LHDs and HIE · 2013. 2. 5. · LHDs and HIE Opportunities and Challenges in the New HIT Landscape...
Transcript of LHDs and HIE · 2013. 2. 5. · LHDs and HIE Opportunities and Challenges in the New HIT Landscape...
LHDs and HIE Opportunities and Challenges in the
New HIT Landscape
to Transform Public Health Practice
and Protect and Improve the Health of
the Community
Presentation to the Kansas Association of Local Health Departments
June 19, 2012, Wichita Kansas
Susan M. Salkowitz
Salkowitz Associates, LLC
Morning Agenda
• Virtual introduction to Kansas
• Public Health HIT/Informatics Landscape
“flyover”-
• Introduction to the Learning Health System
• Federal initiatives-ONC and its activities
• New healthcare delivery models and population
health
• Health Data Initiative
• Healthy People 2020
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Afternoon Agenda
• KHIN Presentation- Laura McCrary
• KDHE/LHD approaches to Meaningful Use, timetable
and options for reporting
• LHD Opportunities and Challenges for Participating in
the emerging HIT/HIE Environment
Options for connectivity and exchange
Data Management- quality, appropriate use
Privacy, Security, Consent Issues
Collaboration, participation with stakeholders
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My Introduction to Kansas
• First “official” visit to KS • Virtual view- web searches and interviews
• What I learned
• Kansas Health Rankings: • Kansas 26th in 2011, down from 23rd in 2010
Determinants rank: 27
Outcomes rank: 21
• Challenges:
• Low Per capita public health funding- 44th
Limited availability of primary care physicians
High prevalence of obesity
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My Introduction to Kansas
• Kansas public health web presence
KDHE website well developed, easy to
navigate, timely information
Exploring/using new technology and Social
Media
Public health informatics development
• Staff interviews & feedback, collegial,
professional, knowledgeable, helpful
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My Introduction to Kansas
• Information Programmatic links to LHDs, providers and community and how
to connect KANHIT webpage
Explanation on status of Meaningful Use Public Health
Measures, timetable and directions for attesting
• Strong evidence of collaboration and best
practice adoption Adaption of applications developed by other states- e.g. MO, UT,
WA
Participation in Open Source Development of BioSense
Collaboration with KSU (Cancer Registry), Kansas Hospital
Association (KHA) (discharges) Kansas Partnership for
Improving Community Health (KanPICH) for Health Matters
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KAN-HIT website
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Public Health in the Health Information Technology Landscape
Electronic Systems Public Health
Surveys and Data collection-NHANES, NIS,BRFS
Vitals-Birth & Death
Hospital discharge- (KHA-KPHA)
•Laboratory (ELS)
•Blood lead
•Disease Reporting-KSEDDS, Epi-Trax
•Syndromic Surveillance-BioSense
•Newborn Screening
•Early Hearing Detection
•Immunization Information Systems (IIS) -
KSWebIZ
•Disease Registries- CDEMS
•Cancer Registries
•Health Alert Network (KS-HAN)
•Emergency Response-
• Operations- (Web-EOC)
• Counter Measures-(KS-CRA)
• Volunteers (K-Serve)
•Environmental health - EPHT
Health Care Systems (EHRs/EMRs)
Ambulatory-Adult, Pediatric
Clinical decision support
Emergency Room
Hospital inpatient/outpatient
Long Term Care
Laboratory
E-Prescribing (Erx)
Imaging systems (PACS)
Administrative data-eligibility/enroll
Claims
Data Management-Use
Quality Measures/Performance Improvement
Analytics-Business Intelligence
Data Management
Data quality- accuracy, completeness
Infomediaries
Federal Initiatives
Office of National Coordinator (ONC)
Standards & Interoperability
HL7, CDA, CDR,LOINC, SnoMed,
CDISC, DICOM, x.12,NUBC, NCPDP,
ICD10, Privacy (HIPAA, FERPA)
Security- Risk Assessment
Certification - ATCBs
HITECH-ARRA-EHR Adoption
Regional Extension Centers (REC)
CMS- Meaningful Use
Payment Models- PCMH, ACO
Exchange Mechanisms
HIEs/HIOs
DIRECT.CONNECT
NHIN, NwHIN
Demonstrations &Innovation
Beacon Communities
CMMI- CMS innovation
Other HHS
Healthy People 2020
Health Data Initiative
Health Policy
Affordable Care Act
Preventive Services Fund
Learning Health System
Triple Aim- Bending the Cost
Curve
Demographics and
Societal Factors
Aging population
Chronic conditions-health behaviors
Health Disparities
Digital Divide
Enabling Technology
•Internet/Web
•Cloud computing
•Software as a Service (SAAS)
•Mobile Devices-Smart
Phones, iPads, tablets
•Telehealth
•Video- U-Tube
•Distance Learning
•Social Networking-
• Facebook, Twitter,
• Linked-in
•Gamification
•GPS/GIS
•Collaboration
• Open-Source
• Wikis
• Directories, EMPIs
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Public Health Information Role
• "The #1 product public health provides to customers is
information.” John Lumpkin, Former Director, Illinois Department of Public Health
• Public Health Informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning (Patrick W. O’Carroll, MD, MPH)
• Public health is extremely broad and might even reflect an interest in information technology with regard to ecology, architecture, climate, agriculture, and such.
• American Medical Informatics Association (AMIA)
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Public Health in a
Learning Health System
• A number of prestigious organizations have advocated for
a transformation in health and healthcare by the next
decade. Integral to this transformation is the
migration from the disease-based to a health-based
model of care and a learning health system, in
which
All persons have access to care,
The population’s health can be measured objectively,
and
A digital infrastructure promotes healthy lifestyles and
enables more efficient and effective care delivery. (NCVHS Shaping a Health Statistics Vision for the 21st Century-Final Report November 2002)
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Public Health in a
Learning Health System
• The health-based model/learning health system, is important for public health because it emphasizes health promotion and disease prevention and
• It enables public health to play a greater role in supporting the nation’s healthcare system and assuring the public’s health —the very tenets for which the sector stands
(NCVHS Shaping a Health Statistics Vision for the 21st Century-Final Report November 2002)
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Public Health in a
Learning Health System
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Core public health functions
require stewardship for data
collection, management,
analysis, and dissemination
across multiple stakeholders,
and extensive communication to
official agencies, healthcare
providers and facilities, health
plans, individuals and the public
at large to document, measure,
inform, educate, promote,
mobilize, assure, and enforce.
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The Learning Health System
National Committee on Vital and Health Statistics (NCVHS)- The Community
as a Learning Health System-Using Local Data to Improve Local Health 13
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The Learning Health System
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LHDs
The Learning Health System
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LHD
Opportunity
The Learning Health System
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Public Health Informatics Drivers
Federal
• Federal initiatives, now deployed, funded opportunities
for public health and informatics
• HITECH ARRA (stimulus) serious funding for public
health prevention, incentives for EHR adoption health
Information exchange and “meaningful use”
• Affordable Health Act (health care reform) March 2010
with many provisions for public health and preventive
services, dedicated Public Health Trust Fund
• Infrastructure to promote adoption, certification,
deployment and use of HIT
• Continued development of Standards to exchange
clinical data electronically including public health
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Public Health Informatics Drivers in
Federal(con’t.)
• Public health recognition in Office of National
Coordinator (ONC)
• Recognition of population health and social determinants
of health and wellness-Revised HP2020
• The Health Data Initiative (HDI) -a public-private
collaboration that encourages innovators to utilize health
data to develop applications to raise awareness of health
and health system performance and spark community
action to improve health. (Todd Park)
• Coordination of PH and informatics organizations
around PH Informatics-(PHII, JAPHIT, NAPHIT, PHDSC,
AMIA-PHI, HIMSS)
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Public Health Informatics
Federal Initiatives
• Federal HIT Infrastructure- Office of the National
Coordinator (ONC) • Promote development of a nationwide Health IT infrastructure that allows for
electronic use and exchange of information that improves quality and
reduces costs while protecting patient health information:
Improves coordination of care and information among stakeholders
Improves public health activities and facilitates early
identification/rapid response to public health emergencies
Facilitates health and clinical research
Promotes early detection, prevention, and management of chronic
diseases
Promotes a more effective marketplace
Improves efforts to reduce health disparities
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Public Health Informatics
Federal Initiatives (con’t.)
• Federal HIT Infrastructure- Office of the National
Coordinator (ONC)
Policy and Standards
EHR adoption- Meaningful Use
Regional Extension Centers (RECs)
Certification and testing of EHRs
• ARRA HITECH Funding streams-
• Demonstrations
State Health Information Exchange (HIE) grants
Beacon and Sharp Grants
• CDC policy changes, grants and technical assistance
• CMS Incentives for EHR adoption- Meaningful Use,
• CMS New care delivery and payment models PCMH, ACOs
• CMMI Innovation Grants-
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ARRA, HITECH and Opportunities for
Public Health
Uses of health IT have the potential to bring many benefits
to public health agencies, including:
• Earlier detection of infectious disease outbreaks
• Improved tracking of chronic disease management
• Improved coordination of care across public and private
providers
• More accurate assessments of disease burden in the
community, or of the impact of community-wide
prevention initiatives
• Trusted stewards of personal information Source: The Value of Health IT in Improving Population Health and Transforming Public Health Practice-A Brief for Local and State Health
Officials A joint Publication of the Public Health Informatics Institute and the InfoLinks and Connections Communities of Practice November 2009
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Public Health Informatics Drivers
Centers for Medicare & Medicaid Services
• NPRM for Meaningful Use (an incentive for EHR
adoption) was published in the Federal Register for
public comments
• Numerous PH organizations made MU comments in an
organized fashion: NAPHIT ASTHO, NACCHO, CSTDE, APHL,
PHDSC, Public Health Informatics Institute, AIRA
• Webinars convened members, organizations and health
departments to collect and vet comments sent individually and
collectively including a coordinated response by JAPHIT.
• PH reporting as menu option in Stage 1 MU.
• State-mandated lab reporting
• Reporting immunizations to state immunization system
• Syndromic surveillance
• identification of patients for outreach and disparities reduction.
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Public Health Informatics Drivers
Centers for Medicare & Medicaid Services
• New care delivery and payment models
• Patient Centered Medical Home- Medicare projects
• Health home: Medicaid projects
• Health Homes for Medicaid Enrollees with Chronic
Conditions
• ACO- Accountable Care Organization
• Medical Neighborhood • The Kansas Patient Centered Medical Home Initiative (Ks PCMHI is a
project of the Kansas Academy of Family Physicians in conjunction
with the Kansas Association of Osteopathic Medicine, the Kansas
Chapter of American Academy of Pediatrics, the Kansas Chapter of
the American College of Physicians, and the Kansas Medical Society.
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Center for Medicare & Medicaid Innovation CMMI- http://www.innovations.cms.gov/
• Initiatives to achieve the IHI Triple-AIM Improving the patient experience of care (including quality and
satisfaction)
Improving the health of the populations
Reducing the per capita cost of health care
• June 12, 2012-Two awards which include KS Project Title: “Multi-community partnership between TransforMED,
hospitals in the VHA system and a technology/data analytics company
to support transformation to PCMH of practices connected with the
hospitals and development of “Medical Neighborhood”
The University of North Texas Health Science Center (UNTHSC), in
partnership with Brookdale Senior Living (BSL), is receiving an award
to expand and test the BSL Transitions of Care Program which is
based on an evidenced-based assessment tool called Interventions to
Reduce Acute Care Transfers (INTERACT
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Meaningful Use (MU)
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Health Outcomes Policy Priority:
Improve population and public health
Care
Goal(s)
Stage 1 Objectives Stage 1 Measures
Eligible Providers Hospitals
Communicate
with public
health
agencies
Capability to submit
electronic data to
immunization registries and
actual submission where
required and accepted
Capability to submit
electronic data to
immunization registries and
actual submission where
required and accepted
Perform at least one test of certified
EHR technologies capacity to submit
electronic data to immunizations
registries
Capability to provide
electronic syndromic
surveillance data to
public health agencies
and actual
transmission
according to
applicable law and
practice
Capability to provide
electronic syndromic
surveillance data to
public health agencies
and actual transmission
according to applicable
law and practice
Performed at least one test of
certified EHR technology's
capacity to provide electronic
syndromic surveillance data to
public health agencies (unless
none of the public health agencies
to
which an EP or eligible hospital
submits such information have the
capacity to receive the information
electronically)
Capability to provide
electronic submission of
reportable lab results (as
required by state or local
law) to public health
agencies and actual
submission where it can
be received
Performed at least one test of the EHR
system's capacity to
provide electronic submission of
reportable lab results to public health
agencies (unless none of the public
health agencies to which eligible
hospital submits such information have
the capacity to receive
the information electronically) 26
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Meaningful Use and PH Informatics
• Participate in national standards organizations such as HL7, LOINC,
develop use cases, ballot standards, produce implementation
guides, ONC S&I initiative
• Develop use cases for Integrated Health Enterprise (IHE),
emergency preparedness and response, immunizations, newborn
screening, early hearing detection scheduled for HIMSS
Connectethon 2011.
• Develop Testing criteria for public health components of meaningful
use for Certification
• Develop education and other tools for Regional Extension Centers
to advise and encourage providers to choose and implement public
health meaningful use components
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Regional Extension Centers (RECs)
• RECs were created last year under the HITECH Act, part of the ARRA Act of 2009. HITECH provided approximately $2 billion in new programs to provide training
and technical assistance and to demonstrate the effectiveness of health information technology in supporting improvement in care.
Under the HITECH Act, $677 million is allocated for the next two years to support a nationwide system of RECs.
• KS REC- KS Foundation for Medical Care, Inc -(KFMC) is the federally designated HITREC for the state of Kansas. http://www.kfmc.org/rec/ Accelerate Health Information Technology (a-HIT) in Kansas!KFMC’s services
are designed to take your organization from its current state – whether you are starting with a paper-based system or just need to optimize your current EHR – to MU in order to qualify for the Medicare or Medicaid Incentives.
target their assistance to eligible primary care providers in smaller practices as well as small and rural hospitals and public health clinics.
will also serve as a resource for all providers in an area, giving assistance, as feasible, to any doctor, hospital or clinic making the request.
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Health Information Exchange (HIE) • Health information exchange (HIE) -transmission of healthcare-
related data among facilities, health information organizations
(HIO) and government agencies according to national standards.
• The State Alliance for e-Health, 2006 NGA ONC-approved models:
Government-Led Electronic HIE: Direct government provision
of the electronic HIE infrastructure and oversight of its use.
(ME, VT)
Public Utility with Strong Government Oversight: Public
sector serves an oversight role and regulates private-sector
provision of electronic HIE. (TN, UT)
Private-Sector-Led Electronic HIE with Government
Collaboration: Government collaborates and advises as a
stakeholder in the private-sector provision of electronic HIE. (
DE, NE)
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Office of the National Coordinator-
HIE Support
• State Health Information (State HIE) Exchange
Cooperative Agreement Program.
In total, 56 states, eligible territories, and qualified State
Designated Entities (SDE) received awards.
• The Beacon Community Cooperative Agreement
Program
provides funding to 17 selected communities throughout the
United States that have already made inroads in the
development of secure, private, and accurate systems of
electronic health record (EHR) adoption and health information
exchange. Many include public health.
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Role of Public Health in Health
Information Exchange (HIE)
• Source of clinical and other health information on clients seen by
public health, or on specimens tested by public health.
• Source of information on emergent issues in a community that could
assist a clinician in diagnostic and treatment decisions.
• Source of population based analysis of individual disease data to
provide improved trends to providers.
• Recipient of reportable disease information.
• Recipient of biosurveillance data reporting streams
• Provider of expert knowledge in population health improvement, and
in clinical and treatment guidelines.
Source: The Value of Health IT in Improving Population Health and Transforming Public Health Practice-A
Brief for Local and State Health Officials A joint Publication of the Public Health Informatics Institute and the
InfoLinks and Connections Communities of Practice November 2009
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Public Health Contribution to
Population Health
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Population-wide Quality Measures
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Healthcare data benefit to Public Health
DavidsonGibson
MUbriefing.pdf
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LHDs in Health Data Exchange DavidsonGibson MUbriefing.pdf
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Role of Public Health in National Quality
Strategy DavidsonGibson MUbriefing.pdf
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NACCHO LHD Operational Jurisdiction
DavidsonGibson MUbriefing.pdf
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Context of LHDs
DavidsonGibson MUbriefing.pdf
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Creation of Public Health Use Cases
DavidsonGibson MUbriefing.pdf
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Overview of KHIN
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Public Health in KHIN
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LHDs and KHIN
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Example from HITE-CT
Connecticut’s HIE
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Example from HITE-CT
Connecticut’s HIE
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Example from HITE-CT
Connecticut’s HIE
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Example from HITE-CT
Connecticut’s HIE
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Example from HITE-CT
Connecticut’s HIE
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Crescent Beacon in LA
Zachery M. Ziwa, Chief Technology Officer, Louisiana Department of
Health & Hospitals 3
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Crescent Beacon in LA
Zachery M. Ziwa, Chief Technology Officer, Louisiana Department of
Health & Hospitals 4
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Crescent Beacon in LA
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Crescent Beacon in LA
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LHD
Opportunity
VT Blueprint for Chronic Care
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Health IT Framework
Evaluation Framework
Medical
Home
Hospitals
Public Health
Programs & Services
Community Health Team
Nurse Coordinator
Social Workers
Nutrition Specialists
Community Health Workers
MCAID Care Coordinators
Public Health Specialist
Specialty Care & Disease
Management Programs
A foundation of medical homes and
community health teams that can
support coordinated care and linkages
with a broad range of services
Multi Insurer Payment Reform that
supports a foundation of medical
homes and community health teams
A health information infrastructure
that includes EMRs, hospital data
sources, a health information
exchange network, and a centralized
registry
An evaluation infrastructure that uses
routinely collected data to support
services, guide quality improvement,
and determine program impact
Mental Health &
Substance Abuse
Programs
Medical
Home
Medical
Home
Medical
Home
Social, Economic, &
Community Services
Healthier Living
Workshops
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Integration of public health from VT
Public Health in the Medical
Neighborhood
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LHD Opportunity
LHD Opportunity
Role of HIE in population health
• Source of improved population health data collection
• Ability to promptly route and deliver to community
clinicians emergent information from public health
• Assist public health in cross-jurisdictional collaboration
on data collection and sharing
• Improved continuity of care
Source: The Value of Health IT in Improving Population Health and Transforming Public Health Practice-A Brief for Local and State
Health Officials A joint Publication of the Public Health Informatics Institute and the InfoLinks and Connections Communities of Practice
November 2009
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Health Data Initiative
• The IOM and HHS has hosted The Health Data Initiative
Forum for 3 years, most recent 6/5-6/12
• to accelerate momentum for the public use of data and
innovation to improve health. It includes
fast-paced demonstrations
range of tools and applications developed using health data,
discussion sessions,
data and apps exposition where participants can interact with
featured innovators
Several public health departments attended and many apps
have been developed for public health
• http://www.hdiforum.org/
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How the Health Data Initiative Works
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LHD Opportunity
About Healthy People
HP2020
• Healthy People provides science-based, 10-year
national objectives for improving the health of all
Americans.
• For 3 decades, Healthy People has established
benchmarks and monitored progress over time
in order to: Encourage collaborations across communities and sectors.
Empower individuals toward making informed health decisions.
Measure the impact of prevention activities.
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What’s New for HP 2020? Focus on the Determinants of Health-
• Identifying, measuring, tracking, and reducing health disparities
through a determinants of Health approach
• New Topic areas for 2020
• Adolescent Health
• Blood Disorders and Blood Safety
• Dementias, including Alzheimer’s Disease
• Early and Middle Childhood
• Genomics
• Global Health
• Healthcare Associated Infections
• Health Related Quality of Life and Well-Being
• Lesbian, Gay, Bisexual, and Transgender Health
• Older Adults
• Preparedness
• Sleep Health
• Social Determinants
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Healthy People 2020 in the
Digital Age
• Stay connected with Healthy People 2020 and the Office
of Disease Prevention and Health Promotion (ODPHP).
• Connect Online
• Subscribe to “Who’s Leading the Leading Health Indicators?”
• Join the Healthy People Consortium
• Follow us on Twitter@GoHealthyPeople on Twitter..
• Connect With Healthy People on LinkedIn
• Join the Healthy People 2020 LinkedIn group and invite your
colleagues to do the same.
• View the Latest Healthy People Videos on YouTube
Healthy People 2020 Announces the Leading Health
Indicators App Challenge
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Accountable Care Act :
Changes in Relationship between PH and HC
• Health Information Technology
• Opportunity to rethink how surveillance is done
• Opportunity to expedite analysis of large sets of
outcome data
• Opportunity for public health to use its surveillance and
epidemiology
• expertise to hold the reformed system accountable
• What does surveillance mean in an era where policy
and community prevention are central?
Source: Trust for America’s Health, Richard Hamburg www.healthyamericans.org/health-reform
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Accountable Care Act :
Changes in Relationship between PH and HC (continued)
• Coverage of key preventive services
Mandated coverage of all USPSTF A and B recommendations
Mandated coverage of all ACIP immunizations
• What does this mean for direct delivery of care by public
health agencies?
• Where is the best place to deliver this care?
• Role of health departments in holding the health care
system accountable
Source: Trust for America’s Health, Richard Hamburg www.healthyamericans.org/health-reform
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Re-organizing Public Health and its Business
National, state and local HIT initiatives and new CDC
direction provide an opportunity for Public Health to…..
• Engage directly in health reform and HIT efforts
• Use new tools for collaboration and outreach
• Collect and exchange data
• Share its expertise in convening community
stakeholders
• Protect confidentiality
• Analyze and disseminate information for health
professionals and the public.
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Kansas Health Matters website
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Re-organizing Public Health and its Business
Re-align and reorganize Public Health business processes
• Technological advancements are changing the way public health must “do business”
Change operational model from “information consumer” to “information broker”
Make organizational changes to meet the needs of community partners
Meet the growing demands to electronically exchange information with physicians, hospitals and other public health agencies
Ensure that they are maximizing the collection and use of data to provide the best community service
(Reference: Informatics on the Organization Chart, Public Health Informatics Institute, Connections 2007 Newsletter)
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Role of Public Health
Critical Success Factors
Public Health Imperatives to get into and stay in the HIE game
• Establish a high level informatics position/function in the health department
Disseminate an informatics strategy
• Embrace standards
Participate as public health subject matter experts in the development and evaluation of use cases
• Collaborate with university informatics programs
• Join and participate in organizations that support public health informatics
• Be aware of funding for informatics initiatives
• Organize to apply for grants and partner or collaborate with other stakeholders.
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LHDs and HIE Opportunities and Challenges in the
New HIT Landscape
to Transform Public Health Practice
and Protect and Improve the Health of
the Community
Presentation to the Kansas Association of Local Health Departments
June 19, 2012, Wichita Kansas
Susan M. Salkowitz
Salkowitz Associates, LLC
Afternoon Agenda
• KHIN Presentation- Laura McCrary
• KDHE/LHD approaches to Meaningful Use, timetable
and options for reporting
• LHD Opportunities and Challenges for Participating in
the emerging HIT/HIE Environment
Options for connectivity and exchange
Data Management- quality, appropriate use
Privacy, Security, Consent Issues
Collaboration, participation with stakeholders
KALHD 6-19-12
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Healthcare Information Technology –
Convergence With PH- CDC Changes
CDC- Positioning to address health reform • Health care system, local, state and national
Clinical preventive services-area of largest impact
Care coordination
Case management
Workflow
• Greater coordination with ONC and Federal and state HIE initiative (PHIN-NwHIN) Sponsorship of attendees and sessions at HIMSS in Atlanta,
March 2010; Davies Public Health Awards
Active participation in standards and policy particularly with public health use cases
Use of social media:Twitter and Facebook collaboration and social networking
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CDC PHI Conference 8/11
KALHD 6-19-12
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CDC & Meaningful Use-
Strengthening the Link between Healthcare Providers and
Public Health
Seth Foldy, MD MPH FAAFP
Senior Advisor Public Health Surveillance and Informatics Program Office KALHD 6-19-12
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CDC & Meaningful Use-
Strengthening the Link between Healthcare Providers and
Public Health
Seth Foldy, MD MPH FAAFP
Senior Advisor Public Health Surveillance and Informatics Program Office
KALHD 6-19-12
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CDC & Meaningful Use-
Strengthening the Link between Healthcare Providers and
Public Health
Seth Foldy, MD MPH FAAFP
Senior Advisor Public Health Surveillance and Informatics Program Office
KALHD 6-19-12
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Standards for Meaningful Use Area HIT Standards Cmte
recommendations Stage 1/2011 Current IFR
Stage 2/2013
Content Exchange or Package
Patient summary data package CCD, CDA template, or HL7 2.5.1
CCD or CCR Alternatives expected to be narrowed based on HIT Stds Committee recommendations
E-prescribing data package NCPDP SCRIPT 8.1/10.6 NCPDP SCRIPT 8.1/10.6 NCPDP SCRIPT 10.6
Lab data reporting to public health agencies package
HL7 2.5.1 HL7 2.5.1 Potentially newer versions, based on HIT Stds Cmte Recommendations
Administrative data package X12 4010A1 and NCPDP 5.1 and CAQH CORE
X12 4010A1 and NCPDP 5.1 and CAQH CORE
X12 5010 and NCPDP D.0 and CAQH CORE
Public Health Surveillance and Reporting
HL7 2.3.1., HL7 2.5.1 HL7 2.3.1., HL7 2.5.1
Potentially newer versions, based on HIT Stds Cmte recommendations
Immunization Reporting to registries
HL7 2.3.1, HL7 2.5.1 HL7 2.3.1, HL7 2.5.1 Potentially newer versions, based on HIT Stds Cmte recommendations
Quality Reporting CMS CDA and respective template lib. specifications
CMS PQRI CMS CDA and respective template library specifications
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Standards for Meaningful Use
Area HIT Standards Cmte recommendations
Stage 1/2011 Current IFR Stage 2/2013
Vocabulary – 2 (codify content)
Lab Orders and Results Local or proprietary codes or candidate Stage 2 standard
Ability to accept LOINC codes
LOINC
Electronic Prescribing Local or proprietary codes or candidate Stage 2 standard
Any code set by an RxNorm drug data source provider that is identified by NLM as being a complete data set integrated within RxNorm
RxNorm
Public Health Surveillance or Reporting
According to applicable public health agency requirements
According to applicable public health agency requirements
GISPE or according to applicable public health agency requirements
Immunizations CVX CVX CVX
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CDC & Meaningful Use-
Strengthening the Link between Healthcare Providers and
Public Health
Seth Foldy, MD MPH FAAFP
Senior Advisor Public Health Surveillance and Informatics Program Office KALHD 6-19-12
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CDC & Meaningful Use- Strengthening the Link between Healthcare Providers and
Public Health
Seth Foldy, MD MPH FAAFP
Senior Advisor Public Health Surveillance and Informatics Program Office
KALHD 6-19-12
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Standards & Interoperability Framework
for PH Reporting
Seth Foldy, MD MPH FAAFP
Senior Advisor Public Health Surveillance and Informatics Program Office KALHD 6-19-12
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Public Health Needs HIEs
Seth Foldy, MD MPH FAAFP
Senior Advisor Public Health Surveillance and Informatics Program Office
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KDHE Support of Meaningful Use
• Website information for
• Disease reporting for Health Professionals
• Laboratory reporting requirements
http://www.kdheks.gov/epi/disease_reporting.html
• Reporting to KS Web-IZ-
http://www.kdheks.gov/immunize/webiz.html
• Meaningful Use information for eligible providers
http://www.kdheks.gov/epi/meaningful_use.htm
• State IT infrastructure for electronic systems for reporting
of MU measures
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KS Meaningful Use Information
on KDHE website
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KDHE Support of Meaningful Use
• Development, support and operation of applicable
systems:
KSWebIZ- Immunization Information System (Registry)
Epi-Trax for notifiable disease reporting
BioSense for Syndromic Surveillance
Vital Records for demographic information
Proposed Medicaid eligibility and enrollment system
• Development of electronic interfaces for uni and bi-
directional reporting from LHD electronic records and
EHRs
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KDHE Support of Population Health
• Public Health Informatics Office
• Vital Statistics data analysis
• Kansas Information for Communities (KIC)
• Healthcare Associated Infections
• Kansas Health Matters
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IIS, Interoperability and
Meaningful Use
CDC releases (ARRA) Funding Enhancing the Interoperability of Electronic
Health Records (EHR) and Immunization Information Systems (IIS)
35 Grantees receive funding to develop interfaces between their IIS and
provider EHR systems.
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KS WebIz
Immunization Information System-IIS
• KSWebIZ-the statewide immunization registry, is a web-based centralized birth to death database that maintains complete, accurate, and secure immunization records for all Kansas residents.
• Various methods of connection are enabled: Data entry via web interface into native application-ability to access all
functionality on a record by record basis
Bi-directional access via KIPHS, Insight for LHDs
Uni-directional or bi-directional interface to selected provider EHRs- Office Practicum, for example.
Bi-directional interface to 14 FQHCs through KHIN (enabled by grant)
Developing one-off interfaces is time consuming, expensive
Providers now being encouraged to report via HIE- moratorium on further individual interface development
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KS WebIz Immunization Information System-IIS
• Meaningful Use-Stage 1
• Some already connected providers have attested
• Exclusion letter to postpone attestation without penalty is posted for
use by all providers
• Providers will benefit by reporting MU via HIE as standardized
formats and use of appropriate standards will be supported
• Reporting by MU eligible providers will be helpful but not sufficient
by itself to greatly increase number of immunization records in
KSWebIZ
• Use of DIRECT not recommended for reporting to KSWebIZ
Not bidirectional
Will not support other KSWebIZ functions
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KS WebIz Immunization Information System-IIS
• Provider Participation in KSWebIZ No legislative requirement for providers to report
Provider participation is voluntary
Participation of an individual may be opted out even if provider is reporting
• Potential impact of reporting via HIE Reduce need for individual interfaces- HIE will parse and translate messages to send
to KSWebIZ
Will support provider Meaningful Use reporting (if applicable)
Will increase the volume and accuracy of the immunization information
Will populate reports by county and zip code level for greater local immunization program support and community assessment
• Future Issues HIE is opt in or opt out- not selective opt out. May reduce IZ records which the patient
does not otherwise object to
HIE may wish to support other IIS functions such as decision support, reminder recall instead of KDHE or
Providers might decide the MU reporting is enough and not use other functions
Incremental roll out of HIE may extend period of provider non-participation
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Lab Interface Improvement
Challenge
There is a lack of harmonized specifications standards and code sets to enable the exchange
of lab results. The cost and time to initiate new electronic laboratory results interfaces
hampers broad adoption of such interfaces. The field by field details of HL7 v2 implementation
guides used by clinical labs and EHRs vary, creating a need for mapping or configuration per
interface, and the prevalence of core subsets of LOINC codes for common tests and analyses
also varies, causing downstream issues in decision support and quality reporting.
Scope Statement Limited to address this challenge for the subset of lab reporting to primary care (internal medicine,
family practice, pediatrics)
Target Outcomes • Achieve cost savings of up to 90% due to lab interface development improvements by 2015
• Reduce total lab interface implementation time by up to 20% by 2013
Meaningful Use
Alignment
Incorporate lab results into EHR as structured data
Related Use
Cases/Stories
• Electronic Health Record (Laboratory
Result Reporting) (ONC/AHIC)
• EHR Lab Scenarios (ONC/AHIC)
• Laboratory sends lab results to ordering provider
(NHIN Direct)
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Surveillance at KDHE
• Moving to Epi-Trax from EDRS
Will be able to accept laboratory reports
electronically- previous system required
manual data entry
• Currently testing Electronic Laboratory
Reporting (ELR)
Exploring hospital labs, then reference labs
Providers do not perform ELR, only Hospitals
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Electronic Laboratory Records
• More problems with lab standards,
vocabulary, coding in KS and nationally
ONC working to get ELRs on board
No incentives to exchange
Some states piloting using Surescripts
Utility of DIRECT for lab results not known-
KDHE looking at other states
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Electronic Laboratory Records
• KHIN and LACIE certified to do business in KS
• Currently in 30 day patient notification for July 1
start date.
• HIEs are engaging partners themselves.
• Some labs do not have the ability to exchange
• LHDs want to get the results sooner but need to
support the state infrastructure
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Syndromic Surveillance
Challenge
The overall adoption rate for syndromic surveillance is extremely low, yet meaningful use
requirements demand an increased level of surveillance reporting. There is a direct need for a
simplified way of reporting standardized data to appropriate public health authorities that will
enable meaningful use requirements associated with surveillance to be fulfilled. It is
debatable as to whether providers can meet existing and future surveillance requirements
with the current implementation guidance available.
Scope
Statement
Develop a syndromic surveillance service specification to be used by vendors to deploy a
standardized syndromic surveillance service within their infrastructure
NOTE: This initiative would complement the work conducted by ISDS and CDC to develop Stage 1
meaningful use recommendations for syndromic surveillance. The ISDS recommendations are
available for public comment and review at :
http://www.syndromic.org/uploads/files/ISDSRecommendation-PROVISIONAL_vFINAL.pdf
Target
Outcomes
• Increase syndromic surveillance reporting by 10% by 2013
• Increase syndromic surveillance data collection response times for at least 2 conditions by 20%
Meaningful Use
Alignment Provide electronic syndromic surveillance data to public health agencies
Related Use
Cases/Stories
• Public Health Case Reporting (ONC/AHIC)
• Hospital or provider send chief complaint data to
public health (NHIN Direct)
• Laboratory reports test results for some
specific conditions to public health (NHIN
Direct)
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Syndromic Surveillance at KDHE
• BioSense now in Open Source
• KDHE participating at CDC
• Working on decision support
• Syndromic data reporting by providers
• Information is available to LHDs, but seems to
be of low value
• Priority on Syndromic surveillance- an effect of
Bioterrorism
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Role of HIE in Surveillance/ELR
• Meaningful use reporting does not change the legal
reporting requirements of notifiable diseases/events, etc.
• KDHE will provide the infrastructure for MU reporting
whether directly from LHDs, providers and hospitals or
via the HIE.
• KDHE is working with KHIN to establish the portals,
security to interact with the HIE
• The HIE will act to simplify provider reporting and make it
more efficient which will increase the frequency and
volume of reports and provide a more robust data base
for state and local use.
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Other KDHE Data Assets
• Population Health Data
KIC web tool based on MO system- updating to 2nd generation
KS Health Matters- vendor supported
Vital Records
• Analytical team
• PH assessment- tied to county health assessment
• Diabetes program track
Tracks eye exams using CDEMS based in provider offices
• BRFS surveys
Health promotion
Awareness
Prenatal
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Other KDHE Data Assets
• Medicaid now located in KDHE
• Managed care being updated
• KEES- New eligibility and enforcement system
Will provide EMPI capability
• Challenges:
Managing core system roll out, testing and implementation
Working with timetable of KHIN deployment
Staff and budgetary issues
Competing priorities
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Public Health Role in HIE
• KHIN- extensive information on website
• KDHE Public Health Role in HIE
KDHE = public health infrastructure of HIE
Portals for bi-directional reporting for surveillance,
immunizations
Support for meaningful use public health measures
• LHD options for connecting
Point to point bidirectional to KDHE Portal(s)
Via interface to LHD system-KIPHS or Insight (FQHCs
via interface with Success EDS)
Via Emdeon EHR Lite to HIE
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LHDs and KHIN
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LHD Challenges
• KIPHS, Insight, Emdeon- choices to make-
• Upgrade, replace, supplement
• Which applications to move and with what priority
• Resource constraints
• Budgetary
• Staff- skills, training, capacity
• Leadership- commitment
• Community partners
• Priorities/ Strategic planning
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LHD Challenges
• What is value proposition for your department to connect
to KHIN?
• Can you identify “Use cases”?
What is the “low hanging fruit”-
(note:- a critical success factor for the learning health system is
“a galvanizing health concern”)
Smoking is still a problem in KS- (17% , 22ND rank)
• Who would be your community partners?
Are there any health coalitions- Izs, Diabetes, etc?
Do you have a Medical Home or Medical Neighborhood project
in your jurisdiction?
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Data Management & Data Quality
Challenges
• Is your LHD engaged in any of the standards efforts for
public health data?
• Do you use systems that have an index/algorithms for
name matching and deduplication?
• If your LHD does not operate an FQHC or family medical
center, how do you think you could use the HIE to share
clinical information with client/patient’s private providers
or hospitals?
• What are the consent/privacy considerations that would
govern such transactions and how would you manage
them
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Data Management & Data Quality
Challenges
• Do you have policies and procedures for personally
owned mobile devices such as smart phones and pads
brought to the office? (BYOD)
• Have you thought about how you will incorporate and
manage data obtained from social media and mobile
technology with standard and required data reporting to
your department?
• Do you have adequate opportunities to provide Local
Health input into state and national discussions?
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Finale!!
• LHDs worry about their continued relevance in the face
of low budgets and low political esteem for government
functions
• The goal of providing quality healthcare for all, while
bending the cost curve, can not be achieved without a
local public health role, doing the functions they do best.
• LHD participation in KHIN can facilitate collaboration,
particularly with the health delivery and payment system,
to improve both the health and care of the population.
• Many more detailed materials, including a HIT
Landscape vocabulary and those referenced in the
presentation, have been posted on your website.
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Contact Information
• After I leave Kansas tomorrow, I will be available “virtually”
• Susan M. Salkowitz, MA, MGA Principal, Health Information Systems Consultant, Salkowitz
Associates, LLC
233 S 6th St #1601, Philadelphia PA
Phone: 215 351 7887
E-mail: [email protected] • Relevant Memberships
Board member: American Immunization Registry Association ( AIRA) 2000-2009
Executive Committee and Board Member, Public Health Data Standards Consortium
Adjunct Senior Fellow- Leonard Davis Institute, University of Pennsylvania
Population Health Associate, Thomas Jefferson University School of Population Health (2007-2012)
Member: APHA,PPHA, AMIA, HIMSS, PAeHi, GPAC
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KALHD 6-19-12