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Vision and Scope

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Title: Vision and Scope Author: Julie Lipstein Last modified by: A Davidson Created Date: 11/25/2013 2:48:13 PM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: Vision and Scope


1
Review of Population and Public Health Objectives
Stage 3 MU
Arthur Davidson, MD, MSPH Meaningful Use
Workgroup December 20, 2013
2
Agenda
  • 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/SI
    Framework
  • SDC
  • HeD
  • DAF
  • Progress
  • CSTE Pilots
  • RCKMS
  • Big pic diagram (Shu)

3
Hospital 1st v. 2nd v. 3rd year PH Menu Objective
Performance
Source CMS Presentation Rob Anthony, December
4, 2013
4
Update on Current Measures - Immunization,
ELR, SS
  • 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
    provider
  • Electronic Laboratory Reporting (ELR)
  • New version of IG is available to HL7 members and
    includes many improvements
  • Syndromic Surveillance (SS)
  • Successful centralized infrastructure utilizing
    BioSense
  • http//www.hl7.org/dstucomments/showdetail.cfm?dst
    uid104

5
(No Transcript)
6
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 PHs commitment to build on standards
    and processes used for other use cases,.
  • ELR Release 1 (HL7 Version 2.5.1 ORUR01)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/o
pi/infectious20disease20surveillance/v251_IG_LB_
LABRPTPH_R1_INFORM_2010FEB.ashx
7
(No Transcript)
8
Key Principle for PH Stage 3 MU
  • Adhere to Standards and Interoperability
    Framework Components Whenever Feasible

Component Purpose
Consolidated CDA Standard message format
Structured 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
9
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

10
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

11
PH c-CDA Progression
2012
2013
2014
Pertussis (NY State)
EHDI (N. Dakota)
Cancer Registry
Pertussis (San Diego)
EHDI (Oregon)
Tuberculosis (Delaware)
12
Electronic Healthcare Associated Infection (HAI)
Detection and Reporting Supporting Patient
Safety
CDC
Reporting system publishes facility-specific
HAI data
  • Specifications
  • eMeasures
  • Decision rules
  • Computer code

Healthcare
Reporting system provides protocol and algorithm

Public Health
Publicly Reported HAI data
Executable expressions of detection and case
reporting algorithms
Reporting protocol for HAI
CMS
  • CDA transmission
  • Manual upload
  • Automated send

NHSN
CDC Programs
HeD
Electronic HAI Report Clinical Document Architect
ure (CDA)
  • Electronic
  • systems
  • EHR
  • Pharmacy
  • ADT
  • Lab

Additional rules applied to populate full HAI
report
HAI detection rules applied to patient-specific
data
Healthcare Facility
13
Progress Whats been completed
CDA/SDC for Public Health Pilot Projects Public
Health Reporting Architecture

Public Health Infrastructure Or Health
Information Exchange (HIE)

CDA-based Case Reports Tuberculossis Pertussis N
ewborn Hearing Screening Outcome Report
Continuity of Care Document (CCD) (pre-population
data)
Public Health
Provider
Electronic Health Record System
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)
EHR Vendors Core Solutions Connexin Allscripts (Te
st Harness) Epic 2012 (Test Harness)
Public Health Infrastructure (Orion Rhapsody)
HIE (OZ Systems)
  • Request Form
  • 2. Provide pre-population data

Form Manager
Form Manager
Form Filler
3. Pre-populated Report Form
Form Receiver
Form Receiver
4. Populated Report Form
Content Creator
  • SendReceive
  • CDA Report

Content Consumer
Content Creator
13
Sources Communicable Disease CDA Pilot Project
Report. 2012. URL https//wiki.phdsc.org/index.ph
p/CDA EHDI CDA Pilot Project Report. 2013. URL
https//wiki.phdsc.org/index.php/EHDI-Pilot
14
Communicable Disease Reporting CDA/SDC Pilot
in NYC and WI
  • Key Outcomes
  • Shift in tradition al public health case report
    (PHCR) use case
  • Leverage existing standard (i.e., CCD -gt 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

15
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/PublicHealthTigerTe
    amMeetingArchives

15
16
(No Transcript)
17
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

17
18
Health eDecisions Use Case 1 (CDS Artifact
Sharing)
  • Use Case 1 Focuses on three artifact types
  • Event Condition Action Rules
  • Order Sets
  • Documentation Templates

18
19
Health eDecision - Use Case 1 Pilot Partnerships
EHR Pilot Content Supplier
Design Clinicals Order Set Heart Failure Zynx Health
Allscripts Rule NQF 068 (Million Hearts) newMentor
Allscripts RCKMS - San Diego Pertussis CDC/CSTE
VA Documentation Template UTI Wolters Kluwer Health
19
RCKMS Reportable Condition Knowledge Management
System
20
RCKMS Long term Scope
Reportable Condition Knowledge Management System
(RCKMS)
Public Health State, Local, Territorial Agencies
PH Reports
Authoring Framework
Query/View
Database Who, What, When, Where, How
Subscription Management Including Notifications
Other Web Services
Structured Output Generator
DSS Web Service
(2) Open CDS
HeD
HeD Compliant format - Triggering Criteria -
Reporting Actions - Links
(1) Health eDecision (Hed)
  • Output file Options
  • HeD file download
  • OpenCDS in Cloud
  • OpenCDS Locally Deployed

20
21
SI Data Access Framework Use Cases
21
22
Data Access Framework - examples
23
Improving population and public health Stage 3
Priorities
  • Stage 3 Functionality Goals
  • MU Outcome Goals
  • Stage 1 2 Functional Objectives
  • Target Outcome Goals
  • MU Outcome Goals
  • 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
  • Patient lists
  • Sharing immunization data
  • Cancer and specialty registry
  • Electronic lab reporting
  • Submission of electronic syndromic surveillance
    data
  • 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

23
24
Improving population and public health Case
Reports
  • Functionality Needed to Achieve Goals
  • Stage 3 Functionality Goals
  • 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
  • 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

24
25
Improving population and public health
Registries
  • Functionality Needed to Achieve Goals
  • Stage 3 Functionality Goals
  • 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
  • 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

25
26
Improving population and public health
Immunization history
  • Functionality Needed to Achieve Goals
  • Stage 3 Functionality Goals
  • 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
  • Eligible Professionals, Hospitals, and CAHs
    receive a patients 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

26
27
Improving population and public health
Electronic lab reporting
  • Stage 3 Functionality Goals
  • Functionality Needed to Achieve Goals
  • 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
  • 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
    practice Measure Successful ongoing submission
    of electronic reportable laboratory results from
    Certified EHR Technology to public health
    agencies for the entire EHR reporting period.

27
28
Improving population and public health
Syndromic Surveillance
  • Functionality Needed to Achieve Goals
  • Stage 3 Functionality Goals
  • 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
  • No Change from Stage 2
  • EP 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

28
29
Former Objective Details Proposed Merged
Registry Objective (404, 405, 407 - EH objective)
  • EH Objective   Capability 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) 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 replace
  • prior requirements for submission to an
    immunization registry.
  • Measure Documentation (or registry
    acknowledgement) of ongoing successful electronic
    transmission of
  • standardized reports from the CEHRT to two
    registries (either mandated or voluntary)). 
    Attestation of
  • submission for at least 10 of all patients who
    meet registry inclusion criteria during the
    entire EHR
  • reporting 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 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)
  • should maintain the registry
  • Certification criteria EHR is able to build and
    then send a standardized report (e.g., standard
    message
  • format) to an external mandated or voluntary
    registry, maintain an audit of those reports, and
    track total
  • number of reports sent.

30
Former Objective Details Case reports 402B
Stage 3 Proposed for Future Stage
Certification 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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