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1 Alean Kirnak Software Partners LLC

2 In , PHDSC developed the Immunization Content standard with IHE This work suggests new registry models PHDSC white paper: silos repeat functionality and don t talk to each other New standards offer new workflow possibilities and related cost savings Refer to PHDSC white paper on public health

3 Decentralized, user-centric workflow Reduction in connectivity costs by transforming order(n 2 ) costs to order (N)

4 Cancer Registries Chronic Disease Management Solutions Quality Reporting Biosurveillance Adverse Event Reporting Organ Donor Registries Immunization Information Systems

5 A process of contributing data to registry Public Health Scenario Scenario Immunization Registries (IIS) Cancer Registries (CCR) A.1 take some clinical action administer vaccines diagnose cancer (xray, path report, etc.) A.2 data enter the clinical action into EHR-S A.3 run decision support validate existing immunization history and determine patient status (up-to-date, vaccines due, etc.) determine if this is a reportable cancer A.4 populate form format "official immunization record -e.g. yellow card" populate standard form for reporting incident A.5 physician data entry of additional info into form signature of provider enter treatment plan A.6 update the local EHR-S save immunization data in XDS registry save treatment plan A.7 populate the registry Send HL7 message to IIS HL7 message sent to CCR from EHR-S A.8 notify additional interested parties local IIS updates state IIS, IIS updates other providers with this patient in common local CCR updates state CCR, CCR updates other providers with this patient in common B use of registry at point of care identify patient (retrieve identifiers from demographic B.1 data) B.2 retrieve registry data retrieve immunization history and other clinical data retrieve cancer case summary B.3 execute decision support validate existing immunization history and determine patient status (up-to-date, vaccines due, etc.) suggest lab tests, further treatment options B.4 take clinical action (i.e. return to step A.1) C additional use of decision support output C.1 case management find children not up to date and try to get them in for their vaccines contact patient for follow-up information on cancer status C.2 reminder/recall send appointment reminders notify for clinical trials C.3 reporting coverage rate reporting, etc. incidence rates, etc.

6 retrieve immunization and other clinical data validate immunization history determine patient status (vaccines due, etc.) Administer and record vaccines forecast next due date provide an official record - yellow card save data in IIS

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9 Stakeholders Web based Application Data Stores Hospital #2 Hospital #1 user Clinic #2 Clinic #1 user All Registry Application Functions: Identity Resolution Retrieval/Update of Data Decision Support Registry Data Store Other provider user Other user

10 retrieve immunization and other clinical data validate immunization history determine patient status (vaccines due, etc.) administer and record vaccines forecast next due date provide an official record - yellow card save data in electronic health records (EHR) system send the data to the IIS

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15 <administerablematerial classcode="mmat" determinercode="instance"> <templateid root=" " /> <templateid root=" " /> <code code="20" codesystem=" " displayname="dtap" />

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20 Stakeholders Service Bus Data Stores Hospital #2 Hospital #1 EMR Clinic #2 Clinic #1 Sec urit y Serv ices Tra nsfo rma tion Serv ices Decision Support Service Patient Identification Service Master Person Index Document Registry (referrals, immunizations) EMR Locate, Retrieve and Update Service Document Repository (referrals, immunizations) Web based EMR interface for small providers Other Service Other Data Store Other patient or provider Interface SDIR (MPI, immunization data)

21 Stakeholders Web based Application Data Stores Hospital #2 Hospital #1 user Clinic #2 Clinic #1 user All Registry Application Functions: Identity Resolution Retrieval/Update of Data Decision Support Registry Data Store Other provider user Other user

22 Mathematics of connections N 2 -> N current proposed SOA

23 Patient-centric approach to data Now the silos talk to each other Two-way exchange of information between providers and public health Providers have incentives to participate Open standards provide for off-the-shelf, competitive components Loosely-coupled services can be reused Certain services such as security can be applied overall

24 Currently in the IHE Planning Cycle PHDSC has proposed an expanded white paper on Service-Oriented Architecture Ties individual standards together in a SOA approach Relates SOA to public health

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