LHDs and HIE Opportunities and Challenges in the New HIT Landscape - - PowerPoint PPT Presentation

LHDs and HIE

Opportunities and Challenges in the New HIT Landscape to Transform Public Health Practice and Protect and Improve the Health of the Community

Presentation to the Kansas Association of Local Health Departments June 19, 2012, Wichita Kansas Susan M. Salkowitz Salkowitz Associates, LLC salkowit@hln.com

Morning Agenda

• Virtual introduction to Kansas
• Public Health HIT/Informatics Landscape

“flyover”-

• Introduction to the Learning Health System
• Federal initiatives-ONC and its activities
• New healthcare delivery models and population

health

• Health Data Initiative
• Healthy People 2020

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Afternoon Agenda

• KHIN Presentation- Laura McCrary
• KDHE/LHD approaches to Meaningful Use, timetable

and options for reporting

• LHD Opportunities and Challenges for Participating in

the emerging HIT/HIE Environment

 Options for connectivity and exchange  Data Management- quality, appropriate use  Privacy, Security, Consent Issues  Collaboration, participation with stakeholders

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My Introduction to Kansas

• First “official” visit to KS
• Virtual view- web searches and interviews
• What I learned
• Kansas Health Rankings:
• Kansas 26th in 2011, down from 23rd in 2010

 Determinants rank: 27  Outcomes rank: 21

• Challenges:
• Low Per capita public health funding- 44th

 Limited availability of primary care physicians  High prevalence of obesity

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My Introduction to Kansas

• Kansas public health web presence

 KDHE website well developed, easy to navigate, timely information  Exploring/using new technology and Social Media  Public health informatics development

• Staff interviews & feedback, collegial,

professional, knowledgeable, helpful

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My Introduction to Kansas

• Information

 Programmatic links to LHDs, providers and community and how to connect KANHIT webpage  Explanation on status of Meaningful Use Public Health Measures, timetable and directions for attesting

• Strong evidence of collaboration and best

practice adoption

 Adaption of applications developed by other states- e.g. MO, UT, WA  Participation in Open Source Development of BioSense  Collaboration with KSU (Cancer Registry), Kansas Hospital Association (KHA) (discharges) Kansas Partnership for Improving Community Health (KanPICH) for Health Matters

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KAN-HIT website

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Public Health in the Health Information Technology Landscape

Electronic Systems Public Health Surveys and Data collection-NHANES, NIS,BRFS Vitals-Birth & Death Hospital discharge- (KHA-KPHA)

• Laboratory (ELS)
• Blood lead
• Disease Reporting-KSEDDS, Epi-Trax
• Syndromic Surveillance-BioSense
• Newborn Screening
• Early Hearing Detection
• Immunization Information Systems (IIS) -

KSWebIZ

• Disease Registries- CDEMS
• Cancer Registries
• Health Alert Network (KS-HAN)
• Emergency Response-
• Operations- (Web-EOC)
• Counter Measures-(KS-CRA)
• Volunteers (K-Serve)
• Environmental health - EPHT

Health Care Systems (EHRs/EMRs) Ambulatory-Adult, Pediatric Clinical decision support Emergency Room Hospital inpatient/outpatient Long Term Care Laboratory E-Prescribing (Erx) Imaging systems (PACS) Administrative data-eligibility/enroll Claims Data Management-Use Quality Measures/Performance Improvement Analytics-Business Intelligence Data Management Data quality- accuracy, completeness Infomediaries Federal Initiatives Office of National Coordinator (ONC) Standards & Interoperability HL7, CDA, CDR,LOINC, SnoMed, CDISC, DICOM, x.12,NUBC, NCPDP, ICD10, Privacy (HIPAA, FERPA) Security- Risk Assessment Certification - ATCBs HITECH-ARRA-EHR Adoption Regional Extension Centers (REC) CMS- Meaningful Use Payment Models- PCMH, ACO Exchange Mechanisms HIEs/HIOs DIRECT.CONNECT NHIN, NwHIN Demonstrations &Innovation Beacon Communities CMMI- CMS innovation Other HHS Healthy People 2020 Health Data Initiative Health Policy Affordable Care Act Preventive Services Fund Learning Health System Triple Aim- Bending the Cost Curve Demographics and Societal Factors Aging population Chronic conditions-health behaviors Health Disparities Digital Divide Enabling Technology

• Internet/Web
• Cloud computing
• Software as a Service (SAAS)
• Mobile Devices-Smart

Phones, iPads, tablets

• Telehealth
• Video- U-Tube
• Distance Learning
• Social Networking-
• Facebook, Twitter,
• Linked-in
• Gamification
• GPS/GIS
• Collaboration
• Open-Source
• Wikis
• Directories, EMPIs

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Public Health Information Role

• "The #1 product public health provides to customers is

information.” John Lumpkin, Former Director, Illinois Department of Public Health

• Public Health Informatics has been defined as the

systematic application of information and computer science and technology to public health practice, research, and learning (Patrick W. O’Carroll, MD, MPH)

• Public health is extremely broad and might even reflect

an interest in information technology with regard to ecology, architecture, climate, agriculture, and such.

• American Medical Informatics Association (AMIA)

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Public Health in a Learning Health System

• A number of prestigious organizations have advocated for

a transformation in health and healthcare by the next

• decade. Integral to this transformation is the

migration from the disease-based to a health-based model of care and a learning health system, in which  All persons have access to care,  The population’s health can be measured objectively, and  A digital infrastructure promotes healthy lifestyles and enables more efficient and effective care delivery.

(NCVHS Shaping a Health Statistics Vision for the 21st Century-Final Report November 2002)

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Public Health in a Learning Health System

• The health-based model/learning health system,

is important for public health because it emphasizes health promotion and disease prevention and

• It enables public health to play a greater role in

supporting the nation’s healthcare system and assuring the public’s health —the very tenets for which the sector stands

(NCVHS Shaping a Health Statistics Vision for the 21st Century-Final Report November 2002)

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Public Health in a Learning Health System

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Core public health functions require stewardship for data collection, management, analysis, and dissemination across multiple stakeholders, and extensive communication to

• fficial agencies, healthcare

providers and facilities, health plans, individuals and the public at large to document, measure, inform, educate, promote, mobilize, assure, and enforce.

12

The Learning Health System

National Committee on Vital and Health Statistics (NCVHS)- The Community as a Learning Health System-Using Local Data to Improve Local Health

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The Learning Health System

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LHDs

The Learning Health System

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LHD Opportunity

The Learning Health System

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Public Health Informatics Drivers Federal

• Federal initiatives, now deployed, funded opportunities

for public health and informatics

• HITECH ARRA (stimulus) serious funding for public

health prevention, incentives for EHR adoption health Information exchange and “meaningful use”

• Affordable Health Act (health care reform) March 2010

with many provisions for public health and preventive services, dedicated Public Health Trust Fund

• Infrastructure to promote adoption, certification,

deployment and use of HIT

• Continued development of Standards to exchange

clinical data electronically including public health

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Public Health Informatics Drivers in Federal(con’t.)

• Public health recognition in Office of National

Coordinator (ONC)

• Recognition of population health and social determinants
• f health and wellness-Revised HP2020
• The Health Data Initiative (HDI) -a public-private

collaboration that encourages innovators to utilize health data to develop applications to raise awareness of health and health system performance and spark community action to improve health. (Todd Park)

• Coordination of PH and informatics organizations

around PH Informatics-(PHII, JAPHIT, NAPHIT, PHDSC, AMIA-PHI, HIMSS)

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Public Health Informatics Federal Initiatives

• Federal HIT Infrastructure- Office of the National

Coordinator (ONC)

• Promote development of a nationwide Health IT infrastructure that allows for

electronic use and exchange of information that improves quality and reduces costs while protecting patient health information:  Improves coordination of care and information among stakeholders  Improves public health activities and facilitates early identification/rapid response to public health emergencies  Facilitates health and clinical research  Promotes early detection, prevention, and management of chronic diseases  Promotes a more effective marketplace  Improves efforts to reduce health disparities

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Public Health Informatics Federal Initiatives (con’t.)

• Federal HIT Infrastructure- Office of the National

Coordinator (ONC)

 Policy and Standards  EHR adoption- Meaningful Use  Regional Extension Centers (RECs)  Certification and testing of EHRs

• ARRA HITECH Funding streams-
• Demonstrations

 State Health Information Exchange (HIE) grants  Beacon and Sharp Grants

• CDC policy changes, grants and technical assistance
• CMS Incentives for EHR adoption- Meaningful Use,
• CMS New care delivery and payment models PCMH, ACOs
• CMMI Innovation Grants-

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ARRA, HITECH and Opportunities for Public Health

Uses of health IT have the potential to bring many benefits to public health agencies, including:

• Earlier detection of infectious disease outbreaks
• Improved tracking of chronic disease management
• Improved coordination of care across public and private

providers

• More accurate assessments of disease burden in the

community, or of the impact of community-wide prevention initiatives

• Trusted stewards of personal information

Source: The Value of Health IT in Improving Population Health and Transforming Public Health Practice-A Brief for Local and State Health Officials A joint Publication of the Public Health Informatics Institute and the InfoLinks and Connections Communities of Practice November 2009

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Public Health Informatics Drivers Centers for Medicare & Medicaid Services

• NPRM for Meaningful Use (an incentive for EHR

adoption) was published in the Federal Register for public comments

• Numerous PH organizations made MU comments in an
• rganized fashion: NAPHIT ASTHO, NACCHO, CSTDE, APHL,

PHDSC, Public Health Informatics Institute, AIRA

• Webinars convened members, organizations and health

departments to collect and vet comments sent individually and collectively including a coordinated response by JAPHIT.

• PH reporting as menu option in Stage 1 MU.
• State-mandated lab reporting
• Reporting immunizations to state immunization system
• Syndromic surveillance
• identification of patients for outreach and disparities reduction.

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Public Health Informatics Drivers Centers for Medicare & Medicaid Services

• New care delivery and payment models
• Patient Centered Medical Home- Medicare projects
• Health home: Medicaid projects
• Health Homes for Medicaid Enrollees with Chronic

Conditions

• ACO- Accountable Care Organization
• Medical Neighborhood
• The Kansas Patient Centered Medical Home Initiative (Ks PCMHI is a

project of the Kansas Academy of Family Physicians in conjunction with the Kansas Association of Osteopathic Medicine, the Kansas Chapter of American Academy of Pediatrics, the Kansas Chapter of the American College of Physicians, and the Kansas Medical Society.

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Center for Medicare & Medicaid Innovation

CMMI- http://www.innovations.cms.gov/

• Initiatives to achieve the IHI Triple-AIM

 Improving the patient experience of care (including quality and satisfaction)  Improving the health of the populations  Reducing the per capita cost of health care

• June 12, 2012-Two awards which include KS

 Project Title: “Multi-community partnership between TransforMED, hospitals in the VHA system and a technology/data analytics company to support transformation to PCMH of practices connected with the hospitals and development of “Medical Neighborhood”  The University of North Texas Health Science Center (UNTHSC), in partnership with Brookdale Senior Living (BSL), is receiving an award to expand and test the BSL Transitions of Care Program which is based on an evidenced-based assessment tool called Interventions to Reduce Acute Care Transfers (INTERACT

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Meaningful Use (MU)

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Health Outcomes Policy Priority: Improve population and public health

Care Goal(s) Stage 1 Objectives Stage 1 Measures Eligible Providers Hospitals

Communicate with public health agencies Capability to submit electronic data to immunization registries and actual submission where required and accepted Capability to submit electronic data to immunization registries and actual submission where required and accepted Perform at least one test of certified EHR technologies capacity to submit electronic data to immunizations registries Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically) Capability to provide electronic submission of reportable lab results (as required by state or local law) to public health agencies and actual submission where it can be received Performed at least one test of the EHR system's capacity to provide electronic submission of reportable lab results to public health agencies (unless none of the public health agencies to which eligible hospital submits such information have the capacity to receive the information electronically)

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Meaningful Use and PH Informatics

• Participate in national standards organizations such as HL7, LOINC,

develop use cases, ballot standards, produce implementation guides, ONC S&I initiative

• Develop use cases for Integrated Health Enterprise (IHE),

emergency preparedness and response, immunizations, newborn screening, early hearing detection scheduled for HIMSS Connectethon 2011.

• Develop Testing criteria for public health components of meaningful

use for Certification

• Develop education and other tools for Regional Extension Centers

to advise and encourage providers to choose and implement public health meaningful use components

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Regional Extension Centers (RECs)

• RECs were created last year under the HITECH Act, part of the

ARRA Act of 2009.

 HITECH provided approximately $2 billion in new programs to provide training and technical assistance and to demonstrate the effectiveness of health information technology in supporting improvement in care.  Under the HITECH Act, $677 million is allocated for the next two years to support a nationwide system of RECs.

• KS REC- KS Foundation for Medical Care, Inc -(KFMC) is the

federally designated HITREC for the state of Kansas. http://www.kfmc.org/rec/

 Accelerate Health Information Technology (a-HIT) in Kansas!
KFMC’s services are designed to take your organization from its current state – whether you are starting with a paper-based system or just need to optimize your current EHR – to MU in order to qualify for the Medicare or Medicaid Incentives.  target their assistance to eligible primary care providers in smaller practices as well as small and rural hospitals and public health clinics.  will also serve as a resource for all providers in an area, giving assistance, as feasible, to any doctor, hospital or clinic making the request.

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Health Information Exchange (HIE)

• Health information exchange (HIE) -transmission of healthcare-

related data among facilities, health information organizations (HIO) and government agencies according to national standards.

• The State Alliance for e-Health, 2006 NGA ONC-approved models:

 Government-Led Electronic HIE: Direct government provision

• f the electronic HIE infrastructure and oversight of its use.

(ME, VT)  Public Utility with Strong Government Oversight: Public sector serves an oversight role and regulates private-sector provision of electronic HIE. (TN, UT)  Private-Sector-Led Electronic HIE with Government Collaboration: Government collaborates and advises as a stakeholder in the private-sector provision of electronic HIE. ( DE, NE)

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Office of the National Coordinator- HIE Support

• State Health Information (State HIE) Exchange

Cooperative Agreement Program.

 In total, 56 states, eligible territories, and qualified State Designated Entities (SDE) received awards.

• The Beacon Community Cooperative Agreement

Program

 provides funding to 17 selected communities throughout the United States that have already made inroads in the development of secure, private, and accurate systems of electronic health record (EHR) adoption and health information

• exchange. Many include public health.

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Role of Public Health in Health Information Exchange (HIE)

• Source of clinical and other health information on clients seen by

public health, or on specimens tested by public health.

• Source of information on emergent issues in a community that could

assist a clinician in diagnostic and treatment decisions.

• Source of population based analysis of individual disease data to

provide improved trends to providers.

• Recipient of reportable disease information.
• Recipient of biosurveillance data reporting streams
• Provider of expert knowledge in population health improvement, and

in clinical and treatment guidelines.

Source: The Value of Health IT in Improving Population Health and Transforming Public Health Practice-A Brief for Local and State Health Officials A joint Publication of the Public Health Informatics Institute and the InfoLinks and Connections Communities of Practice November 2009

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Public Health Contribution to Population Health

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Population-wide Quality Measures

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Healthcare data benefit to Public Health

DavidsonGibson MUbriefing.pdf

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LHDs in Health Data Exchange

DavidsonGibson MUbriefing.pdf

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Role of Public Health in National Quality Strategy

DavidsonGibson MUbriefing.pdf

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NACCHO LHD Operational Jurisdiction

DavidsonGibson MUbriefing.pdf

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Context of LHDs

DavidsonGibson MUbriefing.pdf

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Creation of Public Health Use Cases

DavidsonGibson MUbriefing.pdf

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Overview of KHIN

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Public Health in KHIN

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LHDs and KHIN

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Example from HITE-CT Connecticut’s HIE

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Example from HITE-CT Connecticut’s HIE

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Example from HITE-CT Connecticut’s HIE

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Example from HITE-CT Connecticut’s HIE

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Example from HITE-CT Connecticut’s HIE

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Crescent Beacon in LA

Zachery M. Ziwa, Chief Technology Officer, Louisiana Department of

Health & Hospitals

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Crescent Beacon in LA

Zachery M. Ziwa, Chief Technology Officer, Louisiana Department of

Health & Hospitals

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Crescent Beacon in LA

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Crescent Beacon in LA

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LHD Opportunity

VT Blueprint for Chronic Care

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Health IT Framework Evaluation Framework

Medical Home Hospitals Public Health Programs & Services Community Health Team Nurse Coordinator Social Workers Nutrition Specialists Community Health Workers MCAID Care Coordinators Public Health Specialist Specialty Care & Disease Management Programs

• A foundation of medical homes and

community health teams that can support coordinated care and linkages with a broad range of services

• Multi Insurer Payment Reform that

supports a foundation of medical homes and community health teams

• A health information infrastructure

that includes EMRs, hospital data sources, a health information exchange network, and a centralized registry

• An evaluation infrastructure that uses

routinely collected data to support services, guide quality improvement, and determine program impact

Mental Health & Substance Abuse Programs Medical Home Medical Home Medical Home Social, Economic, & Community Services Healthier Living Workshops 2 KALHD 6-19-12

Integration of public health from VT

Public Health in the Medical Neighborhood

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LHD Opportunity

LHD Opportunity

Role of HIE in population health

• Source of improved population health data collection
• Ability to promptly route and deliver to community

clinicians emergent information from public health

• Assist public health in cross-jurisdictional collaboration
• n data collection and sharing
• Improved continuity of care

Source: The Value of Health IT in Improving Population Health and Transforming Public Health Practice-A Brief for Local and State Health Officials A joint Publication of the Public Health Informatics Institute and the InfoLinks and Connections Communities of Practice November 2009

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Health Data Initiative

• The IOM and HHS has hosted The Health Data Initiative

Forum for 3 years, most recent 6/5-6/12

• to accelerate momentum for the public use of data and

innovation to improve health. It includes

 fast-paced demonstrations  range of tools and applications developed using health data,  discussion sessions,  data and apps exposition where participants can interact with featured innovators  Several public health departments attended and many apps have been developed for public health

• http://www.hdiforum.org/

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How the Health Data Initiative Works

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LHD Opportunity

About Healthy People HP2020

• Healthy People provides science-based, 10-year

national objectives for improving the health of all Americans.

• For 3 decades, Healthy People has established

benchmarks and monitored progress over time in order to:

 Encourage collaborations across communities and sectors.  Empower individuals toward making informed health decisions.  Measure the impact of prevention activities.

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What’s New for HP 2020?

Focus on the Determinants of Health-

• Identifying, measuring, tracking, and reducing health disparities

through a determinants of Health approach

• New Topic areas for 2020
• Adolescent Health
• Blood Disorders and Blood Safety
• Dementias, including Alzheimer’s Disease
• Early and Middle Childhood
• Genomics
• Global Health
• Healthcare Associated Infections
• Health Related Quality of Life and Well-Being
• Lesbian, Gay, Bisexual, and Transgender Health
• Older Adults
• Preparedness
• Sleep Health
• Social Determinants

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Healthy People 2020 in the Digital Age

• Stay connected with Healthy People 2020 and the Office
• f Disease Prevention and Health Promotion (ODPHP).
• Connect Online
• Subscribe to “Who’s Leading the Leading Health Indicators?”
• Join the Healthy People Consortium
• Follow us on Twitter@GoHealthyPeople on Twitter..
• Connect With Healthy People on LinkedIn
• Join the Healthy People 2020 LinkedIn group and invite your

colleagues to do the same.

• View the Latest Healthy People Videos on YouTube

Healthy People 2020 Announces the Leading Health Indicators App Challenge

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Accountable Care Act : Changes in Relationship between PH and HC

• Health Information Technology
• Opportunity to rethink how surveillance is done
• Opportunity to expedite analysis of large sets of
• utcome data
• Opportunity for public health to use its surveillance and

epidemiology

• expertise to hold the reformed system accountable
• What does surveillance mean in an era where policy

and community prevention are central?

Source: Trust for America’s Health, Richard Hamburg www.healthyamericans.org/health-reform

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Accountable Care Act : Changes in Relationship between PH and HC

(continued)

• Coverage of key preventive services

 Mandated coverage of all USPSTF A and B recommendations  Mandated coverage of all ACIP immunizations

• What does this mean for direct delivery of care by public

health agencies?

• Where is the best place to deliver this care?
• Role of health departments in holding the health care

system accountable

Source: Trust for America’s Health, Richard Hamburg www.healthyamericans.org/health-reform

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Re-organizing Public Health and its Business

National, state and local HIT initiatives and new CDC direction provide an opportunity for Public Health to…..

• Engage directly in health reform and HIT efforts
• Use new tools for collaboration and outreach
• Collect and exchange data
• Share its expertise in convening community

stakeholders

• Protect confidentiality
• Analyze and disseminate information for health

professionals and the public.

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Kansas Health Matters website

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Re-organizing Public Health and its Business

Re-align and reorganize Public Health business processes

• Technological advancements are changing the way public health

must “do business”  Change operational model from “information consumer” to “information broker”  Make organizational changes to meet the needs of community partners  Meet the growing demands to electronically exchange information with physicians, hospitals and other public health agencies  Ensure that they are maximizing the collection and use of data to provide the best community service

(Reference: Informatics on the Organization Chart, Public Health Informatics Institute, Connections 2007 Newsletter)

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Role of Public Health Critical Success Factors

Public Health Imperatives to get into and stay in the HIE game

• Establish a high level informatics position/function in the health

department  Disseminate an informatics strategy

• Embrace standards

 Participate as public health subject matter experts in the development and evaluation of use cases

• Collaborate with university informatics programs
• Join and participate in organizations that support public health

informatics

• Be aware of funding for informatics initiatives
• Organize to apply for grants and partner or collaborate with other

stakeholders.

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LHDs and HIE

Opportunities and Challenges in the New HIT Landscape to Transform Public Health Practice and Protect and Improve the Health of the Community

Presentation to the Kansas Association of Local Health Departments June 19, 2012, Wichita Kansas Susan M. Salkowitz Salkowitz Associates, LLC salkowit@hln.com

Afternoon Agenda

• KHIN Presentation- Laura McCrary
• KDHE/LHD approaches to Meaningful Use, timetable

and options for reporting

• LHD Opportunities and Challenges for Participating in

the emerging HIT/HIE Environment

 Options for connectivity and exchange  Data Management- quality, appropriate use  Privacy, Security, Consent Issues  Collaboration, participation with stakeholders

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Healthcare Information Technology – Convergence With PH- CDC Changes

CDC- Positioning to address health reform

• Health care system, local, state and national

 Clinical preventive services-area of largest impact  Care coordination  Case management  Workflow

• Greater coordination with ONC and Federal and state

HIE initiative (PHIN-NwHIN)

 Sponsorship of attendees and sessions at HIMSS in Atlanta, March 2010; Davies Public Health Awards  Active participation in standards and policy particularly with public health use cases  Use of social media:Twitter and Facebook collaboration and social networking

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CDC PHI Conference 8/11

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CDC & Meaningful Use- Strengthening the Link between Healthcare Providers and Public Health

Seth Foldy, MD MPH FAAFP Senior Advisor Public Health Surveillance and Informatics Program Office KALHD 6-19-12 5

CDC & Meaningful Use- Strengthening the Link between Healthcare Providers and Public Health

Seth Foldy, MD MPH FAAFP Senior Advisor Public Health Surveillance and Informatics Program Office

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CDC & Meaningful Use- Strengthening the Link between Healthcare Providers and Public Health

Seth Foldy, MD MPH FAAFP Senior Advisor Public Health Surveillance and Informatics Program Office

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Standards for Meaningful Use

Area HIT Standards Cmte recommendations Stage 1/2011 Current IFR Stage 2/2013 Content Exchange or Package

Patient summary data package CCD, CDA template, or HL7 2.5.1 CCD or CCR Alternatives expected to be narrowed based on HIT Stds Committee recommendations E-prescribing data package NCPDP SCRIPT 8.1/10.6 NCPDP SCRIPT 8.1/10.6 NCPDP SCRIPT 10.6 Lab data reporting to public health agencies package HL7 2.5.1 HL7 2.5.1 Potentially newer versions, based on HIT Stds Cmte Recommendations Administrative data package X12 4010A1 and NCPDP 5.1 and CAQH CORE X12 4010A1 and NCPDP 5.1 and CAQH CORE X12 5010 and NCPDP D.0 and CAQH CORE Public Health Surveillance and Reporting HL7 2.3.1., HL7 2.5.1 HL7 2.3.1., HL7 2.5.1 Potentially newer versions, based on HIT Stds Cmte recommendations Immunization Reporting to registries HL7 2.3.1, HL7 2.5.1 HL7 2.3.1, HL7 2.5.1 Potentially newer versions, based on HIT Stds Cmte recommendations Quality Reporting CMS CDA and respective template lib. specifications CMS PQRI CMS CDA and respective template library specifications

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Standards for Meaningful Use

Area HIT Standards Cmte recommendations Stage 1/2011 Current IFR Stage 2/2013 Vocabulary – 2 (codify content)

Lab Orders and Results Local or proprietary codes or candidate Stage 2 standard Ability to accept LOINC codes LOINC Electronic Prescribing Local or proprietary codes or candidate Stage 2 standard Any code set by an RxNorm drug data source provider that is identified by NLM as being a complete data set integrated within RxNorm RxNorm Public Health Surveillance or Reporting According to applicable public health agency requirements According to applicable public health agency requirements GISPE or according to applicable public health agency requirements Immunizations CVX CVX CVX

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CDC & Meaningful Use- Strengthening the Link between Healthcare Providers and Public Health

Seth Foldy, MD MPH FAAFP Senior Advisor Public Health Surveillance and Informatics Program Office

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CDC & Meaningful Use-

Strengthening the Link between Healthcare Providers and Public Health

Seth Foldy, MD MPH FAAFP Senior Advisor Public Health Surveillance and Informatics Program Office

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Standards & Interoperability Framework for PH Reporting

Seth Foldy, MD MPH FAAFP Senior Advisor Public Health Surveillance and Informatics Program Office

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Public Health Needs HIEs

Seth Foldy, MD MPH FAAFP Senior Advisor Public Health Surveillance and Informatics Program Office

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KDHE Support of Meaningful Use

• Website information for
• Disease reporting for Health Professionals
• Laboratory reporting requirements

 http://www.kdheks.gov/epi/disease_reporting.html

• Reporting to KS Web-IZ-

 http://www.kdheks.gov/immunize/webiz.html

• Meaningful Use information for eligible providers

 http://www.kdheks.gov/epi/meaningful_use.htm

• State IT infrastructure for electronic systems for reporting
• f MU measures

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KS Meaningful Use Information

• n KDHE website

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KDHE Support of Meaningful Use

• Development, support and operation of applicable

systems:

 KSWebIZ- Immunization Information System (Registry)  Epi-Trax for notifiable disease reporting  BioSense for Syndromic Surveillance  Vital Records for demographic information  Proposed Medicaid eligibility and enrollment system

• Development of electronic interfaces for uni and bi-

directional reporting from LHD electronic records and EHRs

KALHD 6-19-12 16

KDHE Support of Population Health

• Public Health Informatics Office
• Vital Statistics data analysis
• Kansas Information for Communities (KIC)
• Healthcare Associated Infections
• Kansas Health Matters

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IIS, Interoperability and Meaningful Use

CDC releases (ARRA) Funding Enhancing the Interoperability of Electronic Health Records (EHR) and Immunization Information Systems (IIS) 35 Grantees receive funding to develop interfaces between their IIS and provider EHR systems.

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KS WebIz Immunization Information System-IIS

• KSWebIZ-the statewide immunization registry, is a web-based

centralized birth to death database that maintains complete, accurate, and secure immunization records for all Kansas residents.

• Various methods of connection are enabled:

 Data entry via web interface into native application-ability to access all functionality on a record by record basis  Bi-directional access via KIPHS, Insight for LHDs  Uni-directional or bi-directional interface to selected provider EHRs- Office Practicum, for example.  Bi-directional interface to 14 FQHCs through KHIN (enabled by grant)  Developing one-off interfaces is time consuming, expensive  Providers now being encouraged to report via HIE- moratorium on further individual interface development

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KS WebIz

Immunization Information System-IIS

• Meaningful Use-Stage 1
• Some already connected providers have attested
• Exclusion letter to postpone attestation without penalty is posted for

use by all providers

• Providers will benefit by reporting MU via HIE as standardized

formats and use of appropriate standards will be supported

• Reporting by MU eligible providers will be helpful but not sufficient

by itself to greatly increase number of immunization records in KSWebIZ

• Use of DIRECT not recommended for reporting to KSWebIZ

 Not bidirectional  Will not support other KSWebIZ functions

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KS WebIz

Immunization Information System-IIS

• Provider Participation in KSWebIZ

 No legislative requirement for providers to report  Provider participation is voluntary  Participation of an individual may be opted out even if provider is reporting

• Potential impact of reporting via HIE

 Reduce need for individual interfaces- HIE will parse and translate messages to send to KSWebIZ  Will support provider Meaningful Use reporting (if applicable)  Will increase the volume and accuracy of the immunization information  Will populate reports by county and zip code level for greater local immunization program support and community assessment

• Future Issues

 HIE is opt in or opt out- not selective opt out. May reduce IZ records which the patient does not otherwise object to  HIE may wish to support other IIS functions such as decision support, reminder recall instead of KDHE or  Providers might decide the MU reporting is enough and not use other functions  Incremental roll out of HIE may extend period of provider non-participation

KALHD 6-19-12 21

Lab Interface Improvement

Challenge There is a lack of harmonized specifications standards and code sets to enable the exchange

• f lab results. The cost and time to initiate new electronic laboratory results interfaces

hampers broad adoption of such interfaces. The field by field details of HL7 v2 implementation guides used by clinical labs and EHRs vary, creating a need for mapping or configuration per interface, and the prevalence of core subsets of LOINC codes for common tests and analyses also varies, causing downstream issues in decision support and quality reporting. Scope Statement Limited to address this challenge for the subset of lab reporting to primary care (internal medicine, family practice, pediatrics) Target Outcomes

• Achieve cost savings of up to 90% due to lab interface development improvements by 2015
• Reduce total lab interface implementation time by up to 20% by 2013

Meaningful Use Alignment Incorporate lab results into EHR as structured data Related Use Cases/Stories

• Electronic Health Record (Laboratory

Result Reporting) (ONC/AHIC)

• EHR Lab Scenarios (ONC/AHIC)
• Laboratory sends lab results to ordering provider

(NHIN Direct)

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Surveillance at KDHE

• Moving to Epi-Trax from EDRS

 Will be able to accept laboratory reports electronically- previous system required manual data entry

• Currently testing Electronic Laboratory

Reporting (ELR)

 Exploring hospital labs, then reference labs  Providers do not perform ELR, only Hospitals

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Electronic Laboratory Records

• More problems with lab standards,

vocabulary, coding in KS and nationally

 ONC working to get ELRs on board  No incentives to exchange  Some states piloting using Surescripts  Utility of DIRECT for lab results not known- KDHE looking at other states

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Electronic Laboratory Records

• KHIN and LACIE certified to do business in KS
• Currently in 30 day patient notification for July 1

start date.

• HIEs are engaging partners themselves.
• Some labs do not have the ability to exchange
• LHDs want to get the results sooner but need to

support the state infrastructure

KALHD 6-19-12 25

Syndromic Surveillance

Challenge The overall adoption rate for syndromic surveillance is extremely low, yet meaningful use requirements demand an increased level of surveillance reporting. There is a direct need for a simplified way of reporting standardized data to appropriate public health authorities that will enable meaningful use requirements associated with surveillance to be fulfilled. It is debatable as to whether providers can meet existing and future surveillance requirements with the current implementation guidance available. Scope Statement Develop a syndromic surveillance service specification to be used by vendors to deploy a standardized syndromic surveillance service within their infrastructure NOTE: This initiative would complement the work conducted by ISDS and CDC to develop Stage 1 meaningful use recommendations for syndromic surveillance. The ISDS recommendations are available for public comment and review at : http://www.syndromic.org/uploads/files/ISDSRecommendation-PROVISIONAL_vFINAL.pdf Target Outcomes

• Increase syndromic surveillance reporting by 10% by 2013
• Increase syndromic surveillance data collection response times for at least 2 conditions by 20%

Meaningful Use Alignment Provide electronic syndromic surveillance data to public health agencies Related Use Cases/Stories

• Public Health Case Reporting (ONC/AHIC)
• Hospital or provider send chief complaint data to

public health (NHIN Direct)

• Laboratory reports test results for some

specific conditions to public health (NHIN Direct)

KALHD 6-19-12 26

Syndromic Surveillance at KDHE

• BioSense now in Open Source
• KDHE participating at CDC
• Working on decision support
• Syndromic data reporting by providers
• Information is available to LHDs, but seems to

be of low value

• Priority on Syndromic surveillance- an effect of

Bioterrorism

KALHD 6-19-12 27

Role of HIE in Surveillance/ELR

• Meaningful use reporting does not change the legal

reporting requirements of notifiable diseases/events, etc.

• KDHE will provide the infrastructure for MU reporting

whether directly from LHDs, providers and hospitals or via the HIE.

• KDHE is working with KHIN to establish the portals,

security to interact with the HIE

• The HIE will act to simplify provider reporting and make it

more efficient which will increase the frequency and volume of reports and provide a more robust data base for state and local use.

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Other KDHE Data Assets

• Population Health Data

 KIC web tool based on MO system- updating to 2nd generation  KS Health Matters- vendor supported  Vital Records

• Analytical team
• PH assessment- tied to county health assessment
• Diabetes program track

 Tracks eye exams using CDEMS based in provider offices

• BRFS surveys

 Health promotion  Awareness  Prenatal

KALHD 6-19-12 29

Other KDHE Data Assets

• Medicaid now located in KDHE
• Managed care being updated
• KEES- New eligibility and enforcement system

 Will provide EMPI capability

• Challenges:

 Managing core system roll out, testing and implementation  Working with timetable of KHIN deployment  Staff and budgetary issues  Competing priorities

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Public Health Role in HIE

• KHIN- extensive information on website
• KDHE Public Health Role in HIE

 KDHE = public health infrastructure of HIE  Portals for bi-directional reporting for surveillance, immunizations  Support for meaningful use public health measures

• LHD options for connecting

 Point to point bidirectional to KDHE Portal(s)  Via interface to LHD system-KIPHS or Insight (FQHCs via interface with Success EDS)  Via Emdeon EHR Lite to HIE

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LHDs and KHIN

KALHD 6-19-12 32

LHD Challenges

• KIPHS, Insight, Emdeon- choices to make-
• Upgrade, replace, supplement
• Which applications to move and with what priority
• Resource constraints
• Budgetary
• Staff- skills, training, capacity
• Leadership- commitment
• Community partners
• Priorities/ Strategic planning

KALHD 6-19-12 33

LHD Challenges

• What is value proposition for your department to connect

to KHIN?

• Can you identify “Use cases”?

 What is the “low hanging fruit”-  (note:- a critical success factor for the learning health system is “a galvanizing health concern”)  Smoking is still a problem in KS- (17% , 22ND rank)

• Who would be your community partners?

 Are there any health coalitions- Izs, Diabetes, etc?  Do you have a Medical Home or Medical Neighborhood project in your jurisdiction?

KALHD 6-19-12 34

Data Management & Data Quality Challenges

• Is your LHD engaged in any of the standards efforts for

public health data?

• Do you use systems that have an index/algorithms for

name matching and deduplication?

• If your LHD does not operate an FQHC or family medical

center, how do you think you could use the HIE to share clinical information with client/patient’s private providers

• r hospitals?
• What are the consent/privacy considerations that would

govern such transactions and how would you manage them

KALHD 6-19-12 35

Data Management & Data Quality Challenges

• Do you have policies and procedures for personally
• wned mobile devices such as smart phones and pads

brought to the office? (BYOD)

• Have you thought about how you will incorporate and

manage data obtained from social media and mobile technology with standard and required data reporting to your department?

• Do you have adequate opportunities to provide Local

Health input into state and national discussions?

KALHD 6-19-12 36

Finale!!

• LHDs worry about their continued relevance in the face
• f low budgets and low political esteem for government

functions

• The goal of providing quality healthcare for all, while

bending the cost curve, can not be achieved without a local public health role, doing the functions they do best.

• LHD participation in KHIN can facilitate collaboration,

particularly with the health delivery and payment system, to improve both the health and care of the population.

• Many more detailed materials, including a HIT

Landscape vocabulary and those referenced in the presentation, have been posted on your website.

KALHD 6-19-12 37

Contact Information

• After I leave Kansas tomorrow, I will be available “virtually”
• Susan M. Salkowitz, MA, MGA

 Principal, Health Information Systems Consultant, Salkowitz Associates, LLC  233 S 6th St #1601, Philadelphia PA  Phone: 215 351 7887  E-mail: salkowit@hln.com

• Relevant Memberships

 Board member: American Immunization Registry Association ( AIRA) 2000-2009  Executive Committee and Board Member, Public Health Data Standards Consortium  Adjunct Senior Fellow- Leonard Davis Institute, University of Pennsylvania  Population Health Associate, Thomas Jefferson University School of Population Health (2007-2012)  Member: APHA,PPHA, AMIA, HIMSS, PAeHi, GPAC

38 KALHD 6-19-12