1. Public Health Data Standards Consortium http://phdatastandards.info http://phdatastandards.info

2. 1 2 nd Connecting Communities for Better Health Learning Forum May 25-26, 2005, Washington DC Technical Aspects Track Developing an Incremental Pathway Towards Interoperability and Health Information Exchange Anna O. Orlova, PhD Executive Director, PHDSC and Johns Hopkins Bloomberg School of Public Health

3. 2 Clinical versus Public Health Concepts Clinical u Anthrax Dx u Asthma treatment u Immunization administration u Blood lead level u Diabetes with ketoacidosis (250.1) (in patient) Public Health u Anthrax epidemic u Asthma surveillance u Immunization stock pile u Level of lead exposure u Diabetes with ketoacidosis (250.1) (in population) Q1. Special considerations of semantic interoperability for public health Based on Steven Steindel’s Presentation “Perspectives on the Developing Public Health Vocabulary, Data Standards and Models.” AMIA, November 2004, Washington DC

4. 3 TO… u Standards in architecture allow data sharing/transfer u Common approach to PH data gathering u Communicate to PH data from outside sources u To provide access to PH data for providers u To coordinate clinical care and PH practices in serving the public’s health FROM … u No Standards for sharing of health information between PH programs u Multiple approaches to PH data gathering u Ability only communicate to one PH program at a time Based on Steven Steindel’s Presentation. AMIA, November 2004, Washington DC Q1. Special considerations of semantic interoperability for public health

5. 4 Semantic interoperability in the past is categorization Q1. Special considerations of semantic interoperability for public health Semantic interoperability in the future is commitment to adhere to all of the standards encompassed in RHIE and global NHIN specification requirements

6. 5 Q2. Specific solutions from public health that could be adopted by other HIE implementers u Missouri u Utah u Rhode Island u New York State Public Health Experience with Data Integration State Health Systems

7. 6 BIRTHS: Birth Loads, Name, DOB, Sex, Race, DCN Other Birth Info Medicaid Encounters Registration, Demographics, Scheduling, Inventory Immunization TB Family Planning Service Coordination EPSOT/DCY Traumatic Brain Injury Eligibility TL-Link Lead Family Care Safety Registry Bureau of Narcotics & Dangerous Drugs Lead Inspection & Abatement Child Care Licensing Accredited Training Registry DEPT. OF SOCIAL SERVICES DCN, Medicaid Enrollment, Aging EDL, Managed Care Info, FAMIS NEOMETRICS: Metabolic & Newborn Hearing Results Audiological Assessment Private Physician Records Real-time Link Data Merge WIC Highway Patrol HEALTH MANAGEMENT & REGULATED SURVEILLANCE Communicable Disease HIV/AIDS STD TB INTEGRATEDINTEGRATED DATABASEDATABASE Laboratories Statewide Network or Web Access INTEGRATEDDATABASEINTEGRATEDDATABASE Missouri Health Strategic Architectures and Information Cooperative Project (MOHSAIC) Ellen Wild, etal. 2004. Key Elements for Successful Integrated Health Information Systems. JPHMP,.S36-47

8. 7 CHARM SERVER Security Manager Data Catalog Child Registration Matcher & Merger Query Monitor Statistics Manager Birth Registration Newborn Metabolic Screening Newborn Hearing Screening Early Intervention Utah Statewide Immunization Info System Medicaid CNEC EPSOT System Child Health Insurance Program DHS-DCPS Foster Care Date Ware House Children With Special Health Care Needs Birth Defects Lead Screening Neonatal Follow-up PHASE IPHASE II Women Infants Children Web Access Charm Agents Charm Agents PHASE III Utah’ Child Health Advanced Records Management System (CHARM) Ellen Wild, etal. 2004. Key Elements for Successful Integrated Health Information Systems. JPHMP,.S36-47

9. 8 DOH MSDS Birth Certificate Hospital Data Entry VRS Vital Records Follow-up CMS FAX Physician or Case Manager Blood Spot Card Draw Blood Sample Mailer A. Establish link to EBC records A Exception Reports B. Report missing or late blood spot cards B C. Allow mailer image viewing through browser Mailer C Hospital HIS INTERNET WAARP Firewall WebServer New York State Integrated Clinical Management System (ICMS) C Source: Perry Smith. 2 nd Connecting Communities for Better Health Learning Forum, May 25-26, 2005, Washington DC

10. 9 Rhode Island’s KIDSNET  RHIO u Newborn Metabolic Screening Registry u Newborn Hearing Screening Registry u Birth Defect Registry u Immunization Registry u Birth Registration

11. 10 Clinical Care ADT- Birth Record Newborn Screening Test Hearing Screening Test Immunization Administration External Laboratory Hospital of Birth HL7 2.4 HL7 3.0 HL7 2.4 Public Health EHR-PH Info Exchange Newborn Screening Registry Hearing Screening Registry Immunization Registry Communicable Disease Registry State Health Department HL7 3.0 HL7 2.4 J2EE PHDSC EHR-PH System Prototype for Interoperability of Clinical and Public Health Systems, HIMSS-2005 Source: Orlova, et al. HIMSS 2005,Dallas TX, February 13-17, 2005

12. 11 PHDSC EHR-PH System Prototype for Interoperability of Clinical and Public Health System Our Prototype Illustrates how interoperability between clinical and public health systems can be achieved with a standards-based infrastructure Is built upon existing systems in clinical care and public health programs Enables electronic data reporting from a clinical setting to multiple public health systems Enables translation of customized standards into HL7 3.0 messaging standard Links clinical and public health systems to provide a continues view of the patient record across the systems involved

13. 12 Q3. Key principles and lessons learned that could be applied elsewhere u Define the goal: The goal is not to build the data exchanges The goal is to provide information for comprehensive and coordinated care via data exchange u Understand work processes of stakeholders and how they will be affected by data exchanges that will emerge u Define how to involve stakeholders To be informed is not enough Involve them in the development and implementation not just develop for them