Project Name: Date: Project Managers: Project Sponsors: Version No: Public Health Informatics Profile Current Situation: The MDH Common Ground grant, focused on chronic disease surveillance, and the MN e-health Initiative, which has an interest in interoperability of public health information systems has a need to collect information about key data sets and information systems in order to move forward with time sensitive strategic planning efforts. Other MDH stakeholders have an interest in an inventory of data sets and systems, but that is beyond the scope of this project at this time due to resource constraints. The information collected previously through inventory project does not contain the necessary information for the purposes of Common Ground and the Minnesota e-health Initiative; therefore a targeted profile of key public health information systems is being developed to meet the needs of Common Ground and MN e-health. Benefit Statement: More detailed profile of a selected sub-set of data sets and information systems at MDH will provide the needed information to: Fulfill requirements related to chronic disease systems profile for Common Ground grant Formulate future recommendations and plans for action for the Minnesota e-health Initiative Business Need or Opportunity: New state law requires all Minnesota health care providers to have interoperable Electronic Health Records by 2015. Our current public health information systems are in need of being modernized to meet the 2015 interoperability mandate. The current status of the various systems at MDH with details on their ability to meet the interoperability mandate which include descriptions of data exchanges (both internal and external to the organization) and the usage of standards is not known. This information is needed to support the efforts of the MN e-health Initiative, specifically the Population Health and Public Health Information Systems workgroup which is charged with making recommendations about modernizing public health information systems at the state and local level to meet the 2015 mandate for interoperability. Further details on the 2015 interoperability mandate and the Population Health workgroup can be obtained from: http://www.health.state.mn.us/e-health/index.html Similarly, the Common Ground project aims to improve chronic disease surveillance and so there needs to be a special emphasis on chronic disease data sets and information systems. The focus is on chronic disease due to the significant population health impact and costs associated with chronic disease. The profile project aims to understand the various data and systems used for chronic disease surveillance in order to make recommendations for improving them and therefore lessening the burden on society by chronic diseases. For more information on Common Ground grant, please visit: http://www.health.state.mn.us/e-health/commgrd/index.html. 12/4/2009 1
Project Objectives: Identify the various stakeholders involved in key public health information flows Obtain details on key information exchanges in the agency (internal and external to the organization) that are support public health surveillance Understand high level data and information infrastructure for selected information systems Understand data and information challenges for selected information systems Identify the specific information exchanges between public health and clinical communities that occur on an on-going basis and are part of interoperability mandate. Understand processes for chronic disease surveillance activities at MDH Stakeholder Perspectives and Needs The project has two different stakeholder perspectives with slightly different needs. Common Ground Focus on chronic disease and risk factor surveillance systems, activities, and data sets collected and used for ongoing chronic disease surveillance One-time need for informing future phases of Common Ground grant purposes Will illustrate how chronic disease surveillance is currently done, gaps in chronic disease surveillance systems/availability of data, and needed improvements Oriented towards chronic diseases and risk factors Chronic Diseases: cancer (of highest priority), asthma, arthritis, heart disease, stroke, injuries, obesity, diabetes Risk factors: tobacco, alcohol, other drugs, nutrition, physical activity, genomics, aging Data collected on MDH Health Promotion and Chronic Disease Division data sets and systems used for ongoing disease surveillance through a survey and inperson interviews Will include a high level analysis of business processes for chronic disease surveillance activities MN e-health Initiative Focus on readiness for health information exchange for public health systems and data sets that are collected for ongoing public health purposes May have a long-term need for tracking modernization efforts towards interoperability over time Will illustrate how public health systems could be modernized to meet the 2015 mandate for interoperability of health information and how information is exchanged across partners Oriented towards systems (e.g., communicable disease reporting system, LIMS, Local Public Health systems PHDoc, etc.) and their data sets in order to assess the level of system interoperability Data collected on MDH systems that collect personally identifiable health information at MDH through a survey only Data collected on Local Public Health agency systems (Champs, Carefacts, PhDoc) through a survey only Data collected on top 5 opportunities from Population Health workgroup through inperson interviews at MDH or Local Public Health agencies to collect information about future needs for meeting the mandate for interoperability Alternate Solutions to the Business Need: 12/4/2009 2
Gather the necessary information via a paper survey and/or web-based survey tool developed by IS&TM. The paper format provides less dependencies on other areas of the department given the short timeframe; however, it also may be less easy to complete as a survey respondent. The paper format also requires hand-entering into a database which is resource intensive. The webbased format provides relative ease of use by the respondent, but this tool has not been tested and hence uncertainity about potential glitches. The web-based format provides automatic data entry into a database for future use. The data from this database is also more likely to be transferred into a future inventory system if MDH decides to move forward with this departmentwide. Solutions to the Business Need: Start by conducting in-person interviews on the major systems within the 5 focus areas of the Population Health workgroup. The in-person interview provides a venue for piloting of the survey instrument, and is more likely to give timely information to serve the MN e-health needs. Then, take the refined survey instrument department wide, and collect basic information on the other information systems from the survey instrument only (no in person interviews). The information needed for collecting information for chronic disease can occur concurrently, since the two are not dependent on one another. Information will be stored in an Excel database for greater flexibility by the project managers for managing the information. Deliverables/Outcomes: Deliverables INSIDE the scope of this project: Development of survey instrument Summaries of in-person interviews Database for survey results Analysis of data Data flow diagrams (chronic disease) Reports to serve both Common Ground and MN e-health Initiative needs 12/4/2009 3
Collection Component 1. Overall List (approx. 80 100) 2. Population Health Workgroup List (approx. 40) 3. Phase 1 (approx. 10) 4. Chronic Disease What s Included Information Collected Reports Produced All systems/data sets that collect data on an ongoing basis (not one time) and are used for public health prevention and control activities MDH systems/data sets that contain personally identifyable health information and name MDH systems/data sets that are used for public health prevention and control activities and deals with diseases Information that needs to be reported to a physician or a system All registries or systems used for surveillance or other vital systems Focus on systems (vs. data sets) that are included in the 2015 mandate for interoperability Systems included Population Health Workgroup Opportunities for Exchange MDH Information systems related to the Population Health workgroup opportunities for exchange including: MEDDS, LIMS, MIIC, WIC 3 Local Public Health systems related to the e-health Initiative Population Health workgroup opportunities for exchange (gather information from LPHA informatics group): Champs, Carefacts, PhDoc MDH Chronic Disease-specific systems for Common Ground: MCSS, Tracking and Follow-up System, Stroke Registry, Traumatic Brain and Spinal Cord Registry, EH Tracking System Systems that are included in Phase 1 of the Population Health Workgroup recommendations including: Disease reporting: MEDDS, LIMS, others Immunizations: MIIC Risk factor surveillance: (none) Newborn screening Maternal and child health indicators and risks: Champs, Carefacts, PhDoc, others? Focus on disease and risk factor areas, detailed analysis initially for cancer programs, work in conjunction with IS&TM staff and contractor for MCSS and Sage project. Current data elements used for surveillance & list of needed elements for better Generated from previous inventory for validation by MDH staff, serves as the denominator Name, purpose, contact person, link between application and data sets, question about 2015 mandate, validation that list is correct Profile survey with no in person interviews Profile survey PLUS information about future needs (in person interviews) LPH: client-centric view of services/info including specifications (key functionalities to provide services), interoperability with state systems, integration of data to support seemless delivery of services, local systems to be more uniform Chronic disease surveillance survey plus in person interviews about surveillance activities Updated list of data sets/systems with ongoing collection at MDH Profile report (current status) Big picture report showing exchange of information between exchange partners Profile report (current plus future) Big picture report showing exchange of information between exchange partners Chronic disease surveillance and indicator reports 12/4/2009 4
surveillance (risk factors and diseases). MDH Scope Statement: Public Health Informatics Profile 12/4/2009 5
Proposed Reports to Include in Analysis: 1) A profile of key public health information systems and data sets at MDH and Local Health Departments needing upgrade (Components 2 and 3). Profile to include: Current System/Data Set Future/Ideal System/Data Set (for Component 3 only) System name / purpose Whether collecting information via this system is mandated by law Collection frequency / collection methods / source types / formats of data collection Whether data is exchanged to/from this system (if so, whom to/from?) Collection frequency / collection methods / source types / formats of data collection If data is not exchanged, reasons for not exchanging and readiness for exchange Data dictionary for selected core Ideal data elements (chronic disease) data elements Use of data standards for selected core data elements (e.g., ICD-9, Existence of data standards for current or ideal system and future use of standards SNOMED) Use of messaging standards for the Future use of messaging standards data (e.g., HL-7, XML) Staff resources needed for supporting system Staff resources needed for supporting system Recent upgrades to system Known needed upgrades Costs of developing/operating Known costs of upgrading system system Current level of interoperability Plans for interoperability LPH: client-centric view of services/info including specifications (key functionalities to provide services), interoperability with state systems, integration of data to support seemless delivery of services, local systems to be more uniform 2) Big picture and visual report of where exchanges of information are happening between exchange partners (Components 2 and 3). Identifies current state of exchange partners and flow of information exchange between partners Provides the context for electronic clinical data exchange Can be categorized by different areas/systems (e.g., chronic disease or a specific system) 3) Profile of the current state of chronic disease surveillance activities at MDH (Components 2 and 4). Description of how programs get access to the data and what they do with it Data flow diagrams by disease areas Description of the challenges of chronic disease surveillance activities Recommendations for improving how we do chronic disease surveillance Data elements currently collected and desired for chronic disease and risk factors 12/4/2009 6
Deliverables OUTSIDE the scope of this project: Inventory of data not needed for Common Ground or MN e-health Initiative purposes. Proposed Approach: Because of the complexity of the scope of the project and dual stakeholders, a prioritized phase approach is recommended. Phase 1 (by May 2008) Generate list in component 1 and validate it with MDH staff. Collect information in component 3 to serve as a pilot for future data collection. Collecting component 3 information first also provides more timely information for the Population Health workgroup. Collect information with LPHA Informatics group to represent Local Public Health Conduct high level data inventory of all chronic disease programs (at the program level rather than data set level) Analyze the data and produce reports which can be replicated with additional data collected across the agency Phase 2 (by June, 2008) Collect information in component 2, analyze information, and produce reports. Collect information needed for component 4 chronic disease surveillance activities (reports on data flows and data elements collected by various programs) Phase 3 (by September, 2008) timeline will be refined once MCSS/Sage contractor is hired Detailed analysis of MCSS and Sage systems (timeline dependent on contractor timeline) Collect additional information for component 4 as needed Project Dependencies: Future work of the MN e-health Initiative and Common Ground project are dependent on the profile project. Constraints: Resources are limited to complete the project; therefore prioritizing is important There is a short timeline to complete the project If students carry out parts of the project, it puts a constraint on our timeline for collecting information in order to transfer to the students for analysis to meet their timeline The project is dependent on involvement from a wide variety of stakeholders, both at MDH and Local Public Health Departments Assumptions: Scope does not change throughout the duration of the project Project is able to get cross-divisional support for taking time to participate in the inventory Staff time will be adequate for duration of the project 12/4/2009 7
Risks: Risk Description Lack of interest from data stewards who provide data Undefined scope creates scope increase Not enough resources are allocated Prob 1=low 5=hi Impact 1=low 5=hi Total Weight (PxI) Plan 4 4 16 Mitigate the risk: Make inventory questions as simple and clear as possible CHI make a formal request for participating across the department, and HPCD director make similar request across HPCD division 3 5 15 Mitigate the risk: Clarify scope up front Bring any proposed changes in scope to project team for assessment of priority and resources 4 5 20 Mitigate the risk: Identify priorities up front Assess number of hours needed to complete the project (phase 1) and plan accordingly 12/4/2009 8
Key Stakeholders: Common Ground Project Team and related chronic disease programs MN e-health Initiative Advisory Committee, Population Health Workgroup Center for Health Informatics Local Public Health Departments Data users who complete the inventory Project Team Members: Role Role Activities (the things they do) Project Sponsors Sponsors and champions the project Provides guidance and direction Makes major decisions affecting the project Resolves cross functional conflicts Project Managers Create and maintain all project plans Manage project scope, time, and cost Lead all project work and communications Project Team Assist in creation of Inventory survey and plan overall project scope and approach Role Responsibilities (the decisions they can make) Approve funding Approve resource assignments Change key project dates Approve scope changes Make team member task assignments Make scope decisions that do not affect major milestone dates Decide when to elevate an issue Plan overall project approach, including survey development Plan overall project approach, including survey development High-Level Milestones: Milestone Estimated Complete Date Development of survey instrument (Components 1, 2, 3, 4) 2/29/08 Complete initial in person interviews (Component 3) 4/15/08 Initial reports completed (Component 3) 5/31/08 Collect department-wide survey information (components 1, 2) 5/15/08 Reports from department-wide survey (Components 1, 2) 6/30/08 Reports from chronic disease analysis (Component 4) 6/30/08 *** These are high level estimates subject to change as more detail is defined 12/4/2009 9
Scope Change Management (how you are going to manage change): to be discussed by project team Project managers will discuss scope changes with the project sponsors for final decisions on scope and related timeline change. Approvals Project Manager: Project Manager: Project Sponsor: Project Sponsor: Date: Date: Date: Date: 12/4/2009 10
Definition of Information System A business application of the computer. It is made up of the database, application programs and manual and machine procedures. It also encompasses the computer systems that do the processing. Processing the Data The database stores the subjects of the business (master files) and its activities (transaction files). The application programs provide the data entry, updating, query and report processing. The Procedures The manual procedures document how data are obtained for input and how the system's output is distributed. Machine procedures instruct the computer how to perform scheduled activities, in which the output of one program is automatically fed into another. Transaction Processing The daily work is the online, interactive processing of the business transactions and updating of customer, inventory and vendor files (master files). Batch Processing At the end of the day or other period, programs print reports and update files that were not updated on a daily basis. Periodically, files must be updated for routine maintenance such as adding and deleting employees and making changes to product descriptions. See transaction processing. Source: PC Magazine http://www.pcmag.com/encyclopedia_term/0,2542,t=information+system&i=44963,00.asp Tech Encyclopedia http://www.techweb.com/encyclopedia/defineterm.jhtml?term=information+system Definition of Chronic Diseases Chronic diseases have been referred to as chronic illnesses, noncommunicable diseases, and degenerative diseases. They are generally characterized by uncertain etiology, multiple risk factors, a long latency period, a prolonged course of illness, noncontagious origin, functional impairment or disability, and incurability. In more general terms, a chronic disease can be defined as a disease that has a prolonged course, that does not resolve spontaneously, and for which a complete cure is rarely achieved. Chronic diseases account for the overwhelming majority of deaths and disability in Minnesota. (MDH Website) 12/4/2009 11
Definition of Interoperability MDH Scope Statement: Public Health Informatics Profile Interoperability defined as: the ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged (National Alliance for Heath Information Technology) Levels of interoperability Level 1: Non-electronic data. Examples include paper, mail, and phone call. Level 2: Machine transportable data. Examples include fax, email, and unindexed documents Level 3: Machine organizable data (structured messages, unstructured content). Examples include indexed (labeled) documents, images, and objects. Level 4: Machine interpretable data (structured messages, standardized content). Examples include the automated transfer from an external lab of coded results into a provider s EHR. Data can be transmitted (or accessed without transmission) by HIT systems without need for further semantic interpretation or translation. In the early stages of interoperability implementation, it is unlikely that any single system will be completely interoperable with every other system at Level 4. But there will be an incremental movement toward this as interoperability of clinical information from a variety of sources becomes more commonplace in systems through increasing use of agreed-upon standards. Initial efforts at achieving eventual Level 4 interoperability should be focused on the clinical information that, generally, is already stored in a coded and structured format, and that would yield the highest clinical value if made interoperable. Examples of these clinical information data types are laboratory results, medications, allergies, problems, procedures, etc. Because they will supply the framework on which interoperability will develop, standards must in every case be open standards, i.e., in the public domain and non-proprietary. Examples of such open standards include IEEE, HL-7, and SNOMED standards. Standards specify much of the detail necessary to ensure interoperability, however, some critical details are in the hands of the organizations that actually implement the standards. To achieve interoperability, organizations involved in data exchange projects need to work together to assure that such implementation details are addressed consistently among the participants. [End] 12/4/2009 12