2012 Annual Meeting“Towards Public Health Sector Transformation
and Section Unity”
ACHIEVING PUBLIC HEALTH GOALS THROUGH INFORMATION TECHNOLOGY STANDARDIZATION – INFRASTRUCTURE
Walter Suarez, MD, MPHExecutive Director, Health IT Strategy and PolicyKaiser Permanente
Hyattsville, MD - November 14-15, 2012
www.phdsc.org
Topics
Need for PH Data Standardization Infrastructure – Proposal for Action
Need for Certification of Public Health Information Systems – Proposal for Actions
Need for Resources for Public Health IT Infrastructure
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Today’s Realities
Not all the data about a person/patient that is needed by public health is in an EHR system
Not all the data in an EHR system is needed by public health
There is data in public health systems that is needed in clinical care, and not currently available to clinicians
There is population-based data needed in clinical care that is not currently captured by public health
There are existing and new sources of data that are used by public health outside of EHR systems
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Public Health Standardization Efforts CDC (PHIN, BioSense, other) ONC (MU, HIEs, Beacon Communities, other)
S&I Framework – Public Health Reporting Initiative PHDSC JPHIT CSTE, NACCHO, ASHTO, NAPHSIS, APHL SDOs
HL7 – PHER IHE – Quality and Public Health ISO – Public Health
WHO; work done in other countries
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Most Active Areas Immunization Systems (MU 1) Syndromic Surveillance (MU 1) Public Health Laboratory Reporting (MU 1) Chronic Disease Registries (MU 2 - Cancer) Interfacing with Clinical Decision Support tools (MU 2) Healthcare Associated Infections (MU 3) Adverse Event Reports (MU 3) Acute Disease Reporting/Surveillance (MU 3) Additional disease registries (MU 3) Vital Statistics (MU 3?) Other Registries (i.e., Hospital Discharges, APCDs)
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Policy Issues
Scope and role of public health changing; lack of understanding of public health needs by clinical care
Increased data demands from clinical care by public health
Capability limitations in some public health infrastructures to support advanced health data standards/vocabularies
Privacy and confidentiality issues affecting the way providers and public health exchange data
Validity and reliability of data sources (data provenance)
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Business and Technical Issues
Business and Operational Issues:
Need for special workflows, operational processes to fulfill public health requests for information
Need to support non-standard 'standards' to submit data to public health
Continued reliance on non-systematized systems and communications to exchange information with public health
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Business and Technical Issues
Technical Issues:
Standards - Limited support for clinical messaging standards
Code sets: Reliance on ICD code sets, with a lack of support for more granular vocabularies/terminologies
Transport and Security: Limited infrastructure capabilities to support public health migration and participating in health information exchanges that allow for real-time, structured exchanges of public health data between clinical care and public health
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Need for Data Standardization Infrastructure:Towards a Common Standard and Interoperability Approach for Public Health Reporting
ONC S&I Framework - Public Health Reporting Initiative
Developing a common set of core data elements that apply to all (or most) public health-related messages
Applying the same overall approach being used in clinical care message exchanges under MU (Consolidated CDA)
Core set of data elements (defined in an HL7 CDA)
A series of 'templates' that define specific, discrete sets of elements applicable to specific clinical domains/message needs
Defining a 'Public Health CCDA'
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Need for Certification of Public Health Information Systems:Need for Voluntary System for Independent Certification of Public Health Information Systems Meaningful Use Program established a model for certification
of electronic information systems In addition to EHRs, there are many other systems that are
used in health care Examples include Hospital Information Systems; Practice
Management Systems; Pharmacy Systems; Laboratory Information Systems; Public Health Information Systems
Pursuing a voluntary mechanism to certify products is generally a minimum first-level step
Creates a market-driven opportunity; Allows purchasers of systems to exercise selection; allows vendors to distinguish themselves
Explore opportunity to work with certification organizations
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Need for Certification of Public Health Information Systems:Need for Resources for Public Health IT Infrastructure
For every $1,000 invested in EHRs, there is $1 invested in public health
Very limited direct money being put into improving public health information systems – and they don’t really come from MU….
The risk for a ‘new digital divide’ between clinical care and public health is growing
Need to develop a formal ‘Call to Action’ to raise awareness of the need to provide sustainable funding for public health to improve systems, adopt and implement standards, resource training, capacity building, support information exchanges, etc
Call to Action can come from JPHIT, but needs to be supported widely by providers, payers, others