Electronic Public Health Case Reporting: Current & Future Possibilities. Joint Public Health Forum & CDC Nationwide Call October 16, 2014

Transcription

1 Electronic Public Health Case Reporting: Current & Future Possibilities Joint Public Health Forum & CDC Nationwide Call October 16,

2 Joint Public Health Forum & CDC Nationwide Call Agenda Introduction & Background- Dan Chaput (ONC) and John Abellera (CDC) Provider Reporting from the Electronic Health Record- Rebecca Gluskin (NYC Department of Health and Mental Hygiene) Public Health Case Reporting Using Consolidated Clinical Data Architecture (C-CDA) Pilot- John Gelletta (Wisconsin Department of Health Services) Structure Data Capture Linkage - Dan Chaput Panel Discussion / Q & A - Led by Jim Daniel (ONC) 2

3 The Business Requirement Adaptability changing requirements Requirements for screening individuals Evolving case definitions Outbreak specific forms Usability and Securablity Use of data from an Electronic Health Record (EHR) Avoid another login in for Providers and Reporters 3

4 Outcomes and Solutions Outcomes Complete, high quality data, delivered faster Reduce duplicate data entry Solutions Underlying concepts are extensible Uses beyond case reporting Thus, a framework Structured Data Capture (SDC) 4

5 Provider Reporting from the Electronic Health Record Rebecca Gluskin, PhD, MS Bureau of Public Health Informatics and Data Services Division of Informatics, Information Technology and Telecommunications NYC Department of Health and Mental Hygiene

6 Disclaimer The views expressed by the presenters and the authors during this meeting are their own and don t represent the official position of the Office of the National Coordinator (ONC) for Health IT, and Centers for Disease Control & Prevention (CDC).

7 NYC s Current Electronic Reporting Currently Providers are mandated to report via: Fax, mail or Reporting Central (in-house developed web application) Challenges with current provider reporting: Data currently exists in EHR Issues with missing, late or incomplete report CDC/CSTE/NACCHO pilot grant exploring opportunities for EHR provider reporting

8 Electronic Health Records: Current Landscape How can the Health Department leverage EHR systems so that providers don t have to re-enter data into Reporting Central? Hundreds of EHR vendors with varying systems and data fields Multiple jurisdictions with varying reporting requirements Leverage and align with Meaningful Use initiatives

9 Pilot Project Background Goal: To pull data from the EHR clinical data architecture (CDA) - continuity of care document (CCD), and pre-populate case CDA report forms. Patient demographics Provider/Reporter demographics Disease details Outcome: 70% of common fields can be mapped, including required fields CCD Surveillance Disease Report

10 Workflow Summary

11 Architecture/Data Flow Pertussis EMR Reporting Pilot NYC DOHMH EPIC Request is made by clicking a URL in the EMR CCD sent Parse the CCD Return Populated Web Form Forms Manager Send URL with prepopulated fields from CCD and empty fields from Reporting Central Store CCD Provider completes the case report missing fields Complete case report stored at the NYC DOHMH Report sent to Surveillance System

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13 Most patient demographics can be automatically populated

14 Provider/ICN selects the form to fill out

15 Disease detail to be entered by the reporter

16 Demographic info on the provider, reporter and facility can be pulled from the EHR

17 Reporter reviews data before submitting

18 Reporter receives a confirmation number

19 Lessons Learned Securing an EHR vendor partner Interpreting EHR document fields/ translating EHR to public health Partnering with an off-site clinical practice to test message transmission

20 Successes Leveraging existing logic from current NYC online provider reporting website Integration with an in-house survey tool to quickly develop forms CDC resources: Structured Data Capture, IHE Specification Collaboration with our grantee counterpart in Wisconsin One standard web service reports to two jurisdictions

21 Next Steps Continue enhancements to streamline workflow for providers in application Document reporting workflow in a clinical setting, get feedback from provider site Incorporate resources for the provider in the application Expand to HIV partner notification and first episode of psychosis.

22 Healthcare Provider Feedback Presented to stakeholders, NYC Assoc. for Professionals in Infection Control and Epidemiology and The Institute for Family Health. They would like the application to: Prepopulate info from the EHR Store the case report in the patient s medical chart to document submitted version of the form

23 Public Health Case Reporting Using Consolidated Clinical Data Architecture (C-CDA) Pilot John Gelletta, WEDSS Informaticist Wisconsin Department of Health Services

24 Electronic Communicable Disease Reporting in Wisconsin In 2007 Wisconsin went live with the Wisconsin Electronic Disease Surveillance System (WEDSS) in five local jurisdictions. By 2009 all local health departments in the state were reporting all communicable diseases (with the exception of HIV) to the state and CDC through WEDSS. Today over 450 medical professionals from 250 hospitals, clinics, small hospital laboratories and correctional facilities utilize WEDSS through a web based provider portal to collect patient communicable disease information. WEDSS also receives electronic lab reports (ELR) from over 49 hospital, clinic system and reference laboratories via an HL7 feed through the Wisconsin State Lab of Hygiene (WSLH).

25 Current Process for Providers to Report Communicable Disease Providers are able to log into WEDSS and manually enter data. Providers have the ability to search WEDSS for ELRs submitted by their facility and generate a case report from them, reducing the amount of typing, however in most cases the Infection Preventionists are transcribing information from their Electronic Health Record (EHR) into WEDSS. Local public health reviews the data submitted and completes the investigation. State epidemiologists reviews the entire case and flags the case for submission to the CDC via NETSS or NEDSS

26 results Provider Lab Suspect Case WEDSS Reporter Health dept. alert x WEDSS Case Reporting Traditional Methods Work Flow Diagram Local Public Health Dept. PH Investigator Assigned Patient Info Gathering WEDSS Reporter x State Epidemiologist CDC

27 Process for Case Reporting Using C- CDA Continuity of Care Document Early in the process of implementing WEDSS providers began requesting the ability to report directly from their EHR systems. Wisconsin, recognizing that electronic communicable disease reporting can diminish the burden on clinicians and hospital Infection Preventionists, as well as, improve the timeliness and accuracy of reporting in 2011 began pursuing the EHR gateway enhancement to capture information directly from a hospital or clinic s EHR. In January 2013 WEDSS went live with the capacity to accept an electronic message directly from healthcare facilities EHR through the Atlas developed WEDSS EHR Gateway.

28 results Dr. Office Lab Communicable Disease CCD WEDSS Form EHR Gateway WEDSS Reporter results x WEDSS Case Reporting Using CDD Work Flow Diagram Local Public Health Dept. PH Investigator Assigned Patient Info Gathering WEDSS Reporter x State Epidemiologist CDC

29 WEDSS (Form Receiver) WEDSS EHR Gateway (Form Manager) EHR (Form Filler) WEDSS EHR Gateway Workflow Integrating Healthcare Enterprise (IHE) Components IHE Demonstration Flow Components Related to Atlas Request is made utilizing Web Service Call Provider completes case report URL form specific to the request is sent back to EHR Case report is sent to State Health Department Form includes patient demographics as well as disease specific questions Form is received and processed into WEDSS

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31 Data Parsed from the CCD Message The WEDSS application is capable of parsing the following common core data set from a CCD message. First Name Middle Name Last Name DOB Gender Home Phone Street Address Apartment Number City State Zip Country Ethnicity Race Pregnant (if female) Expected Delivery Date (if pregnant) Reporting Source Medical Record Number Diagnosed Disease LOINC SNOMED Organizational ID NPI

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37 Pilot Progress In August 2013 Wisconsin Completed integration testing with Epic Systems Corporation s demo EHR, successfully retrieving a disease specific case report form, populating the form from the CCD and submitting the completed form to the WEDSS development site. Wisconsin is actively soliciting providers using the current version of Epic s EHR to pilot the EHR gateway. Wisconsin has also begun discussions with other EHR vendors to begin developing their capacity to submit a CCD to public health. Disease specific EHR supplemental forms have been created for all reportable diseases. WEDSS is able to capture patient demographic information from the CCD message. The next upgrade of the WEDSS system, expected at the end of 2014, will include the functionality to parse treatment and symptom information as well.

38 Challenges Infection Preventionists are typically enthusiastic to support electronic disease reporting, however when the project has been brought to a facilities IT department and management it has consistently been denied due to lack of resources and higher priority projects such as Meaningful Use and the state HIE projects. Providers have expressed concerns that the limited amount of fields parsed from the CCD message did not represent a value for the effort involved in implementation. To address this concern Wisconsin has contracted an enhancement to the WEDSS system to capture additional data elements. This enhancement will be delivered at the end of 2014.

39 Next Steps Recruit a facility to pilot electronic case reporting via CCD messaging. This project focused on pertussis, chlamydia and campylobacter, once successful with these diseases Wisconsin plans to expand to all Diseases Work with other EHR vendors and other providers to further automate the reporting process. Implement enhancement to capture treatment and symptom data from the CCD message

40 Contributing Organizations and Acknowledgements Council of State and Territorial Epidemiologists (CSTE) Ms. Monica Huang, MPH National Association of County and City Health Officials (NACCHO) Atlas Development Corporation (Atlas) Mr. Russell von Blanck, Mr. Rahul Deshpande, Ms. Tanya Oemig, Ms. Zoreh Shahbazi, Mr. Ketan Gandhi, Mr. Mark Marostica Epic Systems Corporation (Epic) Mr.John Stamm, Mr. Mikhail Horne Wisconsin State Laboratory Of Hygiene (WSLH) Mr. William Kurth, Ms. Mary Wedig

41 Standards and Interoperability (S&I) Framework 41

42 Discussion & Questions Discussion & Questions 42