Ways, not places: Death certification from an EHR

Jeff Duncan, MS Utah Department of Health

Email in 1992…Places

http://www.windley.com/archives/2012/03/ways_not_places.shtml

America OnlineMCI

Compuserve

Phil Windley 2012

Email now

SMTP

Evolution of Health IT …PlacesBilling EHR Rx

Laboratory (LIS)

Radiology (RIS)

EDRS

Integrated Delivery systems such as Intermountain Healthcare…Ways

EHR Laboratory (LIS)

Radiology (RIS)

DOH

Payers

Health Information Exchange (HIE)

RxBilling

Clinical Workstation

Others

Internal Communications

External Communications

HL7

HL7

HL7

*Reportable Diseases* Immunizations

*Syndromic Surveillance

HL7

*Death Certification

What is HL7?

• HL7 is…– An ANSI standards organization

– A family of standards for exchanging health information

HL7 v2 Message:

What is in the DSTU?

• Message Structures– ADT^04—Add– ADT^08--Update– ADT^23--Delete

• Message Contents– Demographic fields for matching– Cause of death fields from death certificate

• Constraints– Which fields are optional, which fields are required

• Value sets—what values are allowed

Intermountain’s EHR screen:

2011 20122009 2013

CDC Pan Flu GrantUDOH received funding to create a death reporting interface with Intermountain.

Pilot testingImplemented at one Intermountain Clinic

HL7 Version 2.3 Interface Planning and DevelopmentInterface development and testing

DSTU Implementation

Pilot test expanded to Salt Lake City Metro Area

Timeline of events—UDOH-Intermountain Death Interface

2010

Upgrade to DSTUProject begins

HITECH act and Meaningful Use

Certification Process

Business Rules-matching and merging-update / delete messages

Advantages of certification through EHR

For Physicians:• No need to remember login and password to EDRS• Access to relevant clinical data• Potential for clinical decision support

For Public Health:(hypothesis)Engaging physicians within their workflow in the

EHR will:• Improve timeliness, completeness and accuracy of death

data • Engage more physicians in electronic death registration

Challenges

• Ensure data semantic standards meet the needs of public health

• Ensure standards are flexible to meet the unique needs of individual jurisdictions

• Ensure data quality standards are met or exceeded

Next Steps

DSTU implementation (July, 2013)

Testing for one year

Provide feedback to HL7 (July, 2014)

HL7 ballots and approves normative standard

Industry implements standard.

Acknowledgements

• NCHS– Michelle Williamson

• Intermountain Healthcare Team– Jacob Tripp, PhD

• Utah Department of Health– Leisa Finch, EDR Coordinator

• Multidimensional Software Creations (MDSC)– Stephen Clyde, PhD– Mike Jolley, Project Manager

Questions?

Jeff Duncan, MSPublic Health Informatics Program Manager

Office of Public Health InformaticsUtah Department of Health

jduncan@utah.gov