1 Review of Population and Public Health Objectives Stage 3 MU Arthur Davidson, MD, MSPH Meaningful Use Workgroup December 20, 2013

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Review of Population and Public Health Objectives Stage 3 MU

Arthur Davidson, MD, MSPHMeaningful Use Workgroup

December 20, 2013

Agenda

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Progress with Meaningful Use Measures for Public Health

Evidence of PH Efforts with Standards Cancer HAI (need notes) Updates on Current Measures: Immunization & ELR

(Jim can give someone info for slides) Future of PH – Aligning future measures w/S&I

Framework• SDC• HeD • DAF

Progress • CSTE Pilots • RCKMS

Big pic diagram (Shu)

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Hospital 1st v. 2nd v. 3rd yearPH Menu Objective Performance

Source: CMS Presentation – Rob Anthony, December 4, 2013

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Immunization • New guide provides improvements• Progress with providers is better • ONC test criteria are making interoperability better • PH moving toward accepting data coming form certified

products• Next version (Feb 2014) of IG will include bi-directional w/

History and forecast back to providerElectronic Laboratory Reporting (ELR)

• New version of IG is available to HL7 members and includes many improvements

Syndromic Surveillance (SS)Successful centralized infrastructure utilizing BioSensehttp://www.hl7.org/dstucomments/showdetail.cfm?dstuid=104

Update on Current Measures: - Immunization, ELR, SS

http://www.hl7.org/dstucomments/showdetail.cfm?dstuid=104

http://www.hl7.org/dstucomments/showdetail.cfm?dstuid=104

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Electronic Laboratory Reporting (ELR) – Pattern of Adherence to Standards• Public Health has consistently made efforts to abide by

standards and in turn minimize impact on clinical partners• Proof of PH’s commitment to build on standards and

processes used for other use cases,. • ELR Release 1 (HL7 Version 2.5.1: ORU^R01)1was built on

the HISTP Lab-to-EHR Implementation Guide• ELR Release 2 is the current profile for Electronic

Laboratory Reporting to Public Health (MU Stage 1 and 2).

• Public health has demonstrated readiness for standards and will credibly achieve that for Stage 3.

http://www.odh.ohio.gov/~/media/ODH/ASSETS/Files/opi/infectious%20disease%20surveillance/v251_IG_LB_LABRPTPH_R1_INFORM_2010FEB.ashx

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Key Principle for PH Stage 3 MU

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• Adhere to Standards and Interoperability Framework Components Whenever Feasible

Component PurposeConsolidated CDA Standard message formatStructured Data Capture

Populate standard forms

Health eDecisions Define when standard forms should be collected

Data Access Framework

Query data: 1) by provider and 2) across multiple organizations and by population

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Cancer Reporting• Stage 3 MU Cancer Implementation Guide (IG) should

move to consolidated clinical document architecture (c-CDA) because: – EHR vendors are required to use this format for

Transition of Care documents in Stage 2 MU– eliminates burden of supporting two different formats

for cancer reporting– c-CDA has harmonized and improved templates

across multiple sources– cancer program is ready to move to this new standard

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Cancer c-CDA: Next Steps• Align Cancer IG sections with c-CDA sections (high level

completed)• Add a new document-level template c-CDA R2:

"Ambulatory Healthcare Provider Cancer Event Report”• Add Cancer Diagnosis Section to c-CDA • Perform Gap and Overlap analysis of entries, data

elements, attributes, and value sets• Put new document through HL7 ballot process

Timeline– High level gap analysis performed in November 2013– Detailed gap/overlap analysis work starting in January

2014– Ballot in May 2014

PH c-CDA Progression

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Pertussis (NY State)Pertussis (NY State)

Pertussis (San Diego)Pertussis (San Diego)

Tuberculosis (Delaware)Tuberculosis (Delaware)

EHDI (N. Dakota)EHDI (N. Dakota)

2012 2013 2014+

EHDI (Oregon)EHDI (Oregon)

Cancer RegistryCancer Registry

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Reporting protocol for

HAI

Executable expressions of detection and case reporting

algorithms

HAI detection rules applied to patient-specific

data

Additional rules applied to

populate full HAI report

Healthcare Facility

Reporting system provides protocol and algorithm

Publicly Reported HAI

data

Electronic HAI ReportClinical

DocumentArchitecture

(CDA)

Reporting system publishes facility-specific

HAI data

CDA transmission:

- Manual upload

- Automated send

Electronic Healthcare Associated Infection (HAI) Detection and Reporting:

Supporting Patient Safety

Specifications:•eMeasures

•Decision rules

•Computer code

Electronicsystems:•EHR

•Pharmacy

•ADT

•Lab

CDC

CDCPrograms

CMS

PublicHealth

Healthcare

NHSN

HeDHeD

13Sources: Communicable Disease CDA Pilot Project Report. 2012. URL: https://wiki.phdsc.org/index.php/CDAEHDI CDA Pilot Project Report. 2013. URL: https://wiki.phdsc.org/index.php/EHDI-Pilot

CDA/SDC for Public Health Pilot ProjectsPublic Health Reporting Architecture

Progress : What’s been completed

Public Health Infrastructure

Or Health

Information Exchange (HIE)

Form Manager

Form Receiver

Content Creator

Form Filler

1. Request Form

2. Provide pre-population data

3. Pre-populated Report Form

4. Populated Report Form5. Send–ReceiveCDA Report

Content Consumer

EHR VendorsCore Solutions

ConnexinAllscripts

(Test Harness)Epic 2012

(Test Harness)

Public Health Electronic

Health Record System

Provider

Information Systems:Surveillance Systems

EHDI System

Public Health Information Systems

Delaware Electronic Reporting Surveillance

System (DERSS)New Your State Universal

Public Health Node (UPHN)

San Diego County(Atlas Public Health)Oregon EHDI System

(Filemaker)North Dakota EHDI System

(OZ Systems)

CDA-based Case Reports:Tuberculossis

PertussisNewborn Hearing

Screening Outcome Report

Continuity of Care Document (CCD)

(pre-population data)

Public Health Infrastructure

(Orion Rhapsody)

HIE(OZ Systems)

Form Manager

Form Receiver

Content Creator

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Communicable Disease Reporting – CDA/SDC Pilot in NYC and WI

1. Parse2. Retrieve Form3. Pre-populate web

form

4. Send URL with pre-populated web form

Electronic Medical Record (EMR)

Vendor Test Environ-

ment

(i.e., EPIC)

Reporting Module/Form

Manager

Continuity of Care Document (CCD)

NYC and WI Public Health

Infrastructure

Electronic Disease Surveillance

System

Current Progress (as December 2, 2013) – Finalize Testing in Vendor Environment

5. Physician/ICP submits addition information directly to system

Next Steps – Identify, Recruit, and Implement in Hospital using EPIC EMR System

State/Local Surveillance

System

Key Outcomes•Shift in tradition al public health case report (PHCR) use case

• Leverage existing standard (i.e., CCD -> cCDA)

•Light-weight service for EMR vendors to connect to various jurisdiction reporting end-points

• Minimize development in EMR System

•Extensibility/ portability to other EMR vendors•State and LHD can configure forms based on reporting and business needs specific to jurisdiction

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Structured Data Capture - Tiger Team and Selected Pilots

• Public Health Tiger Team – Community based effort to identify, develop, and

implement SDC Public Health Pilots

• Public Health Pilots– EHDI– Cancer Reporting– Case Reporting

http://wiki.siframework.org/Public+Health+Tiger+Team+Meeting+Archives

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Health eDecisions - Use Cases

• Use Case 1: standard format for sharing CDS knowledge artifacts

– Rules, order sets and documentation templates

– Goal: CDS knowledge authored in standard format can be imported and used in any EHR system

• Use Case 2: standard interface for accessing CDS Web services

– Goal: CDS capability encapsulated using standard interface can be integrated with any EHR system

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Use Case 1 Focuses on three artifact types:1. Event Condition Action Rules2. Order Sets3. Documentation Templates

Health eDecisions – Use Case 1 (CDS Artifact Sharing)

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Health eDecision - Use Case 1: Pilot Partnerships

1919RCKMS: Reportable Condition Knowledge Management System

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Public Health State, Local, Territorial Agencies

RCKMS Long term ScopeReportable Condition

Knowledge Management System (RCKMS)

Authoring Framework

Subscription Management

Including Notifications

DatabaseWho, What, When,

Where, How

Structured Output

Generator

PH Reports

Query/View

HeD Compliant format

- Triggering Criteria- Reporting Actions- Links

DSS Web Service

Other Web Services

HeD

(1) Health eDecision (Hed)

(2) Open CDS

PH Reporters (Clinicians)

Web Service

(3) Open CDS

Local

Output file Options1)HeD file download2)OpenCDS in Cloud3)OpenCDS Locally Deployed

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S&I Data Access Framework Use Cases

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Data Access Framework - examples

DRAFTImproving population and public health: Stage 3 Priorities

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• Efficient and timely completion of case reports

• Efficient and timely means of defining and reporting on patient populations to drive clinical care and identify areas for improvement

• Shared information with public health agencies or specialty societies

• Bidirectional public health data exchange

Target Outcome GoalsMU Outcome Goals

• Providers know the health status of their patient population

• Public health officials know the health status of their jurisdiction

• Providers and specialty societies can track and manage domain specific events related to practice and devices

• Providers and public health officials share information to improve individual and population health

• Patient lists• Sharing immunization

data• Cancer and specialty

registry• Electronic lab reporting• Submission of electronic

syndromic surveillance data

Stage 3 Functionality Goals MU Outcome GoalsStage 1 + 2 Functional Objectives

DRAFTImproving population and public health: Case Reports

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Functionality Needed to Achieve Goals

• CEHRT uses external data to prompt the end-user when criteria are met for case reporting. The date and time of prompt is available for audit. Standardized (e.g., consolidated CDA) case reports are submitted to the state/local jurisdiction and the data/time of submission is available for audit.

• Recommended as certification criteria only

Stage 3 Functionality Goals

DRAFTImproving population and public health: Registries

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• EPs/EHs use CEHRT to electronically submit standardized (i.e., data elements, structure and transport mechanisms), commonly formatted reports to two registries (e.g., local/state health departments, professional or other aggregating resources)

• EP/EH Registries examples: cancer, children with special needs, and/or early hearing detection and intervention or external entities that maintain the registry (e.g., hypertension, diabetes, body mass index, devices, and/or other diagnoses/conditions) that could include accountable care organization, public health agency, professional society, or specialty community. EHs Only: health-care associated infections


DRAFTImproving population and public health: Immunization history

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• Eligible Professionals, Hospitals, and CAHs receive a patient’s immunization history supplied by an immunization registry or immunization information system, allowing healthcare professionals to use structured historical immunization information in the clinical workflow

• Recommended CEHRT Functionality

– Ability to receive and present a standard set of structured, externally-generated immunization history and capture the act and date of review within the EP/EH practice






DRAFTImproving population and public health: Electronic lab reporting

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No Change from Stage 2

EH Objective: Capability to submit electronic reportable laboratory results to public health agencies, except where prohibited, and in accordance with applicable law and practiceMeasure: Successful ongoing submission of electronic reportable laboratory results from Certified EHR Technology to public health agencies for the entire EHR reporting period.


DRAFTImproving population and public health: Syndromic Surveillance

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No Change from Stage 2EP MENU Objective: Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice

EH Objective: Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice

EP/EH Measure: Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period


DRAFTFormer Objective Details Proposed Merged Registry Objective(404, 405, 407 - EH objective)

EH Objective: Capability to electronically submit standardized (i.e., data elements, structure and transportmechanisms), commonly formatted reports to two registries (e.g., local/state health departments,professional or other aggregating resources) from the Certified EHR Technology, except where prohibited,and in accordance with applicable law and practice. This objective is in addition to and does not replaceprior requirements for submission to an immunization registry. Measure: Documentation (or registry acknowledgement) of ongoing successful electronic transmission ofstandardized reports from the CEHRT to two registries (either mandated or voluntary)). Attestation ofsubmission for at least 10% of all patients who meet registry inclusion criteria during the entire EHRreporting period as authorized, and in accordance with applicable State law and practice.

Registries include: cancer, health-care associated infections, children with special needs, and/or earlyhearing detection and intervention or external entities that maintain the registry (e.g., hypertension,diabetes, body mass index, devices, and/or other diagnoses/conditions) that could includeaccountable care organization, public health agency, professional society, or specialty community)should maintain the registry

Certification criteria: EHR is able to build and then send a standardized report (e.g., standard messageformat) to an external mandated or voluntary registry, maintain an audit of those reports, and track totalnumber of reports sent.

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DRAFTFormer Objective Details Case reports – 402B

Stage 3 Proposed for Future StageCertification criteria: The EHR uses external data to prompt the end-user when criteria are met for case reporting. The date and time of prompt is available for audit. Standardized (e.g., consolidated CDA) case reports are submitted to the state/local jurisdiction and the data/time of submission is available for audit.

EP Objective: Capability to use externally accessed or received knowledge (e.g. reporting criteria) to determine when a case report should be reported and then submit the initial report to a public health agency, except where prohibited, and in accordance with applicable law and practice.

Measure: Attestation of submission of standardized initial case reports to public health agencies on 10% of all reportable disease or conditions during the entire EHR reporting period as authorized, and in accordance with applicable state/local law and practice.

Certification ONLY

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Documents

1 Review of Population and Public Health Objectives Stage 3 MU Arthur Davidson, MD, MSPH Meaningful Use Workgroup December 20, 2013