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Anna Orlova and Lori Reed-Fourquet Public Health Data Standards Consortium and eHealthSign Business...
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Transcript of Anna Orlova and Lori Reed-Fourquet Public Health Data Standards Consortium and eHealthSign Business...
Anna Orlova and Lori Reed-Fourquet
Public Health Data Standards Consortium and
eHealthSign
Business Process Analysis (BPA) for Public Health Systems Interoperability:
From Business Cases towards Interoperability Standards
Acknowledgements:
Public Health Data Standards Consortium (PHDSC)
National Association of City and County Health Officers (NACCHO), USA
Participants of the NACCHO Workshop on Business Process Analysis in Public Health, Salt Lake City, UT, December 2011
Centers for Disease Control and Prevention (CDC), USA
Quality, Research and Public Health Committee, Integrating the Healthcare Enterprise (IHE)
Public Health and Emergency Response Workgroup, Health Level Seven (HL7)
Structured Documents Workgroup, HL7
Provider 1
Provider 2
Provider 3
Provider 4
Provider X
Quality Improvement
Public HealthLaboratory
Vital Statistics
Communicable Diseases
Immunization
EnvironmentalHealth
Injury Control
School Health
Chronic Care
Biosurveilance,Preparedness
Genetic Disorders
Women & Children
CDA2
IHE
X12
NCPDP
Quality Improvement
Public HealthLaboratory
Vital Statistics
Communicable Diseases
Immunization
EnvironmentalHealth
Injury Control
School Health
Chronic Care
Biosurveilance,Preparedness
Genetic Disorders
Women & Children
HL7Provider 1
Provider 2
Provider 3
Provider 4
Provider X
From Connectivity to Interoperability
Healthcare Public HealthTODAY
Healthcare Public HealthTOMORROW
Term Definition
Business Area Public health roles (objectives) in the society performed by the agency
Domain Public health program/division/office within an agency that realizes the implementation of a given business area or multiple business areas
Business Process Activities to support a particular role (objective)
Information System Functions
Functional requirements for information systems to support business processes
Case (or Public Health Case)
A health-related event (condition) that by law is of interest to a particular public health program at the local, state or federal level
Public Health Reporting An information exchange (send, recieve, retrieve) on a public health case (health-related event (condition, occurence)) that by law is of interest to a particular public health program at the local, state or federal level
Terms and Definitions
The operation of local, state and federal public health agencies under the core public health functions (assessment, policy and assurance) is focused on enabling resources and services for the public’s health protection. The public health operates under the following business areas:
•Population – Know population to serve•Resources – Know healthcare capacities and other resources to serve the population•Environment – Know the environment in your jurisdiction to prevent and control possible public’s health threat exposure to the served population•Protection – Enable protection of the public in the jurisdiction from diseases and exposure to biohazards, environmental agents and natural disasters •Wellness – Promote wellness for the served population•Direct Care – Enable access to care for underserved population and people with special needs •Agency Operation – Enable program operation to provide services to the population in need•Research – Conduct research to evaluate public health interventions and to develop new interventions
Harmonizing Public Health Operation across Various Domains/Programs
Core Public Health Functions
Public Health Business Processes
Patient-level Population level
ASSESSMENT
Case identification Outbreak identification
Case investigation Outbreak investigation
Case management Outbreak management
ASSURANCE
Case management evaluation
Outbreak management evaluation
POLICYMitigation Mitigation
Business Processes: Patient & Population Level
Information System Functions
Examples of Related IHE Profiles and Standards
Collect Data RFD, XDS, LAB TF (XD*Lab, Lab message), QRPH content (EHDI, PRPH-CA, MCH, DSC), PCC Content (LDS, XDS-MS, XPHR, IC), RPE, RDA, XD* with HL7 CDA for PH ReportingReporting Requirements (Pending HL7 work)Report Criteria Guideline ManagerPractice ManagerData Source Workflow (XDW)
Manage Data (upload, maintain, delete)
Control Access (XUA, ATNA)
Analyze Data (Statistical Algorithms), Syndromic Surveillance Algorithms (DSUB, MPQ), Retrieve Medical Knowledge QRPH-29
Integrate Data IT Infrastructure Profiles (PIX, PDQ, XDS, XDR, On-Demand Documents, XDW)
Report Data PDF, Maps, Send Distribution QRPH-30
Examples of Interoperability Standards by Information Systems Function
Public Health
Business Areas
NACCHO-PHDSC Business Process Analysis for Pubic Health: Project Findings
Public Health Business ProcessesIndividual/Population
Public Health
Business Areas
NACCHO-PHDSC Business Process Analysis for Pubic Health: Project Findings
Public Health Business ProcessesIndividual/Population
Information Systems
Functions
Public Health
Business Areas
NACCHO-PHDSC Business Process Analysis for Pubic Health: Project Findings
Public Health Business ProcessesIndividual/Population
Information Systems
Functions
Data Content
Public Health
Business Areas
NACCHO-PHDSC Business Process Analysis for Pubic Health: Project Findings
Public Health Business ProcessesIndividual/Population
Information Systems
Functions
Data Content
Population
Resources
Environment
Protection
Wellness
Direct Care
Operations
Research
Public Health
Business Areas
Case/Outbreak
IdentificationCase/
Outbreak Investigation
Public Health Business ProcessesIndividual/Population
Information Systems
Functions
Data Content
Case/Outbreak
ManagementCase/
Outbreak Management
EvaluationMitigation
Population
Resources
Environment
Protection
Wellness
Direct Care
Operations
Research
Public Health
Business Areas
Case/Outbreak
IdentificationCase/
Outbreak Investigation
Public Health Business ProcessesIndividual/Population
Information Systems
Functions
Data Content
Case/Outbreak
ManagementCase/
Outbreak Management
EvaluationMitigation
Collect Data
Manage Data
Integrate Data
Analyze Data
Report Data
Population
Resources
Environment
Protection
Wellness
Direct Care
Operations
Research
Public Health
Business Areas
Case/Outbreak
IdentificationCase/
Outbreak Investigation
Public Health Business ProcessesIndividual/Population
Information Systems
Functions
Data Content
Case/Outbreak
ManagementCase/
Outbreak Management
EvaluationMitigation
Collect Data
Manage Data
Integrate Data
Analyze Data
Report Data
Guidelines
Case/Outbreak Reports
Alert & Notification
Quality Reports
Educational Materials
Lab Reports
Care Plans
Population
Resources
Environment
Protection
Wellness
Direct Care
Operations
Research
Public Health
Business Areas
Public Health Program Examples:
Early Hearing Detection & Intervention (EHDI)
andPublic Health Laboratory
Public Health Business ProcessesIndividual/Population
Information Systems
Functions
Data Content
Public Health
Business Areas
Workflow Standards
Health IT Standards
Content Standards
Use Cases
Guiding the HIT Standardization for Public Health
Case/Outbreak
IdentificationCase/
Outbreak Investigation
Public Health Business ProcessesIndividual/Population
Information Systems
Functions
Data Content
Case/Outbreak
ManagementCase/
Outbreak Management
EvaluationMitigation
Collect Data
Manage Data
Integrate Data
Analyze Data
Report Data
Guidelines
Case/Outbreak Reports
Alert & Notification
Quality Reports
Educational Materials
Lab Reports
Care Plans
Population
Resources
Environment
Protection
Wellness
Direct Care
Operations
Research
Public Health
Business Areas
Newborn Hearing ScreeningWorkflow
Short-Term Care Follow-up Workflow
Case Identification
Case Investigation
Case Management
Labor & Delivery Summary
Hearing Screening
Order/Results
MS: Hearing Risk Factors
Labor & Delivery Workflow
Early Hearing Care Plan
Updated Hearing Care Plan
Newborn Care Workflow
Hearing Screening
Quality Measures
Early Hearing Detection and Intervention (EHDI) ProgramWorkflow
StandardsHealth IT Standards
Content Standards
Use Cases
Population
Resources
Environment
Protection
Wellness
Direct Care
Operations
Research
LaboratoryWorkflow
Case Management
Workflow
Case Identification
Case Investigation
Case Management
Chief ComplaintMedical
Summary
Lab order/ Results
Risk Factors
Visit to Provider
Case Management
PlanUpdatedPlan
Case InvestigationWorkflow
PH Questionnaire
Communicable Diseases Programs (Lab Data)Workflow
StandardsHealth IT Standards
Content Standards
Use Cases
Population
Resources
Environment
Protection
Wellness
Direct Care
Operations
Research
Business Processes /
Activities
Information Exchange Content by DomainExamples of
IHE Interoperability StandardsEHDI
PH-LabPreparedness (Anthrax)
Surveillance (Influenza)
CASE IDENTIFICATIONTrigger: Due for screening / Present with symptoms
Input:Notification of birthOutput: Standing order
Input: Medical SummaryOutput: Test Order
Input: Medical Summary Output: Test Order
XDS-MS/XPHR/C32 XDS/XDR/Lab-Technical Framework (TF)PIX/PDQ/QRPH29 – Retrieve medical knowledge/PCC Care Management TF
Trigger: Order test/Standing order for the test
Input: Consent (or by statute)Output:Test order
Input: Consent (or by statute)Output:Test order
Input: Consent (or by statute)Output:Test order
BPPCLAB TF
Trigger: Conduct test
Input: Test orderOutput:Test results
Input: Test orderOutput:Test results
Input: Test orderOutput:Test results
PCD-01/LAB TF/ RFD/XDR/DSUB/NAV
Business Processes, Data Content, Standards: Early Hearing Detection & Intervention & PH Labs
Information Systems (Technical Actors)
Business Actors by Domain
EHDI PH-Lab
Hospital EHR-S Birthing Facility ER, Inpatient
Ambulatory EHR-S Pediatrician Outpatient
Medical Device Hearing Screening Device
N/A
LIMS N/A Public Health LaboratoryClinical LaboratoryReference Laboratory
Public Health Information Systems (IS)
EHDI IS Condition-Specific IS
Actors and Information Systems: Early Hearing Detection & Intervention (EHDI) & PH Labs
N/A – Not applicable
Public Health Report Clinical Information
Source
Public Health Reporting Requirements, Quality Measure Requirements
Source
Public Health Report Source
Public Health Information Source Form
Filler
Public Health Report Form
Manager
Retrieve Public Health Report Form along with CCD pre-pop data [ITI-34]
Deliver pre-pop Public Health report form QRPH-yy
Public Health Report Form
Receiver
Submit Completed Public Health Report Form [ITI-35]
Public Health Reporting Decision Processing Entity
Send Distrib Msg [QRPH-30] Recv Process
Definitions (QRPH-Y1)
Public Health Report
Lab-1 Result Message XD*Lab
PCD-01 Device Result Message
ARPH
APSR
Cardiology (TBD)
XDS-MS, XPHR, LDS
Public Health Report Consumer
Initiate Public Health Reporting Process QRPH-xx
Initiate Public Health Reporting Process QRPH-xx
Retrv Medical Knowledge [QRPH-29]
Interoperability Standards Schema: Early Hearing Detection & Intervention & PH Labs
URL: http://www.phdsc.org/standards/pdfs/PHDSC_Business_Case_Public_Health_HIT-Standardization.pdf
Business Case: Public Health in HIT Standardization
PHDSC Business Case: HIT Standardization Phases, Products and Entities
HIT Standardizati
on Phases
Needs &
Priorities
Development &
Maintenanc
e
Selection &
Harmonization
Testing/Trial Implementati
on
Certification
Deployment
Goals
What should be
accomplished?
What are the standards?
What standards
to use?
Show what can be
accomplished
Certify standards-
based products
Deploy standards-
based products
HIT Standards and
Interoperability Framework Development
Entities
HIT Policy Committee
HIT Standards Committee
SDOs(e.g., HL7,
SNOMED (IHTSDO), LOINC,
ASC X12,NUBC, ISO
TC215)
IHE
S&I Harmonization Framework
Initiatives
IHE
Certification Entities(CCHIT,
Drummond Group, Inc)
IHE & PHDSC
Deployment Workshops
Standards Documents
Use Cases (Description of the health information exchanges)
Standards
Interoperability Specifications
Technical Frameworks
Integration Profiles
Test Reports
Functional Profiles
Certification Criteria
Deployment Reports
On-going Activities ( 2008-now)
Developed methodology for public health participation in HIT standards development & harmonization.
New Activities (2010-11) Develop methodology for public health participation in HIT product testing and certification
Future Activities Develop methodology for evaluation of standard-based HIT products (standards-based HIT products deployment)
Source: Fridsma D. Standards and Interoperability Framework: Principles and Processes. HIT Standards Committee. September 21, 2010. URL: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1817&parentname=CommunityPage&parentid=28&mode=2&in_hi_userid=11673&cached=true
Assuring Health IT Standards for Public Health
HL7 PH Functional Profile HL7 PH Reporting Requirements Standard
IHE PH Reporting Integration Profile
PH Systems Certification
ProposedPH Reporting Initiative
StandardsInteroperability Standards:
Testing & CertificationUse Cases
Interoperability Showcase™
HIT Standardization and PHDSC ProjectsHIT
Standardiza-tion Phases
Needs &
Priorities
Development &
Maintenance
Selection &
Harmonization
Testing /Trial Implemen-
tationCertification Deploy-
ment
Goals What should be accomplished?
What are the standards?
What standards
to use?
Show what can be
accomplished
Certify standards-
based products
Deploy standards-based products
Public Health
Domains Undergoing
HIT Standardiza
-tion
AHIC / MU:Biosurveillance
Immunization
ELR
Public Health Reporting
Newborn Screening
Vital Records
Biosurveillance
Immunization
PH-Lab
Public Health Reporting
Newborn Screening
Vital Records
Biosurveillance
Immunization
PH-Lab
Public Health Reporting
Newborn Screening
Vital Records
PH-Lab
Public Health Reporting
Hearing
Vital Records
PH-Lab
Public Health Reporting
Hearing
Vital Records
PH-Lab
Hearing
ONCStandards
and Interopera-bility
Framework
PHDSC Projects
HITSP Projects
Admin Data
URL: http://www.phdsc.org/standards/pdfs/PHDSC_Business_Case_Public_Health_HIT-Standardization.pdf
QUESTIONS?