Health Perspectives
Supported by the National Center for Health Statistics (NCHS)
Centers for Disease Control and Prevention (CDC)
Grant No. 5U38HM000455-02
2010 PHDSC EHR-PH Task Force
Project Objective:
Conduct re-evaluation of HL7 EHR-S FM
Release 1.1 to identify necessary functionality
for public health reporting and information
sharing across clinical EHR-S and public health
information systems
Re-evaluation of HL7 EHR-S FM from PH Perspectives
Why Now?
■ HL7 EHR-S FM has undergone a series of enhancements
■ Public Health better positioned itself at HL7 by
 Participation in Public Health and Emergency Response
Work Group (PHER WG)
 Participation in HL7/ONC/EHR Biosurveillance Use Case
Alignment Project
■ Public Health has been involved in the national HIT
standardization efforts at HITSP, IHE and other initiatives
■“Meaningful use of EHR-S” warrants meaningful use of public
health information systems
■ CDC/NCHS contract with PHDSC
2010 PHDSC EHR-PH Task Force
Participants:
 93 members joined the Task Force

50% increase in comparison with 2004 EHR-S FM
evaluation with 63 members
Limitations:
 All public health domains are not represented
2010 PHDSC EHR-PH Task Force
Participants Affiliation*
Stakeholders
Number of Participants
Local Public Health
12
State Public Health
25
Federal Agencies
Professional Associations
25 (CDC=22, VA=1, NIST=1, FDA=1)
4 (PHDSC, NAPHIT, AHIMA)
Academia
4
Payor
2
Clinicians
1
IT vendors
19 (EHR=4, PH=15)
Total
92
*We were unable to specify stakeholder category for 1 participant.
2010 PHDSC EHR-PH Task Force
Public Health Participant Jurisdictions:

Public health participants range from local and
state health departments in 17 states as follows:
AK
CA
CO
DE
IL
KY
MA
MI
MN
NC
NE
NY
OH
OR
SD
TN
TX
2010 PHDSC EHR-PH Task Force
Domain/Stakeholder Representation*,**
Domain
Number of Participants
Communicable Diseases
13
Chronic Diseases (including Cancer)
11
Immunization
9
Vital Records
9
Environmental Health
1
Public Health Informatics
24
IT, HIT Standards, HIM, EMR, EHR
38
Law (including HIPAA)
2
Primary Care
3
Behavioral & Occupational Health
2
Birth Defects
1
*Participants may have expertise in several domains.
**Several participants did not specify their area of expertise.
2010 PHDSC EHR-PH Task Force
Participants have sufficient expertise for evaluating
domains included in the Meaningful Use of Health IT
Electronic Reporting from EHR-S to Public Health on:

Communicable diseases (N=13)

Immunizations (N=9)

Biosurveillance (N= 24)

Communicable and chronic disease surveillance based
on ASTHO definition
Plus expertise in:




Chronic diseases (11)
Vital records (9)
Information Technology (38)
Public Health Informatics (24)
2010 PHDSC EHR-PH Task Force
Timeline
Methodology
12/20091/2009
Recruit participants for the HL7 EHR FM Re-evaluation
1/14/10
Re-launch the PHDSC Ad Hoc Task Force on EHR-PH
3/30/10
Solicit feedback on the Model from Task Force Participants
5/14/10
Build an agreement among participants on proposed
revisions/additions
5/22/10
Present proposed revisions/additions to the HL7 EHR SWAT
team for inclusion in the ballot
5/31/10
Generate Recommendation Report document
9/2009
1/2010
5/2010
Present project updates at the HL7 Working Group Meetings
5/26/10
Deliver a webinar for a public health community
2010 PHDSC EHR-PH Task Force
Participation Process
Reviewed sections of
the EHR-S FM
Submitted revisions
to the Project Team
via e-mail using
Excel spreadsheet
Received
spreadsheet with
proposed revisions
prior calls
Review revision
resolution outcomes
Participated in the
revisions resolution
with the HL7 EHR
SWAT Team
Reviewed proposed
revisions during the
calls
Work with the HL7
EHR WG to
incorporate proposed
revisions in the HL7
EHR-S FM R2 ballot
2010 PHDSC EHR-PH Task Force
Comments
HL7 EHR-S Functional Model
Care Management
DC.2
Clinical Decision Support
DC.3
Operations Management and Communication
Supportive
S.1
Clinical Support
S.2
Measurement, Analysis, Research and Reports
S.3
Administrative and Financial
IN.1
Security
IN.2
Health Record Information and Management
IN.3
Registry and Directory Services
IN.4
Standard Terminologies & Terminology Services
IN.5
Standards-based Interoperability
IN.6
Business Rules Management
IN.7
Workflow Management
Information
Infrastructure
Direct Care
DC.1
Source: HL7 EHR-S FM Overview
CDC PHDSC HL7 EHR-S FM
Evaluation
17
HL7 EHR-S Functional Model

ID
Layout of the FM:
 Functional Identification
 Function Type
 Functional Name
 Functional Statement
 Functional Description
 “See also” column
 Conformance Criteria
Type
Name
Statement
(Normative)
(Normative)
Number
Description
See Also
Conformance
Criteria
HL7 EHR-S Functional Model
ID
Type
Name
Statement
Description
DC.1.5
F
Manage
problem list
Create and maintain
patient-specific
problem list
A problem list may include, but is
not limited to: Chronic conditions,
diagnoses, or symptoms, functional
limitations, visit or stay-specific
conditions, diagnoses, or symptoms.
Problem lists are managed over
time, whether over the course of a
visit or stay…
See Also
Conformance Criteria
IN.2.5.1
IN.2.5.2
1. The system SHALL display all active problems associated with a patient.
2. The system SHALL create a history of all problems associated with a patient.
3. The system SHALL retrieve a history of all problems associated with a
patient.
4. The system SHALL provide a user interface to deactivate a problem.
5. The system MAY provide the ability to re-activate a previously deactivated
problem.
6. …
Source: HL7 EHR-S FM Direct Care Chapter
CDC PHDSC HL7 EHR-S FM
Evaluation
19
2010 PHDSC EHR-PH Task Force
Evaluation Outcomes:
HL7 EHR-S FM
Functions
Categories
Total
Comments
Received
Newly
Proposed
Conformance
Criteria
Comments Resolution
Outcomes
(Accepted / Rejected)
Direct Care
259
15
155 / 0
Supportive
13
1
13 / 0
Infrastructure
12
0
12 / 0
TOTAL
284
16
284
2010 PHDSC EHR-PH Task Force
Comments Examples
Direct Care Comments
Section
New- Facility
Demographics
DC.1 Care
Management
Recommendation
comments
Add Country, province, address
elements
4
Capture mode of transport (e.g.
airplane birth)
Capture information surrounding
incident (e.g. trauma, foodborne
illness, communicable disease)
Care communications to/from
public health (e.g. alerts)
1
MAY…SHALL Existing
infrastructure support
3
1
2
Direct Care Comments
Section
Recommendation
#
DC.1.1
MAY…SHOULD provide ability to store/reference imaged documents
Record
-data SHOULD be captured using standardized code sets or nomenclature
management -provide the ability to store/reference imaged documents
3
MAY…SHALL provide the ability to receive, store and present text-based
externally-sourced documents and reports
-ability to receive/store/present text-based externally-sourced docs/reports
2
SHOULD…SHALL provide the ability to request correction of the
administrative or financial data
1
Defer elevate in domain-specific profiles; covered in the externally sourced
information; To be covered by Data Profiles; not universal need
9
NEW: Lab Orders SHOULD contain complete demographic info
-SHALL prevent patient-sourced data from overriding provider-sourced
-SHALL provide the patient the ability to annotate provider-sourced data
-Add to supportive functions S.2.2.2 as another example, there may be
standard reports for public health
-SHALL provide ability to Capture and Maintain multiple patient names
-shall provide the ability to capture and maintain historical demographic data
-Ability to combine demographic and clinical data for PH submission
7
Direct Care Comments
Section
DC.1.2
Manage
Patient
History
DC.1.3
Preferences,
Directives,
Consents and
Authorizations
Recommendation
comments
MAY…SHOULD provide the ability to capture
the relationship between patient and others.
1
SHOULD…SHALL conform to function IN.1.4
(Patient Access Management)
1
Not in most systems at this time; cover under
Data Profiles
5
cover under Data Profiles
2
MAY…SHOULD provide the ability to generate
printable consent and authorization forms.
-display the authorizations associated with a
specific clinical activity
2
NEW: the system SHOULD provide the ability
to manage electronic signature of the patient
for consents and authorizations
1
Direct Care Comments
Section
DC.1.4
Summary
Lists
Recommendation
comments
Update Add to 2.6.2 description … of a health risk (e.g. notifiable
and reportable conditions such as communicable disease,
adverse drug event or patient safety reports) within the cared for
population.....
1
SHOULD…SHALL provide the ability to capture a report of No
Known Drug Allergies
1
Description addition: Medication lists are not limited to medication
orders recorded by providers, but may include, for example,
pharmacy dispense/supply records, patient-reported medications
and additional information such as age specific dosage.
Medication provided by public health during a mass prophylaxis
(e.g. H1N1 vaccinations) would also be included.
5
Include in Data Profiles; already covered in supportive
2
Description addition: Medication provided by public health during
a mass prophylaxis (e.g. H1N1 vaccinations) would also be
included.
1
MAY…SHOULD provide the ability to capture information
regarding the filling of prescriptions
1
Direct Care Comments
Section
Recommendation
comments
DC.1.4
Summary
Lists
Description Addition: For example, Behavioral risk factors
such as tobacco/alcohol use, social history, significant
trends (lab results, weight);
Description Addition: problem list
Description Addition: for clinical, administrative, public
health, financial decision-making
3
MAY…SHOULD provide the ability to re-activate a
previously deactivated problem
-provide the ability to associate encounters, orders,
medications, notes with one or more problems
2
NEW:
SHOULD prepare a report of a patient ‘s immunization
history upon request of the patient, personal
representative or for appropriate authorities such as
schools or day-care centers
1
Direct Care Comments
Section
Recommendation
DC.1.5
Manage
Assessm
ents
Added Social history examples to 2.1.3
1
cover under Data Profiles
1
MAY…SHOULD provide the ability to link data from
external sources, laboratory results, and radiographic
results to the standard assessment.
1
Description addition: Guidelines and protocols presented
for planning care may be site specific, community,
industry-wide standards or as specified by public health.
Description addition: Provide administrative tools for
healthcare organizations and public health authorities
2
Not in most systems at this time;
1
MAY…SHOULD provide the ability to use information from
DC.2.1.4 (Support for Patient and Family Preferences) to
improve the effectiveness of care and treatment plans.
1
DC.1.6
Care
Plans,
Treatment
Plans,
Guideline
s, and
Protocols
comments
Direct Care Comments
Section
DC.1.7
Orders
and
Referrals
Management
Recommendation
#
Description addition: Different medication orders, including discontinue, refill, and renew, and
disposal require
-Orders should be communicated to the correct service provider for completion and .
-Order status will be monitored and alerts sent for uncompleted orders.
3
cover under Data Profiles; covered in supportive/infrastructure functions; Not universal need;
8
MAY…SHALL make common content available for prescription details to be selected by the
ordering clinician - conform to function S.3.3.2
2
MAY…SHOULD provide the ability for the ordering clinician to create prescription detail
- make available common patient med instruction content to be selected by tordering clinician.
- provide the ability to include prescriptions in order sets
-provide the ability to re-prescribe medication by allowing a prior prescription to be reordered
--provide order sets for referral preparation
- provide guidelines to the provider about the appropriateness of a referral
-Update DC.2.4.1 to SHOULD
-provide the ability for a provider to choose from among the order sets pertinent to a certain
disease or other criteria
7
NEW: the system SHOULD provide the ability to communicate order activity to public health
authorities as required by jurisdictional law.
- The system should report medication orders, where appropriate, to public health authorities
(e.g. oncology related medi.orders should be communicated or transmitted to cancer registry).
2
Direct Care Comments
Section
Recommendation
#
DC.1.8
Document
ation of
Care,
Measure
ments and
Results
Description addition: The system should report medication administration, where appropriate, to
public health authorities (e.g. oncology …).
- Results of tests presented in easily accessible manner to appropriate providers and to PH
agencies where public health is a care provider (e.g. newborn screening results)
- route results to other care providers, e.g. nursing home, consulting physicians, PH provider…
3
cover under Data Profiles; covered in supportive/infrastructure functions; Not universal need;
2
MAY…SHOULD notify the clinician when specific doses are due
-conform to function DC.2.3.1.1/2 (Support for Drug Interaction Checking/Patient Specific Dosing
/Warnings), and check/report allergies, drug-drug interactions, and other
-- provide the ability for providers to annotate a result.
--display a link to an image associated with results.
4
SHOULD…SHALL provide ability to recommend required immunizations per pt. risk factors;
provide the ability to capture other clinical data pertinent to the immunization administration;
SHALL transmit/receive required immunization info to PH immunization registry either directly or
via an intermediary, indicate normal and abnormal results; notify relevant providers (ordering,
copy to) that new results have been received
4
NEW: If a public health immunization registry is available, the system SHALL provide the ability
to extract the required information to submit to a public health immunization registry.
- New Subsection 2.6.1.2 ( patient level surveillance) The system SHALL transmit appropriate
patient-level clinical information (e.g. results) to public health notifiable condition programs
- system SHALL provide ability to present numerical/non-numerical current/historical test results
to appropriate provider and to public health entities meeting disease reporting criteria.
3
Direct Care Comments - pending
Section
DC.1.8
Documentation of
Care, Measurements
and Results
DC.1.9 Generate
/Record PatientSpecific Instructions
Recommendation
#
MAY…SHOULD
4
SHOULD…SHALL
1
NEW:- When available, a clinical decision support system MAY
provide target values indicated by public health (e.g., Health People
2010 goal mean total blood cholesterol)
-Add: system functionality Should track and report when decision
support alerts have been disabled. The system may be configured to
notify the user of the status of alerts
--Add: the system SHOULD be able to provide the patient with this
information electronic as well as in paper form
1
Recommendation for future policy modeling work for Public Health
1
Add: The instructions shall not only be available to the patient through
screen prints/paper form -- but also electronically.
1
Direct Care Comments - pending
Section
DC.2
Clinical
Decision
Support
DC.3.1
Clinical
Workflow
Tasking
Recommendation
#
Description:-append Including failure to report a reportable condition to public health
-add geographic proximity (e.g., zipcodes) to the list of potentially shared items of interest
-extend resource examples to include information on local disease incidence rates and open
public health investigations.
-add (e.g. public health education materials)
4
MAY…SHOULD
28
SHOULD…SHALL
15
NEW: The system SHOULD provide the ability to configure rules defining abnormal trends and
public health reportable conditions
-The system SHALL have the capacity to identify, track and provide alerts, notifications and
reports about variances from standard care plans, guidelines and protocols.
-The system SHOULD make data available for aggregation.
-A system MAY provide the patient pop. health measures specific to their condition /location
-The EHR system MAY accept question sets supporting outbreak investigation (eg., exposure
questionnaires, contact tracing) from public health authorities to facilitate information gathering
from the patient.
5
Description: Include PH authorities in the 1st sentence to emphasize the importance of including
PH
1
MAY…SHOULD
10
SHOULD…SHALL
4
Recommendation for future policy modeling work for Public Health
6
Supportive/Infrastructure Functions Comments
Section
Recommendation
#
S.1 Clinical Support
MAY…SHOULD
3
S.2 Measurement, Analysis,
Research and Reports
MAY…SHOULD
1
S.3 Administrative and Financial
Description: Add: The system SHALL provide the
ability to report to public health
1
MAY…SHOULD
5
IN.1.1 Entity Authentication
Description: Replace "disaster" with "emergency"
1
IN.2.4 Extraction of Health Record
Information
SHOULD…SHALL
5
IN.3 Registry and Directory Services
MAY…SHOULD
6
2010 PHDSC EHR-PH Task Force
Recommendations
2010 PHDSC EHR-PH Task Force
Our Recommendations:

Incorporate revisions identified by the Task Force
members into the HL7 EHR FM release 2 ballot

Add 16 new conformance criteria as extensions to
the EHR-S FM

Consider the development of a Public Health
Functional Profile as a basic approach for
identifying certification criteria for standards-based
HIT products
2010 PHDSC EHR-PH Task Force
Our Recommendations (continued):

Work with HL7 EHR WG on defining a new
specification entitled “Data Profile” as a supporting
document to the Functional Profile that will define
standardized data set(s) for information exchanges

Additional work is needed to better define the need
for an independent HL7 Public Health Functional
Model that will define functions for non-clinical data
sources, e.g., environmental and socio-economic
data
2010 PHDSC EHR-PH Task Force
Next Steps:
--Current Project- Continue working with HL7 EHR Working Group on
the comment reconciliation for the EHR-S FM
Release 2 ballot during 2010
2010 PHDSC EHR-PH Task Force
Next Steps:
-- New Project - Conduct a pilot project in 2010-2011in collaboration
with HL7 EHR WG and PHER WG to develop a
methodology for using Functional Profiles and Data
Profiles to establish certification criteria for
standards-based HIT products

Work with Early Hearing Detection and
Intervention program on defining an approach for
setting certification criteria with support from CDC
2010 PHDSC EHR-PH Task Force
More Information about Our Project:
PHDSC web-site
http://www.phdsc.org/health_info/ehr-task-force.asp
PHDSC project wiki
http://wiki.phdsc.org/index.php/EHR-PH_Project
2010 PHDSC EHR-PH Task Force
Why is This Work Important for Public
Health?
2010 PHDSC EHR-PH Task Force
Potential Impacts to Public Heath

Influence of ARRA and HIE on Health IT Standards

Public Health Infrastructure

Public Health Policy and Legislation

Practice of Public Health
2010 PHDSC EHR-PH Task Force
Influence of ARRA and HIE

These initiatives explicitly mention
cooperation/collaboration with “public health”

Many jurisdictions will focus on “low hanging fruit”
and high priority areas:



Immunization registries
Disease surveillance
ANY standardization will help public health sift
through the data that will be sent to public health
departments
2010 PHDSC EHR-PH Task Force
Public Health Infrastructure

Public Health will need to be able to accept the
information that will soon be collected at the Point of
Care via EHR-S

Substantially MORE information is expected to flow into public
health departments as the collection of data moves from a
paper-based collection/reporting approach to an electronic
collection/reporting approach

Advanced knowledge of the structure/nature of the
data will help when adapting, modifying or creating
systems to capture this information.
2010 PHDSC EHR-PH Task Force
Public Health Policy and Legislation

HIE and ARRA will likely cause evaluations of
public health policy, legislation and
administrative rules governing public health

Understanding the EHR-S Functional Model
from public health perspectives can help shape
the discussion of the dialogue on policy changes
2010 PHDSC EHR-PH Task Force
Practice of Public Health



Better understanding of current health of the
community through more accurate and timely
reporting of data
Evidence-based data also results in greater
potential for quantifiable measurements and
predictions
Data-driven model will help manage the
collection AND subsequent evaluation of the
public health interventions
Get Involved!
Anna Orlova, PhD, Executive Director
624 N. Broadway Room 325 Baltimore MD 21205
Phone: 410-614-3463 Fax: 410-614-3097 E-mail: [email protected]
2010 PHDSC EHR-PH Task Force
Questions?
Comments?