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Challenges with Sharing Public Health Information Through a Health Information Exchange
Jon Reid, MBA Health Informatics Manager Utah Department of Health
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Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health-related data …[to]… Prevent or control disease or injury, Identify unusual events of public health importance, and Disseminate and use information for public health action.
Lisa Lee et.al., Am J Prev Med 2011; 41(6):636-640
What is PH surveillance?
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Problem
Public Health Model
Problem Response
Define the problem Collection/surveillance
Identify causes Risk factor
identification
Develop and test interventions
Evaluation research
Implement intervention Training Public awareness
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We need to move from Sherlock Holmes
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To the Matrix
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Combined with The Minority Report
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Public Health Informatics Public Health Informatics has been defined as the
systematic application of information and computer science and technology to public health practice, research.
Need for Epidemiology trained informaticists Effectively and efficiently using technology to
improve data collection and surveillance
How do we get there?
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Initiatives such as Meaningful Use Electronic Lab Reporting (ELR)
Proliferation of EMR systems Need to do more with less
Why is this important?
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Data is relatively poor quality Limited data analysis and interpretation Lack of coordination among LHD/State and
Feds
Computers have made us somewhat more efficient and timely, but
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Public Health Data
Neolithic revolution
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1000 Kilobytes = Megabyte 1000 Mb = Gigabyte 1000 Gb = Terabyte 1000 Tb = Petabyte
Expectation that electronic data exchange will
process hundreds of petabytes of data daily
Petabytes of data
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Current State/local Challenges:
Current and projected large increases in volume of lab and case reports from healthcare (estimated increase 400-500%) Data deluge
Maintain and upgrade surveillance systems with limited PH resources
Reduced funding = fewer staff Need new approaches for data
management, analysis, and visualization
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Current Federal challenges:
Reduced funding = fewer staff Lack of interoperability/standardization
Use of same case definitions Collect same data elements Pendulum swing away from state/local autonomy
Silos of data Goals of surveillance are different at local,
state, and federal levels.
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Process of reliable and interoperable electronic health-related information sharing conducted in a manner that protects the confidentiality, privacy, and security of the information
Health Information Exchange (HIE)
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1 • Mandated reporting
of laboratory diagnoses
2 • Mandated reported
of physician-based diagnoses
3 • Public health
investigation
4 • Disease-based non-
reportable laboratory data
5 • Antibiotic-resistant
organism surveillance
6 • Population-level
quality monitoring
Domains for use of an HIE in Public Health
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Single interface for multiple facilities More control of detection rules Potentially more standardization of vocabulary Large amount of clinical data Aids in investigation Current patient contact information
Benefits of using an HIE
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HIE first priority is to support clinical exchange
Differences in coding/vocabulary Same code may be used for different tests
Data availability Lag in sending data to HIE from EHR system
Patient consent issues Where does filtering occur?
Cost to providers to use HIE for reporting?
Challenges with using an HIE
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HIE will code based on volume, not what is reportable ie, CBC, chemistries, cholesterol, etc..
Public health is generally a lower priority, so changes will take longer
HIE first priority is to support clinical exchange
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Not all codes are equal Incorrect codes Different codes for same test
Vocabulary issues Different uses for same vocabulary by different
facilities
Many different ways to say the same thing
Differences in coding/vocabulary
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Interoperability
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Standards and Interoperability
Standards – the use of a vocabulary with unambiguous meaning between two entities (ex: case definition that says the patient must have a “fever”; lab report that defines a specimen as “S”)
Interoperability – the ability for two entities to exchange data with unambiguous meaning.
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Vocabulary versus Structure
Vocabulary refers to the meaning of the message part.
Syntax or structure refers to the order in which the message was sent I knew a man with a wooden leg named George I almost wrote a check for $1000 I wrote a check for almost $1000
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Facility may batch import data to the HIE Immediately reportable conditions may be delayed
Some facilities may participate in the HIE and other may not Incomplete record or lab/clinical findings
Data retention/removal policies How long is data available
Data availability
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Is there an opt-in or opt-out policy? Who manages consent
Centrally at the HIE Locally within each facility
When consent is changed are all stakeholders notified
Where does data filtration occur?
Patient consent issues
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Data filtration
Can occur at: The sender The trusted third party (e.g. HIE) The receiver
Handshakes?
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Cost related to: Money Time Data quality
Costs to providers or public health The benefit of using the HIE must outweigh
burden of independent interfaces
Costs of using HIE for reporting?
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Case Investigation
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Vision
Automated acquisition of primary investigation data
Cloud data Reduced investigator workload Probabilistic determination of who gets
investigated
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Data collection becomes ability to evaluate data streams, select appropriate streams, and merge them
Use probability determinations to determine if we investigate a case Pertussis – DFA (5%), PCR (40%), cough (10%),
current vaccination (-20%) 50% threshold for investigation
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Challenges
Accuracy Integration of investigation data
Data standards Linking data (think changing addresses)
Master patient index Temporary technology means mandatory changes
in process Data ownership and control Possible loss of creativity
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Data collection
It costs money to collect and store data! Vision is to do neither! Shop at Costco, let others do the fishing and hunting
and Goal should be to eliminate data collection/storage as
a public health function
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Engage HIE early Encourage facilities to join HIE to ease burden
of reporting requirements Make sure codes important to public health
are included in the HIE mapping tables Increase infrastructure in public health to
handle increase of data Train more epidemiologists in informatics
Take-away
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AMIA 10x10 CSTE Scholarship for Public Health Informatics
Online Certificate Program Public Health Informatics Institute (PHII)
Resources
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Dr. Susan Mottice Utah Department of Health
Arizona Department of Health Services Utah Health Information Network (UHIN) The Utah Department of Health
Acknowledgments
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Thank you Jon Reid Utah Department of Health [email protected]