Host Site: Chicago Department of Public Health, Epidemiology and Public Health Informatics

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1 Host Site: Chicago Department of Public Health, Epidemiology and Public Health Informatics Location: Chicago, IL Primary Mentor: Jay Bhatt, MPA, MPH, DO, FACP, Managing Deputy Commissioner, Chief Innovation Officer, Chicago Department of Public Health Secondary Mentor: Matthew Roberts, BA, MPH, Informatics Project Manager, Chicago Department of Public Health Fellow s Workplace Support: The fellow will be placed in an Office of 10 staff, with all senior epidemiologists holding multiple degrees. The Office is located in the heart of the downtown Chicago Loop, and is supported with standard office equipment and some clerical support. The Office direct senior leadership reports to the managing deputy commissioner and innovation director, who is also the secondary supervisor. This Bureau is responsible for developing health systems integration with external partners. The fellow will be placed in the Office of Epidemiology and Public Health Informatics and will be assigned to the Informatics Program. This program is responsible for helping the Chicago Department of Public Health and relevant stakeholders adopt information technology in order to improve public health practice. The fellow will work with the program staff to continue work on projects in various stages of development and initiate new projects to be completed within one years time. Projects will be flexibly tailored based upon the fellow s skill and interest while adhering to agency priorities and fellow competencies. The fellow will receive on-the-job, practical informatics training through work at CDPH and relevant partners, such as the Public Health Node, Alliance of Chicago, and IDPH, in order to expand Interprofessional Education. The fellow will attend routine staff meetings, engage with agency staff and external partners, develop technical and communication skills, and develop project management skills. The fellow will be assigned to assorted work groups and task forces (e.g. Public Health Node, Illinois Meaningful Use, Alliance for Health, HealthLNK, and CAPriCORN (PCORI site). Supportive training will be supplied as needed. ). CDPH will provide access to SAS, Business Objects, ArcGIS, and Tableau to the Fellow. CDPH will grant access to vital records data, lead surveillance data, infectious disease surveillance, vaccine records, and the electronic medical record. Many traditional datasets will be made available for analysis, as well as novel databases that are emerging in the era of Big Data, such as Twitter records and deidentified healthcare data for chronic disease surveillance purposes. CDPH will provide opportunities to develop SAS, R or related statistical tool skills.

2 Community Engagement Partners: Alliance of Chicago Illinois Public Health Node CHITREC Project 1 Title: Sexually Transmitted Infections and Viral Hepatitis Provider EMR Reporting and Clinical Decision Support The traditional model for reporting diseases to state and local health officials is through paper-based and electronic laboratory and healthcare provider reporting. A considerable amount of sexually transmitted illness (STI) and viral hepatitis provider reports are submitted by paper from healthcare centers. Illinois continues to make substantial progress in converting paper laboratory reporting to electronic data feeds, but has made little progress in developing database capacity to receive electronic medical records (EMR) in lieu of provider reporting, expressly for case and treatment data. Technical work to receive this data at the state level has recently completed. This project will complete the work necessary to ensure connectivity of the state database with a major Chicago primary care provider network s EMR system as well as the in-house CDPH clinic. This will reduce substantial cost on both the provider and the public health system in processing paper reports. Further, this project includes the development of clinical decision support algorithms and business logic used for supporting further testing for patients meeting certain criteria. In particular, the prompts will identify candidate patients for hepatitis C screening based upon their age, and will also recommend further PCR testing based upon preliminary antibody test results. As project coordinator, the fellow will work with the Illinois Department of Public Health (IDPH) electronic infectious disease surveillance system (INEDSS) information technology (IT) staff, the Alliance Network IT staff, and the CDPH EMR vendor to bring electronic health record submission to the state s TEST database environment for further evaluation. This unilateral data exchange will move from TEST into PRODUCTION once the data feeds have been vetted and approved. Fellow s Project Role: Leader The fellow will interact on a daily basis with the Department's Informatics Project Manager, the Managing Commissioner, Commissioner's Assistant, the leadership at Alliance, and Alliance's technical team. The fellow will attend assorted tech meetings and discussions on these and related topics throughout the year.

3 As project coordinator, the fellow will manage project planning, associated meetings, and project milestones. This will include providing direct input into HL7 message formats, testing data for data quality as it as transmitted, and providing input and/or directly coordinating the development of the virtual private network file transfer protocol. The fellow will also learn about database design, secure structured message formats, dashboards and business intelligence analytics, and software life cycle development. The viral hepatitis screening project is very similar but has some important differences. With this project the fellow will develop an understanding of the business process and workflows, collect business requirements from end users, personally conduct and oversee application testing and data quality control, and will be involved in the development of an analytical algorithm for clinical decision support. Role of Community Partners: Alliance is a healthcare clinic network designed to integrate services in ways that allow for distinct, local operation with shared support. This institution is leading cutting-edge electronic system development to support primary healthcare delivery. For this project, Alliance will provide learning opportunities for the fellow beyond the project work. This will include providing an understanding of Federally Qualified Health Center (FQHC) informatics, data warehousing, Clinical Decision Support, health IT, clinic-based behavioral risk factor data collection, community based research projects, community based primary care and disparity populations, as well as mentorship. Project 2 Title: E.Q.u.I.P. (EMR-Quiltine Integration Project) The Illinois Tobacco QuitLine (ITQL) is a free, evidence-based tobacco cessation tool available to all Illinois residents. Studies suggest that when an individual is referred to the Quitline by their healthcare provider, they are more likely to succeed at achieving and maintaining cessation. Moreover, true referral from the provider allows ITQL to proactively call the patient, removing one barrier to cessation for the patient. ITQL is currently capable of accepting referrals through their website. The majority of providers in Chicago are unaware of the direct referral option, and most of those who are aware refer through fax machine. The Chicago Department of Public Health (CDPH), in partnership with the Illinois Department of Public Health (IDPH) and the American Lung Association of Illinois (who operates ITQL on behalf of IDPH), is partnering with federally qualified health centers (FQHCs) throughout the City to maximize patient access to the ITQL through provider education, workflow processes, and formalization and digitization of the referral process. Chicago benefits from a robust network of 20 FQHCs with over 100 sites through the city. These clinics serve a patient population with a higher rate of smoking and poverty, and a lower

4 rate of insurance. The FQHCs are a natural partner for this project, given CDPH s mission of addressing population health with a health equity lens. The project involves working with the CDPH EMR vendor, umbrella FQHCs, individual clinic sites, and the Alliance of Chicago to a) ensure appropriate provider knowledge of the Quitline and evidence-based nicotine replacement therapy options; b) support clinics in establishing a workflow where connection to the QuitLine is the norm for appropriate patients; c) streamline the referral process through digitization and eventually EMR integration; and d) collect and analysis Quitline referral data and community-level smoking prevalence data. Fellow s Project Role: Leader Develop and implement a data transfer agreement between CDPH and Alliance of Chicago for community-level smoking prevalence data Create an infographic/map of community-level smoking prevalence data, as well as a visualization of prevalence compared to Quitline call volume by community area, tobacco sales to minor violations, and other variables of interest to inform policy and programmatic efforts. Create a VPN secure file transfer protocol using ILHIE Direct controls, support the testing of file submission, and provide message Quality Control for the EMR integration component. Create a summary of nicotine replacement therapy options and coverage for the clinical decision support tool creation. Co-author at least one journal submission regarding cessation project. Lead at least one journal club for interns/fellows/staff re: cessation efforts with other health departments. Day-to-day activities: Meet bi-weekly with supervisors to assess progress and address barriers Attend provider trainings and workflow process improvement efforts at FQHCs Serve as the main source of contact between Alliance of Chicago and CDPH, interacting no less than bi-weekly to assess progress and troubleshoot Meet at least monthly with FQHC leadership to discuss progress and address any concerns/barriers Observe Quitline sessions for training purposes early in fellowship. Early in fellowship, review literature regarding health systems integration work (IOM report, etc.) and efforts to improve access to cessation (work in Texas, Massachusetts, California, etc.). Fellow to stay up-to-date on literature throughout fellowship. Role of Community Engagement Partners: This project is grounded in partnership and would not be possible without their collaboration: Illinois Department of Public Health funds the Illinois tobacco Quitline. The Fellow will regularly correspond with IDPH to keep them informed of progress and address any concerns.

5 The American Lung Association of Illinois operates the ITQL on behalf of IDPH. The Fellow will have the opportunity to sit in on Quitline calls at the Lung Association in order to familiarize himself/herself with the counseling process. Additionally, the Fellow will join the Lung Association on trainings for FQHC providers and development of workflow processes to maximize the volume and effectiveness of referrals. The FQHCs each have unique needs as they work to serve their patients in the best possible way. The Fellow will interact frequently with various clinic leadership on each stage of the project to discuss progress and address any concerns. The Alliance of Chicago is the key partner for all project components involving informatics and technological improvements. The Fellow will work with the Alliance on the clinic decision support tool component; on gathering of community-level smoking prevalence data; and on the EMR integration of the referral process. Additionally, the Fellow will have opportunities through the Alliance to participate in the development of an advanced clinical data warehouse merging EMR clinic data input into design visualization tools to support public health strategies. Project 3 Title: Lead Risk Score into EMR Support the integration of the lead predictive model into the clinical EMR for clinical decision support to help connect the dots for the provider and encourage additional screening or mitigation. Fellow s Project Role: Participant Gain an understanding of the birth and death vital statistics data available at CDPH Develop basic understanding of electronic medical records and clinical (pediatric) practices Gain familiarity in the steps needed to post datasets to the open data portal Create a statistical model for West Nile Virus positive mosquito pool prediction Gain familiarity in working with STI surveillance data Develop understanding of Twitter data mining and machine learning Gain base level understanding of methods to craft natural language processing algorithms Role of Community Engagement Partners: n/a Project 4 Title: STI School-based Screening Develop the epidemiology and workflows for the program leveraging data. Evaluate targeted schools and pockets of illness among minors; characterize the disease burden. Evaluate the current program

6 workflows and develop alternative solutions for the program. Migrate from paper-based record collection and data management. Support integration with our electronic health record, enterprise case management. This project will also leverage data to identify those at risk to target for outreach and connection to care. The fellow will interact on a daily basis with the Department's Informatics Project Manager, the Managing Commissioner, Commissioner's Assistant, the leadership at Alliance, and Alliance's technical team. The fellow will attend assorted tech meetings and discussions on these and related topics throughout the year. As project coordinator, the fellow will manage project planning, associated meetings, and project milestones. This will include providing direct input into HL7 message formats, testing data for data quality as it as transmitted, and providing input and/or directly coordinating the development of the virtual private network file transfer protocol. The fellow will also learn about database design, secure structured message formats, dashboards and business intelligence analytics, and software life cycle development. The viral hepatitis screening project is very similar but has some important differences. With this project the fellow will develop an understanding of the business process and workflows, collect business requirements from end users, personally conduct and oversee application testing and data quality control, and will be involved in the development of an analytical algorithm for clinical decision support. Fellow s Project Role: Leader Coordinate discussions with the Illinois Department of Public Health (IDPH), Chicago Department of Public Health (CDPH), and Alliance regarding the project plan and timeline. Complete project plan by August 1, Obtain sample message exports from the Alliance Centricity database for evaluation in concert with IDPH INEDSS staff by September 1, Evaluate data quality and provide feedback by October 1, Support development of a secure virtual private network (VPN) secure file transfer protocol (SFTP) connection to INEDSS; ensure completion by December 1, Obtain sustained data transmission into the TEST INEDSS environment by February 1, Test data quality and provide feedback by March 1, Ensure the placement of the data into the PRODUCTION INEDSS environment by May 1, Provide ongoing data quality and feedback throughout. Develop algorithms for the clinical decision support based upon subject matter expert business requirement interviews among communicable disease staff and Alliance healthcare providers. Develop algorithms by November 1, Work with IT specialists to support the introduction of the algorithms into the EMR Centricity platform and coordinate/conduct user testing. Complete testing phase by February 1, Support ongoing record submission quality control.

7 Role of Community Engagement Partners: Alliance is a healthcare clinic network designed to integrate services in ways that allow for distinct, local operation with shared support. This institution is leading cutting-edge electronic system development to support primary healthcare delivery. For this project, Alliance will provide learning opportunities for the fellow beyond the project work. This will include providing an understanding of Federally Qualified Health Center (FQHC) informatics, data warehousing, Clinical Decision Support, health IT, clinic-based behavioral risk factor data collection, community based research projects, community based primary care and disparity populations, as well as mentorship

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