Statewide Data Interoperability For Improving Population Health

Wu Xu, PhDState Health IT Coordinator

Director, Center for Health Data & Informatics

Utah Department of HealthMay 23, 2016

Iona Thraen, PhDUT State Innovation Model GrantDirector, Office of Health Systems

Collaboration

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States as LaboratoriesFor Nationwide Clinical and Public Health Data Interoperability

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Discovering Laboratories’ Commonality

Participants from states and large cities/counties share their interoperability visions, priorities and strategies at the Public Health Informatics for Leaders Forum

Sponsored by Public Health Informatics Institute, April 26, 2016, Atlanta, GA

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Definitions of Population Health

Population Health Domains*

* Adopted from Public Health 101: Healthy People-Healthy Population by R. Reigelman, 2010, Sudbury, Jones & Bartlett.

** http://www.improvingpopulationhealth.org/blog/what-is-population-health.html

Population Health is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group.**

Social & Human Services

Public Health

Community Health

Healthcare Systems

Individual/Consumer

Health

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http://www.phi.org/news-events/806/85-of-hospitals-committed-to-population-health-says-ahaphi-national-survey

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Key Outcome of Population Health

Utah Department of Health’s Definition of Population Health: UDOH integrates its practice with health systems and payers to fully address determinants and outcomes of health in the Utah population and its sub-populations.

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Public HealthHealth Care

Innovative Clinical

Prevention

Traditional Clinical

Prevention

Increase the use of

evidence-based services

Provide services outside the

clinical setting

Total Population or Community-Wide

Prevention

Implement interventions that

reach whole populations

1 2 3

The 3 Buckets of Prevention

• Article by John Auerbach, 2016, available on the Journal of Public Health Management and Practice’s website – www.JPHMP.com

Shared Space: Innovative Clinical Prevention

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Population Health Business Cases with ROI in 5yrs

Promote adoption of evidence-based interventions in collaboration with health care purchasers, payers, and providers

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Informatics Support to the 6|18

Use Case Informatics Support in Utah

Reduce Tobacco Use HIE facilitates “quit-line” referrals

Control High Blood Pressure

APCD estimates of risk populations and cost Population data collection from HIE, systems

Control Asthma APCD risk and cost analysis BRFSS, Inpatient, ED, clinical asthma patient

distribution Outcome evaluation

Control and Prevent Diabetes

Local data to supporting health and cost evidence and monitor progress

APCD patient risk and cost analysis

Data Interoperability for Population Health

= Information Exchanges & Analysis across EHR, HIE & Public Health

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Utah’s Information Exchange Strategies • Develop a Shared Vision• Develop a Shared Statewide Health IT Plan• Develop Governance for The Shared Identification

Services for Utahns (ThSisU)• Leverage State-Designated Health Information Exchange

(HIE)• Leverage Public Health Meaningful Use Reporting• Pilot Other “Meaningful” Public Health Information

Services• Clinical Data Needs for Population Health Collaborative:

Clinical measures and Advanced Analytics

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Utah Statewide Shared Vision, 2015 -

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Alignment Federal and State Health IT Goals

• Federal ONC Goals: Advance Person-Centered

and Self-Managed Health Transform Health Care

Delivery and Community Health

Foster Research, Scientific Knowledge, and Innovation

Enhance Nation’s Health IT Infrastructure

https://www.healthit.gov/sites/default/files/9-5-federalhealthitstratplanfinal_0.pdf

• Utah HIT Goals (Draft): Advance the Health and Well-

being of Individuals and Communities through Person-centered & Self-managed Health

Strengthen Health Care Delivery Transformation

Enhance Utah's Interoperable Health It Infrastructure

Support Research, Innovation, and Implementation Science

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Need for Statewide Master Person Index

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ThSisU: Governance

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ThSisU: Building Blocks and Initial Use Cases

Patient Identity Service• Identity proofing• Link digital identity to patient records• Match digital identities across organizations

Risk Indemnification

ThSisU Identity-related Building Blocks to support appropriate data movement

Selected Care Coordination Use Cases

Trust framework

Pooled-shared knowledge

Business case and financial benefit

Provider Electronic Receiving Specifics• Provider digital identity repository• Provider identity proofing

Care Team• Message interfaces• Care team imputation algorithms tested• Encounter records from member

organizations

Patient Proxy Relationship Management• Proxy relationship verification and policy

Case Information Delivery

Newborn data Bundle• Electronic birth certificate• Screening orders, tracking

results• Pediatrician identification and

follow-up

End of Life Care• Electronic POLST• Advance Directives• Emergency Medical Services

Poison Control • Case coordination with

Emergency Physicians

Meaningful Use (MU) and Health Information Exchange (HIE) are Transforming Silo Pubic Health Systems’ Data Communication and Analytics

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Silo Public Health Information Systems

• UDOH has about 1,000 employees more than 100 stand along information systems. A hospital may report data in about 30 different ways to UDOH A program may use 10 different methods to exchange data with

external entities• Root causes

Historically categorical funding streams and restrictions Decentralized business and IT management structures Legacy systems and aging workforce Lack of federal-state strategic collaboration and adequate

funding

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Transformation by MU and HIE

• Public Health Meaningful Use Reporting Immunization Records (bi-directional) Electronic Laboratory Reporting Syndromic Surveillance Reporting Cancer Registry

• Public Health Uses the Statewide HIE Meaningful Use Reproting Newborn Hearing Screening Results & Diagnostics Reports

Exchange Emergence Medical Services Poisoning Control Data exchange through cHIE

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MU Challenges: EHR-IIS complexities

USIIS

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MU Challenges (cont.)• MU instructions from various sources

CMS, ONC, Medicaid, EHR vendors, UDOH, USIIS, REC, etc.

• Complexity of EHR systems and EHR-USIIS interfaces• Multiple possible points of failure

• Understand and undertake responsibility for data quality– In EHR system and in USIIS– Clinic workflow and staff practices impact data quality

USIIS

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Shared Service for Interoperability

INTERFACES:• SFTP• VPN• HTTPS• SOAP Web Service• PHIN MS• Secure web portal

GATEWAY and INTEGRATION ENGINE: • Mirth Connect• Rhapsody • Shared Service Platform• HIE

“No Door is a Wrong Door” Tradition is Costly.

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PHCP: Electronic Case Reporting

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Direct

1g

HIE Solution

EHR

System B

HIESolution

EHR

System A

My Health

1a

2i

1b

2h

Diagnostics

Test Results

Test Results

HIE SolutionDOH Gateway

Identity Resolver

Public Health

2a

2b2c

EHDI

Test Results

Early Hearing Detection &

Intervention (EHDI)

Diagnosti

cs

Standard-based Message Broker

(eHEX, Direct, HL7v2)

Relationship Resolver

Message O

rchestrator

Message Router

Format Converter

Identity Resolver

Alert/Notification

Central Repository

HIE

2d1c

1d

1e

1f

2e

2g

2f

HIE Use Case 1: EHR sends hearing diagnostics reports to public health registryHIE Use Case 2: EHR receives hearing test results from public health registry

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Vital Records and EHRsBIRTH and DEATH records are fundamental public health data

Registration systems are electronic but silo with manual data entry• Pilot: Quality of Birth Data Extracted from HER

Most of the labor, delivery and newborn care information are available

PDF information (i.e. prenatal or out of network care) can’t automated extracted [J. Duncan, et al. CDC 2015-Q-17144)

• EHR Death Certificate Reporting EHR and EDEN interoperability for physicians to timely enter the

Cause of Death via their own EHR • Death Notification for EHR Patient Identity Validation

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Informatics and Opioids Crisis

• Utah ranked the 4th highest for drug poisoning deaths in the U.S.

• State Interventions:Prescription Drug Management ProgramControlled Substance Database (CSD)

• Informatics SupportEHR - CSD connection or single login for prescribersEducation and decision-support to prescribersAutomated prescription misuse/abuse surveillanceTimely information for community intervention

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Challenges for Analytics and VisualizationFor Population Health Planning

opendata.utah.govPublic Health Assessment App.

Websites for Consumers

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Expanded Needs for Population Health Analytics

Domain Public Health Informatics Population Health Informatics

Data Source Public health data + clinical & other data sources

Data Model Disease/event centric + Person, People, community-centric

Interoperability Silo systems + Linkage and real-time exchange are required

User Public health profession + Diverse external users

Analytics Standard public health measures, pre-defined conditions

+ flexible user-defined measures and populations

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Develop Population Health Informatics

• Develop shared vision and frameworksPopulation health use case driven technical design

• Build interoperability between clinical and public health data Standard terminology and data models Federated infrastructure among all partners Standard shared service platforms

• Flexible and shared analytics functionality for various users

• Standard quality measures for value-based purchasing, payment reform, and community health improvement

Questions?Comments?

Suggestions?

THANK YOU!