Public Health IT Public health enabled Electronic Health Records, Decision Support, and Their Role in the Meaningful Use of Healthcare Technology Lecture.

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Public Health IT Public health enabled Electronic Health Records, Decision Support, and Their Role in the Meaningful Use of Healthcare Technology Lecture c This material (Comp13_Unit4c) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC

EHRs, Decision Support, and Meaningful Use of HIT Learning Objectives 2 1. Describe the strategies, features, and systems needed for public health agencies to define and build the necessary connections to EHRs as identified by the "meaningful use" legislation. (Lecture c) 2. Identify the essential features of four primary public health IT functions including syndromic surveillance, bi-directional immunization registries, public health alerts, ad-hoc reporting, etc. (Lecture c) Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

Immunization Registries 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c Immunization registries is a public health meaningful use function

Motivation Immunization is effective but many children do not receive it 1990’s NYC measles epidemic Without a centralized record-keeping system providers can’t obtain up-to-date records Many providers do not immunize without seeing a child’s record 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

New York Citywide Immunization Registry (CIR) 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c Provides a central record-keeping system to track the immunization status Enables health care providers to readily determine the immunization status of a child during a visit Provides an official printout of an immunization record Identifies children who are overdue for scheduled vaccinations

Law Requirements Reporting of all immunizations administered to all NYC patients under age 19 required within 14 days of administration Must report all historical immunizations in order to report a complete history for a patient Need patient consent to report immunizations administered to patients age 19 and over 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

Methods of Reporting Online Registry Electronic reporting –Web File Repository –EHR CIR Bidirectional Web-Services Real time query and upload 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

Web File Repository (WFR) 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

EHR Immunization Data (Buck, 2010.) In this EHR, ordering new immunizations is a two-step process: 1.Provider orders the immunization 2.Support staff completes the order and administers the immunization, entering the remainder of the immunization data (lot number, location given, etc.) 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

EHR CIR Bidirectional Web-Services (Buck, 2010) 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

Future Functions Receive and view CIR immunization history within the EHR itself Reconcile CIR and EHR immunization histories Report immunization history to CIR in real-time and receive confirmation message Review errors for submitted messages to identify records needing correction Improved matching service to CIR through the use of CIR patient immunization registry IDs 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

EHRs using the Service Columbia Presbyterian onMeetings2/SpringConference/2010/Posters/PHIT/UsinganElectro nic-PHIT_poster.pdfhttp:// onMeetings2/SpringConference/2010/Posters/PHIT/UsinganElectro nic-PHIT_poster.pdf (Buck, 2010) 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

Public Health Alerts and Ad-Hoc Reporting Public health alerts and ad-hoc reporting is a feature set in our meaningful use group 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

Public Health Needs 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c Public Health officials need a mechanism to communicate directly with clinical personnel for a variety of reasons: tracking disease outbreaks research surveys public health detailing visits medication or vaccine recalls Public Health Communication Public Health officials regularly need to assess the health of their communities Surveys conducted at the local, state, and federal levels Public Health Data Gathering

EHR Public Health Solutions 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c If public health officials could distribute relevant messages directly to providers at the point-of-care, they could target their interventions/monitoring more effectively Public Health Alerts If public health officials had a means to get aggregate count information from provider clinics throughout a region, they could track healthcare in virtually real-time Public Health Ad-hoc Reporting

Query Builder 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c (Buck, 2010)

Reporting Policy 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c (Buck, 2010)

Messages Inbox 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c (Buck, 2010)

Registry Reports 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c (Buck, 2010)

Alerts 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c (Buck, 2010)

Reporting 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c (Buck, 2010)

Conclusion Public health enabled EHR can be use to meet both public health and clinical goals Meaningful applications of healthcare technology 22 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

Readings Mostashari F, Tripathi M, Kendall M. A tale of two large community electronic health record extension projects. Health Aff (Millwood) Mar-Apr;28(2): Diamond CC, Mostashari F, Shirky C. Collecting and sharing data for population health: a new paradigm. Health Aff (Millwood) Mar-Apr;28(2): Hripcsak G, Soulakis ND, Li L, Morrison FP, Lai AM, Friedman C, Calman NS, Mostashari F. Syndromic Surveillance Using Ambulatory Electronic Health Records. J Am Med Inform Assoc Mar 4. [Epub ahead of print] Dr. Farzad Mostashari is currently serving as Deputy National Coordinator for Programs and Policy Lurio J, Morrison FP, Pichardo M, Berg R, Buck MD, Wu W, Kitson K, Mostashari F, Calman N. Using electronic health record alerts to provide public health situational awareness to providers. J Am Med Inform Assoc Mar 1;17(2): Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

EHRs, Decision Support, and Meaningful Use of HIT Summary The New York City Department of Health has built an ad-hoc query and alert system that helps them identify emerging acute threats and monitor chronic disease issues throughout the community Bi-directional immunization histories are providing information back to providers about their patients 24 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

EHRs, Decision Support, and Meaningful Use of HIT References – Lecture c References: Buck MD, Anane S, Taverna J, Amirfar S, Singer J. The Hub Population Health System: Distributed Ad-Hoc Queries and Alerts. J Am Med Inform Assoc. Standards & Interoperability (S&I) Framework – Query Health. Retrieved on October 3rd, 2010 from Diamond CC, Mostashari F, Shirky C. Collecting and sharing data for population health: a new paradigm. Health Aff (Millwood) Mar-Apr;28(2): Hripcsak G, Soulakis ND, Li L, Morrison FP, Lai AM, Friedman C, Calman NS, Mostashari F. Syndromic Surveillance Using Ambulatory Electronic Health Records. J Am Med Inform Assoc Mar 4. [Epub ahead of print] Lurio J, Morrison FP, Pichardo M, Berg R, Buck MD, Wu W, Kitson K, Mostashari F, Calman N. Using electronic health record alerts to provide public health situational awareness to providers. J Am Med Inform Assoc Mar 1;17(2): Stockwell M, et al. Using an Electronic Immunization Information System to Improve Immunization Rates. Retrieved on October 1, 2010 from PHIT/UsinganElectronic-PHIT_poster.pdf PHIT/UsinganElectronic-PHIT_poster.pdf 25 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c

EHRs, Decision Support, and Meaningful Use of HIT References – Lecture c Images Slide 8: Web file repository. Retrieved on September 8, 2010 from pdfwww.nyc.gov/html/doh/downloads/pdf/cir/wfr pdf Slide 9: Buck, M. (2010). EHR immunization data- screen shot. New York Department of Health and Mental Hygiene, Primary Care Information Center. Slide 10: Buck, M. (2010). EHR-CIR bi-directional web-services. New York Department of Health and Mental Hygiene, Primary Care Information Center. Slide 12: Buck, M. (2010). EHRs using the service. Retrieved on September 8th, 2010 from PHIT/UsinganElectronic-PHIT_poster.pdf PHIT/UsinganElectronic-PHIT_poster.pdf Slide 16 & 17: Buck, M. (2010). Images of desktop- systems and query building. New York Department of Health and Mental Hygiene, Primary Care Information Center. Slide 18-21: Buck, M. (2010). Images of desktop- systems of eclinicalworks system. New York Department of Health and Mental Hygiene, Primary Care Information Center. 26 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture c