1. Public Health Data Standards Consortium http://www.phdsc.org http://www.phdsc.org

2. CDC EHDI Data Committee ~ Webinar ~ August 16, 2012, Atlanta, GA Clinical Document Architecture (CDA) for Public Health CDA State EHDI Pilot Projects Anna O. Orlova, PhD aorlova@jhsph.edu Executive Director Public Health Data Standards Consortium Baltimore, Maryland, USA

3. CDA for PH Project: Outline History CDA Public Health Reporting CDA for Public Health Pilot Project- EHDI

4. History CDA for PH Project

5. CDA R2 2005 CDA for PH Project Source: Renly S, Krueger J. What’s Next? Why HL7 Messages and HL7 CDA Documents are in our Future. Presentation at the CDC PHIN Vocabulary and Messaging Community of Practice, February 21, 2012

6. HL7 Messages. URL: http://www.ringholm.de/docs/04200_en.htmhttp://www.ringholm.de/docs/04200_en.htm Messages support an ongoing process in real-time; convey status and updates. Messages are about "control" - representing requests that are accepted or refused. There are clear expectations about what the receiver must do.  In such situations the latest version of the data is of importance to support an ongoing process, historic versions of one and the same object are generally not of importance apart from regulatory (e.g. auditing) purposes.  Messages by and large contain “current” data.  The more interactive and tightly coupled your communication process, the more message use is applicable. CDA for PH Project Source: Renly S, Krueger J. What’s Next? Why HL7 Messages and HL7 CDA Documents are in our Future. Presentation at the CDC PHIN Vocabulary and Messaging Community of Practice, February 21, 2012

7. HL7 Documents. URL: http://www.ringholm.de/docs/04200_en.htmhttp://www.ringholm.de/docs/04200_en.htm Documents are persistent, have “static” content and used “post occurrence”, i.e. once the actual process is done. Documents are about persisting "snapshots" at a particular time.  Documents contain data “as it was” when the document was originally created. For documents such as referrals and discharge summaries, it may be more appropriate to see the data as it was understood at the time the referral or summary was constructed rather than viewing the data as it exists now.  Documents are "passive". They capture information and allow that information to be shared, but do not drive any activity. Documents can be superseded and corrected, but they are "static documents" rather than dynamic objects.  The more passive and loosely coupled your communication process is, the more the use of documents is applicable. CDA for PH Project Source: Renly S, Krueger J. What’s Next? Why HL7 Messages and HL7 CDA Documents are in our Future. Presentation at the CDC PHIN Vocabulary and Messaging Community of Practice, February 21, 2012

8. Laboratory Use Case Messages  Orders  Results Documents  Test Result Report  Summaries MSH|^~\&|LABWARE.DE.STAG^2.16.840.1.114222.4.3.3.2.23.2^ISO|DE.Smyrna.SPHL^2.16.840.1.114222.4.1.44596^ISO|US WHO Collab Labsys^2.16.840.1.114222.4.3.3.7^ISO|CDC-EPI Surv Branch^2.16.840.1.114222.4.1.10416^ISO|20111212201328+1900||ORU^R01|20111212201328- 000014085|P|2.3.1|||||||||PHLIP_ORU_v1.0.2^PHIN_Profile_ID^2.16.840.1.114222.4.10.3^ISO PID|1||1038239^^^LABWARE.DE.STAG&2.16.840.1.114222.4.3.3.2.23.2&ISO^PI||^^^^^^S||19980926|M|||304 W 37TH ST^^Wilmington^DE^19802^^^^10003|||||||||||2135-2^Non-Hispanic^CDCREC^NON_HISP^Non Hispanic^L ORC|RE||14085^DE.Smyrna.SPHL^2.16.840.1.114222.4.1.44596^ISO||CM||||||||||||||||AI Du Pont Hospital and Christiana Care Med Ctr|1600 Rockland Road^^Wilmington^DE^19899^^O|^WPN^PH^^^302^6515658 OBR|1||31804^LABWARE.DE.STAG^2.16.840.1.114222.4.3.3.2.23.2^ISO|243365003^ Acid-Fast bacillus ^LN^PCR_Tuberculosis^Tuberculosis PCR^L|||20111108154032+1900|||||||20111108154030+1900|LAVG&Lavage, Bronhial&HL70070&BAL&Bronchial Alveolar Lavage&L|MAREK^Marek^Liz^^^^^^^U|^WPN^PH^^^302^6515658|||||20111108161839+1900|||F OBX|1|CE|38379-4^M TB Cmplx DNA XXX Ql PCR^LN^Tuberculosis^Tuberculosis^L||260373001^Detected^SCT^POS^Positive; Nucleic Acid detected^L|||N|||F|||20111108161839+1900 OBR|2||14085^LABWARE.DE.STAG^2.16.840.1.114222.4.3.3.2.23.2^ISO|PLT40^Epidemiologically Important Information - Tuberculosis^NND|||20111108154032+1900|||||||20111108154030+1900|LAVG&Lavage, Bronchial&HL70070&BAL&Bronchial Alveolar Lavage&L||||||||||F OBX|1|CX|LAB202^Unique Specimen ID^PHINQUESTION||14085^^^LABWARE.DE.STAG&2.16.840.1.114222.4.3.3.2.23.2&ISO||||||F|||20111108161 640+1900 TB Sample Report from the 2012 HIMSS Interoperability Showcase Use Case Source: Renly S, Krueger J. What’s Next? Why HL7 Messages and HL7 CDA Documents are in our Future. Presentation at the CDC PHIN Vocabulary and Messaging Community of Practice, February 21, 2012 CDA for PH Project

9. CDA Lab Result Report XML Schema … … CDA for PH Project

10. Meaningful Use of Health IT Stage I – HL7 messages v2.3.1 or v2.5.1  Syndromic Surveillance –Electronically record, modify, retrieve, submit v2.3.1 or v2.5.1  Laboratory Results Reporting to Public Health  Electronically record, modify, retrieve, submit v2.5.1  Reporting to Immunization Registries  Electronically record, modify, retrieve, submit v2.3.1 or v2.5.1 Stage II – HL7 CDA  Reporting to State Cancer Registries  Reporting of Early Hearing Detection and Intervention (EHDI) Quality Measures to Public Health CDA for PH Project

11. CDA Public Health Case Report Header Social History Section Clinical Information Section Treatment Information Section Encounters Section Relevant Diagnostics and Laboratory Section Immunizations Section TB Sample Report from the 2012 HIMSS Interoperability Showcase Use Case CDA for PH Project

12. CDA Public Health Case Report Social History Occupation: Healthcare Support Occupations HEADER BODY L2 HUMAN READABLE BODY L3 MACHINE PROCESSABLE CDA for PH Project Source: Renly S, Krueger J. What’s Next? Why HL7 Messages and HL7 CDA Documents are in our Future. Presentation at the CDC PHIN Vocabulary and Messaging Community of Practice, February 21, 2012

13. Section Analysis across Continuity of Care Document (CCD) and Public Health Case Reports (PHCR) Prototypes © 2012 Lisa R. Nelson CDA for PH Project PHCR Relevant Diagnostic Tests and/or Laboratory Results Anthrax PHCR Relevant Diagnostic Tests and/or Laboratory Results CCD Continuity of Care Document All Sections: PHCR Clinical Information PHCR Social History CCD Immunization PHCR Encounters PHCR Treatment Information Anthrax PHCR Clinical Information Anthrax PHCR Social History Anthrax PHCR Encounters Anthrax PHCR Treatment Information PHCR Public Health Case Report All Sections: Anthrax PHCR Anthrax Public Health Case Report All Sections: Acute Hepatitis B Tuberculosis Tularemia Alerts Payers Advance Directives Support Problems Functional Status Vital Signs Medications Medical Equipment Procedures Family History Social History Results Immunization Encounters Plan of Care Based on HL7 CDA R2 Implementation Guide for Public Health Case Reporting

14. Selected Conditions 1.Anthrax 2.Chlamydia trachomatis genital infection (& Gonorrhea, Syphilis) 3.Coccidioidomycosis 4.Haemophilus Influenzae, invasive disease, all ages, serotypes 5.Hepatitis B, Acute (& Hepatitis C) 6.Influenza 7.Meningococcal disease, all serogroups 8.Pertussis 9.Silicosis 10.Salmonellosis (& Shigella) 11.Streptococcus pneumoniae, invasive disease 12.Toxic-shock syndrome 13.Tuberculosis 14.Tularemia 15.West Nile virus (& Lyme) CDA for PH Project: Communicable Diseases

15. URL: https://www.projects.openhealthtools.org/sf/projects/mdht © 2012 Lisa R. Nelson Open Source Model Driven Health Tool - MDHT CDA for PH Project

16. © 2012 Lisa R. Nelson Model Driven Health Tool - MDHT The MDHT automatically generates the CDA templates, validation is built-in. CDA for PH Project

17. CDA PH Case Report Templates for Selected Conditions URL: https://wiki.phdsc.org/index.php/PH-Lab#PH-CDA_Templates_Work_Listhttps://wiki.phdsc.org/index.php/PH-Lab#PH-CDA_Templates_Work_List 1.Anthrax 2.Chlamydia trachomatis genital infection (& Gonorrhea, Syphilis) 3.Coccidioidomycosis 4.Haemophilus Influenzae, invasive disease, all ages, serotypes 5.Hepatitis B, Acute (& Hepatitis C) 6.Influenza 7.Meningococcal disease, all serogroups 8.Pertussis 9.Silicosis 10.Salmonellosis (& Shigella) 11.Streptococcus pneumoniae, invasive disease 12.Toxic-shock syndrome 13.Tuberculosis 14.Tularemia 15.West Nile virus (& Lyme) CDA for PH Project: Communicable Diseases

18. CDA Public Health Reporting: CDA for Public Health Pilot for Communicable Disease Case Reporting (November 2011 - May 2012) CDA for PH Pilot Project: Case Reporting

19. Goal Demonstrate ability to receive a CDA-based Public Health Case Report by a Public Health Information System in two jurisdictions CDA for PH Pilot Project: Case Reporting

20. Project Partners Public Health Data Standards Consortium (PHDSC) Council for State and Territorial Epidemiologists (CSTE) Association of Public Health Laboratories (APHL) Delaware Division of Public Health New York State Department of Health San-Diego County Public Health Services IBM Research OZ Systems Core Solutions Labware Connexin Atlas Public Health HLN Consulting Supported by CDC Office of Surveillance, Epidemiology, and Laboratory Services (OSELS)

21. Completed on 05/31/12 Developed CDA-based Public Health Case Reports for 15 selected conditions Conducted 3 pilot projects:  State of Delaware (Tuberculosis)  New York State (Pertussis)  San-Diego County (Pertussis)  MA, MI, OK, SC, WA participated as observers Report will be available on 08-31-12 CDA for PH Pilot Project: Case Reporting

22. CDA Public Health Case Reports https://wiki.phdsc.org/index.php/PH-Lab https://wiki.phdsc.org/index.php/PH-Lab Header Social History Section Clinical Information Section Treatment Information Section Encounters Section Relevant Diagnostics and Laboratory Section Immunizations Section Example: Case Report Documentation: Pertussis Case Reports Pertussis - Data Definitions xlsData Definitions xls Pertussis - Implementation Guide pdfImplementation Guide pdf Pertussis - Case Report 1 (XML File) (JPG Image) 12-05/10(XML File)(JPG Image) Pertussis - Case Report 2 w/Labs (XML File) (JPG Image) 12-05/10(XML File)(JPG Image) CDA for PH Pilot Project: Case Reporting

23. Public Health Reporting Schema: DELAWARE Provider EHR (Core CX360) CDA TB Case Report Delaware PH Communicatio n Server/Router (Orion Rhapsody) CDA TB Case Report Delaware Electronic Reporting Surveillance System (DERSS) CDA -based Actor Diagram CDA for PH Pilot Project: Case Reporting

24. HIE Form Manager (Oz Systems) CDA Pertussis Case Report Provider EHR (Connexin) CCD Content to Pre- populate Pertussis Case Report NYS PH-IS (UPHN) CDA -based Actor Diagram Public Health Reporting Schema: New York State CDA for PH Pilot Project: Case Reporting

25. HIE Form Manager (Oz Systems) CDA Pertussis Case Report Provider EHR (Allscripts, Test Harness) CCD Content to Pre- populate Pertussis Case Report SDC PH-IS (Atlas Public Health) CDA -based Actor Diagram Public Health Reporting Schema: San Diego County CDA for PH Pilot Project: Case Reporting

26. CDA for PH Project: EHDI CDA for PH Pilot - EHDI

27. Goal Demonstrate the ability to receive a CDA-based EHDI Report from a Public Health Information System in two jurisdictions CDA for PH Pilot Project: EHDI

28. CDA Public Health Report Templates: EHDI 1.Notification of Birth - based on newborn admission, ie, establishing newborn’s record in EHR 2.Newborn Hearing Screening Results - based on state-based forms 3.Early Hearing Care Plan (EHCP) - based on state-based plans 4.EHDI Quality Measure 1a – the number of children screened prior to discharge from a birthing facility compared to a total number of live births within the reporting time period. CDA for PH Project: EHDI

29. Health Information Exchange (HIE) Or Public Health Gateway (Vendors?) CDA EHDI Report Birthing Facility EHR (Vendors?) CDA EHDI Report State EHDI Information System (Vendors?) CDA -based Actor Diagram CDA for PH Project: EHDI

30. Timeframe Aug-Sept– Recruitment  2 State participants (To be determined)  X observers (To be determined) October 2012 – Pilot Design November 2012 – Implementation December 10, 2012 – Testing December 31, 2012 – Draft Project Report March 2013 – Final Project Report CDA for PH Project: EHDI

31. Timeframe Aug-Sept– Recruitment  2 State participants (To be determined)  X observers (To be determined) October 2012 – Pilot Design November 2012 – Implementation December 10, 2012 – Testing December 31, 2012 – Draft Project Report March 2013 – Final Project Report CDA for PH Project: EHDI

32. Recruitment

33. Timeframe Aug-Sept– Recruitment  2 State participants (To be determined)  X observers (To be determined) October 2012 – Pilot Design November 2012 – Implementation December 10, 2012 – Testing December 31, 2012 – Draft Project Report March 2013 – Final Project Report CDA for PH Project: EHDI

34. Design Outcomes State-specific teams and work schedule:  Approvers (EHDI program staff, agency’s IT staff)  Implementers (Vendors) State-specific work processes Use Case State-specific data form(s) CDA EHDI Report State-specific data reporting schema CDA for PH Project: EHDI

35. State-Specific CDA EHDI Reports (one of four) 1.Notification of Birth - based on newborn admission, ie, establishing newborn’s record in EHR 2.Newborn Hearing Screening Results - based on state-based forms 3.Early Hearing Care Plan (EHCP) - based on state-based plans 4.EHDI Quality Measure 1a – the number of children screened prior to discharge from a birthing facility compared to a total number of live births within the reporting time period. CDA for PH Project: EHDI

36. Use Case: State-Specific Story – To Be Developed Based on the Consolidated User Story for S&I Public Health Reporting Initiative

37. Health Information Exchange (HIE) Or Public Health Gateway (Vendors?) CDA EHDI Report Birthing Facility EHR (Vendors?) CDA EHDI Report State EHDI Information System (Vendors?) CDA -based Actor Diagram CDA for PH Project: EHDI State-Specific Data Reporting Schema

38. TO BE ADDED EHDI State form here and CDA report Example

39. Timeframe Aug-Sept– Recruitment  2 State participants (To be determined)  X observers (To be determined) October 2012 – Pilot Design November 2012 – Implementation December 10, 2012 – Testing December 31, 2012 – Draft Project Report March 2013 – Final Project Report CDA for PH Project: EHDI

40. IMPLEMENTATION State-specific Work Plan State-specific Test Plan CDA for PH Project: EHDI

41. Timeframe Aug-Sept– Recruitment  2 State participants (To be determined)  X observers (To be determined) October 2012 – Pilot Design November 2012 – Implementation December 10, 2012 – Testing December 31, 2012 – Draft Project Report March 2013 – Final Project Report CDA for PH Project: EHDI

42. TESTING State-specific Test Report CDA for PH Project: EHDI

43. Timeframe Aug-Sept– Recruitment  2 State participants (To be determined)  X observers (To be determined) October 2012 – Pilot Design November 2012 – Implementation December 10, 2012 – Testing December 31, 2012 – Draft Project Report March 2013 – Final Project Report CDA for PH Project: EHDI

44. For more information, please go to PHDSC Project Wiki pages at https://wiki.phdsc.org/index.php/EHDI CDA for PH Project: EHDI

45. Questions? CDA for PH Project: EHDI