Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Public Health and Meaningful Use

Public Health Informatics and Technology Program Office

Office of Surveillance, Epidemiology, and Laboratory Services

Public Health and Meaningful Use of Health IT

Nikolay Lipskiy, MD, DrPH, MBA

Standards and Interoperability Lead,CDC, Public health Informatics and Technology Program Office (PHITPO)

November 3, 2010



Purpose

Describe participation of the CDC in development of public health IT meaningful solutions, meaningful use (MU) strategies and objectives in areas of standardization and interoperability



Background• For decades, CDC has engaged in the development of expertise, information, and tools that

help people and communities protect their health.

• CDC has a strong commitment to support the development and deployment of standard-based public health information systems and for fostering the use and exchange of consistent information among public health partners.

• MU activities became a critical CDC component in further consolidation and improvement of state and national public health systems

• CDC actively participate in development of MU objectives and setting up priorities for population health



Background (cont.)CDC has established the MU Advisory Group and Sub-Groups for specific topics.

The most important objectives of this Group are: 1. Develop CDC strategies:

•Addressing CDC Director’s priorities, particularly:• Excellence in surveillance, epidemiology, and laboratory

services• Strengthen support for state, tribal, local and territorial

public health• Better prevention of illness, injuries, disease, and death.• Supporting the use of health information technology to

improve the quality of health care, reducing health disparities and improving public health. Increase coordination with community resources.

• Coordinating state and community resources to support national and state bi-directional information exchange

2. Serve as the CDC Point of Contact for Meaningful Use3. Guide communication and coordination across the agency



Background (cont.)

CDC MU Advisory Group/ Sub-Groups:

The Standards, Interoperability and Certification Sub-group (SIC SG) is charged with implementing of the Advisory Group vision on: a) Assessment and harmonization of Public Health IT standard solutions for meaningful exchange of informationb) Development and implementation of strategies and solutions for testing and certification of electronic public health records



Meaningful Use: Public Health Opportunities and Potential

ThreatsOpportunities:

1. High visibility and additional attention to informatics

2. Additional resources3. Improvement of care coordination

and additional attention to prevention

4. Improvement of electronic data exchange

5. Potential improvement of interoperability of clinical and population electronic care data exchange

Potential Threats:

1. High interest to included in MU objectives may reduce interest to other important PH priorities

2. Funding challenges for programs that were not included in a scope of MU

3. High interest to MU certification that may reduce interest to PH certification and interoperability

4. Additional challenges in rapid implementation of standards that were not included in MU legislation



MU Stage 1 Public Health Objectives and Development of the “One Stop

Shop” for PH Vocabularies and Messaging Guides

Electronic Laboratory Reporting

Immunization Reporting

Syndromic Surveillance

Reporting

The PHIN VADS Vocabulary Team has started CDC-wide collaborative efforts on assessment of vocabulary-related PH capacities for addressing needs of the meaningful use objectives and maintenance and distribution of respective groups of value sets. This task includes but not limited to a gathering of business requirements from CDC programs and our partners, filling out gaps in standard code systems, binding them into structures of HL7 messages etc.



Syndromic Surveillance Reporting

1. Facility Identifier2. Facility Name3. Facility Location4. Unique Visiting ID5. Visit Date/Time6. Unique Patient Identifier7. Medical Record #8. Age9. Age Units10. Gender11. Zip Code12. State13. County14. Race

15. Ethnicity16. Diagnosis/Injury Code17. Diagnosis Type18. Discharge Disposition19. Disposition Date/Time20. Patient Class21. Chief Complaint/Reason

for Visit22. Temperature23. Pulse Oximetry24. Date of Onset25. Report Date/Time



Syndromic Surveillance Reporting (cont.)

The Public Health Information Network (PHIN) is in a process of development of the Syndromic Surveillance Reporting Messaging Guide

Sets of Value Sets, VADS Views, will be maintained through the PHIN VADS



Health IT Standards and Interoperability: Potential Focus

Areas for MU Stages 2-3Data elements

EHR Data Elements/Conte

nt Standards

Public Health Reporting Measures

Quality Measures

Governance of the National

Data Exchange & Data

Exchange Standards

HIT Certification/ PH

Certification

Standards and Interoperability

Framework



Capturing Additional Data Elements and Adding Content Standards for Public Health

ProgramsCapturing additional behavior risk factors:• drug abuse for patients 13 years old or older • alcohol use for patients 13 years old or older

Reporting laboratory results:Using LOINC codes for reporting tests and SNOMED codes for test results

Reporting family history of diseases (i.e., cancer, diabetes, hypertension, genetic disorders etc.)

Adding to reportable through EHR vital signs:• body temperature

Reporting pregnancy status

Reporting additional demographics:insurance status, current patient residence, patient address history (for 5 past years), country of birth, usual and current occupation, date of death



Quality Measures: Working on PH MU Objectives for Stages 2-3

* People with CVD, taking Aspirin; Adequate BP control for people with hypertension; Controlling hyperlipidemia among people with high Cholesterol; Smoking cessation



Analysis of MU Stage 1 Quality Measures

Several critical national public health priorities were not included in Stage 1. For example:

• Prevention of lower respiratory diseases

• Accidents (unintentional injuries)• Teen pregnancy prevention• Smoking cessation



Quality Measures Workgroup Tiger Teams

•Care Coordination•Efficiency Including Underuse and Overuse•Patient Safety•Patient and Family Engagement•Methodological Issues•Population and Public Health



Care Coordination Tiger Team’s Tasks and PH Priorities (Example)

Source : David Lansky, Co-Chair QM WG / HIT Policy Committee Presentation October 20, 2010

Incorporate

preventive care

tasks that are

related to PH

objectives



Tiger Teams’ Population & Public Health Sub-Domains*

Healthy Lifestyle Behaviors—Longitudinal outcome measures of improvement (or lack of improvement) resulting from patient health-related behaviors.

Effective Preventive Services—Longitudinal outcome measures of improvement (or lack of improvement) resulting from the use of preventive health care.

Health Equity—Longitudinal outcome measures that evaluate the quality of health care across priority populations to track and prevent inequities and health care disparities.

* Source : David Lansky, Co-Chair QM WG / HIT Policy Committee Presentation October 20, 2010



HITPC Population and PH Tiger Team: Potential Stages 2-3 Candidates for

PH-related Quality Measures

Source : David Lansky, Co-Chair QM WG / HIT Policy Committee Presentation October 20, 2010



Public Health and Meaningful Use of Health IT



The National Standards and Interoperability (S&I) Framework

* Documents of the FACA HIT Standards Committee meeting on 09/21/2010

S&I Mission: *

• Promote a sustainable ecosystem that drives increasing interoperability and standards adoption• Create a collaborative, coordinated, incremental standards process that is led by the industry in solving real

world problems• Leverage “government as a platform” –provide tools, coordination, and harmonization that will support

interested parties as they develop solutions to interoperability and standards adoption.

The ONC S&I Process

Public Health will work on integration of the PH domain into the national S&I Framework :• development of PH use cases• assisting ONC in a harmonization

of PH concepts• Development of implementation

specifications etc.



The NIEM Model and PH Infrastructure

Base S&I Framework modeling on the 3 OMG/MDA model abstractions. •Computational Independent Model (CIM)•Platform Independent Model (PIM)•Platform Specific Model (PSM)

* Source: Documents of the FACA HIT Standards Committee meeting on 09/21/2010



Questions?