NAPHSIS Annual Meeting 2014Slide 1 NAPHSIS ANNUAL MEETING | Seattle | June 8-11, 2014 VITAL RECORDS:...

NAPHSIS Annual Meeting 2014 Slide 1NAPHSIS ANNUAL MEETING | Seattle | June 8-11, 2014

VITAL RECORDS: A CULTURE OF QUALITY

Navigating a Vital Records Future in an e-Health Era

Bill Brand, MPHDirector, Informatics Science

Public Health Informatics Institute

NAPHSIS Annual Meeting 2014 Slide 2

Basic premises

• Today’s EHR systems are struggling to met the demands being placed on them

• New generation of public health information systems will be required

• Increased focus on population health improvement brings opportunities and challenges for health departments


About PHII

Transforming health practitioners’ ability to

apply information effectively to improve

health outcomes worldwide.

• Informatics Academy• Requirements Laboratory• Practice Support

Part of the non-profit Task Force for Global Health in Decatur, Georgia


EHR SYSTEMS: EQUAL TO THE TASK?

Slide 4


EHR Systems: Equal to the task?

• Current adoption rates• Impact of Meaningful Use and EHR

certification programs• Current limitations in e-health and health

reform era


EHR Adoption by US Hospitals

ONC Data Brief No. 16 May 2014 ■ ■Adoption of Electronic Health Record Systems among U.S. Non-federal Acute Care Hospitals: 2008-2013


Physician adoption of EHRs


Impact of MU and Certification

• Meaningful Use (MU) accelerated trends already underway

• EHR certification – Standardized functionality– Increased buyer confidence (somewhat)


Future of MU in doubt?• Only four hospitals had attested successfully

for stage 2 (as of May 13)!• Predictions that ~80% will apply for hardship

exemptions – Many may just leave the program

• Increasing pressure to slow down MU process• Certification may shift away from complete

EHR systemsSource: John Halamka, MD, Keynote at Boston Health IT Summit, May 13, 2014


EHR limitations

• Major dissatisfaction with usability– Don’t match workflows– Increasingly seen as patient

safety concern• Not designed as health

care improvement and population health management tools

• Still too many proprietary codes and other idiosyncrasies to be effectively interoperable

• Need to be re-designed for today’s goals


INTEROPERATING WITH EHR SYSTEMS

Slide 12


Public health reporting in an e-health era

• Data reported to HDs increasingly being collected for other purposes– “Enter once, use many times”– Public health as secondary user– No longer control the information value chain– Must understand the who, what, why

• Decreasing interest/ability to interact with stand-alone, external systems


Implications for public health

• Must work within the world of healthcare standards– Must be proactive in developing standards needed for

public health functions– Example: eVitals using HL7 and IHE

• Make functionality seamlessly available to EHR or others systems– Increasingly “behind the scenes”

• Contribute to getting social determinant data in EHRs


Issues for Vital Registration• Will data be structured in EHR as needed for

VR?• Will EHR support additional data entry for VR?• Will EHR data systems support data quality

checks for VR?• Will EHR support needed accountability for VR

reporters?• Will the process support providers’ and VRs’

business needs?Source: Seth Foldy, MD, 2013 NAPHSIS Conference


Vital Registrar/NCHS/PH perspective• BETTER?

– Data received more accurate/appropriate/precise?– Data received more complete?– Data elements meet processing requirements?– DEPEND ON ADEQUACY OF EHR CERTIFICATION

• FASTER– Delivered to EVRS faster?– Registration accomplished faster?– Transmitted to NCHS faster?– Certificates available to individuals faster?– Statistics and tools (e.g. death index) available for use faster?– DEPEND ON PROVIDER BEHAVIOR, EVRS SYSTEM CAPABILITY

• CHEAPER– Less labor per record?– Less labor for follow-ups?– Simplified workflow for record completion? – EVRS cheaper to produce, procure, maintain, replace?– DEPEND ON EVRS SYSTEMS LEVERAGING EHR STANDARDS

Source: Seth Foldy, MD, 2013 NAPHSIS Conference


Tentative Conclusion

• IF certified EHRs capture well-defined data elements using standardized vocabulary, and

• IF EHRs present said data for validation, supplementation, and certification by the health care provider, and

• IF this occurs timely in a clinical-friendly workflow, and• IF EVRS systems build toward ONE clear standard for

receiving and processing this data, • THEN semi-automated EHR reporting could be better,

faster AND cheaper for both clinicians and VR officesSource: Seth Foldy, MD, 2013 NAPHSIS Conference


OPPORTUNITIES AND CHALLENGES IN POPULATION HEALTH IMPROVEMENT

Slide 19


What’s in a name?

• ‘Population’ and ‘population health’ mean different things to different sectors– Public health: Focus is on all people who live, work

or play within jurisdictional boundaries– ACOs: The population of patients for whom they

are responsible– Healthcare: A patient panel of, for example,

hypertensives or diabetics


Assumptions

• Regardless of how ACA gets implemented, the focus on improving health outcomes in populations will continue

• Much greater focus on ‘big data’ analytics to better understand social and other determinants of health


Gartner Hype Cycle for HIT


Assumptions

• Regardless of how ACA gets implemented, the focus on improving health outcomes in populations will continue

• Much greater focus on ‘big data’ analytics to better understand social and other determinants of health

• Healthcare is unlikely to embark on widespread sharing of chronic disease data with public health

• Access to data and analytic capabilities will be through partnerships


Key Capacities and Elements of an Informatics-Savvy Health Department

Informatics Vision & Governance

• Well-articulated informatics vision for how the agency uses information and IT

• Organization-wide approach to interoperability

• Effective relationship with community partners and with central IT

• Policies to ensure confidentiality, security, integrity of data

• Training strategies for improving informatics knowledge and skills across a broad range of staff

• Informatics unit with agency-wide responsibilities

Well-designed & effectively used systems

• Information systems effectively meet the information needs, workflows and practices of staff and programs.

• Systems are interoperable with other internal & external systems


Opportunities for eVital Records Initiative

Get Ready• Develop an informatics-savvy program and workforce• Become familiar with the VR standards• Become familiar with hospital-EHR workflows• Learn from the pilots (MN and UT)• Conduct a readiness assessment of state and local partnersGet Involved• Participate in standards development and testing activities• Contribute to national policy and standards discussionGet Going!• Start an eVital Records Initiative

Adapted from Michelle Williamson, CDC/NCHS

NAPHSIS Annual Meeting 2014 Slide 26NAPHSIS ANNUAL MEETING| Seattle | June 8-11, 2014

VITAL RECORDS: A CULTURE OF QUALITY

Thank YouBill Brand

Public Health Informatics [email protected]

NAPHSIS Annual Meeting 2014Slide 1 NAPHSIS ANNUAL MEETING | Seattle | June 8-11, 2014 VITAL RECORDS:...

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