Meaningful Use - HL7 Version 2
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1 Meaningful Use - HL7 Version 2 HL7 Version 2 and Surveillance
2 Your Ambassadors Today Anna Orlova, PhD, Executive Director, Public Health Data Standards Consortium and Johns Hopkins University Lori Reed-Fourquet, Owner/Consultant, e- HealthSign, LLC
3 What we will cover A public health surveillance story Pre-Meaningful Use public health surveillance efforts Meaningful Use and public health surveillance How HL7 is essential to the story The end of our story
4 Here we have a sick patient Lab The being tests lab examined performs are ordered in the a hospital tests to assist in and diagnosing produces the a lab patient report which is returned to the Diagnosing and Treating ordering Hospital clinician Patients Public Health Surveillance is the Key Activity of Lab Result Health Departments to Protect the Public s Health Typical Modern Hospital Laboratory
5 Here we have a sick patient Lab The being tests lab examined performs are ordered in the a hospital tests to assist in and diagnosing produces the a lab patient report which is returned to the Diagnosing and Treating ordering Hospital clinician Patients Public Health Surveillance Components: 1. Event detection based on the laboratory, clinical encounter data and non-clinical data 2. Event investigation (case investigation/assessment) Lab 3. Event monitoring Result 4. Event management (outbreak management) 5. Evaluation of the event management intervention(s) 6. Event mitigation (prevention) Typical Modern Hospital Laboratory
6 Public Health Surveillance Systems CDC Environmental Public Health Tracking Network - health effects data with human exposure data and environmental hazard data. CDC National Notifiable Disease Surveillance System (NNDSS) laboratory and clinical data on nationally defined list of communicable diseases State Disease Surveillance Systems - laboratory and clinical data on jurisdictionally-defined list of reportable diseases (conditions) Local and State Syndromic Surveillance Systems syndromic data from clinical and non-clinical sources to detect a public health threat event
7 Pre-Meaningful Use Efforts on Public Health Surveillance Lab PHER Report HITSP Electronic Lab Reporting Interoperability HL7 Specification (IS 01) specifies HL message and CDA R2 for laboratory results reporting to public health agencies HITSP Biosurveillance Interoperability Specification (IS 02) specifies HL for message-based and HL7 CDA R2 for structured document submission of syndromic data HITSP Public Health Reporting Interoperability Specification (IS 11) specifies HL for messagebased and HL7 CDA R2 for structured document submission of notifiable/reportable diseases data
8 Pre-Meaningful Use Efforts on Public Health Surveillance Public Health Partners: Lab PHER Report HL7 Council of State and Territorial Epidemiologists (CSTE) Association of Public Health Laboratories (APHL) Public Health Data Standards Consortium (PHDSC)
9 Meaningful Use of HIT and Public Health Surveillance Focus is on Syndromic Surveillance Public Health Stakeholder International Society for Disease Surveillance (ISDS)
10 Meaningful Use of Health IT and Syndromic Surveillance Applies to all healthcare providers (inpatient, outpatient and emergency care) Focuses on infectious diseases Focuses on local and state syndromic surveillance systems not reporting to federal agencies Focuses on: Event detection based on the laboratory, clinical encounter data and non-clinical data Event investigation (case investigation/assessment) Event monitoring Event management (outbreak management) Evaluation of the event management intervention(s) Event mitigation (prevention) Synonym terms used in the past: biosurveillance and situational awareness
11 Meaningful Use of Health IT and Syndromic Surveillance Data Requirements: Facility demographics including contact data for the report and sender data Patient demographics Laboratory and radiology orders and results Vital signs (heart rate, respiratory, blood pressure, height and weight) Observation, symptoms and clinical findings Triage notes Pregnancy status Data elements on severity of illness (ventilated/intubated indicators) ICU indicators
12 Meaningful Use of Health IT and Syndromic Surveillance and Specifies data submission using HL7 v2.3.1 and HL7 v2.5.1 Data requirements are mostly the same as specified in the Biosurveillance Minimum dataset with additions of patient-identifiable data: HITSP Encounter Message Component (HITSP C39) specifies Biosurveillance dataset for message-based data submission HITSP EHR Lab Terminology (HITSP C35, 36, 37) URL specified vocabularies and terminologies for Lab reports HITSP Transaction Package TP48 - specifies Biosurveillance dataset for document-based data submission HITSP Anonymize Component (HITSP C25) - specifies Biosurveillance identifiers to be anonymized Source: HITSP Document Library. URLhttp://
13 Biosurveillance Minimum Dataset: C-39 Encounter Message pkg C39 «component» Encounter Message Specifies content for patient encounter data (excluding laboratory, radiology) in a messagebased functional flow scenario + docid = C39 constrains «base standard» HL7 V2.5 Message -. HL7 V2.5 ADT data structure Key Concepts - Patient encounter data are captured as part of the normal process of care performed by healthcare providers such as hospitals, emergency departments and outpatient clinics - Anonymized if required by jurisdiction - Constrained to AHIC Biosurveillance Minimum Data Set Standards Selection
14 Biosurveillance Minimum Dataset: C48 Encounter Document pkg TP48 «transaction package» Encounter Document + docid = TP48 contains «composite standard» IHE XDS-MS constrains «base standard» HL7 CDA R2 Specifies content for patient encounter data (excluding laboratory, radiology) in a document sharing functional flow scenario IHE Patient Care Coordination Medical Summary (XDS-MS) HL7 CDA R2 -. Key Concepts - Patient encounter data are captured as part of the normal process of care performed by healthcare providers such as hospitals, emergency departments and outpatient clinics. - Anonymized if required by jurisdiction - Constrained to AHIC Biosurveillance Minimum Data Set Standards Selection
15 Biosurveillance Minimum Dataset: C35 EHR Lab Terminology pkg C35 «component» EHR Lab Terminology + docid = C35 «base standard» LOINC constrains Specifies vocabulary for Laboratory Results data LOINC, SNOMED-CT, HL7 V2.5 Code Sets, HL7 V3.0 Code Sets Key Concepts «base standard» SNOMED-CT «base standard» HL7 V2.5 Code Sets constrains constrains -. - Constrained to harmonize AHIC Biosurveillance Minimum Data Set Standards Selection «base standards» HL7 V3.0 Code Sets constrains
16 Syndromic Surveillance Systems: Examples New York City Department of Health and Mental Hygiene Boston Public Health Commission City of Milwaukee Health Department Indiana State Public Health Electronic Surveillance System (PHESS)
17 Vision for Public Health Surveillance under NHIN Percent of Children Tested for Lead with BLL>10 µg/dl in the USA Source: Eileen Koski. Quest Diagnostics. PHIN-2004, May, Atlanta GA
18 Syndromic Surveillance Basics GI Outbreak Event: Time Signal: Alarm threshold Threshold Week Weekly ED Gastrointestinal Syndromes Source: Shaun Grannis. Lecture in Public Health in NHIN Course Johns Hopkins School of Public Health. 2007
19 Source: Shaun Grannis. Lecture in Public Health in NHIN Course Johns Hopkins School of Public Health. 2007
20 Surveillance Information Flow Hospital ED Registration HL7 ADT message Hospital Interface Engine (Routing) Hospital Firewall (Encryption) Network Connection Batched, delivered to ISDH every 3 hours Message Processor Message Listener Firewall (Decryption) Source: Shaun Grannis. Lecture in Public Health in NHIN Course Johns Hopkins School of Public Health. 2007
21 Current PHESS Hospitals (n=72) > 6,500 visits per day ~ 15 MB data per day Goal of 78 hospitals by August 2007 Source: Shaun Grannis. Lecture in Public Health in NHIN Course Johns Hopkins School of Public Health. 2007
22 GI Event Source: Shaun Grannis. Lecture in Public Health in NHIN Course Johns Hopkins School fo Public Health. 2007
23 Natural Disaster Source: Shaun Grannis. Lecture in Public Health in NHIN Course Johns Hopkins School fo Public Health. 2007
24 Sentiweb
25
26 Sentiweb << space (kriging) Time >> Unit = week and space x time
27
28 Public Health Surveillance and Meaningful Use of HIT Traditional Public Health Surveillance (Case Reporting ) Specific Case Notification Messages Syndromic Surveillance (Biosurveillance) Monitor routine clinical data for public health concerns
29 How HL7 is Essential to Public Health Surveillance Story HL7 standards should enable submission of electronic surveillance data to public health agencies according to applicable law and practice. HL format (no implementation guide specified), or HL format in conformance with the Public Health Information Network HL7 Version 2.5 Message Structure Specification for National Condition Reporting Final Version1.0 and Errata and Clarifications National Notification Message Structural Specification specifies the use of Case Notification Message Mapping Guides published by the CDC at
30 Public Health Surveillance and Meaningful Use of HIT What/When/Who/Whom to report (varies by condition and by jurisdiction) Impacts the Provider organization workflow which must be accommodated in the tool used to support fulfillment of reporting requirements Reporting tool options
31 Jurisdiction Reporting Example
32 Jurisdiction Reporting Example
33 Jurisdiction Reporting Example Specialty Forms In the instance where specialty forms or electronic reporting are available, the PD-23 should not be used. Specialty forms are available for the diseases listed below. Some forms are available as fillable PDF documents. When possible, please use this fillable form. HIV/AIDS - Adult HIV/AIDS Case Report Form ( ) Adult HIV/AIDS Case Report Form completion intructions Influenza - Hospitalized and Fatal Cases of Influenza - Case Report Form ( ) Hospitalize and Fatal Flu Cases Form completion instructions Occupational Diseases - Physician's Report Form ( ) Occupational Diseases Form completion instructions Sexually Transmitted Diseases - STD-23 ( ) STD-23 Form completion instructions Tuberculosis - TB-86 ( ) TB-86 Form completion instructions
34 Jurisdiction Reporting Example diseases/pdf forms /pd23 form.pdf
35 What to report Which cases needs to be configurable (varies by jurisdiction) Coded Condition (problems, diagnoses, test results) Chief Complaint Coded Natural Language Processing Content related to the condition Optional in most of the message requirements (unlikely to be sent) Limited availability within the EHR (e.g. travel) Varies by condition (specialized) Agree upon a vocabulary for reportable conditions
36 Public Health Case Reporting Workflow Where is the decision to report? Human EHR HIE Auxiliary Decision Support Utility Interface Engine
37 Public Health Case Reporting Workflow (EHR) EHR Collects Case Reporting Data EHR submits Case Report Level of detail not generally in an EHR Will require follow-up with patient for additional data Workflow and products for case reporting Dedicated Personnel Service or specialty product (EHR Module, 3 rd Party) EHR Surfacing Public Health Case Report Form Retrieve Form for Data Capture (IHE, HITSP) Allows pre-population of EHR data Allows data entry for non-ehr managed data Point of Care
38 Public Health Case Reporting Workflow (Health Information Exchange) HIE May Support Knowledge to Trigger Reporting on Behalf of EHR HIE May Offer Forms Data Capture HIE May Supply Subscription to Notifiable Content to Public Health HIE May Supply Query Access to Public Health Support for Biosurveillance Support for Anonymizing/Pseudonymizing for Data Mining
39 Public Health Case Reporting Workflow (Other Reporting Tools) Auxiliary Decision Support Utility May support other reporting needs (e.g. Quality Reporting/Analysis) Application Service Interface Engine Need to define triggers and content
40 Reportable Condition Processor Realtime Compare to Dwyer I Abnormal flag, Organism name in Dwyer II, Value above threshold Summary Daily Batch To Public Health Inbound HL7 Potentially Reportable Reportable Condition Reportable Conditions Databases To Infection Control Record Count as denominator Print Reports Source: Shaun Grannis. Lecture in Public Health in NHIN Course Johns Hopkins School fo Public Health. 2007
41 The End of Our Story: Enabling Public Health Surveillance via EHR-S Public Health at HL7 Re-evaluation of the HL7 EHR-S Functional Model Release 1.1 from Public Health Perspectives Development of the Public Health Functional Profile Development of the Public Health Domain Analysis Model Public Health at IHE Public Health Reporting Integration Profile
42 Links To More Information CDC Public Health Information Network (PHIN) Resources: URL: mmghomepagecasenotification.html
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