Public Health Data Standards Consortium

Business Case for Public Case Participation in Health Information Technology (HIT) Standardization Anna O Orlova, PhD PHDSC and Johns Hopkins University CDC InfoLinks Community of Practice Call February 11, 2010

Presentation Outline: Acknowledgements Why do we need the Business Case Business Case Overview Proposed Strategy for Business Case Implementation Business Case: Role of Public Health in the National HIT Standardization

Project Team: Walter Suarez, Vicki Hohner, Noam Arzt, Harold Lehmann, Sacchi Girde, Regina Austin Business Case Development Expert Team: Kathleen Cook, Art Davidson, Julia Gunn, Tracy Lockard, Corey Smith, Lesliann Helmus, David Lawton, Marcy Parykaza, BethAnn Posey, Eileen Underwood, Cecil Lynch, Jason Siegel, Lisa Spellman, and Sherry Weingart Business Case Document Reviewers: Marjorie Greenberg, Missy Jamisson, Michael Fitzmaurice, Starla Ledbetter, Bill Brand, Robert Aseltine, Shaun Grannis, Brook Dupree, Alex Hathaway, Neil Calman, James Golden, David Ross, and members of the PHDSC Data Standards Committee Acknowledgements

CDC 5-year Cooperative Agreement “Assure HIT Standards for Public Health”. Started in June 2008 Goal: Represent public health interests in the national HIT standardization process Year 1 Develop a Business Case for Public Health Participation in National HIT Standardization and Launch the Web-pages on HIT Standards Year 2 Disseminate the Business Case Develop a Web-based Interactive Model on the Business Case Implementation Acknowledgements

Why do we need a Business Case? WHY STANDARDS?

Where We Are Now Why Standards

State Health Department: Organizational Chart

All public health activities are supported by customized information systems (databases, registries) developed to address the programmatic needs. Use of IT in Public Health: Where We Are Now

Our information systems do support our programmatic needs Our information systems cannot exchange data between programs within and across public health agencies and with clinical information systems AND…… HIT Standards in Public Health: Where We Are Now BUT……

Towards a Nationwide Health Information Network Where Should We Be in 2014 Why Standards - National Context

US Nationwide Health Information Network (NHIN) in 2014 Source: Dr. Peter Elkin, Mayo Clinic, MN

Regional Health information Exchanges (HIEs) as NHIN Components Source: Dr. Peter Elkin, Mayo Clinic, MN, 2006

Source: Eileen Koski. Quest Diagnostics. PHIN-2004, May, Atlanta GA Percent of Children Tested for Lead with BLL>10 µg/dL in the USA Vision: PH Surveillance under NHIN

Information Systems Interoperability for Public Health Where Should We Be in 2014 Building a NHIN

Implementing Meaningful Use of Health IT: Staged Approach Future CMS Rule Current CMS NPRM Source: W. Suarez, et.al. Review of CMS Meaningful Use NPRM and ONC Standards and Certification IFR: Implications for Public Health. Presentation at JPHIT-PHDSC Webinar, February 4, 2010.

Information Systems Interoperability for Public Health What Would It Take…. Building a NHIN Building the Roadmap for Health Information Systems Interoperability for Public Health. PHDSC White Paper URL:

HIT Standards in Public Health: Where We Are Now Extensive experience in developing standards Focus on data standards (data sets) and messaging standards (HL7) Program-specific approach (immunization, vital statistics, infectious diseases, occupational health and other) Jurisdiction-specific approach Top-down approach: federal agencies lead in the program-specific standardization efforts AND……

Our information systems do support our programmatic needs Our information systems cannot exchange data between programs within and across public health agencies and with clinical information systems AND…… HIT Standards in Public Health: Where We Are Now BUT……

Standards for Meaningful Use of Health IT AreaHIT Standards Committee recommendations Stage 1/2011Current IFR Stage 2/2013 Vocabulary (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 GISPE or according to applicable public health agency requirements ImmunizationsCVX

HIT Standards in Public Health What Is Needed

Business Case for Public Case Participation in Health Information Technology (HIT) Standardization Overview

Objectives: Describe the HIT adoption and need for standards in public health Describe HIT standardization process Define public health role in the HIT standardization process Help build an understanding across the public health community of this role and of the need for participation of local and state public health agencies in the national HIT standardization entities and Describe the strategy for public health participation in the HIT standardization entities with an organized voice Business Case: Role of Public Health in the National HIT Standardization

HIT Standards in Public Health: What Is Needed Learn about the World of Standards and Standardization Process Participate in Standardization Process Enable bottom-up approach, ie, assure that needs of local and state public health agencies are met

HIT Standards in Public Health: What Is Needed Learning about the World of Standards

HIT Standards in Public Health: What Is Needed Learning about the World of Standards: HIT Standards Categories

Standards Categories in Meaningful Use for HIT Source: W. Suarez, et.al. Review of CMS Meaningful Use NPRM and ONC Standards and Certification IFR: Implications for Public Health. Presentation at JPHIT-PHDSC Webinar, February 4, 2010.

Health IT Standards Categories 1. Data Standards, (vocabularies and terminologies) 2. Information Content Standards, (Reference Information Models (RIMs)) 3. Information Exchange Standards (messaging and structured documents submission standards) 4. Identifiers Standards (National Provider Identifier (NPI)) 5. Privacy and Security Standards 6. Functional Standards (processes/workflow and dataflow) 7. Other (IT infrastructure standards) This classification of Health IT standards types has been developed by the Health Information Technology Standards Panel (HITSP, in 2006www.hitsp.org

Charge: “Transmit essential data from electronically enabled healthcare to authorized public health agencies in real-time”. National Biosurveillance Use Case

1. Data Standards Information Content Standards Information Exchange Standards Identifiers Standards Privacy and Security Standards Functional Standards Other – 0 TOTAL = 107 standards This classification of HIT standards types has been developed by the Health Information Technology Standards Panel (HITSP, in 2006www.hitsp.org

HIT Standards in Public Health: What Is Needed Learning about the World of Standards: HIT Standardization Process

Priority Setting Standard Development Standards Maintenance Standards Harmonization Standards Certification Standards Adoption

HIT Standardization Process & Entities Priority Setting Standard Development Standards Maintenance Standards Harmonization Standards Certification Standards Adoption Standards Development Organizations, eg, HL7, LOINC, IHE, etc. Past: HIT Standardization Panel (HITSP) Integrating the Healthcare Enterprise (IHE) Past: Certification Commission for Health Information Technology (CCHIT) Past: AHIC Now: HIT Policy Committee & HIT Standards Committee US

Health Information Technology Standardization Phases, Products and Entities HIT Standardization Phases Priorities & Needs Development & Maintenance Selection & Harmonization Trial Implementation CertificationDeployment Goals What to accomplish What are the standards What standards to use Showcase what can be accomplished Certify standards- based products Deploy standards- based products HIT Standardization Entities HIT Standards Committee HIT Policy Committee (Formerly AHIC) SDOs (e.g., HL7, SNOMED (IHTSDO), LOINC, ASC X12) HITSP IHE NHIN IHE CCHIT Proposed IHE & PHDSC Deployment Workshops Standards Documents Use Cases (Description of the health information exchanges) Standards Interopera- bility Specifications Integration Profiles & Technical Frameworks Implementation Reports Certification Criteria Implementa- tion Reports

HIT Standardization Process & Entities Priority Setting Standard Development Standards Maintenance Standards Harmonization Standards Certification Standards Adoption Standards Development Organizations, eg, HL7, LOINC, IHE, etc. Past: HIT Standardization Panel (HITSP) Integrating the Healthcare Enterprise (IHE) Past: Certification Commission for Health Information Technology (CCHIT) Past: AHIC Now: HIT Policy Committee & HIT Standards Committee US

Building the Foundation for Certified EHR Technology Source: W. Suarez, et.al. Review of CMS Meaningful Use NPRM and ONC Standards and Certification IFR: Implications for Public Health. Presentation at JPHIT-PHDSC Webinar, February 4, 2010.

HIT Standards in Public Health: What Is Needed Participation in HIT Standardization Process

Public Health in HIT Standardization Entities EntitiesNumber of Organizations Number of Public Health Organizations HIT Standards Committee231 HIT Policy Committee202 HL HITSP64130 IHE2517 CCHIT3413 Total178070

Public Health in HIT Standardization Entities

Challenges for Public Health Participation in HIT Standardization Process

lack of awareness for the need to participate and where to participate limited ability for local and state public health practitioners to be involved in the national efforts as they serve particular jurisdictions lack of technical knowledge and informatics skills to participate, and lack of funding to support basic participation, eg, travel to meetings Public Health in National HIT Standardization: Challenges

Standards World – Where to Participate

HIT Policy Committee – recommends policies to the Office of National Coordinator (ONC) for the development and adoption of NHIN HIT Standards Committee – defines national HIT standards priorities ASC X12, SNOMED (IHTSDO), LOINC and others – defines data standards Health Level Seven (HL7) – defines information exchange standards Health Information Technology Standards Panel (HITSP) – selects and harmonizes standards Integrating the Healthcare Enterprise (IHE) – harmonizes standards and demonstrates standards-based HIT solutions (trial implementation), and Certification Commission for Health Information Technology (CCHIT) and other certification bodies as they emerge – certifies standards-based HIT products. Public Health in National HIT Standardization: Where to Participate

Participate Directly Participation in national HIT standardization efforts currently may be viewed as “outside” the interests and authority of state and local governments. However, only through their participation can standards developers meet jurisdiction-specific public health’s needs in standards-based “meaningful” EHR-Ss. Participate Through Professional Associations Participation of public health professional organizations in national HIT standardization entities on behalf of their constituents brings programmatic expertise to the standardization effort and strengthens the voice of public health. It is important for state and local public health agencies to continue their involvement in the standardization activities of various professional organizations to assure that public health’s programmatic interests are addressed in HIT standards and ultimately in standards- based HIT products. Public Health in National HIT Standardization: What Interests to Represent

Qualifications: Deep Understanding of Public Health Ability to Review HIT Standards Documents Who Should Participate: Senior public health program staff Senior public health informaticians IT professionals working in state and local public health agencies Public Health in National HIT Standardization: Who Should Participate

Skills and Knowledge Needed  White Papers  Technical Frameworks  Interoperability Specifications  Requirements Specifications  Integration Profiles  Content Profiles  Certification Criteria Standards are Technical Documents

Public Health in National HIT Standardization: Cost of Participation Time: 25-30% FTE (calls, meetings, document review) Travel: 3-4 meetings/year (3-5 days each) TOTAL~ $40,000 per person/entity

Public health needs to speak with a strong, coordinated voice to HIT standardization entities to Reflect the needs/interests of local, state, and federal public health together Coordinate this voice across the various public health programs and activities There must be coordinated action within the public health community to define how its various program, agency, and jurisdictional interests can all be reflected in the resulting outcome. This action should occur on two levels of efforts: advocacy level and technical level Public Health in National HIT Standardization: How to Coordinate Various Interests

Business Case for Public Case Participation in Health Information Technology (HIT) Standardization Proposed Strategy

Public Health in HIT Standardization Proposed Strategy (a) maximize the impact of those who can participate on behalf of Public Health in the national HIT standardization process, and (b) inform/educate and obtain input, as best as possible, from those who cannot.

What to Achieve? National HIT standardization process requires collective input from Public Health on what public health issues need to be addressed in national interoperable HIT standards. This input needs to be collaboratively developed, put through the national HIT standardization process and uniformly implemented. Public Health’s “Organized Voice on HIT Standards” will have to take on a character reflective of this reality.

What to Achieve? We define Public Health’s Organized Voice on HIT Standards as an open, transparent, participatory process of harmonizing program-specific and jurisdictional needs with national HIT interoperability standards by working with HIT standardization entities on various phases of HIT standardization

Target Audience National HIT Leadership Governors State and Local Health Commissioners Federal Agencies Leadership Leadership of Professional Associations Leadership of Schools of Public Health

Building Public Health’s Organized Voice on HIT Standards Why Participate? Where to Participate? Who Should Participate and How to Participate?  Role of Local and State Agencies  Role of Professional Organizations  Need for Coordination Resources for Participation  educational and informational resources  funding

Why Participate? or Risks of Non-participation threaten public health data gathering activities diminish effectiveness of public health interventions diminish efficiency of public health operations reduce ability to communicate public health information back to clinicians electronically jeopardize adoption of modern interoperable HIT applications in Public Health jeopardize achieving population-level goals of Nationwide Health Information Network minimize the potential of state and local Public Health to receive funding from Federal and other sources that will likely mandate the use of interoperable HIT products

Where to Participate? EntitiesNumber of Organizations Number of Public Health Organizations HIT Standards Committee231 HIT Policy Committee202 HL HITSP64130 IHE2517 CCHIT3413 Total178070

How to Participate: State and Local Agencies Recognize HIT standardization efforts as a distinct role for senior program staff, senior informaticians and/or IT professionals in the agency Devote one or more staff members in a leadership position to carry out an agency’s HIT standardization activities For smaller agencies, outsource HIT standardization efforts where possible to experts-consultants with extensive knowledge of public health Recognize the need for continuing education in public health informatics and HIT standards for agency’s workforce Band together within a region and share the costs associated with the deployment of professionals to represent agency on HIT standardization efforts Participate in and leverage memberships in public health professional associations involved in standardization activities as a way of providing input into the HIT standardization process, and Participate in coordination activities for building Public Health’s Organized Voice on HIT Standards.

How to Participate: Professional Associations ImmunizationAmerican Immunization Registry Association (AIRA) LaboratoryAssociation of Public Health Laboratories (APHL) Epidemiology & Disease Reporting Council for State and Territorial Epidemiologists (CSTE) CancerNorth-American Association of Central Cancer Registries (NAACCR) Vital StatisticsNational Association of Public Health Statistics and Information Systems (NAPHSIS) Newborn Screening Public Health Informatics Institute, Maternal and Child Health Bureau, HRSA Healthcare Management National Association of Health Data Organization (NAHDO) & American Health Information Management Association (AHIMA)

Public Health in HIT Standardization: Need for Coordination Facilitate public health involvement in various HIT standardization entities Coordinate activities of professional organizations Assist local, state and federal agencies Help identify new public health areas for developing new standards and carry out activities needed to initiate standards development efforts in these areas; Conduct outreach activities on public health participation in HIT standardization Educate public health workforce on HIT standards and Help identify and secure resources needed to support the participation of public health professionals in HIT standardization entities

Business Case: Role of Public Health in HIT Standardization ( Participate in HIT standardization and learn PHDSC Web-based Resource Center New HIT Standards Web-pages launched in June 2009 ( PHDSC Quarterly Standard e-Newsletter ( Resources:

Business Case: Public Health in HIT Standardization Join our efforts to launch Coordinated Public Health Action Plan on HIT Standards

Anna Orlova, PhD, Executive Director 624 N. Broadway Room 325 Baltimore MD Phone: Fax: PHDSC Annual Busines s Meeting Users Guide for Source of Payment Typolog y PHDSC- IHE Public Health Task Force June 18, 2008 March 17, 2008 PHDSC Committees Communications and OutreachCommunications and Outreach Data Standard sData Standard s Exte rnal Caus e of Injur y Cod esExte rnal Caus e of Injur y Cod es Hea lth Care Servi ces Data Rep ortin g Guid eHea lth Care Servi ces Data Rep ortin g Guid e Pay er Typo logyPay er Typo logy Nationwi de Health Informati on NetworkNationwi de Health Informati on Network Privacy, Security and Data SharingPrivacy, Security and Data Sharing Professi onal Educatio nProfessi onal Educatio n Welcome to the Public Health Data Standards Consortium The Public Health Data Standards Consortium is committed to bringing a common voice from the public health community to the national efforts of standardization of health information technology and population health. To fulfill this commitment the Consortium: Identifies priorities for the new national standards for population health; Promotes the integration of health-related data systems to meet the health data needs of public and private organizations, agencies and individuals; Participates in national and international efforts on the standardization of health-related information; Represents public health interests in standards development organizations, data content committees & standards harmonization entities; and Educates the public health community about health information technology standards and the health information technology community about public health. Home Listserv Site Map Contact Us Copyright 2008 © Public Health Data Standards Consortium - All Rights Reserved Click here to review the PHDSC's Legal and Privacy StatementLegal and Privacy Statement HOM E About the Consortium Standards Development & Harmonization Health Information Exchanges Privacy & Security Workforce Developmen t Resource s PHDSC Product s Get Involved!

Business Case: Public Health in HIT Standardization “…Coordinated, collective action is required at almost every level of the healthcare system to realize the full benefits of HIT. This makes it unlikely that individual actors, pursuing their own self-interests, would be able to take the full advantage of HIT. The importance of collective action is most apparent in securing effective communication – so-called interoperability – across providers of care in the United States” – David Blumenthal, National Coordinator for HIT.