Electronic Case Reporting to Public Health An EHR Vendor s Perspective Public Health - EHR Vendors Collaboration Initiative
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1 Electronic Case Reporting to Public Health An EHR Vendor s Perspective Public Health - EHR Vendors Collaboration Initiative June 30,
2 Joint Public Health Forum & CDC Nationwide phconnect Community: Public Health EHR Vendors Collaboration Initiative URL: 2
3 PH - EHR Vendors Collaboration Initiative Agenda Announcements and Introduction Electronic Case Reporting to Public Health An EHR Vendor s Perspective Monica Coley, Integration Strategist, Cerner Michelle Peterson, Sr. Strategist Public Health, Cerner Audience Questions and Discussion 3
4 Electronic Case Reporting to Public Health An E.H.R. Vendor s Perspective Monica Coley, MPH, Integration Strategist Michelle Peterson, Sr. Strategist Public Health
5 Cerner s Response Approach Case Reporting Value Added Model Architecture Provider/Vendor E.H.R. Model Architecture Provider/Vendor E.H.R. Connectivity to Platform Public Health Community Platform Model Architecture Workflow Incorporation Various Care Settings Data Collection Considerations Urgent/Immediate Adoption Considerations Providers and Health Systems Public Health Agencies Additional Reporting Considerations 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 5
6 Case Reporting Value Added Identifying probable, suspect and confirmed cases Enhanced public health surveillance and response Early identification of cases Increased reporting Data value across the care continuum Analytics dashboards and reporting Public health case investigation and outbreak management Health care organization population management Leverages Clinical Data Repositories for Public Health Reporting 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 6
7 Model Architecture
8 Provider/Vendor EHR Model Architecture Qualified data for initial core messages based on trigger codes/coding vocabularies Set of trigger codes defined and maintained at national level and mapped within Provider/Vendor EHR Initial core messages pushed to the platform based on qualifying trigger codes Additional messages pushed as other qualifying data enters system 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 8
9 Provider/Vendor EHR Connectivity to Public Health Community Platform Cloud Connectivity to Public Health Community Platform Provider EHR vendors may choose to connect each health system individually or through a centralized repository for all client health systems or through HIE Recommend ability to support multiple content standards, including Fast Healthcare Interoperability Resources (FHIR), for increased interoperability for future public health reporting use cases, including case reporting Core Messages VMR has been proposed Benefit Decision Support Standard Challenge Not widely adopted by vendors and industry Opportunity Potential to Translate VMR to FHIR Messages in the Future FHIR Resources Benefit Vendor collaboration for development Challenge 2017 Projected for Final Specifications 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 9
10 Public Health Community Platform Model Architecture Initial Core Messages Supports: All available data including initial data, data updates and corrections Collection and reporting of data to be collected per case definition Data standardization and normalization Provides longitudinal record Maps to standard vocabularies Ensures data quality 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 10
11 Public Health Community Platform Model Architecture Determination of Reportability Centralized decision support to determine reportability Algorithm or Criteria to Determine Case Reportability Ability to scale algorithm to jurisdictional logic Supports public health case definitions for conditions or diseases e.g. (probable, suspect, confirmed, laboratory-confirmed) Centrally Managed & Maintained CDS Agnostic & Runs Outside of Provider/Vendor EHR 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 11
12 Public Health Community Platform Model Architecture Electronic Case Report Forms Platform identifies appropriate data elements to be populated in form per identification of reportability and public health jurisdiction requirements Platform sends notice of reportability to Provider/Vendor E.H.R. SMART App + FHIR Allows for data content to be communicated via FHIR Resources Allows for a more visual or user experience via SMART App SMART App allows for SCD Integration, but SCD does not allow for SMART App Integration (SMART More Powerful) FHIR can provide questionnaires 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 12
13 Public Health Community Platform Model Architecture Electronic Case Report Forms Provider/Vendor EHR auto-populates additional data elements as available Based on Provider/Vendor E.H.R. capabilities for rendering forms Provider completes case reporting form within EHR, in context of the patient s medical record, with ability to: Document supplemental data collected in physician notes, through infection control solutions, and through patient follow-up Validate data prior to submission to the public health agency Route completed report to Public Health agency 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 13
14 Public Health Community Platform Model Architecture Potential Challenges Case and level of data available determines following scenarios: Blank Forms Returned Pre-Populated Forms Returned Workflow Dependencies: Alerting & Updating Capabilities Platform capabilities to push alerts/updates Provider/Vendor EHR to receive alerts/updates from platform Requests for additional information related to outbreaks, etc, supported by both platforms 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 14
15 Public Health Community Platform Model Architecture Reporting and Analytics Consider standard analytics reporting and customized reporting based on health system, provider, and public health agencies Consider reporting concise view in gaps Provide providers and health system s access to all data reported to public health, including standard accounting for disclosure reports Streamline population management across the care continuum Consider data collection at different points of care data may be collected by nurse, physician, population health manager or infection control Provide data in registry view for additional population management to account for various end users Provide registry views within the Provider/Vendor EHR, for streamlined workflow 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 15
16 Workflow Incorporation
17 Workflow Incorporation Various Care Settings Different workflows based on venue of care Public Health Increased opportunity and incentive to collect data at the point of care or through follow-up Increased opportunity to reach patients post visit via phone or patient surveys Ambulatory Care and Urgent Care Increased reporting of reportable conditions of public health Opportunity to collect data at the point of care may vary by case Opportunity to report additional data post visit may vary Information, including results provided to patients via phone and/or patient portals Increased opportunity for public health coordination with providers to collect additional data based on case investigations and cases associated with outbreaks Acute & ED Increased opportunity of reporting by providers and infection control Data collection in the ED May be limited based on criticality and length of stay Indigent/transient population follow-up may not be possible Increased opportunity to collect data during hospital admission Typically responsibility of infection control during admission 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 17
18 Workflow Incorporation Data Collection Considerations Data Collection Considerations Possible limitations Jurisdictional readiness to accept certain data elements may vary based on: Existing infrastructure Jurisdictions may need to develop and/or enhance current infrastructure Resources to receive, test and validate Data collected in different venues of care 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 18
19 Workflow Incorporation Data Collection Considerations Data Collection Considerations Consider data tiers Tier 1: Pre-populated from the Platform Required e.g., Data provided in initial core message or message updates Tier 2: Auto-populated from the E.H.R. Required, RE and Optional e.g., Patient Demographics, Basic Clinical Information (Onset Date, Travel, Signs/Symptoms) Dependent on E.H.R. capabilities to render forms for auto-population of data Tier 3: Supplemental Data Requested for Specific Case Definition Recommended standard set of fields based on case definitions (Occupation, school) Consider data generally collected across jurisdictions and some unique data Tier 4: Jurisdictional Data (Outbreak specific) Needs Additional Discussion Consider scalability for vendors and collection based on various care settings 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 19
20 Workflow Incorporation Urgent/Immediate Timeliness Reportable Cases Recommend Provider/Vendor EHR to trigger tasks and alerts for urgent cases Trigger based on public health jurisdictional law requirements Telephone report to public health agency as required by jurisdictional law within set timeframe (typically 4 hours) of suspect or confirmed cases Outbreaks, unusual occurrence of any disease, exotic or newly recognized diseases, and suspect act of terrorism should continue to be reported by phone Example: VHF, Anthrax, Botulism, Cholera, Measles, Mumps, Smallpox, Rubella, etc. Continue to report cases electronically through platform 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 20
21 Adoption Considerations
22 Adoption by Providers and Health Systems Considerations Costs to connect to model infrastructure (Sustainability of Overall Model) Ease of use within venue of care workflows (i.e. auto-populated data and streamlined within workflow) Payment reform (Incentives & Penalties) Platform flexibility and sustainability to support future public health reporting (other use cases) 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 22
23 Adoption by Public Health Agencies Considerations Limited number of public health registries that can accept data today Management to provide updates to trigger codes/coding vocabulary mappings E.H.R. Capture of Additional Requirements Opportunity and limitations depending on venue of care Public health agency system capabilities may vary Ability to accept data via FHIR and/or other standards Ability to electronically accept all supplemental data elements Some provider data may have to continue to be collected by public health epidemiologists per case or outbreak and not through supplemental case reporting (Example: patient food logs for salmonella) 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 23
24 Additional Reporting Considerations
25 Additional Reporting Considerations Any changes to current reporting Immunizations, Electronic Laboratory Reporting, Syndromic Surveillance Considerations for health systems who have fully adopted reporting Clearly outlined what is captured through existing mechanisms verses case reporting Avoid any duplicate data reporting Timelines for reporting Provider/Vendor E.H.R. Readiness Public Health Community Platform Readiness Jurisdiction Readiness to Accept Meaningful Use Readiness Final Rule to be released CEHRT Guidance Certification criteria to be released 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 25
26 Team Collaborators Thank You Bob Harmon, MD Physician Executive Public Health & Govt. David McCallie, MD Sr. VP Medical Informatics Pam Angotti Strategist - Regulatory Melany Blakemore Sr. Manager - Infection Control Kyle Carson Sr. Strategist - Performance Improvement Jennifer Conner Director - Infection Control Angelica Eddleman Client Executive Govt. Cory Gassner Sr. Software Engineer Public Health Kelly Luden Sr. Strategist - Infection Control Dana Partlowe Integration Architect - Consulting Tamara Pomerantz Sr. Integration Strategist - Consulting Stephanie Rogers Sr. Director Infection Control Jennifer Schwartz Solution Designer Public Health Andrew Statler Sr. Strategist Millennium Jenni Syed Sr. Software Architect FHIR Sara Charlson Sr. Director - Quality Jennifer Besch Director Quality 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 26
27 Electronic Case Reporting to Public Health An E.H.R. Vendor s Perspective Monica Coley, MPH, Integration Strategist Michelle Peterson, Sr. Strategist Public Health
28 Discussion & Questions Discussion & Questions 28
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