National Center for Public Health Informatics HL 7 Pleniary: Grid Enabled Public Health Services Dr. Leslie Lenert, Director, National Center for Public Health Informatics 5/12/2019

CDC – CCHIS - NCPHI ________ Centers for Disease Control and Prevention (CDC) Coordinating Center for Health Information and Service (CCHIS) ________ National Center for Health Statistics National Center for Public Health Informatics (NCPHI) National Center for Health Marketing 5/12/2019

CDC MISSIONS: Health Protection, Health Equity, and Organizational Excellence NCPHI MISSION: To protect and improve the public’s health and to promote health equity through science and service in health information technology and informatics 5/12/2019

NCPHI: Guiding Principles Public health/healthcare integration Application of best practices Applied science Emphasis Areas Public Health Practice Informatics Integration of Public Health with the National Health Information Network Consumer Health Informatics 5/12/2019

Current State Overview NCPHI is finishing significant transformation Newly established Center Management and leadership is developing Efforts aligning to dynamic environment Evolving health IT landscape Growing number and breadth of partners Expanding resource intensive regulatory requirements Increasing public scrutiny Standards Development Organizations Public Health Informatics Centers of Excellence CDC Programs NCPHI Office Of the National Coordinator (ONC) RHIOs HIEs Health Depts. Vendors / Consultants Academia HHS NIH AHIC FDA Hospitals 5/12/2019

Strategic Themes Moving Forward Science & Services Future Development & Operations Partnership & Collaboration Present Systems & Applications 5/12/2019

Select Programs & Vision for the Future Initiate Improve Expand Sustain Program Management Operations CDC Unified Process CDC Enterprise Architecture CDC Enterprise GIS Program CDC Enterprise GIS Program CDC Vocabulary Community of Practice NEDSS Platform Countermeasure and Response Administration Outbreak Management System Epi Info BioSense CDC Information Resources Governance NCPHI Organizational Excellence Planning Measurement, Evaluation & Improvement Research & Science Present 5/12/2019

NCPHI’s Agenda Services Approach: Partnerships Ontology modeling Vocabulary development Standards based messaging and data exchange Single sign-on access to diverse data sources Form and questionnaire generation and administration Data validation Case identification and decision support Natural language processing Geofencing and electronic quarantine Approach: Partnerships Internal (CDC and CCHIS) Cross-agency (FDA, AHRQ, etc.) Cross-Department (DHS, FCC, etc.) External (AHIC, State, local and territorial public health, RHIOs, etc.) Strategy: Collaboration Open Source Software Service Oriented Architectures Federated Systems Grid Computing Existing Proposed 5/12/2019

Health Protection Framework HAN PHIN Alerting OMS CRA (CIT/CAT) PHIN Vocabulary PHIN Messaging Surveillance systems (NEDSS) Data Information Knowledge Decisions Plans Actions HEALTH THREAT DEOC Call Down List PHIN Directory Data Warehousing Enterprise Geospatial Data Warehouse Monitoring (BIC) BioSense SiteScape (i.e. GIS Knowledge Base) Epi-X 5/12/2019

Health Protection Framework Foundation Actions Data Plans HEALTH THREAT Information Decisions Knowledge EDUCATION POLICY EVALUATION RESEARCH APPLICATIONS & SERVICES STANDARDS 5/12/2019

Current Approach 5/12/2019

Service Oriented Architectures for Public Health Collaborative, Efficient, Agile PHIN Open Source Services 5/12/2019

Modular Approach Demonstrated Collaborative, Efficient, Agile 5/12/2019

Modular Approach Demonstrated Collaborative, Efficient, Agile 5/12/2019

Goal State Collaborative, Efficient, Agile 5/12/2019

Public Health Information Network Data Exchange Provider State and Local Public Health PH Observation Report Msg. Case Report Criteria Standard Msg/Question/Forms NND Reporting Criteria NND Case Classification Messaging Standards Vocabulary Standards Syndrome Criteria Standard Messaging Public Health Observation Messages Public Health Case Reports CDC Data Warehouse Data Marts PHIN MS Broker Enterprise Applications 5/12/2019

Decision Support as a Service on the grid 5/12/2019

Public Health Interface with Provider Community PHIN Services Provider PH Standardized Vocabulary Message Data Marts Vocabulary Services PH Case Reporting Criteria Case Report Criteria State and Local NND Reporting PH Data Collection Forms Message Validation CDC Programs PH Case Report Msg. Public Health Interface Public Health Interface NND Condition Classification Case Filter Information Request Processing PH Case Information Request Knowledge Management Diff Dx PH Observation Report Msg. BioSense Syndromic Detection OMS Patient Records Case/Alert Information Exchange Outbreak Detection HAN 5/12/2019

CDC Research on Reasoner Framework For Distributed Decision Support 5/12/2019

Foundation: A Public Health Ontology OBX-3 OBX-17 SPM-4 OBX-8 OBX-7 OBX-5 Links to HL7 2.X for Compatibility 5/12/2019

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Message Classification 5/12/2019

Case Detection Algorithm applied between the data and its Set of relationships Different types of relationships to other concepts DATA - Attributes or instances of the object Object Concepts in the Ontology Relationships to other objects 5/12/2019

Integration of Public Health with Clinical Decision Support DOH sends alert to community re Legionella cases in Parkchester community in the Bronx Practice Alert in EHR this center only if patient presents with cough – matched to order set to help provider with dx and tx of possible Legionella infection Cough 5/12/2019

After entering his chief complaints of cough and fever, along with vital signs, a new BPA appears. This BPA has been set to trigger with chief complaint of cough for patients presenting at our Parkchester center only. 5/12/2019

The physician who sees this alert can accept an order set configured specifically for evaluation and management of possible legionaire’s disease. By selecting the “accept” button, this order set (SmartSet) will appear… 5/12/2019

Summary and Conclusions Transforming environment demands public health integration with clinical information systems and regional health exchange. CDC HIE RFA points the way to new model for integration of clinical and public health services Move from a network to a grid with services published on the grid for various activities Public health activities well suited to grid implementation Potential synergies with clinical decision support. 5/12/2019

Questions 5/12/2019

BioSense 5/12/2019

CRA Countermeasure Inventory Tool 5/12/2019

PHIN Vocabulary and Distribution System 5/12/2019

CDC Team (SiteScape) 5/12/2019