johns hopkins schooi of medicine division of health sciences informatics march 23, 2007

Johns Hopkins SchooI of MedicineDivision of Health Sciences Informatics

March 23, 2007

Nationwide Health Information Network Update

Anna O. Orlova, [email protected]

Public Health Data Standards Consortium &

Johns Hopkins Bloomberg School of Public Health

Baltimore, Maryland, USA

Towards a Nationwide Health Information Network (NHIN)

Where Should We Be in 2014

Building a NHIN NHIN-2004 NHIN-2005-2006 NHIN-2007

On July 21, 2004 the Department of Health and Human Services (DHHS) announced the decade of health information technology for “delivering consumer–centric and information-rich health care.”

The vision is to build a National* Health Information Network (NHIN) of regional health information exchanges formed by health care providers who will utilize electronic health record systems.

Thompson TG and Brailer DJ. The Decade of Heath Information Technology to Deliver Consumer-centric and Information-rich Health Care. Framework for Strategic Action. US DHHS, July 21, 2004.

US National HIT Strategic Plan

* Original term “National” has been changed on “Nationwide” in January 2006

DHHS’ Framework for Health Information Technology: Building a NHIN

NHIN will be based on:

Electronic Health Record Systems (EHRS) that will enableRegional Health Information Exchanges (RHIEs) organized viaRegional Health Information Organizations (RHIOs)

Thompson TG and Brailer DJ. The Decade of Heath Information Technology to Deliver Consumer-centric and Information-rich Health Care. Framework for Strategic Action. US DHHS, July 21, 2004.

President’s Strategic Framework for HIT

Provider Record Laboratory Results Specialist Record

RecordsReturned

Index of where patients have records

Temporary Aggregate Patient History

Authorized RHIO

Inquiry

Requests for Records

AnotherRHIO

RHIO Patient data

to other RHIO

Source: Jennie Harvell. The Decade of Health Information Technology – Framework for Strategic Actions. MMIS Conference, September 2004

US Nationwide Health Information Network

US Health Information Network - 2014

Source: Dr. Peter Elkin, Mayo Clinic, MN

RHIOs as NHIN ComponentsSource: Dr. Peter Elkin, Mayo Clinic, MN, 2006

Emerging data shows the value that standardized health information exchange will provide to all stakeholders:Healthcare purchasers and payersHospitals and other healthcare providersLaboratoriesPracticing cliniciansPublic health

Source: John Glaser, Janet Marchibroda, Jim Schuping. CCBH. Washington, D.C. December 6-7, 2004URL: www.ehealthinitiative.com

Nationwide Health Information Network (NHIN)

Building a NHIN

On November 15, 2004 Office of National Coordinator for Health Information Technology (ONC), Department of Health and Human Services (DHHS), released

THE REQUEST FOR INFORMATION (RFI) on the Development and Adoption of a “National”

Health Information Network

Over 500 responses from various healthcare stakeholders has been submitted.

Building a NHIN

URL: http://www.dhhs.gov

PHDSC RESPONSE TO THE RFI

on the Development and Adoption of a “National” Health Information Network

was submitted to DHHS on January 18, 2005

Public Health Data Standards Consortium

URL: http://phdatastandards.info or http://www.phdsc.org

PHDSC Model:

RHIOEHR-PH

Info Exchange

PHDSC Model for Electronic Health Record-based Data Exchange

In October 2005 DHHS Office of National Coordinator (ONC) awarded several NHIN contracts ($65M) as follows:

Standards Harmonization EHR Certification NHIN Architecture Prototypes Health Information Security and Privacy

NHIN Development Process

URL: http://www.hhs.gov/healthit/ahic.html

DHHS NHIN Contracts Standards Harmonization - Harmonize the health care and

technology standards used in health information interchange to address gaps and conflicts in current standards

EHR Certification - Set forth certification criteria for the many electronic health care record products and technologies currently available on the market

NHIN Prototypes - Develop and evaluate prototypes for the network architecture to assess the feasibility of developing a national health information network prototype

Privacy - Address privacy and security policy questions affecting the exchange of health information.

Work resulting from each of these projects will be used by HHS to develop and refine the business case for establishing the network.

A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability

Healthcare Information Technology Standards

Panel (HITSP)

Nationwide Health

Information Network (NHIN)

Architecture Projects

The Health Information Security and

Privacy Collaboration

(HISPC)

The Certification Commission

for Healthcare Information Technology

(CCHIT)American

Health Information Community

(Community)

The Community is a federally-chartered commission that provides input and recommendations to DHHS on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected in a smooth, market-led way.

The Community is chartered for two years, with the option to renew and duration of no more than five years.

The DHHS intends for the Community to be succeeded within five years by a private-sector health information community initiative that, among other things, would set additional needed standards, certify new health information technology, and provide long-term governance for health care transformation.

NHIN Development Process

* AHIC URL: www.hhs.gov/healthit/ahiccharter.pdf


Healthcare Information Technology

Standards Panel (HITSP)

Nationwide Health





(HISPC)

The Certification Commission for


(CCHIT)American Health

Information Community

(Community)

Arlington, VASeptember 20, 2006

Standards Harmonization Technical Committees UpdateReport to the Healthcare Information Technology Standards Panel

Discussion Document

Contract HHSP23320054103EC

HITSP includes 206 member organizations:

17 SDOs (8%) 161 Non-SDOs (79%) 18 Govt. bodies (8%)

10 Consumer groups (5%)

HITSP includes 206 member organizations:

17 SDOs (8%) 161 Non-SDOs (79%) 18 Govt. bodies (8%)

10 Consumer groups (5%)

HITSP Standards Categories

1. Data Standards (vocabularies and terminologies)

2. Information Content Standards (RIMs)3. Information Exchange Standards4. Identifiers Standards5. Privacy and Security Standards6. Functional Standards7. Other

HITSP definition

HITSP Framework for Interoperability Specification Development HITSP receives Use Cases and Harmonization

Requests from external sources, such as Community and ONC.

The Use Case or Request defines scenarios, business actors, and business and functional/interoperability requirements.

HITSP develops Interoperability Specifications supporting the Use Cases: technical actors, transactions, content and terminology.

Source: HITSP Meeting, Arlington VA, September 20, 2006

HITSP Framework for Interoperability Specification Development HITSP identifies constructs which are logical

groupings of base standards that work together, such as message and terminology.

These constructs can be reused like building blocks.

While reuse is a HITSP goal, it is established in the context of a use case and its functional/interoperability requirements.

HITSP constructs are version controlled and, if reused, will be uniquely identified.


I

Harmonization Request

Harmonization Process Steps

II

RequirementsAnalysis

III

Identificationof Candidate

Standards

IV

Gaps,Duplications

and Overlaps

Resolution

V

Standards Selection

VI

Constructionof

InteroperabilitySpecification

VII

InspectionTest

VIII

InteroperabilitySpecification

Releaseand

DisseminationIX

Program Management

BeginSupport

ReceiveRequest

The standards harmonization process is a seriesof steps taken by industry stakeholders


Use Case/Modification Request

Interoperability Specification

Transaction1… n components or composite standards

Component1... n base standards or composite standard

Base Standard

#1

Base Standard

#2

Base Standard

#3

Transaction Package1…n transactions or composite

standards

Package (Composite)

Standard

Component (Composite)

Standard

Transaction(Composite)

Standard

Pot

entia

l for

Reu

se in

Oth

er C

onte

xt

Defines and N

arrow

s Context

Policy Makers and Industry

Base Standard

#4

HITSP

Base Standard

#6

Base Standard

#7

Base Standard

#8

Base Standard

#9

Base Standard

#5

HITSP Framework


The Community identified 3 breakthrough areas for the NHIN development process in 2006:

Biosurveillance Consumer Empowerment Electronic Health Record

Standard Harmonization Process

* AHIC URL: www.hhs.gov/healthit/ahiccharter.pdf

Consumer Empowerment Use Case

Allow consumers to establish and manage permissions access rights and informed consent for authorized and secure exchange, viewing, and querying of their linked patient registration summaries and medication histories between designated caregivers and other health professionals.


Electronic Health Record Use Case

Allow ordering clinicians to electronically access laboratory results, and allow non-ordering authorized clinicians to electronically access historical and other laboratory results for clinical care.


Biosurveillance Use Case

Transmit essential ambulatory care and emergency department visit, resource utilization, and lab result data from electronically enabled health care delivery and public health systems in standardized and anonymized format to authorized Public Health Agencies with less than one day lag time.


Ambulatory Care

PharmacyResponse Team

State Public HealthSurveillance System

Event Detection

DHHS

1- Report/retrieve symptoms, diagnosis & medication prescription data from EMRs

2 – Data mining of EMR notes

3 – Notify on increased number

of cases & recommend to

order pathogen test

6 – Reportpositive

test result electronically & by phone

7 – Report on the positive case electronically & by phone

Media

LocalPublic HealthSurveillance System

Hospital

NeighboringJurisdictions

PUBLIC

Laboratory

4 – Orderpathogen

test

5 – Reporttest results

EHRS

Biosurveillance Technical Committee Recommendationscd Bio Interoperability Specification

«interoperability specification»Bio-surveillance

+ docId: = IS-02

«transaction»Pseudonimize

+ docId: = IST-24

«transactions»Anonymize

+ docId: = IST-25

«component»Resource Utilization

Message

+ docId: = ISC-47

«component»Encounter Message

+ docId: = ISC-39

«component»Radiology Message

+ docId: = ISC-41

«composite standard»IHE PIX

- PIX Query: ITI-9

«base standard»HL7 2.5

Message

«component»Lab Report

Document Structure

+ docId: = ISC-37

«composite standard»IHE XDS Lab

+ Provide & Register Document Set: ITI-15

«composite standard»IHE XDS

«base standard»ISO 15000

ebRS 2.1/3.0

«base standard»HL7 CDA r2

«base standard»HL7 V3 Lab

«component»Lab Report

Message

+ docId: = ISC-36

«component»EHR Lab

Terminology

+ docId: = ISC-35

«composite standard»IHE NAV

«component»Acknowledgements

+ docId: = ISC-45

«transaction package»Radiology Report

Document

+ docId: = ISTP-49

«transaction package»Retrieve Form for Data

Capture

+ docId: = ISTP-50

«composite standard»IHE RFD

«base standard»XForms

«transaction package»Encounter Document

+ docId: = ISTP-48

«composite standard»IHE XDS-MS

«composite standard»IHE XDS-I

«base standard»DICOM 2003

«base standard»LOINC

«base standard»SNOMED-CT

«base standard»HL7 2.5 Code

Sets

«base standards»HL7 3.0 Code

Sets

«transaction»Patient ID Cross-

Referencing

+ docId: = IST-22

«transaction package»Manage Sharing of

Documents

+ docId: = ISTP-13

contains

implements

constrains

contains

constrainsconstrains

constrains

constrains

constrains

constrains

contains

contains

constrains

contains

constrains

constrains constrains

constrains

contains

contains

references

contains

constrains

constrains

constrains

references

constrains

constrains

implements

constrains

constraints

constrains

contains

contains

contains

contains

contains

implements

AHIC-ONC BIO Consolidated Use Case

BaseStd

HL7 V2.5

BiosurveillancePatient-level data to Public Health

Message-based Submission

Transaction Package

Consumer/Patient Id X-ref

IHEPIXPDQ

IHEXDS

BaseStd

ISO 15000ebRS 2.1/3.0

HITSP

Component

Anonymize

Transaction

Pseudonymize

BaseStdISODTS/25237

HIPAA

DICOM

Component

Lab Report Message

Component

Lab Terminology

BaseStd

LOINC

Component

Encounter Msg

Component

Radiology Msg

BaseStd

HL7V2.5ADT^xxx

HCPCS

CPT

CCCICD 9/10

NCCLS

UB-92

FIPS 5-2

HL7 V3

HL7 V2.5SNOMED-CT

LOINC

UCUM

HAVE

TerminologyStandards

URL

SNOMED-CT

BaseStd

HL7V2.5ORU^R01

Message-basedScenario

Biosurveillance – Patient-level and Resource Utilization Interoperability Specification

BaseStdHL7

QBP^Q23RSP^K23


Component

Lab Report Document

BaseStd

HL7 V2.5

BiosurveillancePatient-Level Data to Public Health

Document-based Submission

IHEPIXPDQ

IHEXDS

BaseStdHL7

CDA r2

IHE XDS-LAB

BaseStd

ISO 15000ebRS 2.1/3.0

Transaction Package

Manage Sharing of Docs

Transaction

Notif of Doc Availability

IHE NAV

Component

Lab Terminology

BaseStd

LOINC

HITSP

IHE XDS-MS

IHE XDS-I

BaseStd

DICOMHCPCS

CPT

CCCICD 9/10

NCCLS

UB-92

FIPS 5-2

HL7 V3

HL7 V2.5SNOMED-CT

LOINC

UCUM

HAVE


URL

SNOMED-CT

Document-basedScenario

Transaction Package


Component

Anonymize

Transaction

Pseudonymize

BaseStdISODTS/25237

HIPAA

DICOM


BaseStdHL7

QBP^Q23RSP^K23




Nationwide Health





(HISPC)





(Community)

RTI International coordinates assessment of health information exchange among states

In May 2006, RTI established the National Health Information Security and Privacy Collaboration (HISPC) by announcing the 34 states and U.S. territories who signed agreements to join this project. The project is a national collaboration created to address privacy and security policy questions affecting the exchange of health information.

The project is being managed by RTI in cooperation with the National Governors Association under a contract from the Department of Health and Human Services (HHS), Agency for Healthcare Research and Quality. RTI's project team includes multidisciplinary experts in privacy and security law and in health care management together with state and territorial governments.

Health Information Security and PrivacyHealth Information Security and Privacy Collaborative (HISPC)Collaborative (HISPC)

URL: http://www.rti.org/page.cfm?nav=7&objectid=6D0A81F4-6A6D-44A5-BD5E14B2A7077ED6

Review of State Findings

Health Information Security and PrivacyHealth Information Security and Privacy Collaborative (HISPC)Collaborative (HISPC)

Source: Walter G. Suarez. Advancing State Approaches Towards Solutions and Implementation. Health Information Security and Privacy Collaborative. Regional Meeting, November 17, 2006 – Boston, MA

34 states and U.S. territories signed agreements to join HISPC project

Purposes of Health Information Exchange Relevant Scenarios

Treatment Scenarios 1-4

Payment Scenario 5

RHIO Scenario 6

Research Scenario 7

Law Enforcement Scenario 8

Prescription Drug Use/Benefit Scenarios 9 and 10

Healthcare Operations/Marketing Scenarios 11 and 12

Bioterrorism Scenario 13

Employee Health Scenario 14

Public Health Scenarios 15-17

State Government Oversight Scenario 18

Health Information Security and PrivacyHealth Information Security and Privacy Collaborative (HISPC) - ScenariosCollaborative (HISPC) - Scenarios

1. User and entity authentication to verify that a person or entity seeking access to electronic personal health information is who they claim to be.

2. Information authorization and access controls to allow access only to people or software programs that have been granted access rights to electronic personal health information.

3. Patient and provider identification to match identities across multiple information systems and locate electronic personal health information across enterprises.

4. Information transmission security or exchange protocols (i.e., encryption, etc.) for information that is being exchanged over an electronic communications network.

5. Information protections so that electronic personal health information cannot be improperly modified.

6. Information audits that record and monitor the activities of health information systems.

7. Administrative or physical security safeguards required to implement a comprehensive security platform for health IT.

8. State law restrictions about information types and classes, and the solutions by which electronic personal health information can be viewed and exchanged.

9. Information use and disclosure policies that arise as health care entities share clinical health information electronically.

Nine Domains of Privacy and Security

Health Information Security and PrivacyHealth Information Security and Privacy Collaborative (HISPC) – DesignCollaborative (HISPC) – Design

Nov.- Dec. 06 March 2007

Review of State Findings: Variation Analysis

Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA

Review of State Findings

Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA




Nationwide Health





(HISPC)





(Community)

NEXT STEPS

Role of Public Health in a NHIN

W W W . I H E . N E TW W W . I H E . N E T

Providers and Software DevelopersWorking Together to Deliver

Interoperable Health Information Systemsin the Enterprise

and Across Care Settings

Presented by Dan Russler, M.D., IHE PCC Co-chair

IHE Workshop – June 19, 2006

Integrating the Healthcare Enterprise (IHE) Overview

Why IHE?

1970’s—Mainframe Era--$100,000 per interface 1990’s—HL7 2.x--$10,000 per interface 2000’s—IHE Implementation Profiles—

Cheaper than a new phone line!

How? IHE Eliminates Options Found in Published Standards

Who is IHE? IHE is a joint initiative among:

American College of Cardiology (ACC) Radiological Society of North America (RSNA) Healthcare Information Management Systems Society (HIMSS) GMSIH, HPRIM, JAHIS (laboratory) American Society of Ophthalmology American College of Physicians (ACP) American College of Clinical Engineering (ACCE) And many more….

Began in 1997 in Radiology (RSNA) and IT (HIMSS) International effort: IHE- Europe and IHE-Asia Additional sponsors for Cardiology including ASE, ESC, ASNC,

SCA&I, HRS and more

Electronic Health Record

Cardiology

Laboratory

Radiology

Oncology

Future

Domains

IHE

IT Infrastructure

14 Integration Profiles



1133 IInntteeggrraattiioonn PPrrooffiilleess

Patient Care Coordination

1 Integration Profile

Patient Care

Devices

Pathology

Eye Care

IHE 2006 – Nine Active Domains IHE 2006 – Nine Active Domains Over 100 vendors involved world-wide,Over 100 vendors involved world-wide, 5 Technical 5 Technical

FrameworksFrameworks37 Integration Profiles, Testing at Connectathons37 Integration Profiles, Testing at ConnectathonsDemonstrations at major conferences world-wideDemonstrations at major conferences world-wide

15 Active national chapters on 4 continents15 Active national chapters on 4 continents

IHE Standards-Based Integration Solutions IHE Standards-Based Integration Solutions IHE Standards-Based Integration Solutions IHE Standards-Based Integration Solutions

Professional Societies Sponsorship Healthcare Providers & Software Developers

Healthcare IT Standards HL7, DICOM, etc.

General IT Standards Internet, ISO, etc.

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile

IHE Process

IHE in 2006 – 18 Month Development Cycles IHE in 2006 – 18 Month Development Cycles

• First Cycle:First Cycle:• Planning Committee Proposals:Planning Committee Proposals: November, 2005*November, 2005*• Technical Committee Drafts: Technical Committee Drafts: June, 2006*June, 2006*• Public Comment Due:Public Comment Due: July 2006July 2006• Trial Implementation Version: Trial Implementation Version: August 2006August 2006• Mesa Tool Test Results Due:Mesa Tool Test Results Due: December 2006December 2006• IHE Connectathon: IHE Connectathon: January 2007January 2007• HIMSS Demo: HIMSS Demo: February 2007February 2007• Participant Comments Due:Participant Comments Due: March 2007March 2007• Final Implementation Version: Final Implementation Version: June 2007June 2007

IHE Technical Frameworks

Pt. Registration [RAD-1] Patient Update [RAD-12]


Placer Order Management [RAD-2] Filler Order Management [RAD-3]

ADT

Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]

Image Display

Modality Image/Evidence Stored [CARD-2]

Storage Commitment

[CARD-3]

Procedure Scheduled [RAD-4]

Procedure Updated [RAD-13]

Query Modality Worklist [RAD-5]

Performed Procedure

Step Manager

Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7]



Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]


Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]



Placer Order Management [RAD-2] Filler Order Management [RAD-3]

ADT

Query Images [RAD-14] Retrieve Images/Evidence [CARD-4]

Image Display


Storage Commitment

[CARD-3]


Procedure Updated [RAD-13]


Performed Procedure

Step Manager




Order Placer

Acquisition Modality

ImageManager

ImageArchive

DSS/ Order Filler

Patient Update [RAD-12]


Storage Commitment

[CARD-3]

Evidence Creator Modality PS in Progress [CARD-1]

Modality PS Completed [RAD-7]

Instance Availability Notification [RAD-49]


ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure


Modality Procedure Step Completed [RAD-7]J.Doe ->

J.Smith

Patient Update/Merge [RAD-12]

Modality Procedure Step Completed [RAD-7]

PatientRegistration [RAD-1]

Patient Update/

Merge [RAD-12]

Modality Procedure Step In Progress [CARD-1]


Perform Acquisition

Filler Order Mgmt - Status Update [RAD-3]


ImageManager/

PPS Manager

Filler Order Management -New [RAD-3]

One or the other methods of creating an order is used


ADT Order Placer

Register J.Doe

AcquisitionModality

Placer OrderManagement –New [RAD-2]

Patient Reconciliation

Department System Scheduler/Order Filler

Schedule Procedure


Modality Procedure Step Completed [RAD-7]J.Doe ->

J.Smith

Patient Update/Merge [RAD-12]

Modality Procedure Step Completed [RAD-7]

PatientRegistration [RAD-1]

Patient Update/

Merge [RAD-12]



Perform Acquisition



ImageManager/

PPS Manager

Filler Order Management -New [RAD-3]

One or the other methods of creating an order is used

Detailed standards implementation guides

HIMSS IHE Interoperability ShowcaseFebruary 2006 Participants

Leadership Level

Blue WareCernerGE Healthcare +IDX

IBMInitiate SystemsInterSystems MiSys Healthcare Quovadx Siemens

Implementer LevelAllscriptsCanonCapMedCardiac ScienceCGI-AMS CompassCareCPSI DictaphoneDR SystemsEastman KodakEclipsys Epic SystemsHIPAAT

HX TechnologiesINFINITT TechnologyKryptiqMcKesson MedAccess PlusMedical Informatics MediNotes MNINational Institute of Sci & TechNextGen Healthcare Philips Medical ScImageWitt Biomedical

Supporter Level:

Acuo

Bond

Carefx

Clearcube

Dairyland

EMC

Identrus

Intel

Mediserve

Medkey

Motion Comp.

Picis

Pulse

Sentillion

Organizational participant:

American Coll. of Clinical Eng.

Catholic Healthcare West

US Dept of Defense

US Dept of Veterans Affairs

DMP–French Natl. Personal EHRHealth Level 7 HTP IEEEMidmark Diagostics GroupHIMSS RHIO FederationLiberty AllianceUniv. of Washington

IHE Connectathon, January 2006•300+ participants, 120+ systems300+ participants, 120+ systems•60+ systems developers60+ systems developers•Four Domains: Cardiology, IT Infrastructure, Four Domains: Cardiology, IT Infrastructure,

Patient Care Coordination, RadiologyPatient Care Coordination, Radiology•2800+ monitored test cases2800+ monitored test cases

IHE Integration Profiles for Health Info NetsWhat is available and has been added in 2005 and is for 2006

Patient Demographics Query

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient

electronic health record

Cross-enterprise Document Point-Point Interchange

Media-CD/USB & e-mail push

Emergency Referrals

Format of the Document Content and associated coded vocabulary

PHR Extracts/Updates


ECG Report Document


Lab Results Document Content


Scanned Documents

Format of the Document ContentImaging Information


Medical Summary (Meds, Allergies, Pbs)

Format of the Document Contentand associated coded vocabulary

Consistent TimeCoordinate time across networked

systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication to create

a secured domain.

Basic Patients Privacy Consents

Establish Consents & Enable Access Control

Document Digital Signature

Attesting “true-copy and origin

Notification of Document Availability

Notification of a remote provider/ health enterprise

Request Formfor Data Capture

External form with custom import/export scripting

Patient Id MgtPatient Id MgtSecuritySecurityClinical and PHRClinical and PHRContentContent

Health Data ExchangeHealth Data Exchange OtherOther


Component

Lab Report Document

BaseStd

HL7 V2.5

BiosurveillancePatient-Level Data to Public Health

Document-based Submission

IHEPIXPDQ

IHEXDS

BaseStdHL7

CDA r2

IHE XDS-LAB

BaseStd

ISO 15000ebRS 2.1/3.0

Transaction Package

Manage Sharing of Docs

Transaction

Notif of Doc Availability

IHE NAV

Component

Lab Terminology

BaseStd

LOINC

HITSP

IHE XDS-MS

IHE XDS-I

BaseStd

DICOMHCPCS

CPT

CCCICD 9/10

NCCLS

UB-92

FIPS 5-2

HL7 V3

HL7 V2.5SNOMED-CT

LOINC

UCUM

HAVE


URL

SNOMED-CT

Document-basedScenario

Transaction Package


Component

Anonymize

Transaction

Pseudonymize

BaseStdISODTS/25237

HIPAA

DICOM


BaseStdHL7

QBP^Q23RSP^K23

PHDSC was Invited to Sponsor PHDSC was Invited to Sponsor Public Health Domain at IHEPublic Health Domain at IHE

Providers and Software DevelopersWorking Together to Deliver

Interoperable Health Information Systemsin the Enterprise

and Across Care Settings

Electronic Health Record

Cardiology

Laboratory

Radiology

Oncology

Future

Domains

IHE

IT Infrastructure




1133 IInntteeggrraattiioonn PPrrooffiilleess

Patient Care Coordination

1 Integration Profile

Patient Care

Devices

Pathology

Eye Care

IHE 2006 – Nine Active Domains IHE 2006 – Nine Active Domains Over 100 vendors involved world-wide,Over 100 vendors involved world-wide, 5 Technical 5 Technical

FrameworksFrameworks37 Integration Profiles, Testing at Connectathons37 Integration Profiles, Testing at ConnectathonsDemonstrations at major conferences world-wideDemonstrations at major conferences world-wide

15 Active national chapters on 4 continents15 Active national chapters on 4 continents

TEN: Public Health

PHDSC was Invited to Sponsor PHDSC was Invited to Sponsor Public Health Domain at IHEPublic Health Domain at IHE

Public Health Efforts at IHE – due July 2007

White Paper on Public Health PHDSC-sponsored

White Paper on QualitySiemens-sponsored

White Paper on Aggregate Data Retrieval from Document-Sharing Resource

Siemens- and Oracle-sponsored

Profile Proposal on Laboratory Data ExchangesIBM-sponsored

To describe the organization and functions of public health in the US in order to inform the development of the IHE integration profiles for interoperable clinical and public health information systems.

IHE White Paper on Public Health: Goal

WHAT IS PUBLIC HEALTH?

Knowledge Management in Public Health

State Health DepartmentOrganizational Chart

Provider 1

Provider 2

Provider 3

Provider 4

Provider X

Communicable Diseases

Immunization

Vital Records

Injury Control

School Health

Chronic Care

Biosurveilance, BT,

Preparedness

Genetic Disorders

HEDIS

Clinical-Public Health Paper-based Health Data Exchanges

On average49% of cases got reported(CDC, 2006).

Clinical Care

ADT-Birth Record

Newborn Screening Test

HearingScreening Test

Immunization Administration

External Laboratory

Hospital of Birth

HL7 2.4

HL7 3.0

HL7 3.0

HL7 2.4

HL7 2.4

Public Health Surveillance

EHR-PHInfo Exchange

NewbornScreeningRegistry

Hearing ScreeningRegistry

ImmunizationRegistry

CommunicableDiseaseRegistry

HTB

State Health Department

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WrtwertghghgghhghgWrtwrtghghghghghWtrwtrghggWrtwrtghghghAadkalfjkaldkfjalkdjflajkflkdjghghghghghghghgfhjfghjfh

HealthcareTransactionViewer

HL7 3.0

HL7 3.0

HL7 2.4

HL7 3.0

J2EE

J2EE

HTB – Health Transaction Base

EHR-PH System Prototype for Interoperability in 21st Century Health Care System

Source: Orlova, et al. HIMSS 2005,Dallas TX, February 13-17, 2005 and AMIA, Washington DC, November, 2005

WHERE TO START?

WE NEED TO HARMONIZE:

DATA FORMSWORKFLOW

POLICIES

Provider 1

Provider 2

Provider 3

Provider 4

Provider X

Communicable Diseases

Immunization

Vital Records

Injury Control

School Health

Chronic Care

Biosurveilance, BT, Preparedness, Syndromic

Surveillance

Genetic Disorders

HEDIS

EHR

CDA2

IHELAB

X12

NCPDP

NBS

TB, STD.……

IR

VR

ECIC

SH

CVD, Asthma

Diabetes

BT

HEDIS

Forms EHR-PH Data Exchange: Clinical & Public Health Systems

WHERE TO START?


DATA FORMSWORKFLOW

POLICIES

Ambulatory Care

PharmacyResponse Team


Event Detection

DHHS

1- Report/retrieve symptoms, diagnosis & medication prescription data from EMRs

2 – Data mining of EMR notes

3 – Notify on increased number

of cases & recommend to

order pathogen test

6 – Reportpositive

test result electronically & by phone

7 – Report on the positive case electronically & by phone

Media


Hospital


PUBLIC

Laboratory

4 – Orderpathogen

test


EHRS

Ambulatory Care

Pharmacy


Event Monitoring

DHHS

2 - Monitor newly diagnosed cases

& vaccination data from EMRs

1 – Send health alert

6 – Send order to activate emergency

vaccination

9 – Send updates on the event

Media

10 – Send health alert to the public

3 - Monitor ER visits &

hospitalizations data from EMRs

7 – Order/ Supplyvaccine

HospitalState Public HealthSurveillance System


8 – Monitorvaccinesupplies

Response Team

PUBLIC

Lab

4 – Orderpathogen

test


EHRS

Ambulatory Care

Pharmacy


Event Management

DHHS

2 - Monitor newly diagnosed cases

& vaccination data from EMRs

1 – Send Outbreak updates

6 – Send Rapid Flu Test Kits

9 – Send outbreak updates

Media

10 – Send outbreak updates

to the public

3 - Monitor ER visits,

hospitalizations data from EMRs & utilization data

7 – Delivervaccine



8 – Monitorvaccinesupplies

Response Team

PUBLIC

Lab

4 – Orderpathogen

test


EHRS

9 – Activatecoordinated

response

Laboratory

Ambulatory Care

Pharmacy School

Local CVDSurveillance System

Cardiovascular Disease (CVD) Surveillance

DHHS

4 – Prescribe Medication and Treatment Plan

1 – Conduct Routine Check-ups

7 – Report Data to Schools

2 – Ordercholesterol

test

Media

10 – Conduct Health

Education

6 – Fill Prescription




Payor

11 – Send reports


8– CoordinateCare

PUBLIC

5 – Monitor Treatment

EHRS

12– Conduct Surveys (BRFSS)

Laboratory

Ambulatory Care

Pharmacy School

Local AsthmaSurveillance System

Asthma Surveillance

DHHS

4 – Prescribe Medication and Treatment Plan

1 – Conduct Routine Check-ups

7 – Report Data to Schools

2 – Orderallergen

test

Media

10 – Conduct Health

Education

6 – Fill Prescription



Hospital


Payor

11 – Send reports


8– CoordinateCare

PUBLIC

5 – Monitor Treatment

EHRS

12– Conduct Surveys (BRFSS)

WHERE TO START?


DATA FORMSWORKFLOW

POLICIES

Examples of Notifiable/Reportable Conditions by Selected States

Notifaible/Reportable Diseases

(in alphabetical order)

CDC CA FL IN MA MD MN NC

MD Lab MD Lab MD Lab MD Lab MD Lab MD Lab MD Lab

Acquired Immunodeficiency Syndrome (AIDS) - - -

Alcohol Related Birth Defects - - - - - - - - - - - - - -

Amebiasis - - - - - - - -

Anaplasmosis - - - - - - - - - - - - -

Anisakiasis - - - - - - - - - - - - -

Animal bites - - - - - - - - - - -

Animal bites for which rabies prophylaxis is given, - - - - - - - - - - - - -

Anthrax

Arboviral neuroinvasive and neuroinvasive diseases, all - - - -

California group - - - - - - - - - - - - - -

Eastern equine encephalitis virus - - - - - - - - - - - -

WHERE TO START?

SELECT PUBLIC HEALTH DOMAINS TO BEGIN WITH

Source: Eileen Koski. Quest Diagnostics. PHIN-2004, May, Atlanta GA

Percent of Children Tested for Lead with BLL>10 µg/dL in the USA

Vision for Public Health Surveillance via NHIN

johns hopkins schooi of medicine division of health sciences informatics march 23, 2007

Documents

department of health

informationrich health

information rfi

health care providers

health sciences informatics

nhin nhin

us dhhs

nhin componentssource