1. Riki Merrick, APHL Anna Orlova, PhD, PHDSC Lise Stevens, FDA Nikolay Lipskiy, MD, DrPH, MBA – CDC CSTE Conference June 5 th, 2012 The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of CDC, FDA or APHL.

2. Office of the Chief Scientist National Coordinator for Health IT Office of Economic Analysis & Modeling Office of the Chief Privacy Officer Deputy National Coordinator for Operations Deputy National Coordinator for Programs & Policy Office of Policy & Planning Office of Standards & Interoperability Office of Provider Adoption Support Office of State & Community Programs The Standards and Interoperability (S&I) Framework is a forum –enabled by integrated functions, processes, and tools – for implementers and experts to achieve harmonized interoperability for healthcare information exchange It represents one investment and approach adopted by the Office of Standards & Interoperability to fulfill its charge of enabling harmonized interoperability specifications to support national health outcomes and healthcare priorities, including Meaningful Use, the Nationwide Health Information Network, etc.

3. Source: http://wiki.siframework.org/S%26I+Framework+Functions

4.  Every S&I Initiative focuses on a single challenge  Using a set of value-creating goals and outcomes  Creating of content, technical specifications and reusable tools and services  Enhance efficiency, quality and effectiveness of the delivery of healthcare Growing number of S&I initiatives since 2011 http://wiki.siframework.org

5.  ORIGIN: Public Health Reporting Initiative (PHRI) first community led initiative grew out of the Laboratory Reporting Initiative  FOCUS:  Provider-Initiated Reports of Individual-level Electronic Health Records (EHR) information to Public Health Agencies …as opposed to Query of EHRs  Harmonization / alignment of data elements across different Public Health Agencies (domain specific) http://wiki.siframework.org/Public+Health+Reporting+Initiative Provider EHR Local/State/ Federal PH Provider - Initiated Report

6.  Reduce variability in data exchange specifications across public health programs and jurisdictions  Improve interoperability and data exchange between healthcare and public health  Reduce burden on senders  Reduce burden on public health to receive, extract, translate, load and analyze  Core date elements for most ready PH programs possibly by Stage 3 (October 2015; testing 2012)  Possibly after Stage 3 (later phase of initiative)

7.  Over 100 members from a wide variety of stakeholder organizations:  Federal/State PH reporting programs  Standards Development Organizations  Vendors  Professional Associations  Five (5) co-leads, Two (2) Liaisons for Stakeholder Communications and Outreach, Two (2) Facilitators and an ONC Liaison  Bi-Weekly meetings (Wednesdays 4-5P EST) http://wiki.siframework.org/Public+Health+Reporting+Initiative

8.  Over 30 user stories contributed from local, state and Federal agencies and from PH associations  Identify Core data elements for all reports  Harmonize data elements to simplify reporting process  Created 5 domains:  Communicable disease  Chronic disease  Newborn/Child health  Adverse event reporting  Infrastructure/quality/research (not in first phase) http://wiki.siframework.org/PH+Reporting+User+Stories#User Stories

9.  Immunization reporting to immunization registries (MU stage 1)  Electronic laboratory reporting of reportable condition lab results (MU stage 1)  Syndromic surveillance reports (MU stage 1)  Cancer registry reports (proposed MU stage 2)

10.  Describing stakeholders, actors, triggers  ID core data elements  Harmonize vocabularies  Analyze existing standards (e.g., HL7 2.5.1 or Clinical Document Architecture (CDA)) OUT OF SCOPE (among other things):  Defining reportable events in a jurisdiction  Extensive bi-directional communication (beyond acknowledgments)  Defining transport protocols

11.  PHRI - Charter – Completed  User Stories - Completed Domain specific Consolidated across Domains  Use Case – Completed  Data Element Harmonization Profile – June Domain specific Consolidated for Common Core Elements across Domains  User Story Readiness Assessment – June  Functional Requirement Analysis and Standards Selection – June  Technical Specification (Implementation Guide) – August  Pilots – September

12.  Data mapping/harmonization:  Defining core common data elements for PH and mapping to EHR data model – most of them exist already!  Adding data elements to MU stage 3, if required occupational data elements, smoking status value sets  Modeling PH data elements to clinical care using Federal Health Information Model (FHIM)  Reconciling PH programs Occupational data elements use across programs Different stages of readiness of the programs

13.  Assessment of potential readiness of user stories by Stage 3 of Meaningful  Selection of appropriate message/document format(s)  Creation of Implementation Guide  Reference implementation and pilot test  Consideration by HIT Standards Committee (4 th Qtr)

14. Phase 1Phase 2 User Story / Use Case Development Phase 1Phase 2 2/293/143/284/11 4/25 5/9 5/23 2/15 2/1 1/17 1/3 Standards Analysis and Selection; Data Dictionary; DAM Pilot Readiness Assessment 6/6 6/20 7/47/18 8/1 8/15 Implementation Guide Development Public Comment Public Comment - CLOSED Public Comment Communication / Outreach Functional Requirements / Data Element Requirements / IE Requirements PHRI – Use Case /Standards Harmonization / Specification You Are Here Courtesy of John Stinn

15. Phase 1 (September-December 2011) Charter has been finalized All participants work together on - assessment of needs for the process - building a consensus on public health reporting definitions - building a consensus on a scope of the Public Health Reporting HIT Standardization Framework - development of criteria and selection use cases - defining a list of WGs Forming workgroups and starting assessment of existing artifacts in a scope of the initiative Development of detailed work plan AugSeptOctNovDecJanFebMarAprilMayJuneJulyAugSeptOct Initiation PHRI - Roadmap User Story Validation Use Case Documentation FR / Modeling Stds Harm Phase 2 & 3 (January-May; May - October) Harmonization of selected use cases into a single use case Identification of core data elements and data classes Working on harmonization of FHA and segment enterprise architecture for public health reporting Working on terminology Identification and Harmonization of vocabulary / content Exchange Standards Development of implementation documentation Completion of assessment of business process, policy barriers Open source reference implementation Pilot Demonstration Spec Develop. Reference Implementation Pilot Evaluation for Certification Courtesy of John Stinn

16. For current status and to participate, visit the wiki: http://wiki.siframework.org/Public+Health+Rep orting+Initiative To contact the speaker: rmerrick@iconnectconsulting.com