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

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2nd Connecting Communities for Better Health Learning Forum

May 25-26, 2005, Washington DC

Population Health Track

Where and How Does Public Health Fit into Regional Health Information Exchanges

Anna O. Orlova, PhD

Executive Director, PHDSC and Johns Hopkins Bloomberg School of Public Health

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DHHS’ Framework for Strategic Action: Decade of HIT Delivering Consumer–centric and Information-rich Health Care - July 21, 2004

1. Inform Clinical Practice

2. Interconnect Clinicians

3. Personalize Care

4. Improve Population Health

Unify public health surveillance architectureStreamline quality and health status monitoringAccelerate research and dissemination of evidence

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RESPONSE TO THE REQUEST FOR INFORMATION (RFI)

on the Development and Adoption of a National Health Information Network

from the Office of National Coordinator for Health Information Technology (ONCHIT),

Department of Health and Human Services;

Released on November 15, 2004

Towards National Health Information Network:

Public Health Perspectives

Submitted to ONCHIT on January 18, 2005

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Participants from the Following Organizations(in alphabetical order):

American Health Information Management Association (AHIMA)

American Immunization Registry Association (AIRA)

American Public Health Association (APHA)

Association of Public Health Laboratories (APHL)

Association of State and Territorial Directors of Nursing (ASTDN)

Association of State and Territorial Health Officers (ASTHO)

Centers for Disease Control and Prevention (CDC)

Council for State and Territorial Epidemiologists (CSTE)

National Association of Health Data Organizations (NAHDO)

National Assoc. of County and City Health Officials (NACCHO)

PHDSC RESPONSE TO THE ONCHIT RFI

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Emerging data shows the value that standardized health information exchange will provide to all stakeholders:

Healthcare purchasers and payersHospitals and other healthcare providersLaboratoriesPracticing cliniciansPublic health

Source: John Glaser, Janet Marchibroda, Jim Schuping. CCBH. Washington, D.C. December 6-7, 2004URL: www.ehealthinitiative.com

National Health Information Network (NHIN)

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PHDSC Model:

RHIOEHR-PH

Info Exchange

PHDSC Model for Electronic Health Record-based Data Exchange

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Local and State Public Health Programs CDC Public Health Information Network (PHIN)

embracing many CDC programs including:Health Alert Network (HAN)National Electronic Disease Surveillance System (NEDSS)Epidemiology Information Exchange (EPI-X)Environmental Public Health Tracking Network (EPHTN)

HRSA Maternal & Child Health Programs HRSA Rural Health Care Programs

Examples of Public Health Programs/Systems that Will be

Impacted/Aligned by NHIN

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Examples of Public Health Programs Provided by Local Health Departments

Personal Health Services Providing Service (%)

Population Level Assurance Services

Providing Service (%)

Adult Immunizations 91 Communicable Disease Control 94Childhood Immunizations 89 Health Education/Risk

Reduction87

Tuberculosis Testing 88 Epidemiology and Surveillance 84STD Testing and Counseling

65 High Blood Pressure Screening 81

HIV Testing and Counseling

64 Tobacco Use Reduction 68

EPSDT 59 Cancer Screening 58Family Planning 58 Diabetes Screening 53WIC 55 Cardiovascular Disease

Screening50

Prenatal Care 41 Injury Control 37

Dental Care 30 Violence Prevention 22HIV Treatment 25 Occupational Safety and Health 13

Primary Care 18

Source: Scutchfield, F.D., & Keck, C.W. Principles of public health practice, 2nd ed. 2003. Thomson/Delmar Learning: Clifton Park, NY.

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PHDSC Leadership in Electronic Health Record

(EHR)Dec-March 04PHDSC Ad Hoc Task Force on

Electronic Health Record-PublicHealth (EHR-PH) to validate Health Level 7(HL7) EHR Functional

Model

July-Dec. 04 Pediatric EHR – Public Health Perspectives. Contract from HRSA

Jan-Feb. 05 Demonstration of Interoperability Across Clinical and Public HealthSystems via EHR, HIMSS-2005

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Cross-mapping of Clinical and Public Health Pediatric Data

Clinical system is a significant source of data for pediatric public health systems

59% data concepts used in clinical care maps to public health data needs

Significant redundancy can be overcome if EHR systems will populate public health programs

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Clinical Care

ADT-Birth Record

Newborn Screening Test

HearingScreening Test

Immunization Administration

External Laboratory

Hospital of Birth

HL7 2.4

HL7 3.0

HL7 3.0

HL7 2.4

HL7 2.4

Public Health

EHR-PHInfo

Exchange

NewbornScreeningRegistry

Hearing

ScreeningRegistry

ImmunizationRegistry

CommunicableDiseaseRegistry

State Health Department

HL7 3.0

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

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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 programsEnables electronic data reporting from a clinical setting to multiple public health systemsEnables translation of customized standards into HL7 3.0 messaging standardLinks clinical and public health systems to provide a continues view of the patient record across the systems involved

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Barriers Public health organization:

(1) various categorical programs(2) organized by state laws public health settings

vary in the ways their funded and managed

Understand commonalities among public health programs and settings in terms of data sources, users, goals and functions

Define business processes for integrating healthcare and public health practices

Involve public health stakeholders in standardization efforts

Develop public health vocabulary

Public Health Challenges for System Integration

Source: Electronic Health Record: Public Health Perspectives. PHDSC. White Paper. March 2004

Solutions