Enhancing Public Health Surveillance. Possible Roles of Health Information Technology and Exchange

Transcription

1 Enhancing Public Health Surveillance Possible Roles of Health Information Technology and Exchange

2 Key Task Develop a sustainable business model(s) for public health collaboration with HIE s and/or the medical community.

3 HIE A Major Activity A five-year, thirty-eight million dollar effort in three areas WA/ID, IN, NY Initiated in February 08 Coordinators WA/ID SAIC IN Regenstrief Institute NY Health Research Inc. NYSDOH NYCDOHMH

4 Superb Attributes for Team Success WA/ID IN Technical expertise Government experience CDC and NHIN Thirty years of HIE experience Internationally renowned research center NY Significant state funding for statewide HIE State and local HD s Public health informatics, IT and epidemiology

5 HIE Key Deliverables Minimum Biosurveillance Data Set (MBDS)* Expand geographic coverage Increase number of data elements Assess utility and feasibility

6 Minimum Biosurveillance Data Set MDS Category # Examples: Base Facility Elements Daily Facility Summary Report Patient Data Elements Clinical Data Elements Laboratory & Infectious Disease Test Orders Laboratory & Infectious Disease Results Facility: Identifier, Name, Location, # of Facility Beds, # Licensed Beds Admissions, Discharges, and Deaths in last 24 hours, Facility Status, Staffing, Ventilators DOB, Age, Gender, Zip Code, State, and Event Date/Time Diagnosis/injury code, Chief Complaint, Temperature Order Number, Test/Procedure Name and Test/Procedure Code Performing Lab, Specimen Source, Results

7 HIE Key Deliverables Minimum Biosurveillance Data Set (MBDS) Bidirectional communication*

8 Bidirectional Communication State HD CDC HIE 1 Medical Community Local HD Hospitals, Labs, Clinics and Others Relay Data

9 Bidirectional Communication State HD 2 CDC HIE 1 Medical Community Local HD Manage Data to Support Medical Community Needs

10 Bidirectional Communication State HD CDC 3 2 HIE 1 Medical Community Local HD Relay Information That State and Local HD s Desire

11 Bidirectional Communication State HD CDC HIE 1 Medical Community Local HD State HD Sends Information to CDC in GIPSE* Format * Geocoded Interoperable Population Summary Exchange

12 Bidirectional Communication 5 State HD CDC HIE 1 Medical Community Local HD Initiate Alerts Request Additional Information Beyond GIPSE

13 Bidirectional Communication CDC 5 4 State HD HIE 1 Medical Community Local HD Alerting Request Detailed Patient Information

14 Bidirectional Communication CDC 5 4 State HD HIE 7 1 Medical Community Local HD Alerting Enhanced HAN

15 Bidirectional Communication CDC 5 4 State HD Local HD HIE Medical Community Enhance case reporting Automated case detection and reporting Natural language processing for ELR

16 HIE Key Deliverables Minimum Biosurveillance Data Set (MBDS) Bidirectional communication Case Reporting Translation Business process Technology innovations Partnership strategies

17 Public Health Perspectives Possible Scenarios Robust HIE/Robust Health Department Northwest Public Health Information Exchange - biosurveillance

18 NW Public Health Information Exchange WA OR ID

19 Self-sustaining non-profit Health Information Exchange Connects 36 primarily independent hospitals in Eastern Washington and Northern Idaho 75% of hospitals in Eastern Washington 80% of hospitals in Northern Idaho 100% of hospitals in Spokane Consolidated EHR across all hospitals Also provides an EMR to 98 independent physician clinics 19

20 Seamlessly Connecting Clinical Care and Public Health Filtering Electronic Health Records (EHRs) for public health Syndromic surveillance Electronic laboratory reporting Case reporting Hospital acquired infections Health alerts Using NHIN standards to convey clinical information to public health

21 Supporting Automated Clinical Care and Public Health Information Sharing Healthcare Facility Patient Encounters sent to HIE Health Information Exchange Public Health Decision Support Create Biosurveillance Records Public Health Alerts CONNECT GATEWAY Public Health Alerts Case Notification Biosurveillance Data CONNECT GATEWAY Lab Reporting Case Reporting State Analytics Biosurveillance CONNECT GATEWAY Summary Data CONNECT GATEWAY National Biosurveillance Analytics Biosurveillance

22 Increase in Patient Encounter Coverage 2008 Q Q3

23 Timeliness of Influenza Surveillance Data Study performed by Washington State Department of Health

24 Influenza Surveillance Data Feed Conclusions NWPHIE data accurately reflects trends in ILI activity as compared to hospitalized and fatal lab-confirmed influenza cases in eastern Washington NWPHIE is well suited to monitor trends at the state level and community levels NWPHIE data is resistant to changes in workload levels and seasonal fluctuations NWPHIE data is more timely than ILINet provider data and traditional notifiable disease reporting

25 Public Health Perspectives Possible Scenarios Robust HIE/Robust Health Department Northwest Public Health Information Exchange - biosurveillance Indiana Public Health/HIE collaborative bidirectional communication

26 Bidirectional Communication Situational Awareness Three Missions Recognition of an Emergent Threat Raise Awareness of Threat Action in Response to Threat Initial Question How can health information exchange (HIE) facilitate efficient and effective dissemination of information to clinicians that keeps them informed of public health threats in their communities?

27 DOCS4DOCS (D4D) Delivers laboratory and other clinical messages from one organization to the patient s responsible provider (PCP) Managed by the Indiana Health Information Exchange Delivered in three formats Fax Electronic inbox (Web-based application) Integration with the Electronic Health Record (EHR) system 6 million messages each month to 13,000+ Database routinely updated

28 Results Delivery An Illustration

29 Expanding D4D to Support Public Health Marion County Health Department (MCHD) partnered with Regenstrief and IHIE to notify physicians of important, emergent situations involving public health threats Salmonella exposure at local restaurant System went live in May 2009 Utilized several times for H1N1 updates

30 Health Information Exchange IN Hospitals, IDNs Generate H1N1 Alert Physician Practice

31 Bidirectional Communication Methods Clinical messaging is a push technology Message authored by Public Health entity Message integrated into clinical workflow using established systems and processes for communication Other methods to support bidirectional communication Case Reporting Pre-populate notifiable condition reports with HIE data to increase rate of spontaneous reporting Decision Support

32 Public Health Perspectives Possible Scenarios Robust HIE/Robust Health Department Developing HIE/Robust Health Department New York Public Health/HIE collaborative

33 Members of the NY Team Public Health Organizations New York State Department of Health New York City Department of Health and Mental Hygiene New York State Association of County Health Officials Regional Health Information Organization Partners Bronx (Bx) RHIO Brooklyn RHIO (BHIE) New York Clinical Information Exchange (NYCLIX) THINC RHIO, Inc. Western NY Healthelink (WNYCIE) Long Island Patient Information exchange (LIPIX)

34 Data Exchange Data Visualization Data Exchange Data Visualization Direct Data Reporting Direct Data Reporting Universal Public Health Node (UPHN) Statewide Health Information Network for New York (SHIN-NY).. 34

35 Universal Public Health Node (UPHN) Allows Public Health to function as a node on the Statewide Health Information Network (SHIN-NY) Participating RHIOs interface with the UPHN following common specifications as a standard, publishable interface Four primary functions will be initially developed to facilitate the data exchange between Public Health and a RHIO

36 Universal Public Health Node Functions Patient Query Line List Query Anonymize & Re-Identify Analytic Query Find and Get data from HIEs for a specific individual based on query parameters Request and receive patient-level data for a specific disease condition in a patient/case line list format. Ability to transmit MDS line list data to public health with a pseudonymized linker and the ability to re-identify patient data back to a specific person for epidemiologic follow-up Analytic (aggregation/ summarization) queries based on pre-defined list of disease conditions and transmit counts to public health on both a scheduled and ad-hoc basis

37 Public Health Perspectives Possible Scenarios Robust HIE/Robust Health Department Developing HIE/Robust Health Department New York Public Health/HIE collaborative Now, what if all of the HIE s/rhio s in NY were in a developing phase? The UPHN could capture data directly from health care facilities with EMR s.

38 Public Health Perspectives Possible Scenarios Robust HIE/Robust Health Department Developing HIE/Robust Health Department Developing HIE/Developing* Health Department *Developing Health Department = Further infrastructure development needed for some surveillance activities.

39 Developing HIE and Health Department Can we conceive a possible methodology that would enable these jurisdictions to have a functional surveillance effort pending further development?

40 Flu Pandemic Initiative January, 2010 One Activity 715 facilities available to provide data across 47 states 32 state and 32 city/county health department can access and view data

41 Flu Pandemic Initiative Optimal Coverage One Activity More than 1100 facilities available to provide data

42 Developing HIE and Health Department Can we conceive a possible methodology that would enable these jurisdictions to have a functional surveillance effort pending further development? Yes, it appears there are several possible ways to support these areas and facilitate enhanced national surveillance.

43 Some Final Thoughts Optimism Vigilance Industry Perseverance