Statewide Data Interoperability For Improving Population Health Wu Xu, PhD State Health IT Coordinator Director, Center for Health Data & Informatics Utah Department of Health May 23, 2016 Iona Thraen, PhD UT State Innovation Model Grant Director, Office of Health Systems Collaboration

States as Laboratories For Nationwide Clinical and Public Health Data Interoperability 2

Discovering Laboratories’ Commonality Participants from states and large cities/counties share their interoperability visions, priorities and strategies at the Public Health Informatics for Leaders Forum Sponsored by Public Health Informatics Institute, April 26, 2016, Atlanta, GA 3

Definitions of Population Health Population Health Domains* * Adopted from Public Health 101: Healthy People-Healthy Population by R. Reigelman, 2010, Sudbury, Jones & Bartlett. ** population-health.html Population Health is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group.** Social & Human Services Public Health Community Health Healthcare Systems Individual/Co nsumer Health 4

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Key Outcome of Population Health Utah Department of Health’s Definition of Population Health: UDOH integrates its practice with health systems and payers to fully address determinants and outcomes of health in the Utah population and its sub-populations. 6

Public Health Health Care Innovative Clinical Prevention Traditional Clinical Prevention Increase the use of evidence-based services Provide services outside the clinical setting Total Population or Community-Wide Prevention Implement interventions that reach whole populations The 3 Buckets of Prevention Article by John Auerbach, 2016, available on the Journal of Public Health Management and Practice’s website – Shared Space: Innovative Clinical Prevention 7

Population Health Business Cases with ROI in 5yrs Promote adoption of evidence-based interventions in collaboration with health care purchasers, payers, and providers 8

Informatics Support to the 6|18 Use CaseInformatics Support in Utah Reduce Tobacco Use  HIE facilitates “quit-line” referrals Control High Blood Pressure  APCD estimates of risk populations and cost  Population data collection from HIE, systems Control Asthma  APCD risk and cost analysis  BRFSS, Inpatient, ED, clinical asthma patient distribution  Outcome evaluation Control and Prevent Diabetes  Local data to supporting health and cost evidence and monitor progress  APCD patient risk and cost analysis 9

Data Interoperability for Population Health = Information Exchanges & Analysis across EHR, HIE & Public Health

Utah’s Information Exchange Strategies Develop a Shared Vision Develop a Shared Statewide Health IT Plan Develop Governance for The Shared Identification Services for Utahns (ThSisU) Leverage State-Designated Health Information Exchange (HIE) Leverage Public Health Meaningful Use Reporting Pilot Other “Meaningful” Public Health Information Services Clinical Data Needs for Population Health Collaborative: Clinical measures and Advanced Analytics 11

Utah Statewide Shared Vision,

Alignment Federal and State Health IT Goals Federal ONC Goals:  Advance Person-Centered and Self-Managed Health  Transform Health Care Delivery and Community Health  Foster Research, Scientific Knowledge, and Innovation  Enhance Nation’s Health IT Infrastructure -5-federalhealthitstratplanfinal_0.pdhttps:// -5-federalhealthitstratplanfinal_0.pdf Utah HIT Goals (Draft):  Advance the Health and Well- being of Individuals and Communities through Person- centered & Self-managed Health  Strengthen Health Care Delivery Transformation  Enhance Utah's Interoperable Health It Infrastructure  Support Research, Innovation, and Implementation Science 13

Need for Statewide Master Person Index 14

ThSisU: Governance 15

ThSisU: Building Blocks and Initial Use Cases Patient Identity Service Identity proofing Link digital identity to patient records Match digital identities across organizations Risk Indemnification ThSisU Identity-related Building Blocks to support appropriate data movement Selected Care Coordination Use Cases Trust framework Pooled-shared knowledge Business case and financial benefit Provider Electronic Receiving Specifics Provider digital identity repository Provider identity proofing Care Team Message interfaces Care team imputation algorithms tested Encounter records from member organizations Patient Proxy Relationship Management Proxy relationship verification and policy Case Information Delivery Newborn data Bundle Electronic birth certificate Screening orders, tracking results Pediatrician identification and follow-up End of Life Care Electronic POLST Advance Directives Emergency Medical Services Poison Control Case coordination with Emergency Physicians 16

Meaningful Use (MU) and Health Information Exchange (HIE) are Transforming Silo Pubic Health Systems’ Data Communication and Analytics

Silo Public Health Information Systems UDOH has  about 1,000 employees  more than 100 stand along information systems.  A hospital may report data in about 30 different ways to UDOH  A program may use 10 different methods to exchange data with external entities Root causes  Historically categorical funding streams and restrictions  Decentralized business and IT management structures  Legacy systems and aging workforce  Lack of federal-state strategic collaboration and adequate funding 18

Transformation by MU and HIE Public Health Meaningful Use Reporting  Immunization Records (bi-directional)  Electronic Laboratory Reporting  Syndromic Surveillance Reporting  Cancer Registry Public Health Uses the Statewide HIE  Meaningful Use Reproting  Newborn Hearing Screening Results & Diagnostics Reports Exchange  Emergence Medical Services  Poisoning Control Data exchange through cHIE 19

MU Challenges: EHR-IIS complexities USIIS 20

MU Challenges (cont.) MU instructions from various sources  CMS, ONC, Medicaid, EHR vendors, UDOH, USIIS, REC, etc. Complexity of EHR systems and EHR-USIIS interfaces Multiple possible points of failure Understand and undertake responsibility for data quality – In EHR system and in USIIS – Clinic workflow and staff practices impact data quality USIIS 21

Shared Service for Interoperability INTERFACES: SFTP VPN HTTPS SOAP Web Service PHIN MS Secure web portal GATEWAY and INTEGRATION ENGINE: Mirth Connect Rhapsody Shared Service Platform HIE “No Door is a Wrong Door” Tradition is Costly. 22

PHCP: Electronic Case Reporting 23

Direct 1g HIE Solution EHR System B HIE Solution EHR System A My Health 1a 2i 1b 2h Diagnostics Test Results HIE Solution DOH Gateway Identity Resolver Public Health 2a 2b 2c EHDI Test Results Early Hearing Detection & Intervention (EHDI) Diagnostics Standard-based Message Broker (eHEX, Direct, HL7v2) Relationship Resolver Message Orchestrator Message Router Format Converter Identity Resolver Alert/ Notification Central Repository 2d 1c 1d 1e 1f 2e 2g 2f HIE Use Case 1: EHR sends hearing diagnostics reports to public health registry HIE Use Case 2: EHR receives hearing test results from public health registry 24

Vital Records and EHRs BIRTH and DEATH records are fundamental public health data  Registration systems are electronic but silo with manual data entry Pilot: Quality of Birth Data Extracted from HER  Most of the labor, delivery and newborn care information are available  PDF information (i.e. prenatal or out of network care) can’t automated extracted [J. Duncan, et al. CDC 2015-Q-17144) EHR Death Certificate Reporting  EHR and EDEN interoperability for physicians to timely enter the Cause of Death via their own EHR Death Notification for EHR Patient Identity Validation 25

Informatics and Opioids Crisis Utah ranked the 4 th highest for drug poisoning deaths in the U.S. State Interventions:  Prescription Drug Management Program  Controlled Substance Database (CSD) Informatics Support  EHR - CSD connection or single login for prescribers  Education and decision-support to prescribers  Automated prescription misuse/abuse surveillance  Timely information for community intervention 26

Challenges for Analytics and Visualization For Population Health Planning opendata.utah.gov Public Health Assessment App. Websites for Consumers 27

Expanded Needs for Population Health Analytics DomainPublic Health InformaticsPopulation Health Informatics Data SourcePublic health data+ clinical & other data sources Data ModelDisease/event centric+ Person, People, community-centric InteroperabilitySilo systems+ Linkage and real-time exchange are required UserPublic health profession+ Diverse external users AnalyticsStandard public health measures, pre-defined conditions + flexible user-defined measures and populations 28

Develop Population Health Informatics Develop shared vision and frameworks  Population health use case driven technical design Build interoperability between clinical and public health data  Standard terminology and data models  Federated infrastructure among all partners  Standard shared service platforms Flexible and shared analytics functionality for various users Standard quality measures for value-based purchasing, payment reform, and community health improvement 29

Questions? Comments? Suggestions? THANK YOU!