1. Unit 3: Interoperability Standards in Public Health IT
Welcome to Public Health IT, Unit 3. In this unit we will be discussing interoperability standards in public health IT.
Lecture a – Types of Electronic Public Health Reporting Identified by the EHR Incentive Program
This material (Comp13_Unit3a) 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 This material was updated by Columbia University under Award Number 90WT0004.
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2. Interoperability Standards in Public Health IT Learning Objectives
Objective 1: Explain and describe the Meaningful Use and MIPS Advancing Care Public Health Objective
Objective 2: Describe the Public Health Engagement process required for Meaningful Use compliance
Objective 3: Know the ONC Certified Capabilities of EHRs that support public health capabilities
Objective 4: List and discuss the public health IT standards used for Meaningful Use and MIPS Advancing Care public health objectives or referred to in the ONC Standards Advisory
The learning objectives for the interoperability standards in public health IT unit are: 1) Explain and describe the Meaningful Use and MIPS Advancing Care Public Health Objective, 2) Describe the Public Health Engagement process required for Meaningful Use compliance, 3) Know the ONC Certified Capabilities of EHRs that support public health capabilities, and 4) List and discuss the public health IT standards used for Meaningful Use and MIPS Advancing Care public health objectives or referred to in the ONC Standards Advisory. This lecture we will introduce the public health objective in the EHR Incentive Program otherwise known as Meaningful Use and in the Merit-Based Incentive Payment System programs. We will review each type of public health electronic reporting contained within the objective.

3. Reporting to public health
Electronic reporting to public health is one of the initiatives of the EHR Incentive program
Initially, immunizations, syndromic surveillance, and reportable lab results
List expanded with each stage
In addition to public health authorities, communication to clinical data registries added
Communication is done using health care interoperability standards
One of the initiatives of the EHR incentive program or Meaningful Use was to have EHRs electronically communicate with public health authorities so that the information collected could be used to for public health monitoring and to improve the health of the public. Initially, immunizations, syndromic surveillance, and reportable lab results were communicated. The list expanded with each stage and eventually included communication to specialized registries supported by public health organizations as well as private registries. The new MIPS regulation includes the same public health objective. The communication between EHRs and public health authorities is done using interoperability standards such as HL7 Version 2 and Clinical Document Architecture or CDA and terminology standards such as LOINC for lab results, and NDC codes for immunizations.
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4. Beyond Meaningful Use
Starting in Stage 3, the public health authorities can be electronically queried by EHRs for a complete immunization forecast on a patient
This type of bi - directional use of the information collected would allow health care providers to more rapidly benefit from the public health and clinical data registry sources
Ultimately, clinicians could make decisions based on a more complete view of a specific patient or recommendations based on knowledge gained from the analysis of data collected on patients as a whole
Starting in Meaningful Use Stage 3, the public health authorities can be electronically queried by EHRs for a complete immunization history and forecast on a patient to guide them in making immunization decisions. This type of bi-directional use of the information collected would allow health care providers to more rapidly benefit from the public health and clinical data registry sources. This change from uni-directional to bi-directional communication provides advanced interoperability. Ultimately, bi-directional communication with public health and clinical data registries could allow for clinicians to have a more complete view of a specific patient across the care continuum. It might also allow them to receive recommendations based on knowledge gained from the analysis of data collected on patients as a whole.
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5. Types of data electronically reported
Immunizations
Syndromic surveillance
Reportable results
Notifiable conditions (cases)
Cancer cases
Health surveys
Health care associated infections
Etc.
Through the efforts of the meaningful use program, EHRs now electronically send immunizations, syndromic surveillance, and reportable results to public health authorities throughout the United States. Other interfaces have been built to communicate specific disease information such as cancer cases or other information of interest to public health authorities such as electronic case reporting, health care associated infections, and others. The next set of slides will describe the types most commonly communicated electronically.
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6. Type of data electronically reported: immunizations
Report patient immunizations to a local public health authority
The ultimate goal (which is reflected in Stage 3) is that a clinician can query to get an up to date immunization list containing immunizations from a variety of sources
Reporting immunization information to a local public health authority has been part of the Meaningful Use program since Stage 1. The ultimate goal (which is reflected in Stage 3) is that a clinician is not only able to send immunization information, he or she can also query the public health authority to get a full immunization history and forecast on a patient that is created using up to date immunization information from a variety of sources.
3.1 Figure (Creative Common, Public Domain acquired from Public Health Image Library)
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7. Type of data electronically reported: syndromic surveillance
Early reporting of conditions to a local public health authority to allow for early detect of patterns signaling a public health problem
Examples:
Notification of all emergency or urgent care admissions which include the patient’s chief complaint
Notifications of flu – like symptoms reported at doctor’s offices
Syndromic surveillance has also been part of Meaningful Use since Stage 1. The concept of syndromic surveillance is to provide timely information to allow for early detection of possible public health problems. For inpatient, emergency, and urgent care, this means reporting on every single admission and discharge so that surveillance can be done on the reasons for admission and the diagnosis on discharge across a public health jurisdiction and patterns can be detected – such as a rise in the number of Zika cases. It is also possible for a public health authority to conduct syndromic surveillance on non-urgent ambulatory care. However, there is currently no standard widely adopted to support the non-urgent case. In this case it does not make sense to report every visit because there are so many and many are not of a serious nature. While there is no standard implementation guide, some public health authorities have published their own ambulatory specifications, such as the NY City Department of Health which tracks flu-like symptoms for non-urgent doctor visits.
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8. Type of data electronically reported: reportable lab results
Electronic reporting labs of positive lab results for specific tests being monitored which would indicate specific public health case concerns or patterns
Public health authorities determine the list of tests to be reported on
For example, a positive TB test
Public health authorities regularly determine what hospital lab results they want to monitor abnormal results on across their jurisdiction. For example, the list most likely contains tuberculosis. When a lab test on the reportable lab results list has an abnormal value, it is reported to the public health authority.
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9. Type of data electronically reported: electronic case reporting
Reporting when a clinician documents in the EHR that a patient has a condition that is on an established list of reportable conditions
‘‘Reportable conditions’’ defined by the state, territorial, and local public health authorities to monitor disease trends and support the management of outbreaks
Examples would include patient having a contagious virus such as Zika or Ebola.
Another type of data electronically reported is Electronic Case Reporting. Electronic Case Reporting to public health authorities is triggered when a clinician documents in the EHR that a patient has a condition that is on an established list of reportable conditions. The current list of reportable conditions is defined by the state, territorial, and local public health authorities to ensure that they monitor disease trends and support the management of outbreaks. Examples of notifiable conditions would include patients having a contagious virus such as Zika or Ebola.
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10. Type of data electronically reported: public health registries
Reporting of specific data sets to a public health specialized registry
“Administered by, or on behalf of, a local, state, territorial or national public health agency and which collects data for public health purposes”
For example, hospital birth and death reporting, antimicrobial use and resistance, or national health care surveys
A public health specialized registry focuses on the collection of a specific set of data. It is administered by, or on behalf of, a local, state, territorial or national public health agency and which collects data for public health purposes. Some examples might include hospital birth and death reporting, antimicrobial use and resistance, and national healthcare surveys results.
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11. Type of data electronically reported: clinical data registries
Reporting of specific data sets to a clinical data registry
“NOT administered by, or on behalf of, a local, state, territorial or national public health agency and which collects data for public health purposes”
Example might include a registry for a specific chronic disease or traumatic injury
A Clinical Data Registry refers to a registry that is focused on specific sets of data just like the public health registries. However, it is NOT administered by, or on behalf of, a local, state, territorial or national public health agency and which collects data for public health purposes.” An example might include a registry for a specific chronic disease or traumatic injury. Perhaps a professional society manages the registry.
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12. Unit 3: Data Standards in Public Health IT, Summary – Lecture a
This lecture summarized how public health objectives play a role in both the Meaningful Use and the MIPS programs
It described the different types of information being electronically reported which includes:
Immunizations
Syndromic surveillance
Reportable results
Notifiable conditions (cases)
Information for specialized public and non – public registries
This lecture summarized how public health objectives play a role in both the Meaningful Use and the MIPS programs. It also described the different types of information being electronically reported which includes immunizations, syndromic surveillance, reportable results, notifiable conditions otherwise known as case reporting, and information for public and non-public registries such as cancer case information and healthcare surveys.

13. Data Standards in Public Health IT References – Lecture a
Accredited Standards Committee X12. Retrieved on July 10th, 2010 from
Agency for Toxic Substances & Disease Registry. Retrieved on July 10th, 2010 from
American College of Radiology national Electrical Manufactures Association (ACR- NEMA).
AHIMA Industry Standards and Activities. Retrieved on July 10th, 2010 from
American Dental Association. Retrieved on July 10th, 2010 from
American Society for Testing & Materials. Retrieved on July 10th, 2010 from
Analysis of Unique Patient Identifier Options Final report.
Association for Information and Image Management:. Retrieved on July 10th, 2010 from
No audio.

14. Data Standards in Public Health IT References – Lecture a (Cont’d – 2)
CCHIT.
Clinical and Laboratory Standards Institute (CLSI). Retrieved on July 10th, 2010 from
Clinical Data Interchange Standards Consortium. Retrieved on July 10th, 2010 from
Computer Security Division Community Security Resource Center. Retrieved on July 10th, from
Designated Standard Maintenance Organization (DSMO). Retrieved on July 10th, from
Gartner Healthcare Presentation. Retrieved on July 10th, 2010 from
Global Patient Identifiers. Retrieved on July 10th, 2010 from
No audio.

15. Data Standards in Public Health IT References – Lecture a (Cont’d – 3)
Health Industry Business Communications Council (HIBCC). Retrieved on July 10th, from
HIMSS Health Information Exchange
HIMSS Overview of HIE & RHIOs.
HL7. Retrieved on July 10th, 2010 from
Institute of Electrical and Electronics Engineers. Retrieved on July 10th, 2010 from
Institute of Medicine Recommendation for a National Chronic Disease Surveillance System
International Organization for Standardization (ISO). Retrieved on July 10th, 2010 from
Mapping and Public Health.
National Council for Prescription Drug Programs.
No audio.
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16. Data Standards in Public Health IT References – Lecture a (Cont’d – 4)
National Institute of Standards and Technology. Retrieved on July 10th, 2010 from
Nationally Notifiable Diseases Surveillance System. Retrieved on July 10th, 2010 from
Office of Surveillance, Epidemiology, and Laboratory Services.
Public Health Informatics Institute. Retrieved on July 10th, 2010 from Public Health Informatics and Information Systems edited by Patrick W. O’Carroll, William A. Yasnoff, M. Elizabeth Ward, Laura H. Ripp, & Ernest L. Martin, 2003 ISBN
National Information Standards Organization (NISO). Retrieved on July 10th, 2010 from
National Uniform Billing Committee (NUBC). Retrieved on July 10th, 2010 from
No audio.
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17. Data Standards in Public Health IT References – Lecture a (Cont’d – 5)
Reliable Patient Identification Project.
Sample Universal Healthcare Identifier.
Shapiro, J. S. Evaluating Public health uses of health information exchange.
White Paper Unique Health Identifier for Individuals. Retrieved on July 10th, 2010 from
No audio.
Chart, Tables and Figures:
3.1 Figure: Creative Commons, Public Domain acquired from Public Health Image Library.
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18. Unit 3: Interoperability Standards in Public Health IT
This material (Comp 13 Unit 3a) 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 IU24OC This material was updated in 2016 by Columbia University under Award Number 90WT0005.
No audio.
End.