Claire Broome, M.D. Health Information Technology Summit March 7, 2005
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Transcript of Claire Broome, M.D. Health Information Technology Summit March 7, 2005
Leveraging Health IT: How can informatics
transform public health (and public health transform
health IT)?
Claire Broome, M.D.
Health Information Technology Summit
March 7, 2005
How can informatics transform public health (and vice versa)?
How can informatics transform public health? Overview of public health role Early detection and Biosense initiative Progress in HIT capacity at state and local health
departments How can public health transform health information
technology?
What is the “business” of public health?
Surveillance (disease tracking) Early outbreak detection : bioterrorist, foodborne Assess health status of population Assist in planning access to health care
Investigation of causes and transmission pattern Development of effective interventions to prevent
disease and promote health Vaccines Decision support for eye care for diabetics
Public HealthInformation
Network (PHIN)
Health Department
Public HealthLab
CDC and Other
Federal Organizations
Public
VaccinationCenter
AmbulatoryCare
Hospital orHealth Plan
Investigation Team
Law Enforcement and First Responders
RXPharmaceutical
Stockpile
Non-Clinical SourcesOTC, 911, etc.
Early Event Detection
Outbreak Management
Surveillance/Case Reporting
Connecting Lab Systems
Secure Communications
Analysis & Interpretation
Information Dissemination & Knowledge Management
Countermeasure administration and
Response
Federal Health Architecture, NHIN
& Consolidated Health Informatics
Public Health Information Network
Public Health Information Network - Vision
To transform public health by coordinating its functions and organizations with information systems that enable:
real-time data flow computer assisted analysis decision support professional collaboration rapid dissemination of information to public health,
clinical care and the public
How can informatics transform public health (and vice versa)?
How can informatics transform public health? Overview of public health role Early detection and Biosense initiative Progress in HIT capacity at state and local health
departments How can public health transform health information
technology?
Surveillance approaches for early detection of outbreaks
Informed alert health care provider notifies local or state health department 24/7 contact
“Syndromic surveillance” --healthcare databases and novel data sources (veterinary labs, retail supermarket sales, business absentee data, etc) analyzed with various aberration detection algorithms Systematic evaluation of utility of data sources, algorithms,
systems needed Disease specific health surveillance system detects an increase in
disease specific reporting National Electronic Disease Surveillance System (NEDSS)
Any “signal” irrespective of source will need confirmation, investigation
Early event detection is critical for Bioterrorism management and response
The most useful tools will be dual use; Bioterrorism capable and regularly exercised for “routine” public health activities
Multiple data sources should be co-ordinated to facilitate signal evaluation and reduce user burden
Both diagnostic and pre-diagnostic (syndromic) data exist in electronic form in many yet untapped health-related data stores
BioSense - Principles
BioSense Software System
National “safety net” – help support early event detection in major cities
An implementation of identified standards A platform for the implementation and evaluation
of different analytic approaches Connection to the CDC BioIntelligence Center to
support early detection analysis at local, state and national levels
Data Sources Currently Available
DoD – Ambulatory Care and ER Diagnoses - Up to four diagnosis codes (IDC-9-CM) identifying the reason for every US ambulatory care (including ER) visit
DoD - Procedures - Procedure codes (CPT) ordered for every U. S. ambulatory care visit
VA - Ambulatory Care and ER Diagnoses - Diagnosis codes (IDC-9-CM) for every US ambulatory care visit (including ER) in 172 hospitals and 650 outpatient clinics nationwide
VA – Procedures - Procedure codes (CPT) for every U.S. ambulatory care visit
Clinical Laboratory Tests - Clinical lab tests ordered nationally BioWatch Results - Lab result for BioWatch environmental
collectors
System Status Views for all states and all BioWatch cities
300 state and local health department user accounts
In use in CDC BioIntelligence Center
Have set up custom views for high profile events—eg G8 meeting
Detection algorithms CuSum, “Smart Scores” – implemented
SatScan - pending
“Punchcards”and Analytical
Summary
Region Selection
BioSense Home PageAnalytical Summary Information
“News” andImportantDetailed
Information
Data LoadReport
Demonstration Data
BioSense Health Indicators PageData Visualization
User Options Menus
Links to Syndrome-Specific
Display Pages
Syndrome-Specific“Consolidated”
Graphs
Demonstration Data
BioSense Health Indicators PageSyndrome-Specific Maps
Data SourceSpecific
Maps
Zip Code“Mouse Over”
DisplayZoom-In/Out
And Map Navigation
Tool
Demonstration Data
HIT could facilitate linking additional data important for early detection to Biosense
Claims clearinghouses Hospital systems and health plans Hospital information systems vendors Other national clinical testing labs Regional Health Information Organizations With local and state health departments, local
clinical care sites
How can informatics transform public health (and vice versa)?
How can informatics transform public health? Overview of public health role Early detection and Biosense initiative Progress in HIT capacity at state and local health
departments How can public health transform health information
technology?
Public Health Information Network Funding
September 2002 Public Health and Social Services Emergency Fund
$1 billion for state and local public health preparedness capacity
CDC and HRSA require in grant guidance use of standards for IT investments—www.cdc.gov/cic
September 2003, 2004 : continued state Preparedness funding
HRSA grants $498 million ; CDC $870 million All 50 states funded for continuous internet connectivity to
counties (fy1999) and surveillance planning ( fy 2000)
Moving from conceptual to real
state and local health departments have different stages of electronic systems and IT capacities
Each state/jurisdiction will need to develop specific plans Which systems to integrate What funding streams available
Central concept of PHIN is implementation of standards based interoperable systems so all Support interoperability with clinical care partners, other
states Efficient use of technical expertise, tools Plan for extensibility
How does PHIN improve local and state capacity?
Web entry: case information available to local & state health departments immediately on entry (no paper, no mail)
Supports case investigation by state and local health dept
Standardized data sent electronically to CDC Same application for over 140 diseases, replacing
disease specific “stovepipe” applications
How does PHIN accelerate disease detection by local & state health?
Electronic laboratory results reporting (ELR) from clinical diagnostic laboratories For pre-defined results of public health importance,
electronic message to health department automatically sent
Message includes structured data including test, result, provider ID, patient age, sex
Multi-jurisdiction labs, public health labs, some local labs Nebraska sees 3 fold increased number of cases
reported; data at state within days of visit instead of weeks
Status of state PHIN enhancements January 2005
Grantee capacity Impact on disease reports
In daily use
Develop or deploy
planning
Capacity for web data entry
More timely 25* 13 14
Electronic Lab Reporting (excludes lead only)
More timely
More cases
26 14 12
*application in use: 1 commercial (3 states); NEDSS Base System (10 states); custom (12 states) ,
How will public health benefit from PHIN and HIT?
Increased timeliness for early detection: ELR, Biosense Increased number of cases reported: ELR Decreased data entry burden—for health department
(web entry; data automatically entered) For partners Easier to track and manage workflow for investigators Better alerting and communications Increased analysis capacity for state and local
personnel As EHR’s and decision support mature, can implement
public health guidelines in clinical practise
How can informatics transform public health (and vice versa)?
How can informatics transform public health? Overview of public health role Early detection and Biosense initiative Progress in HIT capacity at state and local health
departments How can public health transform health information
technology?
How can public health accelerate interoperable standards based health information systems?
Public health intrinsically must exchange information with all clinical partners in a population Shouldn’t all RHIO’s have a public health participant?
Evident public value—outbreak detection, preparedness Concrete solutions for standards based interoperability – e.g.
bidirectional secure messages (ebXML) HL7 V 3 messages Implementation guides for message content—eg lab results Development of data use agreements
Public Health content & services for EHR’s
How do we get to standards based interoperable systems?
Gartner Group project on PHIN implementation – PHIN is a multi-organizational business and technical architecture Technical standards Data standards Specifications to do work
Is also a process Commitment to the use of standards Commitment to participating in development and
implementation of specifications
Improving preparedness: enhanced diagnosis and reporting
Information on clinical presentations: E-mails via states, professional societies Web sites—CDC >12,000,000 downloads CDC’s Distance Learning network 10 programs for >1,300,000
participants (fall 2001 events) Diagnostic capacity for BT and chemical agents
Laboratory Response Network—CDC & APHL-reagents & protocols from web site
Ability to contact health department 24/7 States funding for epidemiology staff, communications with
hospitals Communications platforms, alerting protocols
Public Health Information Network Tools available from CDC
Software for industry standards based bi-directional inter-institutional messaging transport (PHIN MS)
ebXML “handshake,” PKI encryption and security Technical assistance & direct assistance available
for public health partners (eg security IVV)
PHIN Vocabulary Access and Distribution Services, including web accessible Standard Reference Tables
Implementation Guides that specify data standards, message format
Example of a potentially useful “tool”: PHIN Messaging System
(PHIN-MS)Software for industry standards based inter-institutional message
transport available from CDC ebXML “handshake”, PKI encryption and security Payload agnostic (HL-7, text file, etc) Bi-directional data exchange
PHIN-MS in use by state and local partners for point to point messaging (ED and lab to state; state to CDC)
Several commercial systems planning to incorporate
integration broker
laboratory information system
How do we get there from here?
We don’t have the ideal technology, but there is much we can do NOW
Standards and tools can help Leverage funds, hardware, software, technical
expertise, experience Let’s commit to working together to transform
the public’s health!
Background Information
What does PHIN have to do with HIPAA?
HIPAA mandates national health care data standards and policies in four areas: Transaction content; unique identifiers for providers, health plans;
security; privacy PHIN architecture standards are HIPAA compliant:
supports “dual use” for security, messaging elements Approach to PHIN data standards is HIPAA compliant:
Adopting HIPAA standards where relevant eg electronic laboratory reporting in PHIN uses HIPAA claims attachment
Advocating inclusion of data elements relevant to public health with SDO’s
What does PHIN have to do with HIPAA Privacy Rule?
Privacy Rule allows current practice of sharing data with public health Rule permits health care providers to share
individually identifiable information with legally authorized public health entities for public health activities
Public health activities include surveillance (NEDSS), investigation, intervention