Centers for Disease Control and Prevention (CDC)

Electronic Public Health Data Exchange: Right Time, Right Place

Presenter: John Eichwald, MAMarch 4, 2013

CDC Programs Represented TodayMeaningful Use Public Health Technical AssistancePublic Health Reporting InitiativeCancer RegistriesEarly Hearing Detection and InterventionVital RecordsImmunization Information SystemsPHIN Vocabulary ServicesNational Healthcare Safety NetworkPublic Health Clinical Decision Support

Supporting Meaningful Use Implementation by CDC Programs and Jurisdictional Public

Health AgenciesMeaningful Use Public Health Technical Assistance (TA) Team

Assist in resolving issues and problems preventing successful achievement of the Meaningful Use public health objectives

Provide focused policy and technical expertise Identify successful methods used to resolve similar issues Rapidly resolve misunderstandings and simple problems Document and learn from the real problems occurring the

field

Team’s Purpose and Goals

MU TA Team Support: Request Statistics

26%

14%

28%

2%

4%

26%

Technical Assistance Requests Categories

ImmunizationReportable Lab ResultsSyndromic Surveil-lanceCancer Multiple Public Health MeasuresOther (Transport, Pol-icy, General, etc.)

Technical Assistance Requests Categories

Categories # %SS 52 28%Other (Transport, Policy, General, etc.)

47 26%

IIS 47 26%ELR 26 14%ALL 8 4%CANCER 3 2%Total 183

Technical Assistance Requests # %Requests received via the Meaningful Use Mailbox

117 64 %

Requests received via HITRC’s Burning Issues Workgroup

10 5 %

Requests received via other channels

56 31 %

Total Requests 183Total Closed 175 96 %Total Open (In Process)

8 4 %

Technical Assistance RequestTotals

meaningfuluse@cdc.gov

Supporting Harmonization of Electronic Data Exchange through the Public Health Reporting

Initiative (PHRI)In 2012 CDC actively participated in the Office of National Coordinator (ONC) Standard and Interoperability (S&I) PHRI.PHRI Goal : Harmonize HIT standards and implementation guides for interoperable communication between clinical care and public health for public health reporting

Minimize unnecessary modification of EHRs and their certification by harmonizing with other ONC-certification criteria and other S&I Framework activities

Develop implementation guides to maximize future extensibility and re-usability for multiple public health domains

Minimize impact on established Stage 1 MU public health reporting objectives while potentially simplifying such reporting in the future

Develop implementation guides while accounting for the needs of subsequent inter-jurisdictional communication (e.g., transfer of cases between jurisdictions and national notification requirements) and population-level reporting.

Facilitate future certification of public health information systems that are interoperable with ONC-certified EHRs

Step Description Outputs/Artifacts

Functional RequirementsAnalysis

• Document implementation requirements per Domain / User Stories

Documented functional requirements, including data classes

Data Harmonization and Modeling

• Collect User Story Data Elements• Achieve consensus regarding

common core data elements across user story domains

• Update Federal Health Architecture Data Model with inclusion of classes for public health

Public Health Data Harmonization Profile

Harmonizing Data Exchange Implementation Guides

• Access the structure and content of the Consolidated Clinical Data Architecture (C-CDA) Implementation Guide (IG)

• Reconcile PHRI common core data elements with C-CDA and 2009 HL7 Public Health Case Reporting IG

PHRI C-CDA library of templates

2012 PHRI: Processes and Results

Time Period

Numberof New Registries

1930 21940 21960 61970 141980 141990-1995

5

1996-2000

8

2001+ 2From: NAACCR CINA: 2001-2005

The US Requires Reporting of Cancer to the National Cancer Programs

Cancer Program Accomplishments Electronic Health Record (EHR) reporting to

central cancer registries (CCRs) Cancer Reporting is a new menu item for Eligible

Professionals (EPs) for Meaningful Use (MU) Stage 2 (2014 implementation)

Development of Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries (“Cancer IG”), based on IHE Physician Reporting to a Public Health Repository – Cancer Registry (PRPH-Ca)

Two Comparative Effectiveness Research (CER) projects pilot testing provider EHR cancer reporting (KY and MO)

Electronic pathology reporting (ePath) to CCRs Based on IHE Anatomic Pathology Reporting to Public

Health – Cancer Registry (ARPH) profile 42 states are live with ePath reporting 7 anatomic pathology laboratories reporting to CCRs 30 states use eMaRC Plus, CDC-developed software tool,

for receiving and processing ePath reports

Cancer and Meaningful Use CMS Meaningful Use Stage 2 Final Rule,

August 2012: “Capability to identify and report cancer cases to a

State cancer registry “ ONC 2014 Edition EHR Certification Criteria

Final Rule: Requires use of Implementation Guide for Ambulatory

Healthcare Provider Reporting to Central Cancer Registries (“Cancer IG”) for EHRs to create and transmit cancer reports to cancer registries

Change proposal approved in December 2012 to align IHE PRPH-Ca profile with the Cancer IG. Both use HL7 Clinical Document Architecture (CDA).

CDC-developed software tool, eMaRC Plus, is freely available to all states for receiving and processing CDA reports

Sets stage for other public health (case) reporting

For more information, please contact the Meaningful Use Public Health Technical Assistance Team

Early Hearing Detection and Intervention Information System (EHDI-IS)

• CDC’s EHDI Team, as part of the National Center on Birth Defects and

Developmental Disabilities , supports state and territorial EHDI programs

working to advance surveillance capability and interoperable data

systems.

• Newborn screening can potentially capture the entire newborn

population, providing one of the first meaningful interoperability

opportunities in an individual’s healthcare lifespan

• EHDI provides an opportunity to establish bi-directional information

exchange between clinical care and public health in a relatively simple

and feasible way

EHDI Standards-based Information Exchange

IHE Newborn Admission Notification Information

(NANI)

HL7 EHDI Messaging Data Standard Trial Use (DSTU)

IHE Early Hearing Care Plan

(EHCP)

CQM EHDIClinical Quality Measure

(CMS 31v1/NQF 1354)

IHE Quality Measure

Execution(QME-EH)

IHE EHDI Cross-enterprise

WorkflowDocument

Labor & Delivery

Newborn Screening

State EHDI Program

Medical Home

Federal Reporting

CareTasks

&States

e-MeasureDefinition

Specialist

HL7 v2

HL7 v2 HL7 CDA R2

HL7 HQMF

HL7 QRDA

Us Case 5Vital Registration and Care Coordination for Newborn

Hearing Screening

Care Theme: Maternal & Newborn Health

Use Case 16

Interoperability ShowcaseIn collaboration with IHE

• Background

– The National Vital Statistics System (NVSS) provides essential data on all U.S. births and deaths

• Over six million vital events are reported annually• Information collected includes a wide range of demographic, medical, and geographic data

derived from 4 million birth certificates and from about 2.4 million death certificates and fetal death reports

• Events are registered by 57 registration areas: 50 states, 2 cities, and 5 U.S. territories• Vital statistics data are widely used to monitor and improve the nation’s health, e.g., track and

explain trends in cesarean delivery, preterm and low birth weight births, causes of infant death and disparities in health among populations groups 

– Detailed data on all events are transmitted to the Center for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS)

• Much of the information collected for birth and death certificates and fetal death reports are captured in hospital medical records

• Vital statistics and standards communities have collaborated to build upon more than a century’s effort in standardization to encourage EHRs to capture medical and health information in a format consistent with the vital statistics requirements

GOAL is to improve the timeliness, accuracy, and completeness of vital records data

Electronic Health Record (EHR) and Vital Record (VR) Systems Information Exchange

Electronic Health Record (EHR) and Vital Record (VR) Systems Information Exchange

Capturing birth and death data in electronic health record systems

Electronic exchange using HL7and IHE-based standards

Improving the timeliness, accuracy, andcompleteness of vital records data

Electronic Health Record (EHR) and Vital Record (VR) Systems Information Exchange

Document Transaction Status

HL7 Version 3 Domain Analysis Model: Vital Records, Release 1 (R1) Domain Analysis Model

Published and freely available during pilot period that began February 2012

HL7 EHR-System Functional Model (EHR-S FM) Vital Records Functional Profile, R1 EHR-S Functional Profile

Published and freely available during pilot period that began February 2012

HL7 EHR-S FM Public Health Functional Profile R1 EHR-S Functional ProfilePublished and freely available during pilot period that began February 2012

HL7 Version 2.5.1 Implementation Guide (IG): Vital Records Death Reporting, R1 –Draft Standard for Trial Use (DSTU)

Death related information from a clinical setting to the vital records electronic registration system

Available for download and comments on the HL7 DSTU Commenting Site

HL7 Version 3 CDA R2 IG: Reporting Death Information from the EHR to Vital Records, R1 (DSTU)

Death related information from a clinical setting to the vital records electronic registration system

Balloted in HL7 May 2012 ballot cycle. Goal to publish as DSTU in early 2013

HL7 Version 2.51 IG: Reporting Birth & Fetal Death Information from the EHR to Vital Records, R1 (DSTU)

Live birth and fetal death related information from a clinical setting to the vital records electronic registration system

Balloted in HL7 Jan. 2012 ballot cycle. Goal to publish as DSTU in early 2013

HL7 Version 3 CDA R2 IG: Reporting Birth & Fetal Death Information from the EHR to Vital Records R1 (DSTU)

Live birth and fetal death related information from a clinical setting to the vital records electronic registration system

Balloted in HL7 Sept. 2012 ballot cycle. Goal to publish as DSTU in early 2013

Integrating the Healthcare Enterprise (IHE) Birth and Fetal Death Reporting (BFDR)  Content Profile

Defines the EHR content that may be used to pre-populate and transmit birth and fetal death information to vital records systems for vital registration purposes

IHE published for trial implementation August 2012

Integrating the Healthcare Enterprise (IHE) Vital Records Death Reporting (VRDR) Content Profile 

Defines the EHR content that may be used to pre-populate and transmit death information to vital records systems for vital registration purposes

Under development. Goal to publish by fall 2013

Special thanks to those who collaborated with us during the IHE 2013 Connectathon interoperability testing to support the Vital Records and EHDI standards development

work

Thank You!!!!!

Immunization Interoperability:2012 Successes Indicators

CDC provided funding to eligible state/city/local Immunization Information Systems (IIS) to enhance EHR-IIS interoperability using HL7

96% of IIS or their designee are now able to send and receive HL7 2.3.1 and/or HL7 2.5.1 messages

Simple Object Access Protocol (SOAP) web services for immunization data transport according to CDC Expert Panel’s recommended Web Services Definition Language (WSDL) implemented by more than 43% of IIS

Published HL7 Version 2.5.1 Implementation Guide for Immunization Messages, Release 1.4 Worked with NIST to develop certification testing for MU2

based on the Implementation Guide New effort to use MU2 testing with IIS to improve conformance

Release of 2D Barcode on Vaccines and Vaccine Information Statements (VIS) Pilot testing underway in 10 states and ~220 provider sites 2D Barcoded Vaccines

• Current: Havrix, Pediatric DT, Menactra, Adacel, Fluzone, IPOL

• Release Soon: Daptacel, Tenivac, Pentacel 12/25 VIS have 2D barcodes: edition date & type of VIS

CDSi (Clinical Decision Support for Immunizations) Released Logic Specification – computable and consistent

representation of childhood vaccine recommendations and schedules

Resources include logic tables, business rules, supporting data For use in clinical EMR and IIS

Immunization Interoperability: 2012 Successes Indicators (cont.)

Vocabulary Access and Distribution System (VADS): A Web-Based PH Enterprise Vocabulary System

In 2004, CDC developed a web-based enterprise vocabulary system called the Public Health Information Network Vocabulary Access and Distribution System (PHIN VADS) for accessing, searching, and distributing HL7 messaging value sets used within the PHIN and NHIN.

Provides all the vocabulary metadata needed for HL7 messaging. Promotes sharing and reusing of the value sets. Hosts multiple versions of value sets that allow implementers to have access

to the current, past and the future versions of value sets and value set collections

Provides web services (API) that allows HL7 interface engines, medical and public health

applications to obtain the value sets as well as validate the vocabulary present in HL7 messages.

Provides detailed code system metadata for value set concepts such as context, hierarchy, synonyms and alternate codes. This will facilitate the implementation of value sets and improve the quality of local vocabulary mapping to standards.

PHIN VADS can be accessed at a public web site - http://phinvads.cdc.gov CDC Vocabulary and Messaging team manages the PHIN VADS.

VADS: Developing a Sustainable Approach for Supporting Partners

Electronic Reporting to the National Healthcare Safety Network (NHSN) via Clinical Document Architecture (CDA)

NHSN and CDA Capability • Currently accepting CDA files for:

Central line associated bloodstream infection (CLABSI) Catheter associated urinary tract infection (CAUTI) Surgical site infection (SSI) Multi-drug Resistant Organism and C. dfficile laboratory

identified (LabID) events Central line insertion practices (CLIP) Dialysis events Antimicrobial use

• Approximately 500 hospitals are reporting to NHSN via CDA – over 5000 hospitals report to NHSN

Public Health Clinical Decision Support (CDS)

Decision Support Providing public health alerts/guidelines to providers in EHR

systems• GE, Alliance of Chicago & Lehigh Valley

Working with CDC programs to deliver public health information at the point of care for screening, diagnostic evaluation, treatment & education

• HIV/STD & Million Hearts programs CDS Partnerships

CDS Consortium, Federal CDS Collaboratory, ONC Health eDecisions S&I Initiative

Development of Geospatial Community Health Record Engaging HD in Memphis & Methodist Le Bonheur Hospital

Dashboard of health indicators e.g. obesity, heart disease & stroke Working with Million Hearts program & others in OSELS

Managing Emerging Events:Public Health EHR Alerting Flow

FB Outbreak Identified

States/CDC monitoring

public health discover

foodborne outbreak

SymptomsLocationsEvent InformationGuidance e.g. Consumption history

message sits on a standalone knowledge repository

FB Message Created

Us Case 5

Visit the CDC Public Health Use Case Interoperability

DemonstrationsUse Case #3 – Biosurveillance Monitoring and Detection: “Updating and Leveraging National Healthcare Registries in Care Delivery”

Use Case #4: Immunizations Registry Updating and Utilization - “Updating and Leveraging National Healthcare Registries in Care Delivery”

Use Case #7 – “Cancer Care Coordination and Ambulatory Care Reporting to a Central Cancer Registry”

Use Case #16: Maternal & Newborn Health – “Birth Event Reporting and Care Coordination for Newborn Hearing Screening”

Interoperability ShowcaseIn collaboration with IHE

Thank YouContacts:• CDC Standards & Interoperability: Nikolay Lipskiy,

NLipskiy@cdc.gov• Cancer Reporting: Wendy Blumenthal, WBlumenthal@cdc.gov• Early Hearing Detection and Intervention: John Eichwald, JE

ichwald@cdc.gov• Vital Records Standards: Michelle Williamson,

MWilliamson@cdc.gov• Immunization Information Systems: Warren Williams,

WWilliams1@cdc.gov• PHIN VADS: Roochi Sharma, RSharma@cdc.gov

• Email: phinvs@cdc.gov• Online Forum: http://www.phconnect.org/group/phinvads

• National Healthcare Safety Network: Daniel Pollock, DPollock@cdc.gov

• Clinical Decision Support: Nedra Garrett, NGarrett@cdc.gov

The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention

For more CDC information please contactTelephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.atsdr.cdc.gov