Solano County Health and Social Services PH Lab HIE project

Linking 4 County PH Labs and linking reports to hospitalsStephan Betz, Ph.D.Assistant Director for OperationsSolano County Health and Social ServicesMarch 21, 2013

Solano County Health and Social Services PH Lab HIE project - Overview

• Link primary care, behavioral health, public health, clinical lab, public health lab data: ~17,000 current patients

• Regional PH Lab includes Solano, Napa, Yolo, Marin counties.• 119,962 potential clients of PHP of California in these four counties• Build HIE while building new PH Lab Information system, using

Mirth Connect, a data channeling system• Engaged in a partnership with Redwood Mednet to build the HIE

channels.• Unique opportunity for region wide standardized structured

reporting

Solano County Health and Social Services PH Lab HIE project

Purpose: Share developments of Public Health Lab Information System in 3-4 counties Kick off a process to receive input for standardized reporting

Solano County Health and Social Services PH Lab HIE project – Why bother?

PH Lab data allow providers to:

• Share communicable disease reports

• Receive lab results electronically in the provider’s EHR as part of the HITECH Meaningful Use Initiative Phase 2

• Standardize structured reporting (Ron Chapman’s second day at work)

Solano County Health and Social Services PH Lab HIE project - Plan

• Link County Nextgen system to PH Lab IMS “Advanced Business Software”

• Link PH Lab to other Nextgen users: Community Clinics• Link PH Lab to Marin clinics using Centricity• Meet Meaningful Use Stage 2 criteria• Lessons Learned: Keep field and messaging definitions broad and

general, use content to dynamically transmit information

Solano County Health and Social Services PH Lab HIE project – Plan more

• Get input from communities of interest: Providers, patients, Care Coordinators, Other County Labs, County Health Officers

• Develop scenarios in partnership with key stakeholders• Develop functional requirements in partnership with key

stakeholders• Develop message content requirements in partnership with key

stakeholders

Solano County Health and Social Services PH Lab HIE project – Status

• Design Jan – May 2013

• Test June – July 2013

• Go Live July 2013

Solano County Health and Social Services PH Lab HIE project – Potential Components

ABC PHIMS

Solano County Health and Social Services PH Lab HIE project – Current Design Steps

Develop a substantial roadmap document resulting in Standardized Structured DataProduce a planning document that specifies PH Lab reporting Work with Nextgen EHR Connect on linking to the bundled interface to achieve a 60% discountFocus on infection report and analysisTest, then re-test, then test again

Solano County Health and Social Services PH Lab HIE project – Challenges

Implementation guides not adopted Format “Forest”Cost and time for broad adoption too high Customization of interfaces is common creating a need for configuration per interface, Composition of core subsets varies -> issues in decision support and quality reporting.Result-reporting formats must conform to CLIA regulation (42 CFR 493.1291(c)) creating data format rigidityMeaningful Use doesn't provide incentives to change practices. No compelling ROI

Solano County Health and Social Services HIE project - Components

• e-Prescribing to improve medication reconciliation at local acute care facilities• Electronic Labs -- Clinic laboratories receive electronic orders from or deliver

electronic test results into certified EHRs at clinics• Public health laboratory receives electronic orders and posts electronic test

results to clinics (present) and local hospitals (future)• Care Transition Messaging -- Eligible providers receive care summaries for their

patients from specialty care (present) and local hospitals (future); Eligible providers push patient care summaries to other systems via Mirth Connect;

• IZ Reporting -- Submit immunization reports to the California Immunization Registry (CAIR) (Future)

• DiSTRIBuTE -- Enable hospitals to publish daily syndromic surveillance signals to CDC / Public Health (future)

Solano County Health and Social Services HIE project – Data Fields

Demographics

Address line 1Address line 2CityStateZip CodeCountyCountryPhone numberPatient’s ID 1Patient’s ID 2

PMISC1PMISC2Guarantor Demographics:  Name, DOB, Address, Phone (if different from patient)Insurance CompanyPolicy NumberGroup NumberRelationship to PatientCard Holder’s Demographics: Name, DOB, Address, City, State, Zip Code, Phone Policy Begin DatePolicy End Date

Referral Number

Solano County Health and Social Services HIE project – Data Fields

Diagnosis, Analysis, Report, AlertsSpecimen Collection DateSpecimen Collection TimeSpecimen Source/ContainerSpecimen Information (for specimens in series such as TB)Submitter Specimen NumberSubmitter Medical Record NumberDiagnosis CodeReason for TestingOrdering PhysicianLicense Number

Submitter Name (Hospital / clinic)Specimen Receive DateSpecimen Receive TimeStatus CodeBill ToCopy to (for Public Health notifications)

Solano County Health and Social Services PH Lab HIE project – Reporting Data

BLOOD LEAD LEVEL 2216 42.0%MYCOBACTERIUM CULTURE 486 9.2%MYCOBACTERIUM MICROSCOPIC 483 9.2%T-SPOT.TB 156 3.0%NEISSERIA GONORRHOEAE PROBE-TEC 152 2.9%CHLAMYDIA TRACHOMATIS PROBE-TEC 152 2.9%QUANTIFERON-TB GOLD 150 2.8%SERUM RPR QUALITATIVE 104 2.0%NITRATE CHEMISTRY TESTING 98 1.9%HIV EIA SERUM 91 1.7%MYCOLOGY CULTURE FOR IDENTIFICATION 90 1.7%HIV 1 EIA ORAL FLUID 87 1.7%VIRUS PCR TESTING 80 1.5%MICROSCOPIC EXAMINATION - GCS 76 1.4%MYCOLOGY PRELIMINARY REPORT 75 1.4%ENTERIC CULTURE FOR IDENTIFICATION 64 1.2%PRIMARY CULTURE - ENTERIC 62 1.2%ENTERIC CULTURE PRELIMINARY 59 1.1%

Lab Results Interface

Solano County Health and Social Services PH Lab HIE project – Reporting Flow

Lab System Channels Provider

EHR

Solano County Health and Social Services PH Lab HIE project – Data Flow

Note: Provider and Laboratory use their own systems to pull up reports and requests.

Solano County Health and Social Services PH Lab HIE project

Questions?Linking 4 County PH Labs and linking reports to hospitalsStephan Betz, Ph.D.sjbetz@solanocounty.com