Public Health Reporting Initiative

Stage 3 Sprint: Implementation Guide Development

Phone: 800-857-9362 x93830

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Agenda

• New Member Introductions• Begin review of sections of Implementation Guide

– This week will focus on CDA• Next Steps • Additional Questions?

Suggested Ground Rules

• Everyone may speak• ID your name & user story (report type)• Listen carefully• Read assigned work and minutes before each meeting• Limit “back-pedalling” to critical issues• Yield when it is “good enough”- do not let perfection threaten

good• Seek consensus quickly; let moderator test consensus• If consensus fails, Tier 2 steps back to see if consensus can

procede for this first version of the specification• Concerns about process? Immediately bring to Foldy’s attention

– 678-733-4289– skf6@cdc.gov

Implementation Guide ScheduleTask Elements finalized by Data

Mapping Group (12 PM ET)Implementation Guidance reviewed by Stage 3 Sprint Group (2 PM ET)

Develop preliminary ToC(s) N/A 8/30/12“Week 1” Data Elements 8/30/12 9/6/12

Patient InformationPatient Contact InformationPayer InformationProvider InformationSocial HistoryFamily HistoryProcedure

“Week 2” Data Elements 9/6/12 9/13/12EncounterOrder / Diagnostic TestFacilityResultSpecimen

“Week 3” Data Elements 9/13/12 9/20/12Vital Sign IndicatorsAdverse EventDiagnosisHealth Concern/ProblemExposureMedicationEmployment InformationImmunization

Outstanding Topics & Draft Review 9/20/12 9/27/12Other section review (e.g., Intro) 9/27/12Implementation Guide(s) Final Draft 10/4/12

Approach

Reference Documents

Current reference documents being utilized to develop the implementation guide include:• Implementation Guide for CDA Release 2.0 - Consolidated

CDA Templates - (US Realm)• IHE Quality, Research and Public Health (QRPH) - Technical

Framework Supplement - Maternal Child Health - Birth and Fetal Death Reporting (MCH-BFDrpt) Trial Implementation

• IHE Patient Care Coordination (PCC) - Technical Framework Supplement - Labor and Delivery Profiles - (Includes LDHP, LDS and MDS)

• IHE Patient Care Coordination (PCC) - Technical Framework Supplement - CDA Content Modules - Trial Implementation

• HOMEWORK – sprint team to provide additional references for inclusion in the implementation guide on a weekly basis

Report Document TemplatePublic Health Common Core Report Generic report type that captures all of the core

common data elementsBirth and Fetal Death (Vital Statistics) Data elements considered for inclusion in other reports; full

report considered for future developmentMaternal Health Encounter

Adverse Event Report **Occupational Health Report Data elements considered for inclusion in other reports; full

report considered for future developmentNewborn Hearing Screening

Syndromic Surveillance Move to 2.x listCommunicable Disease **ImmunizationCancer Reporting Uses 2.x messages for pathology/lab reporting.HAI?Birth Defect?

Homework – list out types of public health reports to think about as we craft the guidance

Patient Information – Data Elements Data Element Name Description Format Vocab / Value Set Links (PHIN VADS) Guidelines

Medical Record Number

Patient medical record number Integer

Language Subject’s primary or spoken language. Coded Value ISO 639-2 ISO

Marital Status Status of marriage Coded Value HL7 Marital Status HL7 2.x marital status

Patient Address Address of the subject of the report, including Address Type

Address

Patient Age Age of the subject of the report at the time of diagnosis

Quantity Can be calculated value - Note for children under 2 years of age, can include months.

Patient Date of Birth Date of birth (DOB) of the subject of the report Date/Time

Patient Email Email address of the subject of the report Network/Email address

Patient Ethnicity Detailed ethnicity of the subject of the report. Coded Value CDC Race and Ethnicity CDC Ethnicity Can be rolled up into ethnicity group.Patient Ethnicity GroupEthnicity group of the subject of the report Coded Value CDC Race and Ethnicity CDC Ethnicity Can be created by rolling up detailed ethnicity

into ethnicity group.

Patient Sex Current sex of the subject of the report Coded Value HL7 Administrative GenderHL7 2.x table 001

HL7 v3 Administrative Gender

Patient ID Identifier for the subject of the report (i.e., Patient ID)

Composite ID

Patient Name Name of the subject of the report Person Name

Patient Phone Phone number of the subject of the report Telephone Number

Patient Race Detailed race information about the subject of the report.

Coded Value CDC Race and Ethnicity (Race Categories)

CDC Race Can roll up to race category from detailed race information from CDC Race and Ethnicity Hierarchy.

Patient Race Category Race category of the subject of the report Coded Value CDC Race and Ethnicity (Race Categories)

CDC Race Can roll up to race category from detailed race information from CDC Race and Ethnicity Hierarchy.

Patient status indicator—Provider facility level

Indicates the active/inactive status of the patient at the provider site level. See MIROW “Management of Moved or Gone Elsewhere (MOGE) and Other Patient Status Designations in IIS” guidelines.

Coded Value Active,Inactive - Permanently,Inactive - MOGE,Inactive - Lost to follow up,Inactive – Unspecified,Unknown.

Patient Information – CDA

Patient information within a CDA-based public health report is represented in the CDA header through the recordTarget element. The recordTarget element identifies the patient or patients whose health history is/are described within this payload. A recordTarget is represented as a relationship between a person and an organization, where the person is in a patient role (PatientRole class). The entity playing the role is a patient (Patient class). The entity scoping the role is an organization (Organization class). A patient is uniquely identified via the PatientRole.id attributes.

Used By ContainsPublic Health Core Report Patient Information

included in the CDA HeaderAdverse Event Report Patient Information

included in the CDA Header

Patient Contact Information – Data Elements

Data Element Name Description Format Vocab / Value Set Links (PHIN

VADS) Guidelines

Contact Address

Address of the authorized contact(s) for the subject of the report

Address      

Contact Name Name of the authorized contact(s) for the subject of the report

Person Name

     

Contact Phone Phone number of the authorized contact(s) for the subject of the report

Telephone Number

     

Contact Email Email address of the authorized contact(s) for the subject of the report.

Network/Email address

     

Contact Relationship

This represents the type of support provided, such as immediate emergency contacts, next of kin, family relations, guardians, agents, et cetera (i.e., relationship of the authorized contact(s) to the subject of the report)

Coded Value

Personal Relationship (HL7)

HL7 v3 Personal Relationship Role Type

this is unique from the relationship concept in the family history object.

HL7 2.5 User Table 2

Patient Contact Information – CDA

Patient Contact Information is included within the CDA Header and can use multiple elements depending on the type of relationship being established. It is expected that for a public health report, the following general rules may apply when defining different patient contacts:

Type of Relationship (CDA Name)

General Usage Usage in Public Health Reports

Informant Used for direct relationship types

Informants can be used to define specific relationships to the patient that relate to their most immediate family – i.e. spouse For example, if a person is diagnosed as exposed to a toxic substance, immediate contact information can be provided for a spouse.

Custodian Used for indirect relationship types

Custodians would not be required at this time in public health reports. continued

Patient Contact Information – CDA

Type of Relationship (CDA Name) General Usage Usage in Public Health Reports

Informant Used for direct relationship types Informants can be used to define specific relationships to the patient that relate to their most immediate family – i.e. spouse For example, if a person is diagnosed as exposed to a toxic substance, immediate contact information can be provided for a spouse.

Custodian Used for indirect relationship types Custodians would not be required at this time in public health reports.

Participant Used for supporting relationships Support relationships can be established using the HL7 Personal Relationship Type value set, to identify the specific type of supporting relationship. For example, a public health agency may wish to contact a patient’s supporting relationship to make further inquiries about a specific diagnosis that has been found.

Guardian Used for legal relationships Guardian can be defined where the patient is a child or is incapable of specific communication. For example, during a mass casualty event, a public health report may include information about a specific child’s guardian

Patient Contact Information – CDA

continued

The following table summarizes data elements used to define a <participant> relationship. Note that optionality is not defined.

CDA Data Element Name XPATH CDA PHRI

typeCode ClinicalDocument/participant/@typeCode templateId ClinicalDocument/participant/templateId/@root classCode @classCode codeCode code/@code displayName code/@displayName codeSystem code/@codeSystem codeSystemName code/@codeSystemName Address use addr/@use Address addr Telephone use telecom/@use Telephone # telecom/@value associatedPerson associatedPerson/name

Homework

• Questions for sprint team review• What report types would use patient contact

information?• What patient contact information data elements

would be required in all report types?• Overall optionality to be proposed?

Payer Information – Data Elements

Data Element Name Description Format Vocab / Value Set Links (PHIN

VADS) Guidelines

Insurance Type Type of insurance Coded Value

Source of Payment Typology or X12 Data Element 1336 Insurance Type Code

Source of payment typology

 

Payer Information – CDA

Questions for sprint team review

• In what reports would payer information data elements (insurance type) be included?

• As of now, is anything besides insurance type needed?

Provider Information – Data Elements

Data Element Name Description Format Vocab / Value Set Links (PHIN

VADS) Guidelines

Provider Address

Address of the person who provided care for the subject of the report

Address      

Provider Email Email address of the person who provided care for the subject of the report

Network/Email address

     

Provider ID Identifier of the person who provided care for the subject of the report

Instance Identifier

National Provider Identifier (NPI)

  Can be qualified with identifier type. Able to repeat.

Provider Name Name of the person who provided care for the subject of the report

Person Name

     

Provider Organization

Organization that the provider represents

Entity Name

     

Provider Phone Phone number of the person who provided care for the subject of the report

Telephone Number

     

Provider Role Role played by the person who provided care for the subject of the report

Coded Value

NUCC Health Provider Role

HL7 Provider Role

HL7 Provider Role  

Provider Type The type of the provider - may include one type for an individual and one for an organization (e.g., Physician, Dentist, etc.)

Coded Value

NUCC Health Provider Taxonomy

  For Vital Records, must record the attendant at birth.

2 value sets - one for individual and one for organization.

Provider Information – CDA

Information for providers within the public health report is primarily reported in two ways: • Tied to the <participant> element• Tied to a specific service event

Used By ContainsPublic Health Core Report Provider information included

in both the CDA Header and for each encounter documented

Adverse Event Report Provider information included in both the CDA Header and for each encounter documented

Provider Information – CDA

Core Common CDA Data Element

Name

XPATH CDA PHRI

typeCode ClinicalDocument/participant/@typeCode R R

templateId ClinicalDocument/participant/templateId/@root R R

classCode @classCode R R codeCode code/@code R R displayName code/@displayName R R codeSystem code/@codeSystem R R codeSystemNa

me code/@codeSystemName R R

continued

Provider Information – CDA

Core Common CDA Data Element Name

XPATH CDA PHRI

Provider Address Address use addr/@use R RProvider Phone Telephone use telecom/@use R RProvider Name associatedPerson associatedPerson/

name R R

Provider Organization Provider Role Provider Type

Homework

Questions for sprint team review

• Expectation is all report types will include provider information. Any concerns?

• Implementation will focus on documenting provider information at the top level (as PCP) and also at the encounter level. Any concerns?

Social History – Data Elements Data Element Name Description Format Vocab / Value Set Links (PHIN

VADS) GuidelinesSocial History Type

Value that describes the type of social history being conveyed by the observation (smoking status, employment detail, etc…)

Coded Value HITSP C80 Social History Type

  e.g., tobacco, alcohol, drug use, sexual history

Social History Observed Value

Value describing the social history (e.g. smoking history).

Coded Value HITSP C80   Code values are same as those used in Meaningful Use Stage 1, which are the Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey Smoking Status Recodes (http://www.cdc.gov/nchs/nhis/tobacco/tobacco_recodes.htm). This value set was created because the Smoking Status Recodes have no registered OID.

Social History Free Text

Free text description of social history not associated with a coded value

String      

Social History Start Date/Time

Social History Start Date/Time Date/Time      

Social History End Date/Time

Social History End Date/Time Date/Time      

Social History Duration

Social History Duration Date/Time      

Social History Type

Value that describes the type of social history being conveyed by the observation (smoking status, employment detail, etc…)

Coded Value HITSP C80 Social History Type

  e.g., tobacco, alcohol, drug use, sexual history

Social History Observed Value

Value describing the social history (e.g. smoking history).

Coded Value HITSP C80   Code values are same as those used in Meaningful Use Stage 1, which are the Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey Smoking Status Recodes (http://www.cdc.gov/nchs/nhis/tobacco/tobacco_recodes.htm). This value set was created because the Smoking Status Recodes have no registered OID.

Social History – CDA

Social History Type Value Set

Code Name Required229819007 Tobacco use and exposure (observable

entity) R

256235009 Exercise (observable entity) R2160573003 Alcohol intake (observable entity) R2364393001 Nutritional observable (observable

entity) R2

364703007 Employment detail (observable entity) O425400000 Toxic exposure status (observable entity)

O

363908000 Details of drug misuse behavior (observable entity) R2

228272008 Health-related behavior (observable entity) R2

Social History within CDA<text>

<content ID="socialhistory-1">Recently retired as a day care worker. Immigrated

from China 30 years ago. Husband passed away in 2003. 3 supportive children. Denies

current or history of tobacoo, EtOH, illicits. Exposed to second-hand smoke by

husband.</content>

</text>

<entry typeCode="DRIV">

<observation classCode="OBS" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.1.33" />

<id root="a13c6991-5c8b-11db-b0de-0800200c9a66" />

<code code="14679004" displayName="Occupation"

codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">

<originalText>

<reference value="#socialhistory-1" />

</originalText>

</code>

<statusCode code="completed" />

<effectiveTime>

<low value="19971203" />

<high value="20001203" />

</effectiveTime>

Homework

• Questions for sprint team review

• What report types will use the social history section?• Any additional social history types to be covered in the Social

History Type value set?• Are there any concerns in using Social History to capture the

following core common objects:• Employment Information• Toxic Exposure

Family History – Data Elements

Data Element Name Description Format Vocab / Value Set Links (PHIN

VADS) Guidelines

Family Relationship Type

Value describing the type of family relationship (e.g., genetic relationship, in-law, foster child, etc.)

Coded Value

HL7 FamilyRelationshipType

   

Family Member Sex

Sex of the family member. Coded Value

HL V3 Administrative Gender

   

Family Member Ethnicity

Ethnicity of the family member Coded Value

CDC Race and Ethnicity

   

Family Member Race

Race of the family member. Coded Value

CDC Race and Ethnicity

   

Family Member Name

Name of the family member. Person Name

     

Family Member Address

Address of the family member Address      

Family Member Date of Birth

Date of birth for the family member. Date/Time      

Family Member Observation

Observation about the family member.

Coded Value

SNOMED-CT    

Family History – CDA

The Family History section contains data defining the patient’s genetic relatives in terms of possible or relevant health risk factors that have a potential impact on the patient’s healthcare risk profile. Public health reports (for example, reports on the relationship between a mother and their child) would report similar data elements for each family member, linked as a set of observations tied to the patient.

Used By ContainsPublic Health Core Report A Public Health Core Report

MAY include a Family History Section

continued

Family History – CDA

Figure 2 - Family History Conceptual Overview – CDA continued

As noted in Figure 2, the Family History section of a CDA Public Health Report is populated by creating a Family History Organizer for each family member, with observations then being associated with that Organizer.

Homework

Questions for Sprint Team Review

• What report types will use the Family History section?• Any needed extensions for Family history needed?

Procedure – Data Elements

Data Element Name Description Format Vocab / Value Set Links (PHIN

VADS) Guidelines

Procedure Code

Code expressing the procedure (note: this includes, for example, diagnostic/therapeutic/surgical interventions or procedures but not laboratory procedures)

Coded Value

Support for SNOMED-CT, CPT-4, ICD-9 (volume 3) and/or ICD-10 (PCS)

   

Procedure Date/Time

Date/time procedure was performed

Date/Time      

Procedure Reason

Reason for procedure Coded value

SNOMED-CTICD-9 (volume 1&2)ICD-10

  May link to diagnosis or problem list.

Procedure Not Performed Reason

Reason procedure was not performed

String      

Procedure – CDA

Used By Contains

CDA Element Name XPATH CDA PHRI

section OID templateId/@root O R2code code/@code R RdisplayName code/@displayName R RVocabulary OID code/@codeSystem R RcodeSystemName Code/@codeSystemName R Rtitle title R2content ID Text/content/@ID R2content text Text/content/@text R2typeCode @typeCode R RclassCode procedure/@classCode R RmoodCode procedure/@moodCode R Rid procedure/id R R

continued

Procedure – CDA

CDA Element Name XPATH CDA PHRI

statusCode procedure/statusCode R Rprocedure code procedure/code/@code R RdisplayName procedure/code/@displayName R RcodeSystem OID procedure/code/@codeSystem R RcodeSystemName procedure/code/@codeSystemName R RUnique Document Id externalDocument/id/@root RDocument code externalDocument/code/@code RDocument displayName externalDocument/code/@displayName RDocument codeSystem externalDocument/code/@codeSystem RDocument codeSystemName

externalDocument/code/@codeSystemName RDocument text externalDocument/text RPerforming Physician entry/procedure/performer/assignedEntity/assignedPerson/name R

continued

Procedure – CDA

continued

The following table contains an example of how the different parts of a procedure would be documented using CDA for a public health report:

Field Values Content Values Referencessection OID 2.16.840.1.113883.10.20.1.12 code 47519-4 Vocabulary OID 2.16.840.1.113883.6.1 HL7 v3 – codeSystemcodeSystemName LOINC code/@displayName History of Procedures title Procedures content id Proc-x content text #text ClinicalDocument/component/structuredBody/component/section/entry/typeCode Code Description HL7 v3 - ActRelationshipType

DRIV Is derived from

Procedure – CDA Field Values Content Values References

ClinicalDocument/component/structuredBody/component/section/entry/procedure/classCode PROC HL7 v3 - ActClassmoodCode Code Description HL7 v3 - moodClass

EVN EventProcedure Activity Template ID 2.16.840.1.113883.10.20.1.29

id code xxx codeSystemName 2.16.840.1.113883.6.104 displayName ICD-9 Procedures statusCode code completed effectiveTime - low YYYYMMDDHHMM effectiveTime - high YYYYMMDDHHMM

ClinicalDocument/component/structuredBody/component/section/entry/procedure/targetSiteCodecode XXXXXXX Use Procedure Value Set heredisplayName codeSystem 2.16.840.1.113883.6.96 SNOMED CTcodeSystemName SNOMED CT

ClinicalDocument/component/structuredBody/component/section/entry/procedure/code/originalText/Reference value #proc-x

Homework

Questions for sprint team review

• What report types would use procedures?• What procedure types are anticipated for public health

reports?

Final Homework for next week

• Review of reference documents• Review slides (paying attention to additional homework

items)• Review next set of core common objects to discuss CDA

and HL7 2.x implementation next week• Spreadsheet available on wiki here: http://

wiki.siframework.org/PHRI+Implementation+Guide • Review ‘week 2’ tab

Questions / Discussion?

• Wiki Page• http://wiki.siframework.org/PHRI+Implementation+Guide

• Or click “Implementation Guide” button from any PHRI wiki page

• Will post presentations, meeting minutes, “homework”, and documents for review

• Additional Questions? Contact Lindsay Brown (lrbrown@cdc.gov)

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