Surveillance & Informatics Epidemiologist. Illinois Department of Public Health. Division Chief, Patient Safety and Quality

Transcription

1 Assignment Location: Illinois Department of Public Health Chicago, Illinois Primary Mentor: Secondary Mentor: Stacey Hoferka, MPH, MSIS Surveillance & Informatics Epidemiologist Illinois Department of Public Health Mary Driscolll, RN, MPH Division Chief, Patient Safety and Quality Illinois Department of Public Health Mentor Information Stacey Hoferka received her MPH from the University of Illinois at Chicago in infectious disease epidemiology and a MS in Information Science, with a concentration in geoinformatics from the University of Pittsburgh. She has been the Surveillance and Informatics Epidemiologist for the Illinois Department of Public Health since In this role, she works with both state and local health department staff in communicable disease, environmental health, chronic disease and emergency preparedness to increase their utilization of surveillance data at IDPH. Prior to taking the position at IDPH, she worked at the DuPage County Health Department in Wheaton, IL, from as the Manager of the Communicable Disease and Epidemiology Program. She has worked on syndromic surveillance systems for several years using various analytic tools including BioSense, ESSENCE and RODS. Her informatics experience includes the review and evaluation of Electronic Laboratory Reporting and syndromic surveillance data. She is a current member of the BioSense 2.0 Governance Group. She is actively involved with the International Society for Disease Surveillance presenting on topics from data sharing, emerging trends in Enterovirus D68, collaboration among BioSense user workgroups, heat related morbidity and record linkage supported by the Health Information Exchange. She is a current mentor to an Applied Public Health Informatics Fellow for the class of She supports the APHI fellow s informatics training on tools, such as R, Rhapsody and HL7, encouraged her participation in national conferences, including the International Society for Disease Surveillance and provides opportunities for joint collaboration with Northwestern University, the other fellowship site in In her role as Manager of CD and Epidemiology at DuPage, Ms. Hoferka supervised epidemiologists, CD specialists and interns that supported absenteeism, mandatory reportable disease, syndromic and BMI surveillance system. Staff and interns that she managed were elevated to roles of manager or full time positions. Publications: Hoferka S, Handler I, Linthicum S, Jovanov D, Trick W, Kauerauf J. Leveraging the Master Patient Index in Public Health Surveillance through Collaboration between Illinois Department of Public Health and the Illinois Health Information Exchange International Society for Disease Surveillance Conference. Hoferka S, Rennick M, Austin E, Burke A, Ergas R, Fiedler J, Streichert L. Community Engagement among the BioSense 2.0 User Group International Society for Disease Surveillance Conference.

2 Hoferka S, Wiedeman C, Lall R, Coletta M, Burkom H. Tractable Use Case Problems to Foster Collaboration for the Advancement of Public Health Surveillance International Society for Disease Surveillance Conference. Mary Driscoll is currently the Division Chief, Division of Patient Safety and Quality at the Illinois Department of Public Health. Driscoll is responsible for advising the Department on all issues of Patient Safety and Quality Health Care, as well as for the implementation of mandated patient safety and quality initiatives, like the consumer guide to Health Care, the Hospital Report Card, and Adverse Event Reporting. She is also the IDPH liaison to the state Health Information Exchange (HIE) and chair of the Public Health Committee of the HIE. The Hospital Discharge Data, which hospitals report to IDPH by law, resides in Driscoll s Division. Using the discharge data, she has produced IDPH papers on MRSA, Clostridium difficile, and the rise in Caesarean section deliveries. Driscoll has worked closely with HRSA and the CDC on a number of health initiatives such as building electronic infrastructure and capacity to refer the uninsured and underinsured into specialty care services, universal HIV testing, counseling and education for pregnant women, immunization and flu vaccine initiatives, and organizing Illinois hospitals to participate in infection surveillance through the CDC National Health Safety Network (NHSN Driscoll is part of Illinois overall strategic planning on implementation of Health Reform and service delivery change. She is also one of the developers of the public health node which accepts provider data for meaningful use. Driscoll has worked in health care services for over 30 years, recently leaving the service arena for a more policy focused position at Illinois Department of Public Health. Her extensive background in service delivery, particularly for the underserved, and her current role in quality and patient safety will serve to assist the team in promoting use of data to promote both primary and secondary prevention in clinical settings. Selected publications: Henderson H, German V, Panter A. T, Huba J, Driscoll M, et al. Systems Change Resulting From HIV/AIDS Education and Training. Evaluation & The Health Professions December Panter A. T, Huba J, Melchior L. A, Driscoll M, et al. Trainee Characteristics And Perceptions Of HIV/AIDS Training Quality Evaluation & The Health Professions June Fischer, BS, Martinez, E., Driscoll, M., Conway, T. Smarter, Faster, Fairer an Electronic Referral System for the Urban Safety Net In Press Health Affairs May Assignment Description The fellow will work at Illinois Department of Public Health (IDPH) in the Office of Health Protection and Division of Patient Safety and Quality. IDPH has a strong collaboration with the Governor s Office of Health Innovation and Technology (GOHIT) that administers the Illinois Health Information Exchange (ILHIE) and the Medical Research Analytics and Informatics Alliance (MRAIA) which supports the Public Health Node (PHN). IDPH is working with both these entities to implement Meaningful Use public health reporting requirements.

3 This placement provides a fellow with hands on learning opportunities in public health informatics working with both a mature, well established disease surveillance system and one or more innovative, less developed, surveillance system(s). The Illinois National Electronic Disease Surveillance System (I NEDSS) was established in 2004 to collect data on mandatory communicable disease reporting in Illinois. Improving the timeliness and completeness of data into I NEDSS involves the expansion of Electronic Laboratory Reporting (ELR) to hospitals and the collection of relevant clinical data from provider Electronic Health Records. State wide, syndromic surveillance is a new initiative for IDPH, and the fellow will work extensively on the implementation of syndromic surveillance while gaining insight into the challenges faced when developing new systems. The projects proposed in this application will provide opportunities to work collaboratively as follows: For syndromic surveillance, the community of practice through the International Society of Disease Surveillance offers numerous opportunities to engage with other jurisdictions nationally. The primary mentor is actively involved in this community. The STD registry was initially developed through healthcare partners with the Alliance of Chicago ( a network of Community Health Centers, Federally Qualified Health Centers and safety net providers that provide care to hard to reach populations. The mission of the Alliance is to share resources and integrate services in order to more efficiently and effectively deliver accessible quality health care to the communities we serve. The Alliance s strategic vision is to continue promoting the thoughtful use of Health Information Technology (HIT) in the Safety Net to promote access, improve quality, and efficiency. As the fellow works on the projects, they will engage this organization along with the Chicago Health IT Regional Extension Center Day to Day Activities Participate in conference calls and webinars about Meaningful Use, syndromic surveillance, health information exchange and Electronic Laboratory Reporting Conduct on boarding activities that include validation of HL7 messages for quality, recommending corrections, evaluating timeliness and completeness of data, conducting calls with hospital staff as needed and monitoring continuous submissions of data Support Meaningful Use Stage 2 requirements including registration of providers, acknowledgment of data submissions and maintenance of web content and documentation for public health reporting Assist with the establishment of an ambulatory care surveillance system Conduct analysis of syndromic surveillance data to characterize public health related events, such as influenza trends, heat related illness or health visits due to a unique event or emergency using SAS and GIS Review the data in BioSense to identify any lapses in submission or incorrect processing of data. Participate in stakeholder meetings that include staff from IL HIE, PHN, Department of Healthcare and Family Services and the IDPH informatics team Potential Projects include: 1. Ambulatory Surveillance

4 IDPH is accepting data from Eligible Professionals that will satisfy the Meaningful Use Stage 2 public health reporting objective for syndromic surveillance. Collection of this data into a surveillance system will be supported using a model of the Chicago Health Atlas, a project developed by the primary mentor, Abel Kho, for exchanging patient health data confidentially while applying an algorithm that manages patient identity. The fellow will support the system development and initial on boarding of a limited number of health system providers. Various formats for exchange of health data will be considered including, HL7, CDA/C32 and flat files. The data collected in this pilot will be analyzed for quality, completeness, public health value and representativeness of the data. Understand and perform ETL (extract, transform, load) services that convert data from an HL7 message standard into a state maintained database. Analyze data using SAS or R for disease trends or prevalence rates Public Health impact: Outpatient data from physicians will be submitted routinely to the IDPH and assessed for data quality and disease trends. 2. Hospital Syndromic Surveillance All hospitals in Illinois will be required to participate in emergency department syndromic surveillance reporting in Up to 100 new HL7 data feeds will be established and need to be validated during testing. The data are submitted to the Centers for Disease Control and Prevention s BioSense 2.0 syndromic surveillance system and reviewed weekly to assure completeness of reporting for all hospitals in Illinois. Analysis of data from BioSense will be performed to support public health situational awareness and response activities. Independent epidemiological projects will be supported if the fellow is interested in evaluating specific public health problems using syndromic surveillance data. Analyze data using R to understand disease trends and data quality. Engage hospitals for continuous quality improvement Present results of analysis in reports, conference presentations and publications. Public Health impact: Continuous monitor data from 185 emergency departments in Illinois for disease trends 3. Specialized Registry for reporting clinical data on Sexually Transmitted Infections.

5 Sexually transmitted infections represent the largest volume of communicable disease cases reported each year in Illinois. In addition to ELR, clinical information on treatment and symptoms must be reported by the provider. If this data is contained in the EHR, then it can be reported electronically into INEDSS, saving hours of provider and local health department time performing manual entry and improving the timeliness and completeness of this data. A pilot has already been completed for STI reporting from one health group using the electronic transmission of data from a CDA document to I NEDSS. This project would expand STI reporting to all Eligible Professionals using the menu option in Meaningful Use Stage 2 for specialized registry reporting. Communicate with providers about reporting specifications Perform data validations Analyze STI data. Public Health impact: Expand public health capacity to receive case reports directly from the Electronic Medical Records into the communicable disease database, I NEDSS 4. PopHealth PopHealth is an open source reference implementation software service that automates the reporting of Meaningful Use quality measures. PopHealth integrates with a healthcare provider's electronic health record (EHR) system using continuity of care records. PopHealth streamlines the automated generation of summary quality measure reports on the provider's patient population. PopHealth is designed to simplify the reporting of summary quality measures, and streamline the exchange of summary quality data. Demonstration of Meaningful Use requires the reporting of quality measure data. PopHealth supports healthcare providers and EHR vendors by reporting clinical quality measures from electronic health record continuity of care files. PopHealth runs on the Ruby on Rails web framework, the MongoDB open source document database, JavaScript, and Redis. Enhancement: To be able to measure 2014 CQM,s the providers needs to be able to produce a QRDA cat I Clinical Care Documents from EMR which then will be imported to the pophealth tool to produce QRDA cat III reports for CMS.

6 Most of the providers are not able to do that from various reasons: Don t record all the data elements Their EMR is not capable of creating the QRDA cat I reports The versions of the EMR they are operating are not upgraded to the most recent version. Technical part of this project encompasses development, evaluation and implementation of data processing mechanisms and tools to support near real time extraction, transformation and loading of required data sets to the Pophealth measuring engine. Working with participating Clinics and clinicians to identify and fix the patient care workflow gaps to ensure the data recorded are compliant with the CQM,s measures and requirements Making data available for analytical and reports use, and developing/modifying/transitioning tools for analyst and report use. Identify, evaluate, and apply new software technologies for developing, and deployment new mechanism and tools into PopHealth Public Health impact: Identify and engage 3 pilot sites in the first 3 month Find the missing elements in the pilot sites (4 month) Propose the changes in the workflow to start capturing the elements (5 month) Help the technical team to spec and develop a transformation engine(12 month) 5. XDRO Registry development Carbapenem resistant Enterobacteriaceae (CRE) are deadly infections that have few treatment options. Since 2008, CRE infections in Illinois have increased across the spectrum of healthcare facilities. The Centers for Disease Control and Prevention (CDC) identified CRE as one of its top priorities for public health, and created a CRE toolkit that emphasizes regional surveillance and improvement of inter facility communication. To address these strategies, the Illinois Department of Public Health (IDPH) and the Chicago CDC Prevention Epicenter (CDC Epicenter) combined expertise in CRE epidemiology, informatics, and public health to create a novel, web based informatics tool: the Extensively Drug Resistant Organism (XDRO) registry. Since November 1, 2013, all acute care hospitals, long term care facilities, and laboratories have been required to report CRE isolates to this registry.

7 The current XDRO registry allows for inter facility communication via manual querying, whereby staff at a healthcare facility can type a patient s name and date of birth into the XDRO registry website to query the patient s CRE history. However, manual querying is only feasible for smaller facilities that admit 1 to 25 patients per day. Larger facilities, such as hospitals, require an automated alert of a patient s CRE status at the time of admission, to effectively assess the CRE status of all patients who are admitted. A pilot is currently underway to develop this automated alerting system at two major hospitals. An APHIF Fellow could work with IDPH and the CDC Epicenter to fully develop this notification system, and possibly expand automated alerting to facilities across the state. Concurrently, IDPH and the CDC Epicenter are exploring the uses of the XDRO registry as a surveillance and outbreak detection tool. Software, such as SatScan, is being integrated with GIS mapping technology to track geographic and social network clusters of CRE over time. The APHIF Fellow would have ample opportunities to further refine this process and participate in developing more sophisticated approaches to outbreak detection and response of CRE. Goal 1: Develop a system to automatically search the XDRO registry and send electronic alerts to healthcare facilities where CRE positive patients recently have been admitted, to facilitate timely implementation of infection control practices. Objective 1: In the next year, a process for securely notifying appropriate facility personnel will be developed. Objective 2: In the next year, the electronic alert system will be piloted with at least two hospitals. Objective 3: Over the next two years, the alert system will be expanded to additional large healthcare facilities in the state. Goal 2: Integrate SaTScan and ArcGIS software with the XDRO registry to help identify CRE clusters. Objective 1: In the next year, parameters will be identified to determine the best methods to detect geographic clusters. Objective 2: Over the next two years, the best methods to detect patient sharing clusters using hospital discharge data will be identified.

8 Public Health impact: Create a bi directional surveillance system that can notify healthcare facilities of potential cases of extensively drug resistant organisms.