1. PHDSC Ad Hoc Task Force on Electronic Health Record-Public Health (EHR-PH) Public Health Data Standards Consortium http://phdatastandards.info/ Anna O. Orlova, Ph.D. PHDSC and Johns Hopkins School of Public Health 2004 PHDSC Annual Meeting on Public Health Data Standards March 18, 2004 Bethesda, MD

2. Participants PHDSC Ad Hoc Task Force on Electronic Health Record-Public Health (EHR-PH) Developers Caesar, Craig; Claudio, Yvonne; Connor, Kathleen; Cortes, Leslie; Coto, Arturo; Davis, Robert; Eisenberg, Floyd; Gioia, Phillip; Greenberg, Marjorie; Grinsteinner, Alan; Hollar, David; Jackson, Brian; Jenkins, Melinda; Kitchelt, Maureen; Kukafka, Rita; Lafferty, Particia; Manderscheid, Ron; Merryweather, Patricia; Murphy, Gretchen; Orlova, Anna; Peeples, Malinda; Saba, Virginia; Spivack, Richard; Suarez, Walter; Timpka, Toomas; Van Duyne, Ron; Williamson, Michelle. Validators Arzt, Noam; Berkowitz, Murray; Brandes, Wayne; Brown, Kevin; Buckeridge, David; Cernoch, Jennifer; D’Attore, Terry; Edmunds, Margo; Elee, Olivia; Forslund, David; Gordon, Barry; Hanken, Mary Alice; Hanrahan, Lawrence; Hall, John; Keelaghan, Eithne; Kim, George; LaVenture, Martin; Ledbetter, Starla; Len, Christie; Lober, Bill; Marchbroda, Janet; Mittal, Vikrant; Richesson, Rachel; Ryan, Deborah; Sappington Rodney; Singer, Steve; Sullivan, Janet; Wangia, Victoria.

3. Goal: To provide a public health perspective to the evaluation of the HL7 EHR functional model Objectives: bring the state and local public health agencies and public health research community’s perspective into the on-going efforts to develop the HL7 functional model for the EHR, and to demonstrate the benefits of an organized interaction between the public health and clinical health care. PHDSC Ad Hoc Task Force on Electronic Health Record-Public Health (EHR-PH)

4. Timeline PHDSC Ad Hoc Task Force on Electronic Health Record-Public Health (EHR-PH) Dec. 2, 2003Call for Participation Dec.15 Call for Developers and Validators Jan. 5, 20041 st Call for Developers Jan.152 nd Call for Developers First Draft Jan.18-23HL7 EHR SIG Meeting, San Diego, CA Second Draft Feb.101 st Call for Validators Third Draft Feb. 262 nd Call for Validators Fourth Draft Mar. 9, 2004Final Document

5. The Task Force activities show a need for a better understanding of informatics perspectives of public health by the various stakeholders as follows: (1)public health organization (domain/programs and hierarchical fragmentations) and stakeholders, (2)commonalities among public health domains/programs and public health settings in term of data sources, users, public health goals and functions, (3)role of the EHR in integrating primary care and public health practices, and (4)the processes for involving the various public health stakeholders in the national effort for the standardization of health care data via the EHR. PHDSC Ad Hoc Task Force on Electronic Health Record-Public Health (EHR-PH)

6. WHITE PAPER on Electronic Health Record: Public Health Perspectives Purpose: (1) to communicate to the public health community a need for broader involvement in the national effort to standardize clinical and public health data and systems and (2) to describe public health perspectives on the EHR. Outline: I.The Field of Public Health – Informatics Perspectives II.EHR: Clinical Care and Public Health Interactions - EHR for Public Health - EHR: Barriers for Implementation III.EHR Functional Model and Public Health IV.Developing Use Cases for EHR Demonstration Plus 9 Attachments PHDSC Ad Hoc Task Force on Electronic Health Record-Public Health (EHR-PH)

7. White Paper on Electronic Health Record: Public Health Perspectives Outcomes: (1)EHR is critical to bridge clinical care and public health (2)Cross-mapping of the HL7 EHR functional model to core public health functions (assessment, policy and assurance) demonstrates that at this high level of abstraction, these core public health functions are well represented in the HL7 EHR functional model. (3)More granular level of cross-mapping is needed to assure the ability of the model to support public health work flow and data flow. (4) Examples of Use Cases were developed for more granular cross-mapping of the HL7 EHR functions and EHR. (5)EHR expands traditional public health to population health by allowing for integration environmental, social, economic and other data types critical to protection of health of the US population PHDSC Ad Hoc Task Force on Electronic Health Record-Public Health (EHR-PH)

8. Feedback from the HL7 & EHR Collaborative To the PHDSC EHR-PH Participants “Your process was the most thorough of any validation conducted to date, producing the most comprehensive and in depth report of any validation requested by HL7 and the EHR Collaborative.” “Your commitment and strong desire to assess the link between public health and the HER was demonstrated not only by the sheer number of people who developed the tools and validated the model, but also the quality of the report as well.” “ As you may have seen in the media lately, the HER standard is gaining visibility as we get closer to the release of the ballot (March 18). Based on the excellence of this report, I will make every attempt to draw attention to the work you’ve done and the results you’ve found.” To the PHDSC EHR-PH Participants “You are simply not going to believe how awesome this report from public health is. It is the most comprehensive validation report filed to date with the EHR Collaborative”. “You’ll find more than a few testimonial statements in the letter HL7. It would be really terrific to highlight public health’s linkage to the EHR.” “Based on this report, there are now some more definitive statements that can be made to the media” “plans to highlight these results to the media and the rest of the industry”…..”to publish in journals of the HER Collaborative ( e.g., JAHIMA, JAMA, JAMIA, JHIM)” PHDSC Ad Hoc Task Force on Electronic Health Record-Public Health (EHR-PH)

9. Use Case-I Immunization: Option - Child has a record in EHR and Immunization Registry Use Case-II Infectious Disease: Inhalation Anthrax Use Case-III Chronic Disease Screening: Hypertension Use Case-IV Chronic Disease: Diabetes and RetinopathyScreening Use Case-V Traumatic Brain Injuries- external cause of injury reporting PHDSC Ad Hoc Task Force on Electronic Health Record-Public Health (EHR-PH) EHR: Toward Implementation

10. Use Case: Traumatic Brain Injuries - External Cause of Injury Reporting MODEL OF WORK FLOW & DATA FLOW Data classes needed: 1.Patient demographics 2.Provider information 3.Care provided 4.Injury cause 5.Care cost

11. From Use Case(s) Implementation Demonstration to National Population Health Data Model to Public Health Information Network to Global Health Data Model to Global Electronic Health Information Network Public Health Data Standards Consortium http://phdatadtandards.info/

12. Public Health Data Standards Consortium http://phdatadtandards.info/ SO, UNITED WE STAND Global Electronic Health Information Network