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A Briefing for the A Briefing for the American Health Information American Health Information Community Community on Biosurveillance on Biosurveillance Bringing public health surveillance, monitoring, and Bringing public health surveillance, monitoring, and response into the electronic age response into the electronic age Materials Developed in Consultation With: Thomas R. Frieden, M.D., M.P.H., & Farzad Mostashari, M.D., M.S.P.H., New York City Department of Health and Mental Hygiene John Loonsk, M.D., Office of the National Coordinator for Health Information Technology, HHS Leah Devlin, D.D.S., M.P.H., & Steve Cline, D.D.S., North Carolina Department of Health Edward Sondik, Ph.D., National Center for Health Statistics, HHS George Hardy, M.D., M.P.H. & Mary Shaffran, M.P.A., Association of State and Territorial Health Officials Laura Conn, M.PH., Centers for Disease Control and Prevention, HHS This briefing has been developed under the auspices of Health Systems Research, Inc. under a contract with the Office of the National Coordinator, HHS November 29, 2005

A Briefing for the American Health Information Community on Biosurveillance A Briefing for the American Health Information Community on Biosurveillance

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Page 1: A Briefing for the American Health Information Community on Biosurveillance A Briefing for the American Health Information Community on Biosurveillance

A Briefing for theA Briefing for theAmerican Health Information American Health Information CommunityCommunityon Biosurveillanceon Biosurveillance

A Briefing for theA Briefing for theAmerican Health Information American Health Information CommunityCommunityon Biosurveillanceon BiosurveillanceBringing public health surveillance, monitoring, and Bringing public health surveillance, monitoring, and response into the electronic ageresponse into the electronic age

Materials Developed in Consultation With:

Thomas R. Frieden, M.D., M.P.H., & Farzad Mostashari, M.D., M.S.P.H., New York City Department of Health and Mental Hygiene

John Loonsk, M.D., Office of the National Coordinator for Health Information Technology, HHS

Leah Devlin, D.D.S., M.P.H., & Steve Cline, D.D.S., North Carolina Department of Health

Edward Sondik, Ph.D., National Center for Health Statistics, HHSGeorge Hardy, M.D., M.P.H. & Mary Shaffran, M.P.A., Association of State and

Territorial Health OfficialsLaura Conn, M.PH., Centers for Disease Control and Prevention, HHS

This briefing has been developed under the auspices of Health Systems Research, Inc. under a contract with the Office of the National Coordinator, HHS

November 29, 2005

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Scope and Boundaries of Scope and Boundaries of the Issue the Issue Scope and Boundaries of Scope and Boundaries of the Issue the Issue

Transformative potential of health IT Transformative potential of health IT for Public Healthfor Public Health• Prevention-focused personal health Prevention-focused personal health

recordsrecords• Prevention-focused clinical decision Prevention-focused clinical decision

support toolssupport tools• Population-wide chronic disease Population-wide chronic disease

managementmanagement• Population-level quality monitoringPopulation-level quality monitoring• Public health surveillancePublic health surveillance

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Possible BreakthroughsPossible BreakthroughsPossible BreakthroughsPossible Breakthroughs

Potential IT breakthroughs for Public Health:Potential IT breakthroughs for Public Health:

Strengthen existing public health IT systemsStrengthen existing public health IT systems Promote the delivery of standardized health Promote the delivery of standardized health

care data to public health for biosurveillance care data to public health for biosurveillance purposespurposes

Build a nation-wide system that collects Build a nation-wide system that collects information from different jurisdictions and/or information from different jurisdictions and/or clinical facilities and enables both local and clinical facilities and enables both local and central analysis, alerts, and actionscentral analysis, alerts, and actions

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Specific Biosurveillance Use-Specific Biosurveillance Use-CaseCaseSpecific Biosurveillance Use-Specific Biosurveillance Use-CaseCase

Transmit essential ambulatory care and emergency department visit,

utilization, and lab result data from electronically enabled health care

delivery and public health systems in standardized and anonymized format to authorized Public Health Agencies

with less than one day lag time

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Harmonized Use-CaseHarmonized Use-CaseHarmonized Use-CaseHarmonized Use-Case

January 18, 2006 January 18, 2006

NHIN Contractors submit use-casesNHIN Contractors submit use-cases March 19, 2006March 19, 2006

AHIC releases harmonized use-caseAHIC releases harmonized use-case June 29, 2006June 29, 2006

HITSP releases draft standards for use-caseHITSP releases draft standards for use-case Oct 31, 2006Oct 31, 2006

Data Sub Group releases minimum data setData Sub Group releases minimum data set

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AHIC Priority Issues AHIC Priority Issues (10/31/06)(10/31/06)AHIC Priority Issues AHIC Priority Issues (10/31/06)(10/31/06)

Lack of central dissemination process for public health HIT standards

Privacy/ Security Concerns Storage, retrieval, and management concerns

of large amounts of data Lack of EHR case reporting, adverse events,

and electronic lab reporting (ELR) integration Lack of interoperable bi-directional

communication Lack of EHR decision support to prompt

• Immunization reminder• Prevention guidelines

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ScopeScopeScopeScope

““actions that are required to identify specific clinical care information used in the context of care and share these data with public health organizations to support Biosurveillance needs including initial event detection, situational awareness, outbreak management and response support”

Does not include how data are used by PH agencies (including alerts back to providers)

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Scenario FlowScenario FlowScenario FlowScenario Flow

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Ambulatory EHRsAmbulatory EHRsAmbulatory EHRsAmbulatory EHRs NAMCS 2005 Survey:NAMCS 2005 Survey: 24% physicians reported using EHRs24% physicians reported using EHRs

• Uncertainty in definition, includes full or partialUncertainty in definition, includes full or partial• 3% annual increase3% annual increase• Higher rates with larger practices, HMOsHigher rates with larger practices, HMOs• Lower rates in NortheastLower rates in Northeast

Features:Features:• Demographics reporting- 21%Demographics reporting- 21%• Physician notes- 18%Physician notes- 18%• Lab results- 17%Lab results- 17%• Public health reporting- 5%Public health reporting- 5%

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PHDSC Use-CasePHDSC Use-CasePHDSC Use-CasePHDSC Use-Case

Focus on Ambulatory EHR- PH linkageFocus on Ambulatory EHR- PH linkage Includes public health investigation and responseIncludes public health investigation and response Requirements Analysis MethodologyRequirements Analysis Methodology

• Generated by end-users, used by information system Generated by end-users, used by information system developersdevelopers

• GoalsGoals• ActorsActors• Benefits to stakeholdersBenefits to stakeholders• Use-case description (scenario)Use-case description (scenario)• FunctionsFunctions• Data SourcesData Sources• Description of data flow and workflowDescription of data flow and workflow• List of data elementsList of data elements• Standards neededStandards needed• Process Issues encounteredProcess Issues encountered

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