ONC Standard and Interoperability (S&I) Public Health Reporting Initiative (PHRI) Nikolay Lipskiy, MD, DrPH; CDC ONC S&I PHRI Co-Lead November 8, 2012

Charge: The S&I Public Health Reporting Initiative will develop and implement a standardized approach to electronic public health reporting from EHR systems to local, state and federal public health programs that addresses the needs of several different reporting use cases, with the long-term goal of reducing the difficulty (to both providers and public health agencies) of implementing electronic versions of the broad spectrum of public health reporting. Scope: The scope at Phase I is limited to the use of a healthcare provider’s EHR system for reporting patient-level events of public health interest to a public health agency. This Use Case focuses on a provider-initiated report – a report sent from a provider (using an EHR system) to a public health agency system with information about a particular public health event. Out of scope: Defining specifications and guidelines on reportable event criteria (e.g., defining reportable conditions) – this Initiative will enable healthcare providers to submit a report based on jurisdictionally defined laws and regulation, but will not be responsible for defining the reporting criteria. Defining automated ‘business rules’ to identify potential reportable events – this Initiative will enable healthcare providers to submit a report but will not describe the criteria or business rules to identify when such a report should be sent Describing the process for public health agencies to perform follow-up activities, including case monitoring Defining specifications and guidelines for reporting by means other than the transmission of an electronic message or document (e.g., telephone voice, manual web-entry and mailed or faxed information) Describing any additional or extensive bi-directional communication between a public health agency and a healthcare provider beyond the sending of a public health report and the acknowledgement of receipt of that report Identifying transport protocols Identifying security requirements, methodologies, procedures, and/or protocols Identifying information and data stewardship practices and policies Background

PH Data Harmonization and Standardization: Addressing Goals of a “Blueprint” for PH in 21 st Century 1.We support CSTE and other organizations that declare data harmonization and standardization as a critical component of the Public Health “Blueprint” for 21 st Century During 2011 CSTE meetings members of this organization updated goals of surveillance making an overarching goal as following: “To provide actionable health information to public health staff, government leaders, and the public to guide public health policy and programs.”*  Biosurveillance standardization  Defining the most valuable information and data for public health agencies  Advocating for public health needs by developing recommendations for information technology specifications for local, state, territorial, and national surveillance systems  Defining the technical data specifications  Encouraging states to standardize methods and decrease needless variation in surveillance practices 2. We support a national agenda on building public health preparedness through defining standard data sharing elements Reference: Perry F. Smith et al., “Blueprint Version 2.0”: Updating Public Health Surveillance for the 21st Century, J Public Health Management Practice, 2012, Copyright C 2012

The Initiative utilizes the concept of a ‘modular’ provider-initiated report consisting of 3 components: Core Common Data Elements – harmonized data elements that are widely shared across several report types. EHR systems are expected to be able to produce these data elements but public health systems may choose to receive these elements at their discretion. Report Type Specific Data Elements – harmonized data elements (although variance is allowed where necessary) that are broadly required across public health for a specific report type (e.g., a communicable disease case report, a birth record report, etc.). Where possible, report type data elements are detailed and harmonized, but future companion documents and phases of the Public Health Reporting Initiative may be required to cover data elements for various types of reports. Implementation Specific Data Elements – additional, relatively unique, or non-harmonized data elements required by a particular jurisdiction or public health program (e.g., a TB report in California). Data Harmonization Approach

Data Harmonization Domains and Harmonized User Stories Communicable Diseases Chronic Diseases Child Health Adverse Events Quality and Infrastructure 5 Domains Figure 1. Public health domains that participated in data harmonization Figure 2. User stories by domain that were harmonized

1.Allergy / Adverse Event 2.Employment Information 3.Encounter / Patient Visit 4.Exposure / Injury 5.Facility 6.Family History 7.Health Problem / Diagnosis 8.Immunization 9.Medical Devices 10.Medication 11.Order / Diagnostic Test 12.Order / Diagnostic Test 13.Patient Contact Information 14.Patient Information 15.Payer Information 16.Physical Exam 17.Procedure 18.Provider Information 19.Report Metadata 20.Result 21.Social History 22.Specimen 23.Vital Sign Indicator Objects for data harmonization purposes were defined as foundational building blocks for future public health reporting standardization. For each object, there is a core content that is covered by core set of data elements (that are defined regardless of domain); the objects can be extended by programs for specific domains (for example, a pregnancy visit). The Core Common Data Elements are composed of these objects and associated elements. The following objects organize the core common set of data elements for the Public Health Reporting Initiative: Core Common Data Elements: Objects

Core Common Data Elements: the Object Summary

Core Common Data Elements: Description of Common Core Data Elements

Data Harmonization Profile: FHIM component (example)

Development of Data Harmonization Profile: Lesson Learned The PHRI identified several key lessons that should be applied to subsequent phases of data harmonization. Some of them are: 1.We believe that our results demonstrate a successful approach in the development of public health reporting common core data elements that may serve as a foundation for the development of new profiles for data exchange, the improvement of existing profiles and further steps in the development of a Federal Health Architecture (FHA). 2.We learned that a data harmonization step should precede the development of data exchange specifications. In this way, a harmonization of existing data exchange specifications and the development methodology for consolidated specifications will become systematic and predictable. 3.We learned that there are gaps in existing national policies and procedures which focus on the coordination, development and maintenance of standardized data elements and value sets. For example, the relationship between PHIN Vocabulary Access and Distribution System (VADS), AHRQ United States Health Information Knowledgebase (USHIK) and National Library of Medicine (NLM). Furthermore, a successful implementation of standardized content will depend on the successful coordination and maintenance of clinical care and public health vocabularies. 4.Our collaboration with Federal Health Information Modeling (FHIM) leveraged previous work to harmonize and model common information in the clinical domain with federal partners (DoD, VA, FDA, etc.). The result demonstrated that public health reporting data elements were successfully modeled to FHIM clinical care domains. This work can be expanded further to harmonize other public health domains and report types to FHIM both horizontally (between federal organizations) and vertically, through jurisdictional-level government agencies and clinical care providers

The Data Harmonization Profile is available for public comment and review here: mment mment Review Period: 10/31/12 – 11/13/12 Submit comments using the discussion board on the wiki or by ing Lindsay Brown Questions? Nikolay Lipskiy Data Harmonization Profile: Review and Submit Your Comments