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

2. Pilot Participants ~ Webinar ~ Clinical Document Architecture (CDA) for Public Health CDA State EHDI Pilot Projects Anna Orlova, PhD aorlova@jhsph.edu Public Health Data Standards Consortium Baltimore, Maryland, USA

3. CDA for PH Project: Outline Project Background Pilot Design Pilot Implementation

4. CDA for PH Project: Background What is being exchanged?  HL7 V2.x Messages  HL7 CDA Documents  Examples Relationship to Meaningful Use (MU) Stage 2 Modeling - Model Driven Health Tools

5. URL: http://www.ringholm.de/docs/04200_en.htmhttp://www.ringholm.de/docs/04200_en.htm  HL7 2.3 standard is currently in use in Electronic Health Records Systems (EHRs) and often used in public health information systems  Support point-to-point communication  Messages contain “current” data  Convey status and updates for an ongoing process in real-time  Used when latest version of data is of importance to support an ongoing process  The more interactive and tightly coupled your communication process, the more message use is applicable. HL7 Message-based Standards: HL7 2.x and 3.0 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. URL: http://www.ringholm.de/docs/04200_en.htmhttp://www.ringholm.de/docs/04200_en.htm  They are the Continuity Care Record (CCD) standard and Clinical Document Architecture (CDA) standards  They represent information in documents (i.e., forms)  Used “post occurrence”, i.e. once the actual process is done to provide "snapshots" at a particular time  Contain data “as it was” when the document was originally created  Capture information and allow it to be shared  Can be superseded and corrected, but are "static documents" rather than dynamic objects  The more passive and loosely coupled your communication process is, the more the use of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. HL7 Document-based Standards: CCD/CDA 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. 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 Tuberculosis 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 HL7 Standards: Laboratory Use Case

8. CDA Lab Result Report XML Schema … … HL7 CDA Standard CDA Lab Result Report Human Readable

9.  Stage I – Use HL7 CDA documents  Clinical EHRs  Stage I – Use HL7 v2.3.1 or v2.5.1 messages to electronically record, modify, retrieve, submit public health data  Syndromic Surveillance – use v2.3.1 or v2.5.1  Laboratory Results Reporting to Public Health – use v2.5.1  Reporting to Immunization Registries - use v2.3.1 or v2.5.1  Stage II – Use HL7 CDA documents  Reporting to State Cancer Registries  Reporting of Early Hearing Detection and Intervention (EHDI) Quality Measures to Public Health HL7 Standards in Meaningful Use of HIT

10. URL: https://www.projects.openhealthtools.org/sf/projects/mdht © 2012 Lisa R. Nelson Open Source Model Driven Health Tool - MDHT Building CDA Public Health Reports (Templates)

11. © 2012 Lisa R. Nelson Model Driven Health Tool - MDHT The MDHT automatically generates the CDA templates, validation is built-in. Building CDA Public Health Reports in MDHT

12. CDA for PH Project: Pilot Design Goal Project Outcomes Use Case EHDI Reports to exchange PH Reporting Schema

13. Goal Demonstrate the ability to receive a CDA-based EHDI Report by a Public Health Information System in two jurisdictions State-Specific CDA EHDI Report for Newborn Hearing Screening Results CDA EHDI Pilot Project

14.  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 EHDI Pilot Project: Outcomes

15. State-Specific using S& I Framework PHRI Consolidated User Story CDA EHDI Pilot Project: Use Case 1.Child is delivered. If live birth follows steps 3-9, 2.Clinician conducts initial physical exam 3.Newborn is due for hearing test 4.Clinician orders hearing test 5.Hospital staff conducts hearing test 1.Hospital staff enter data on the hearing test in the EHR database 2.EHR pre-populate information to the Birth/Fetal Death Facility Worksheet 3.Hospital staff and clinician review the Birth/Fetal Death Facility Worksheet 4.Information is electronically sent on hearing test to the PH IS directly or via HIE 5.PH program IS (EHDI IS) receives notification of report availability 6.PH programs’ staff reviews the report and create PH IS record on a child in EHDI IS Out of scope }

16. 1.Newborn Hearing Screening Results - based on state-based forms 2.Early Hearing Care Plan (EHCP) - based on state-based plans CDA EHDI Report Exchange

17. State-Specific CDA EHDI Reports Templates Instances CDA EHDI Pilot Project: Report mapping

18. Information Manager Birthing Facility EHR State EHDI Information System CDA EHDI Pilot Project: Data Exchange Public Health Reporting Schema: EHDI Hearing Screening Device Newborn notification report Screening Result Msg Early Hearing Care Plan

19. CDA for PH Project: Implementation Project Roles Implementation Testing Outcomes Timeline

20. CDA for PH Pilot Project: Project Roles Supported by CDC Office of Surveillance, Epidemiology, and Laboratory Services (OSELS) NameProject Mgmt Data Mgmt Data Model Test Mgmt PHDSC ✔✔✔✔ State PH program ✔✔ Vendor System ✔✔

21. State-specific Work Plan  Data Model  CDA Model  Sample document instances  User Story mapped to CDA model State-specific Test Plan  Steps to be tested  Record of test results CDA EHDI Pilot Project: Implementation

22. State-specific Test Report  Screenshots  CDA documents  Validation reports Project Report  Project overview  Goals  Actors and Roles  Test plan  Outcomes CDA EHDI Pilot Project: Testing Outcomes

23.  Aug - Sept– Recruitment  2 State participants (To be determined)  X State 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 EHDI Pilot Project: Timeframe

24. PHDSC Team: Anna Orlova, Principal Investigator Sarah Quaynor, Pilot Project Manager and Data Manager ???, Pilot Project Technical Manager Lisa Nelson, Data Modeler Maiko Minami, Project Coordinator Alla Fridman, Program Manager For more information, please go to PHDSC Project Wiki pages at https://wiki.phdsc.org/index.php/EHDI CDA EHDI Pilot Project

25. Questions? CDA EHDI Pilot Project