1. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Public Health and Meaningful Use of Health IT Nikolay Lipskiy, MD, DrPH, MBA Standards and Interoperability Lead, CDC, Public health Informatics and Technology Program Office (PHITPO) November 3, 2010

2. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Purpose Describe participation of the CDC in development of public health IT meaningful solutions, meaningful use (MU) strategies and objectives in areas of standardization and interoperability

3. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Background For decades, CDC has engaged in the development of expertise, information, and tools that help people and communities protect their health. CDC has a strong commitment to support the development and deployment of standard-based public health information systems and for fostering the use and exchange of consistent information among public health partners. MU activities became a critical CDC component in further consolidation and improvement of state and national public health systems CDC actively participate in development of MU objectives and setting up priorities for population health

4. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Background (cont.) CDC has established the MU Advisory Group and Sub-Groups for specific topics. The most important objectives of this Group are: 1. Develop CDC strategies: Addressing CDC Director’s priorities, particularly: Excellence in surveillance, epidemiology, and laboratory services Strengthen support for state, tribal, local and territorial public health Better prevention of illness, injuries, disease, and death. Supporting the use of health information technology to improve the quality of health care, reducing health disparities and improving public health. Increase coordination with community resources. Coordinating state and community resources to support national and state bi-directional information exchange 2. Serve as the CDC Point of Contact for Meaningful Use 3. Guide communication and coordination across the agency

5. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Background (cont.) CDC MU Advisory Group/ Sub-Groups: The Standards, Interoperability and Certification Sub-group (SIC SG) is charged with implementing of the Advisory Group vision on: a) Assessment and harmonization of Public Health IT standard solutions for meaningful exchange of information b) Development and implementation of strategies and solutions for testing and certification of electronic public health records

6. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Meaningful Use: Public Health Opportunities and Potential Threats Opportunities: 1.High visibility and additional attention to informatics 2.Additional resources 3.Improvement of care coordination and additional attention to prevention 4.Improvement of electronic data exchange 5.Potential improvement of interoperability of clinical and population electronic care data exchange Potential Threats: 1. High interest to included in MU objectives may reduce interest to other important PH priorities 2. Funding challenges for programs that were not included in a scope of MU 3. High interest to MU certification that may reduce interest to PH certification and interoperability 4. Additional challenges in rapid implementation of standards that were not included in MU legislation

7. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services MU Stage 1 Public Health Objectives and Development of the “One Stop Shop” for PH Vocabularies and Messaging Guides Electronic Laboratory Reporting Immunization Reporting Syndromic Surveillance Reporting The PHIN VADS Vocabulary Team has started CDC-wide collaborative efforts on assessment of vocabulary-related PH capacities for addressing needs of the meaningful use objectives and maintenance and distribution of respective groups of value sets. This task includes but not limited to a gathering of business requirements from CDC programs and our partners, filling out gaps in standard code systems, binding them into structures of HL7 messages etc.

8. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Syndromic Surveillance Reporting 1.Facility Identifier 2.Facility Name 3.Facility Location 4.Unique Visiting ID 5.Visit Date/Time 6.Unique Patient Identifier 7.Medical Record # 8.Age 9.Age Units 10.Gender 11.Zip Code 12.State 13.County 14.Race 15. Ethnicity 16. Diagnosis/Injury Code 17. Diagnosis Type 18. Discharge Disposition 19. Disposition Date/Time 20. Patient Class 21. Chief Complaint/Reason for Visit 22. Temperature 23. Pulse Oximetry 24. Date of Onset 25. Report Date/Time

9. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Syndromic Surveillance Reporting (cont.) The Public Health Information Network (PHIN) is in a process of development of the Syndromic Surveillance Reporting Messaging Guide Sets of Value Sets, VADS Views, will be maintained through the PHIN VADS

10. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Health IT Standards and Interoperability: Potential Focus Areas for MU Stages 2-3 Data elements EHR Data Elements/Content Standards Public Health Reporting Measures Quality Measures Governance of the National Data Exchange & Data Exchange Standards HIT Certification/ PH Certification Standards and Interoperability Framework

11. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Capturing Additional Data Elements and Adding Content Standards for Public Health Programs Capturing additional behavior risk factors: drug abuse for patients 13 years old or older alcohol use for patients 13 years old or older Reporting laboratory results: Using LOINC codes for reporting tests and SNOMED codes for test results Reporting family history of diseases (i.e., cancer, diabetes, hypertension, genetic disorders etc.) Adding to reportable through EHR vital signs: body temperature Reporting pregnancy status Reporting additional demographics: insurance status, current patient residence, patient address history (for 5 past years), country of birth, usual and current occupation, date of death

12. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Quality Measures: Working on PH MU Objectives for Stages 2-3 * People with CVD, taking Aspirin; Adequate BP control for people with hypertension; Controlling hyperlipidemia among people with high Cholesterol; Smoking cessation

13. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Analysis of MU Stage 1 Quality Measures Several critical national public health priorities were not included in Stage 1. For example: Prevention of lower respiratory diseases Accidents (unintentional injuries) Teen pregnancy prevention Smoking cessation

14. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Quality Measures Workgroup Tiger Teams Care Coordination Efficiency Including Underuse and Overuse Patient Safety Patient and Family Engagement Methodological Issues Population and Public Health

15. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Care Coordination Tiger Team’s Tasks and PH Priorities (Example) Source : David Lansky, Co-Chair QM WG / HIT Policy Committee Presentation October 20, 2010 Incorporate preventive care tasks that are related to PH objectives

16. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Tiger Teams’ Population & Public Health Sub-Domains * Healthy Lifestyle Behaviors—Longitudinal outcome measures of improvement (or lack of improvement) resulting from patient health-related behaviors. Effective Preventive Services—Longitudinal outcome measures of improvement (or lack of improvement) resulting from the use of preventive health care. Health Equity—Longitudinal outcome measures that evaluate the quality of health care across priority populations to track and prevent inequities and health care disparities. * Source : David Lansky, Co-Chair QM WG / HIT Policy Committee Presentation October 20, 2010

17. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services HITPC Population and PH Tiger Team: Potential Stages 2-3 Candidates for PH-related Quality Measures Source : David Lansky, Co-Chair QM WG / HIT Policy Committee Presentation October 20, 2010

18. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Public Health and Meaningful Use of Health IT

19. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services The National Standards and Interoperability (S&I) Framework * Documents of the FACA HIT Standards Committee meeting on 09/21/2010 S&I Mission: * Promote a sustainable ecosystem that drives increasing interoperability and standards adoption Create a collaborative, coordinated, incremental standards process that is led by the industry in solving real world problems Leverage “government as a platform” –provide tools, coordination, and harmonization that will support interested parties as they develop solutions to interoperability and standards adoption. The ONC S&I Process Public Health will work on integration of the PH domain into the national S&I Framework : development of PH use cases assisting ONC in a harmonization of PH concepts Development of implementation specifications etc.

20. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services The NIEM Model and PH Infrastructure Base S&I Framework modeling on the 3 OMG/MDA model abstractions. Computational Independent Model (CIM) Platform Independent Model (PIM) Platform Specific Model (PSM) * Source: Documents of the FACA HIT Standards Committee meeting on 09/21/2010

21. Public Health Informatics and Technology Program Office Office of Surveillance, Epidemiology, and Laboratory Services Questions?