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

2. Public Health Data Standards Consortium CDA EHDI Pilot Project Clinical Document Architecture (CDA) for Public Health CDA State EHDI Pilot Projects

3. CDA EHDI Pilot Project: Outline Health Level Seven (HL7) CDA Standard CDA for Public Health Reporting: Pilot Project for Communicable Diseases CDA for Public Health Reporting: Pilot Project for EHDI

4. CDA R2 2005 CDA for PH Project: History of HL7 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

5. 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data “as it was” when the document was originally created  Capture information and allow it to be shared  Can be superseded and corrected, but are "static documents" rather than dynamic objects  The more passive and loosely coupled your communication process is, the more the use of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

6. CDA Test Result Report XML Schema … … HL7 CDA Standard CDA Test Result Report Human Readable

7.  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

8. CDA for Public Health Reporting: Pilot Project for Communicable Diseases (November 2011 - May 2012) CDA for Public Health Reporting

9. Goal Demonstrate ability to receive a CDA-based Public Health Case Report by a Public Health Information System in two jurisdictions CDA for PH Pilot Project: Case Reporting

10. Completed on 05/31/12 Developed CDA-based Public Health Case Reports for 15 selected conditions in MHDT Conducted 3 pilot projects:  State of Delaware (Tuberculosis)  New York State (Pertussis)  San Diego County (Pertussis)  CT, MA, MI, OK, SC, WA, OH participated as observers Report available on project wiki CDA for PH Pilot Project: Case Reporting

11. CDA PH Case Report Templates for Selected Conditions 1.Anthrax 2.Chlamydia trachomatis genital infection (& Gonorrhea, Syphilis) 3.Coccidioidomycosis 4.Haemophilus Influenzae, invasive disease, all ages, serotypes 5.Hepatitis B, Acute (& Hepatitis C) 6.Influenza 7.Meningococcal disease, all serogroups 8.Pertussis 9.Silicosis 10.Salmonellosis (& Shigella) 11.Streptococcus pneumoniae, invasive disease 12.Toxic-shock syndrome 13.Tuberculosis 14.Tularemia 15.West Nile virus (& Lyme) Building CDA Public Health Reports in MDHT

12. Header Social History Section Clinical Information Section Treatment Information Section Encounters Section Relevant Diagnostics and Laboratory Section Immunizations Section HL7 CDA Standards for Public Health Case Report

13. CDA Public Health Case Reports https://wiki.phdsc.org/index.php/PH-Lab https://wiki.phdsc.org/index.php/PH-Lab Header Social History Section Clinical Information Section Treatment Information Section Encounters Section Relevant Diagnostics and Laboratory Section Immunizations Section Example: Case Report Documentation: Pertussis Case Reports Pertussis - Data Definitions xlsData Definitions xls Pertussis - Implementation Guide pdfImplementation Guide pdf Pertussis - Case Report 1 (XML File) (JPG Image) 12-05/10(XML File)(JPG Image) Pertussis - Case Report 2 w/Labs (XML File) (JPG Image) 12-05/10(XML File)(JPG Image) CDA for PH Pilot Project: Case Reporting

14. URL: https://www.projects.openhealthtools.org/sf/projects/mdht Open Source Model Driven Health Tool - MDHT Building CDA Public Health Reports (Templates)

15. Model Driven Health Tool - MDHT The MDHT automatically generates the CDA templates, validation is built-in. Building CDA Public Health Reports in MDHT

16. MDHT Library of Public Health Reports

17. Public Health Reporting Schema: DELAWARE Provider EHR (Core CX360) CDA TB Case Report Delaware PH Communication Server/Router (Orion Rhapsody) CDA TB Case Report Delaware Electronic Reporting Surveillance System (DERSS) CDA-based Actor Diagram CDA for PH Pilot Project: Case Reporting

18. CDA EHDI Pilot Project CDA for Public Health Reporting: EHDI Pilot Project

19. Goal Demonstrate the ability to receive a CDA-based EHDI Report by a Public Health Information System in two jurisdictions CDA EHDI Pilot Project

20. 1.Notification of Birth - based on newborn admission, the birthing facility’s EHR sends a report to establish a newborn’s record in state public health EHDI information system 2.Newborn Hearing Screening (NHS) Outcome Report- based on state-based forms 3. EHDI Quality Measure 1a – it measures the number of children screened prior to discharge from a birthing facility compared to a total number of live births within the reporting time period; it is based on individual patient-level NHS reports and Notification of Birth reports to compute QM EHDI-1a 4.Early Hearing Care Plan (EHCP) - based on state-based plans CDA EHDI Report Templates

21. 1.Notification of Birth - based on newborn admission, the birthing facility’s EHR sends a report to establish a newborn’s record in state public health EHDI information system 2.Newborn Hearing Screening (NHS) Outcome Report - based on state-based forms 3. EHDI Quality Measure 1a – it measures the number of children screened prior to discharge from a birthing facility compared to a total number of live births within the reporting time period; it is based on individual patient-level NHS reports and Notification of Birth reports to compute QM EHDI-1a 4.Early Hearing Care Plan (EHCP) - based on state-based plans CDA EHDI Pilot Project Scope

22. CDA EHDI Pilot Project: Newborn Hearing Screening 1.Child is delivered. 2.Clinician conducts initial physical exam 3.Newborn is due for 4.Clinician orders an 5.Hospital staff conducts 6.Hospital staff enter data on the in the EHR database and generate 7.Information is electronically sent on to the PH EHDI IS directly or via HIE 8.PH program EHDI IS receives Notification of Report Availability 9.PH programs’ staff reviews the report and create PH EHDI IS record on a child in PH EHDI IS and upload in PH EHDI IS 10.PH IS sends Acknowledgement of Receipt of the Report to EHR directly or via HIE. Use Case Actors: Business Actors Technical Actors Flow of Events Data Categories 1&2. Demographics, Labor & Delivery Record, Newborn EHR 3. Consent 4. Standing Order 5. Hearing Test Results 6. Hearing Test Results, NHS Outcome Report 7. NHS Outcome Report 8. Notification of Report Availability 9. Updated Pubic Health EHDI Record 10. Acknowledgement of Receipt Newborn Hearing Screening Newborn, Caregiver, Clinicians, Public Health Program Staff EHR, HIE, Public Health (PH) EHDI IS Pre-Conditions: Post-Conditions: Preferred Timing EHR System, Health Information Exchange (HIE) Public Health Information System Daily updates

23. Health Information Exchange (HIE) Or Public Health Gateway (Vendors?) CDA NHS Outcome Report Birthing Facility EHR (Vendors?) CDA NHS Outcome Report State EHDI Information System (Vendors?) CDA-based Actor Diagram CDA EHDI Pilot Project Design Proposed Public Health Reporting Schema: EHDI

24.  Aug - Sept– Recruitment  2 State participants (To be determined)  X State observers (To be determined)  November 2012 – Pilot Design  December 2012 – Implementation  January 10, 2012 – Testing  February, 2013 – Draft Project Report  May 2013 – Final Project Report CDA EHDI Pilot Project: Timeframe

25. TEAM States Participants:  Maryland, Massachusetts, Michigan, North Dakota, Oregon, Rhode Island States Observers  Florida, Missouri, Ohio, Pennsylvania, South Carolina, Texas, Washington, Deloitte PHDSC Team CDA EHDI Pilot Project: TEAM

26. PHDSC Team: Roles Project Director – Anna Orlova Program Manager – Alla Fridman Project Manager – Sarah Quaynor Technical Manager – Lori Fourquet Data Modeler – Lisa Nelson Project Coordinator – Maiko Minami CDA EHDI Pilot Project: TEAM

27. State Team (Approvers and Implementers): Roles Project Manager – coordinate state project activities EHDI Program Staff – define use case and data requirements EHDI Program IT Staff/Vendor – receive CDA report State Dept.CIO Staff – coordinate with vendors/EHDI program State Dept. IT Staff/Vendor – transmit CDA report to EHDI Birthing Facility Staff – coordinate with EHR vendor Birthing Facility EHR Vendor – generate and send CDA report HIE Staff – coordinate with vendors/State Dept./EHDI program HIE Vendor – transmit CDA report CDA EHDI Pilot Project: TEAM

28. Overall Documentation Project Charter Presentation Project Report Project Wiki Pages https://wiki.phdsc.org/index.php/EHDI https://wiki.phdsc.org/index.php/EHDI CDA EHDI Pilot Project

29. State-Specific Documentation State NHS Reporting Requirements (Guidelines) State NHS Report Form State-specific CDA NHS Report Form State-specific Use Case State-specific Design State-specific Work Plan State-specific Test Plan and Test Report with Screenshots and Validation Documentation State-specific presentation State-specific Project Wiki Pages https://wiki.phdsc.org/index.php/EHDI https://wiki.phdsc.org/index.php/EHDI CDA EHDI Pilot Project

30. Outcomes  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 NHS Report  State-specific pilot design  State-specific implementation CDA EHDI Pilot Project: Next Steps

31. CDA EHDI Pilot Project: State-Specific Use Case 1.Child is delivered. 2.Clinician conducts initial physical exam 3.Newborn is due for 4.Clinician orders an 5.Hospital staff conducts 6.Hospital staff enter data on the in the EHR database and generate 7.Information is electronically sent on to the PH EHDI IS directly or via HIE 8.PH program EHDI IS receives Notification of Report Availability 9.PH programs’ staff reviews the report and create PH EHDI IS record on a child in PH EHDI IS and upload in PH EHDI IS 10.PH IS sends Acknowledgement of Receipt of the Report to EHR directly or via HIE. Use Case Actors: Business Actors Technical Actors Flow of Events Data Categories 1&2. Demographics, Labor & Delivery Record, Newborn EHR 3. Consent 4. Standing Order 5. Hearing Test Results 6. Hearing Test Results, NHS Outcome Report 7. NHS Outcome Report 8. Notification of Report Availability 9. Updated Pubic Health EHDI Record 10. Acknowledgement of Receipt Newborn Hearing Screening Newborn, Caregiver, Clinicians, Public Health Program Staff EHR, HIE, Public Health (PH) EHDI IS Pre-Conditions: Post-Conditions: Preferred Timing EHR System, Health Information Exchange (HIE) Public Health Information System Daily updates

32. State-specific CDA EHDI Reports Templates Instances in MDHT CDA EHDI Pilot Project: Data

33. Health Information Exchange (HIE) Or Public Health Gateway (Vendors?) CDA NHS Outcome Report Birthing Facility EHR (Vendors?) CDA NHS Outcome Report State EHDI Information System (Vendors?) CDA-based Actor Diagram CDA EHDI Pilot Project Design State-Specific EHDI Reporting Design

34. FOR PARTICIPANTS AND OBSERVERS List of Participants and Observers  Validate your contact information – by Oct 29th  Assemble State Team (Staff and EHR, HIE, PH Vendors) – by Nov 10th  Supply State Team contact information – by Nov 10th PROJECT CHARTER  Review and send revisions in track changes – by Oct 30th  Finalize Project Charter by Nov 30 th PRESENTATION  Review and provide revisions by Oct 31 st CDA EHDI Pilot Project: Next Steps

35. FOR PHDSC TEAM Nov 1 st Call- Educate Participants and Observers about interoperability standards that may be used in the state- specific CDA EHDI pilot projects, e.g., CDA, CCD, RFD, XDR, XDS, EHCP, PCD01  Assemble documentation on these standards in wiki By Nov 15 th Call Assess State technical capabilities and secure vendor commitment Review State EHDI forms - Participants and Observers will submit their NHS forms by Oct 30 to Maiko Minami Define State-specific use cases Start development of State projects designs CDA EHDI Pilot Project: Next Steps

36. CDA EHDI Pilot Project: Time Commitment Source: Public Health Data Standards Consortium (PHDSC). Clinical Document Architecture (CDA) for Public Health. CDA Pilot Project Report. October 2012. URL: https://wiki.phdsc.org/images/f/f1/PHDSC-CDA-for-PH-Pilot-Report-FINAL-10-12-12.pdfURL: https://wiki.phdsc.org/images/f/f1/PHDSC-CDA-for-PH-Pilot-Report-FINAL-10-12-12.pdf

37. Resources: 1.PHDSC. Clinical Document Architecture (CDA) for Public Health. CDA Pilot Project: Communicable Diseases. Report. October 2012. URL: https://wiki.phdsc.org/images/f/f1/PHDSC-CDA-for-PH-Pilot-Report- FINAL-10-12-12.pdfURL: https://wiki.phdsc.org/images/f/f1/PHDSC-CDA-for-PH-Pilot-Report- FINAL-10-12-12.pdf 2.CDA for Public Health Pilot Project: Communicable Diseases wiki pages – URL: https://wiki.phdsc.org/index.php/CDAhttps://wiki.phdsc.org/index.php/CDA 3.CDA for Public Health Pilot Project: Communicable Diseases PHDSC-IBM CDC Press Release. URL: http://www- 03.ibm.com/press/us/en/pressrelease/38602.wsshttp://www- 03.ibm.com/press/us/en/pressrelease/38602.wss 4.CDA for Public Health Pilot Project: Communicable Diseases Forbes on NYS Pilot. URL: http://www.forbes.com/sites/amywestervelt/2012/08/27/could-technology- help-stem-the-spread-of-whooping-cough/ http://www.forbes.com/sites/amywestervelt/2012/08/27/could-technology- help-stem-the-spread-of-whooping-cough/ PHDSC CDA for Public Health Pilot Project

38. For CDA EHDI Pilot Project information, please go to PHDSC Project Wiki pages at https://wiki.phdsc.org/index.php/EHDI PHDSC Team Point of Contact: Maiko Minami maiko@hln.commaiko@hln.com CDA EHDI Pilot Project

39. Questions? CDA EHDI Pilot Project