1. Public Health Reporting Initiative January 4, 2012

2. Agenda TopicTime Allotted Welcome / Agenda Overview – John Stinn4:00 – 4:05 Action Item Review - John Stinn4:05 – 4:10 User Story Domains Update Communicable Disease – Nikolay Lipskiy / Michael Coletta Adverse Events – Lise Stevens Child Health – Anna Orlova / Therese Hoyle Chronic Disease – Riki Merrick Infrastructure, Quality, and Research – Anna Orlova / Lise Stevens 4:10 – 4:25 Identified Issues / Clarification – Lise Stevens Workflow items Stakeholder requirements agreements Open decision points: scope (lab reporting, billing data) 4:25 – 4:35 Use Case Schedule – John Stinn4:35 – 4:40 Discussion Definitions Sub-Working Group – Riki Merrick Standardization Framework Narrative – Anna Orlova Upcoming Meetings 4:40 – 4:50 Action Items / Next Steps – John Stinn4:50 – 5:00 Adjourn5:00

3. Consolidated User Story 1: Communicable Diseases, Reporting from EHR Initial report from the EHR system (Communicable Diseases) Patient, Provider (Hospital, Physician’s office), Laboratory, PH agency 1.Patient was admitted to a hospital ER or came to a provider’s office 2.Provider provided clinical examination and assessed medical history. (same info used for reporting to 2 different programs) 1.[trigger: all ED records sent] If clinician assessment indicates that Patient has symptoms that should be reported through Syndromic Surveillance (SS) system, a SS report was sent to PH agency. Electronic confirmation was sent from PH agency /SS system to Provider. 2.[trigger: clinically significant symptoms of reportable communicable disease – sent before lab results are obtained] If patients’ symptoms require a specific communicable disease PH reporting w/o waiting lab results, a preliminary report was sent to PH agency 3.Provider ordered lab tests. Provider staff took samples and sent them to Laboratory. 4. Laboratory performed the ordered tests on received specimens. Laboratory send results to Provider and PH agency (if needed) 6.Provider re-examined clinical findings and lab results; he sent a communicable disease preliminary report to a PH agency (some initial reports require clinical and lab component). 7.Electronic message was validated by PH agency/information system 8.Electronic confirmation was sent from PH agency to Provider User Story Names: Actors: Flow of Events: Pre-condition Post-condition Preferred Timing for Each Event Type EHR System, Health Information Exchange (HIE) Public Health Agency’s Information System

4. Consolidated User Story 2: Communicable Diseases, Reporting from Electronic Laboratory System Initial report from the Laboratory system (Communicable Diseases) Laboratory, PH agency, Provider 1. Laboratory performed the ordered tests on received specimens. Laboratory send results to Provider and positive results to PH agency 2. Electronic message was validated by PH agency/information system 3. Electronic confirmation was sent from PH agency to Laboratory User Story Names: Actors: Flow of Events: Pre-condition Post-condition Preferred Timing for Each Event Type Electronic Laboratory System Public Health Agency’s Information System

5. Consolidated User Story: Child Health, Birthing Facility 1.Child is delivered. If live birth follows steps 3-9, 2.Clinician conducts initial physical exam 3.Newborn is due for 4.Clinician orders an 5.Hospital staff administers and conducts and collects and conducts 6.Hospital staff enter data on the in the EHR database 7.EHR pre-populate information to the Birth/Fetal Death Facility Worksheet 8.Hospital staff and clinician review the Birth/Fetal Death Facility Worksheet 9.Information is electronically sent on to the PH IS directly or via HIE 10.PH program IS receives notification of report availability 11.PH programs’ staff reviews the report and create PH IS record on a child in 12.PH IS sends Acknowledgement of Receipt of the Report to EHR directly or via HIE. Use Case Name: Actors: Flow of Events: Data Categories 1&2 Demographics, Antepartum Record, Prenatal record, Labor & Delivery Record, Postpartum record, Newborn EHR 3. Consent (not for birth registration) 4. Test Order or Standing Order 5. Immun. Record, Test Results, Birth Defect Record 6. Immun. Record, Hearing Test Results, Birth Defect Record, Birth Record, Heelstick Lab Order 7&8. Birth/Fetal Death Facility Worksheet 9. Initial PH Report 10. Notification of Report Availability 11. Updated PH Record 12. Acknowledgement of receipt Vital Records, Hearing, Immunization, Birth Defects, Metabolic Screening Newborn, Caregiver, Clinician, Hospital staff, Public health program staff Pre-Conditions: Post-Conditions: Preferred Timing EHR System, Health Information Exchange (HIE) Public Health Information System Daily updates

6. Consolidated User Story: Child Health, Inpatient Setting Child Health Patient, physician, clinician, public health program staff 1.Patient comes to Physician for a general check-up and he/she is due for 2.Physician orders 3.Clinician administers an immunization or conducts hearing test> 4.Clinician enter data on the in the EHR database 5.Clinician sends report to the PH IS directly or via HIE 6.PH program IS receives notification of report availability 7.PH program staff reviews the report and updated PH IS 8.PH IS sends Acknowledgement of Receipt of the Report to provider EHR directly or via HIE. Use Case Name: Actors: Flow of Events: Pre-Conditions: Post-Conditions: Preferred Timing for Data exchange EHR System, Health Information Exchange (HIE) Public Health Information System Daily updates Data Categories 1. Demographics, Consent 2. Test Order, Referral 3. Test Results 4. Test Results 5. Initial PH Report 6. Notification of Report Availability 7. Updated PH Record 8. Acknowledgement of receipt

7. Consolidated User Story 1: Chronic Diseases (cancer, occupational health) Chronic Diseases, Outpatient Flow Patient, Provider/Physician, Laboratory, PH agency 1.Patient comes to Physician with symptoms of a disease or for a check up 2.Physician provides clinical examination and assesses medical history. 3.Physician orders lab (clinical or pathology) and any diagnostic tests. Office staff takes samples and sends them to Laboratory. Any diagnostic tests are performed. 4.Laboratory performs ordered tests on received specimens. TRIGGER:reportable condition identified/diagnosed 5.Laboratory send results to Physician and PH agency for reportable conditions 6.Physician re-examines clinical findings/diagnostic results and lab results TRIGGER: reportable condition identified/diagnosed 7.Physician sends report to a PH agency for reportable conditions 8.Electronic report validated by PH agency/information system 9.Electronic confirmation/acknowledgement was sent from PH agency to Provider User Story Names: Actors: Flow of Events: Pre-condition Post-condition Preferred Timing for Each Event Type EHR System Public Health Agency’s Information System Varies, prefer real-time

8. Consolidated User Story 2: Chronic Diseases (Quality, NCHS, NE CVD) Chronic Diseases Patient, Provider/specific healthcare facility, PH agency 1.Patient comes to a specific healthcare facility TRIGGER: Patient admitted to specific healthcare facility 2. Physician orders tests, counsels and or treats patient 3. Providers/data entry clerks add lab results to the orders, medications, imaging results, history of some of these results, based on the diagnosis code TRIGGER: Patient is discharged from specific healthcare facility 4. (a) (from specific healthcare facility) and preferred Billing personnel sends discharge claim record to PHAgency or (b) (from clearing house) 1. Billing personnel sends discharge claim record to clearing house 2. Clearing House personnel sends discharge claim records to PHAgency 5. Electronic message was validated by PH agency/information system 6. Electronic confirmation /acknowledgement was sent from PH agency to Provider/facility User Story Names: Actors: Flow of Events: Pre-condition Post-condition Preferred Timing for Each Event Type EHR System Public Health Agency’s Information System Admit – 5 days after admit and 24 hours after billing code Discharge – preferred quarterly (accepted monthly or 24 hours)

9. Consolidated User Story 3: Chronic Diseases (MI genetic counseling) Chronic Diseases Patient, Provider/specific healthcare facility, PH agency 1.Patient comes to a genetic counselor 2.Patient undergoes genetic counseling for BRCA gene, Lynch syndrome, or for cardiac death in the young 3.Counselor may request physician to order genetic testing 4.Counselor may receive genetic test results 5.Counselor may have follow up visit with patient to discuss results TRIGGER:Counseling process is completed 6. Counselor send report to PHAgency 7. Electronic message was validated by PH agency/information system 8. Electronic confirmation/acknowledgement was sent from PH agency to Provider/facility User Story Names: Actors: Flow of Events: Pre-condition Post-condition Preferred Timing for Each Event Type EHR System Public Health Agency’s Information System varies

10. Issues / Clarification - Lise Workflow items Stakeholder requirements agreements Open decision points: scope (lab reporting, billing data)

11. Use Case Schedule/Development Check out the “User Stories” page on the wiki for more information about the consolidated use case ActionDate User Story working groups will present a draft of the harmonized user story for each domain 12/21/11 Harmonized Use Case Draft for member review1/25/12 Final Draft of Harmonized Use Case2/8/12

12. Discussion Definitions Sub-Working Group – Riki Merrick Standardization Framework Narrative – Anna Orlova Other?