1. NAPHSIS Annual Meeting 2014Slide 1 NAPHSIS ANNUAL MEETING | Seattle | June 8-11, 2014 VITAL RECORDS: A CULTURE OF QUALITY Death Certification from an EHR in Utah: How’s this for meaningful? Jeff Duncan Health Informatics Program Manager Utah Department of Health

2. NAPHSIS Annual Meeting 2014Slide 2 The Idea “ Why can’t I just login to my EHR and sign a death certificate?” -Anonymous physician, University of Utah Medical Center, 2007

3. NAPHSIS Annual Meeting 2014Slide 3 Who uses an EHR in 2007? – Intermountain Healthcare What infrastructure would we use to get data from an EHR into our death database? – Existing HL7 interface for immunization data How do we ensure NCHS and UDOH data standards? – Very detailed contract specifications and lots of coordination Questions we asked then…

4. NAPHSIS Annual Meeting 2014Slide 4 200920102011201220132014 CDC Pan Flu Grant UDOH received funding to create a death reporting interface with Intermountain. Pilot testing Implemented at one Intermountain Clinic HL7 Version 2.3 Interface Planning and Development Interface development and testing Pilot test expanded to Salt Lake City Metro Area Timeline of events—UDOH-Intermountain Death Interface Upgrade to DSTU Project begins Implement DSTU HITECH Meaningful Use Stage I

5. NAPHSIS Annual Meeting 2014Slide 5 Original Project Goals Improve timeliness – Surveillance depends on timeliness – < 72 hours for physician to certify Improve data quality – Reduce ill-defined causes of death – Increase amount of information on death certificate Increase physician participation – 70 to 80% use EDEN

6. NAPHSIS Annual Meeting 2014Slide 6 Overview of EHR Certification Process

7. NAPHSIS Annual Meeting 2014Slide 7 Death certificates per month over HL7 interface

8. NAPHSIS Annual Meeting 2014Slide 8 Timeliness

9. NAPHSIS Annual Meeting 2014Slide 9 Change in workflow Funeral Director Initiates record Physician Certifies record EDEN Workflow (94% of deaths) Physician certifies record in HELP2 Funeral Director initiates record in EDEN Intermountain Workflow (51% of deaths)

10. NAPHSIS Annual Meeting 2014Slide 10 Number of Unique ICD10 codes

11. NAPHSIS Annual Meeting 2014Slide 11 Other conditions listed?

12. NAPHSIS Annual Meeting 2014Slide 12 Interval listed for underlying cause?

13. NAPHSIS Annual Meeting 2014Slide 13 Challenges 1. Change in Workflow

14. NAPHSIS Annual Meeting 2014Slide 14 Challenges Matching and merging – Link on name, DOB, sex, SSN – Must be exact match or manual resolution Data precedence – Name – Date of death – Time of death – Date last seen – ME Case

15. NAPHSIS Annual Meeting 2014Slide 15 2007 2014 Who uses an EHR in 2007 2014? 85% of hospitals – Intermountain Healthcare 85% of hospitals What infrastructure would we use to get data from an EHR into our death database? – Existing HL7 interface for immunization data Need infrastructure to support reporting from health care to public health How do we ensure NCHS and UDOH data standards? – Very detailed contract specifications and lots of coordination – Standards Development and Implementation Questions we ask now…

16. NAPHSIS Annual Meeting 2014Slide 16 Standards Development and Implementation HL7 Death Reporting IHE Vital Records Death Reporting (VRDR) Profile – EHR presents YOUR form to the physician – Provides guidance to EHR vendors and Vital Records vendors Reciprocate data exchange through standards – Patient discovery can be used to report fact and cause of death back to healthcare

17. NAPHSIS Annual Meeting 2014Slide 17 Acknowledgements NCHS – Michelle Williamson – Delton Atkinson Intermountain Healthcare Team – Jacob Tripp, PhD Utah Department of Health – Leisa Finch, EDR Coordinator Multidimensional Software Creations (MDSC) – Stephen Clyde, PhD – Mike Jolley, Project Manager

18. NAPHSIS Annual Meeting 2014Slide 18 NAPHSIS ANNUAL MEETING| Seattle | June 8-11, 2014 VITAL RECORDS: A CULTURE OF QUALITY Thank You Jeff Duncan jduncan@utah.gov