S&I Public Health

*We will start the meeting 3 min after the hour

September 23 2014

Housekeeping

This meeting is being recorded and un-paused and will be available via the wiki

*Please mute your phone when not speaking to assist with background noise.

Today’s Agenda

• Announcement– A couple of updates

• Continue last weeks discussion• Wrap-up

Announcements

• CoP for Leveraging FFP for Medicaid HIT Activities – This Friday, 9/26 from 2-3 PM

• Educational/Webinar Series - From Silos to Systems Interoperability: Domain/User Story Specific Presentations

Announcements

• FHIR – Evolution and Status– Date/Time - Tuesday, September 30   Noon to 1:00 p.m.

Eastern/11:00 to Noon Central– Presenter–  Lloyd McKenzie: Co-chair, FHIR Management Group; Co-Chair,

HL7 Modeling & Methodology Work Group; Member, FHIR Editorial Team; Consultant, Gordon Point Informatics

– Description– This exclusive Members Only webinar will address the following:– Status updates from the recent Chicago WGM– Summary of Connectathon and Clinical Connectathon outcomes– Plans and progress towards the second DSTU release– Upcoming opportunities to learn more 

Other Updates

• General Update– NPRM/Final Rule– http://cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-re

leases-items/2014-08-29.html– http://www.ofr.gov/OFRUpload/OFRData/2014-21021_PI.pdf

Updates

• Nationwide Interoperability Roadmap Community Home (comments closed but viewable)

– http://confluence.siframework.org/display/NIRCH/Nationwide+Interoperability+Roadmap+Community+Home

– http://www.healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf

On the table from last time

• A core message– The basis for any of our work streams

Clinical Care / EHR Public Health

MaintainPH Trigger

Codes

Record DX/Problem

In EHR

Decision Support Rules

Decision Support Engine

Parse(for future

consideration)

PHA PreparednessUses

Forms Manager

PH Surveillance

System

Clinical “Notification”

Creation

Pre-Population

Respond to QueuedClinical

“Notification”WithURL

Reporter

Continue process with Web-Based,

Pre-PopulatedReport Form

StorageForm Retrieval

Provider

Pre-populated form

EHR

PH System

SynchronousSDC / RFD

TransactionsOver SOAP or

eventually FHIR

Example work flow (John Loonsk/Dan Chaput, v5a) for discussion only – 9/23/2014

Asynchronous Core, “Initial”Case Message

CCDAand

+Communication to

Reporter

From our last meeting

Core, Suspect Case Message C-CDA (working group)

• Shall we form a working group?• Call for volunteers• Charge to the group

– Time limited – Address the two concepts issue

• Attempt to limit to data in a certified EHR (risk - Kelly and Dan M)• Minimum but all necessary• Or data recorded• Core concept

– Key is keeping this limited

– Core message maintains context of reporter and patient to pass to second step

– Jurisdictional information, where it should be reported (any/all jurisdictions involved)

Core, “Initial” Case Message Message

Context

A core, “initial” case report message will be used when a

provider has recorded a problem or diagnosis that suggests a

reportable condition in an EHR. At that point, data will be sent

to public health in the form of a core, “initial” case message to:– initiate the reporting process– to determine the full circumstances under which the

condition should be reported– to establish what other data elements are needed for a full

case report, and – to set-up the process for how, when, and where the final

case report should be submitted

Draft Core, “Initial” Case Message Requirements

1. The message should only include data elements that are consistently recorded and available in EHRs

– The first step of the process is automated, so there is no opportunity at this point in the data flow for the input of new data (that comes later)

– Public health may separately seek to add data to those that are always recorded in an EHR as part of care, but that is separate from this process

2. The message should include shared, relevant public health case reporting data that are important to confirming reportabilty, to automatically populating parts of the eventual full case reporting form, and for potential preparedness purposes (how much data?)

Draft Core, “Initial” Case Message Requirements

3. The message should not include data elements that are used in the provision of care but are not relevant to these first steps in public health case reporting. Some data will not be relevant to all final public health reports, but as little irrelevant data as possible should be in the core message. (e.g it should not include insurance data)

4. A logical data model that could guide the use of different standards and one or more specific, certifiable, implementation guides should be the product of this process

5. The specific implementation guide(s) should be in use now and close to those being used for transitions of care or other MU activities

6. In the longer term, a more complete public health core, “initial” case message implementation guide can be developed and balloted

7. The message should include the problem list or diagnostic code(s) that matched the public health trigger codes and indicated that the provider has identified a “initial” reportable condition

Draft Core, “Initial” Case Message Requirements

8. The message should include location information necessary to determine the jurisdiction(s) in which a report should be submitted

9. The message should include electronic contact information for the role of reporter in that clinical setting

10. The message should include patient identifying information needed to maintain / re-establish the context of the specific patient in the next steps in the reporting process

1. This could be done with either a case number or the patient’s name or both

Draft Core, “Initial” Case Message Requirements

Message Concepts

• Report– Provider– Patient

• Diagnosis• Laboratory Results

– Reporter– System– Point of Care– Eliminated - Employment

More items…

• On deck– Vocab and terms– The rendering question– The pre-population question– Representing the variation (synch and asynch) in

work flow scenarios• Provenance

– Anyone care to join a brief discussion with Dan to review his findings and think about next steps?

S&I Public Health Contact Information

ONC Public Health Lead: Daniel Chaput (daniel.chaput@hhs.gov) CDC Public Health Lead: John M. Saindon (uzn0@cdc.gov)

PHTT Wiki Page: http://wiki.siframework.org/Public+Health+Tiger+Team SDC Wiki Page: http://wiki.siframework.org/Structured+Data+Capture+InitiativeDAF Wiki Page: http://wiki.siframework.org/Data+Access+Framework+HomepageCQF Wiki http://wiki.siframework.org/Clinical+Quality+Framework+Initiative PHRi Archived Wiki http://wiki.siframework.org/Public+Health+Reporting+Initiative

Weekly PHTT Meeting Info (Tuesdays):• Time: 2:00pm - 3:00pm Eastern• URL: https://siframework1.webex.com/• Dial-In Number: 1-650-479-3208• Access Code: 665 131 907