1. HL7 Electronic Health Record System (EHR-S) Public Health Functional Profile (PHFP) Project PHDSC Annual Business Meeting November 8, 2012 Hetty Khan Health Informatics Scientist Centers for Disease Control and Prevention National Center for Health Statistics Classifications and Public Health Data Standards Staff

2. NCHS/PHDSC Collaboration on Standards Activities for Public Health NCHS supports the PHDSC’s goal to empower the healthcare and public health communities with health information technology standards to improve individual and community health NCHS provides support for PHDSC projects to develop Health Level Seven (HL7) International standards to support public health requirements 2

3. Health Level Seven International (HL7) HL7 Vision To Create the Best and Most Widely Used Standards in Healthcare HL7 Mission HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients © 2002-2009 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off

4. What is the HL7 EHR-S Functional Model?  The EHR-S FM presents a superset of functions for an EHR system from which a user/setting specific subset can be generated  The HL7 EHR-S FM standard is consensus-based and internationally-oriented  Creates a common platform for providers, vendors, partners, stakeholders and others to describe needed EHR functionality

5. Direct Care DC.1Care Management DC.2Clinical Decision Support DC.3Operations Management and Communication Supportive S.1Clinical Support S.2Measurement, Analysis, Research and Reports S.3Administrative and Financial Information Infrastructure IN.1Security IN.2Health Record Information and Management IN.3Registry and Directory Services IN.4Standard Terminologies & Terminology Services IN.5Standards-based Interoperability IN.6Business Rules Management IN.7Workflow Management Functions describe the behavior of a system in user-oriented language so as to be recognizable to the key stakeholders of an EHR System EHR-S Functional Model at a Glance

6. EHR-S FM Standard

7. What is a Functional Profile? An HL7 EHR-S Functional Profile is a subset of functions identified for a specific healthcare delivery setting or domain, for example: Long Term Care Ambulatory Care Behavioral Health Pharmacy Child Health Clinical Research Public Health

8. Public Health Functional Profile (PHFP) Project  Development of the PHFP is:  funded by NCHS/CDC  supported by the Public Health Data Standards Consortium (PHDSC)  co-sponsored by : HL7 Electronic Health Record Work Group HL7 Public Health & Emergency Response Work Group

9. Public Health Functional Profile  Public Health Functional Profile (PHFP):  Conforms to the HL7 EHR-S FM  Includes a subset of functions of the EHR-S FM required or desired for implementation in EHR systems or health care delivery settings to support the needs of public health and public health-clinical information exchanges for specific public health programs (domains)

10. NCHS/PHDSC Timeline for HL7 EHR-S FM Projects 2004200820102011 2012 2013 Evaluation of EHR-S FM: Public Health Perspective NCHS developed Vital Records Functional Profile (VRFP) Re- evaluation of EHR-S FM R.1.1 PHFP Release 2: All previous domains and adding 9. Adverse Events PHFP Release 1.1, Version 2: 4. Public Health Laboratory 5. Occupational Disease 6. Health Statistics 7. Deep Vein Thrombosis 8. Birth Defects PHFP Release 1.1, Version 1: 1. Vital Records 2. Early Hearing Detection and Intervention 3. Cancer

11. PHFP - Release 1.1, Version 1 2010 - 2011

12. PHFP - Release 1.1, Version 2 2011- 2012

14. Direct Care DC.1Care Management DC.2Clinical Decision Support DC.3Operations Management and Communication Supportive S.1Clinical Support S.2Measurement, Analysis, Research and Reports S.3Administrative and Financial Information Infrastructure IN.1Security IN.2Health Record Information and Management IN.3Registry and Directory Services IN.4Standard Terminologies & Terminology Services IN.5Standards-based Interoperability IN.6Business Rules Management IN.7Workflow Management Functions describe the behavior of a system in user-oriented language so as to be recognizable to the key stakeholders of an EHR System EHR-S Functional Model at a Glance

15. EHR-S FM Release 2 Chapter Reorganization Overarching (O) Care Provision (CP) Care Provision Support (CPS) Population Health Support (POP) Administrative Support (AS) Record Infrastructure (RI) Trust Infrastructure (TI) Direct Care (DC) Supportive (S) Information Infrastructure (IN)

16. The R1.1 Direct Care and Supportive Functions have been regrouped into four Chapters: Release 2 Reorganization Care Provision Support CPS.1Record Management CPS.2Support Externally-sourced Information CPS.3Support Clinical Documentation CPS.4Support Orders CPS.5Support Results CPS.6Support Treatment Administration CPS.7Support Future Care CPS.8Support Patient Education & Communication CPS.9Support Care Coordination & Reporting Care Provision CP.1Manage Clinical History CP.2Manage Externally-sourced Information CP.3Manage Clinical Documentation CP.4Manage Orders CP.5Manage Results CP.6Manage Treatment Administration CP.7Manage Future Care CP.8Manage Patient Education & Communication CP.9Manage Care Coordination & Reporting

17. Release 2 Reorganization Population Health Support POP.1Support for Health Maintenance, Preventive Care and Wellness POP.2Support for Epidemiological Investigations of Clinical Health Within a Population POP.3Support for Notification and Response POP.4Support for Monitoring Response Notifications Regarding a Specific Patient’s Health POP.5 Donor Management Support POP.6 Measurement, Analysis, Research and Reports POP.7 Public Health Related Updates POP.8 De-Identified Data Request Management POP.9Support Consistent Healthcare Management of Patient Groups or Populations Administration support AS.1 Manage Provider Administrative Information AS.2 Manage Patient Administrative Information AS.3 Manage Personal Health Record Administration AS.4Manage Communication AS.5Manage Clinical Workflow Tasking AS.6Manage Resource Availability AS.7 Manage Encounter/Episode of Care Administration AS.8Manage Financial Transaction Processing

18. Release 2 Reorganization The R1.1 Infrastructure support Functions have been regrouped into two Chapters: Record Infrastructure RI.1Record Management RI.2Record Synchronization RI.3Record Archive Trust Infrastructure TI.1Security TI.2Audit TI.3Registry and Directory Services TI.4Standard Terminology and Terminology Services TI.5Standards-Based Interoperability TI.6Business Rules Management TI.7Workflow Management TI.8Database Backup and Recovery TI.9 System Management Operations and Performance

19. PHFP Transition - Release 2 2012 - 2013

20.  Public Health Functional Profile may:  Lay the foundation for developing a Public Health Information Systems (PHIS) Functional Model Include functions and criteria applicable to PHIS 2012-2013 Project Task: – Analyze the PHFP R2 to determine the core set of functional requirements that are common to all public health domains included in the profile, identifying potential areas for harmonization Public Health Functional Profile Purpose and Vision

21. Public Health Functional Profile: Vision Public Health Laboratory Cancer Registries Occupational Disease Vital Records EHDI Common Public Health Functions Health Statistics Birth Defects DVT/PE Adverse Events

22. Plans for PHFP Certification 2012-2013 Serve as a reference for certification of EHR systems that include functionality to support PH domains  2012 – 2013 Project Task:  Meet with public health and EHR certification experts to review and discuss the PHFP and to determine how it may serve as the infrastructure to support certification of EHR systems that meet PH requirements for the public health domains included in the PHFP  Develop recommendations on EHR systems certification based on the outcomes of the review and discussion of the PHFP by the certification experts

23. Functional Profiles

24. Questions? National Center for Health Statistics Classifications and Public Health Data Standards Staff