Popula'on Health, Public Health, & Meaningful Use

Transcription

1 Popula'on Health, Public Health, & Meaningful Use James W. Buehler, MD Health Commissioner Philadelphia Department of Public Health Delaware Valley Chapter HIMSS January 29,

2 Overview: What are the connec'ons across Public Health, Popula'on Health, & Healthcare? Phila. Dept. of Public Health: Who are we? How is our shared landscape evolving? What are the impacts of Meaningful Use Affordable Care Act Where are we: public health repor'ng & MU? What s on the horizon? 2

3 PDPH Vision & Mission Our vision is of a city in which every resident is able to: Live a long, healthy, and produc've life; Be free of preventable disease and disability; and Live, work, learn, shop, and play in environments that promote health. Mission: To protect and promote the health of all Philadelphians and to provide a safety net for the most vulnerable. 3

4 Public Health is Popula'on Health: PDPH opera'onal divisions Environmental Health Restaurant inspec'ons, vector control, lead poisoning preven'on Air Management Services Air quality monitoring, regula'on, commercial noise control Disease Control STD, TB, flu, outbreak response, disease monitoring, emergency preparedness AIDS AcBviBes CoordinaBng Office Preven'on, screening, treatment Chronic Disease PrevenBon/Get Healthy Philly Tobacco control, obesity preven'on Maternal, child, & family health Home visi'ng, breas[eeding Medical Examiner s Office Autopsies, fatality review programs, bereavement support Public Health Lab Clinical, public health, emergency preparedness Ambulatory Health 8 primary care health centers, EHR rollout 4

5 Policy 5

6 Health Promo'on & Protec'on: Programs & Partnerships Opening of New Neighborhood Farmers Market Chris'an Street YMCA, September 2014 Image: Green Mountain Energy 6

7 Pa'ent Care Services Health Federa'on Youth Poster Compe''on,

8 HIT, HIE, & QI: Long- term trends accelerated by Meaningful Use Beher informa'on for pa'ent care Beher informa'on about popula'on health People enrolled in an insurance program Pa'ents under care of a provider People in a poli'cal jurisdic'on We need to know: What is the health of our popula'on? How well are we doing our job? Requirements of interest to public health: ReporBng to health departments: PopulaBon health monitoring Promote use of preven've services: prompts and QI measures Decision support 8

9 9

10 Public Health Repor'ng in Meaningful Use Disease surveillance Monitor trends Characterize at- risk popula'ons Iden'fy urgent situa'ons Inform programs Meaningful Use: Lab results for reportable condi'ons Syndromic surveillance Immuniza'on registry, aka Immuniza'on Informa'on System (IIS) Cancer registry (new, in Stage 2) 10

11 Disease Repor'ng Mandated by State Law Physicians, clinics, hospitals, laboratories Lab- ini'ated repor'ng for infec'ous diseases Promotes 'meliness & completeness Focus on large commercial labs (predates MU) S'll need remainder of clinical info Meaningful Use Hospitals: Lab results for reportable condi'ons Onboarding & ahesta'on: Via State Health Dept. No Phila. Hospitals yet onboarded Future: fully automated case repor'ng (clinical & lab info) ONC did not select for inclusion in Stage 3 Focus of ac've development 11

12 Electronic Laboratory Repor'ng Data Managed More Quickly All reportable diseases % 80% 60% 40% 20% Salmonella cases % % Cases thru ELR 0 Mean # Days 'l Ac'on Example: Summer 2013 Salmonella outbreak associated with catered lunches detected in 2-3 days aqer onset of illness 12

13 Automated Repor'ng: High Volume Diseases Can Be Addressed 24,000 20,000 PosiBve HCV Test Reports 19,785 16,000 12,000 11,140 12,820 14,539 8,000 4, Impact: Faster recogni'on, detec'on, & inves'ga'on of acute infec'ons 13

14 Philadelphia Immuniza'on Registry: KIDS Plus Philadelphia and State Registries Ahesta'on via both registries Providers in Phila. required to report to Phila. KIDS Plus (Child & Adult) State downloads reports to Phila. KIDS Plus Phila. to state uploads (under development) KIDS Plus Data collec'on: HL7 Interface and Billing or EMR delimited files Direct entry Paper logs Methods of transport: Batch messaging to sftp SOAP web services

15 KIDS Plus: Improved Timeliness Median Number of Days between Vaccina'on and Entry into KIDS Plus Overall HL7 Real Time N/A 0 HL7 Daily Batch N/A 2 EMR Flat File (~monthly) Billing (~monthly) Manual (in house) Populated using weekly feed from state e- birth cer'ficates >1,000 Ac've Users (providers, school nurses, prison health, shelters ~45 providers (of 165) using HL7 repor'ng Backlog of adult vaccina'ons reported via insurers billing records State forwards into for Phila. residents 15

16 KIDS Plus IIS Repor'ng 2012 Vaccina'on Counts (Cumula've Jan- Dec) by Repor'ng Method million vaccina'ons 3% received through HL million vaccina'ons 54% received through HL7 16

17 Syndromic Surveillance Rapid snapshot of health status for broad syndrome groups Limited data collec'on: demographics, chief complaint or discharge diagnosis Hospital ED: most common source Philadelphia: Home grown system started in 2002 Transi'oning to State system Operated by: Health Monitoring Systems, Inc. (HMS) Current: 16 via HMS; 3 via legacy system Meaningful Use Onboarding & ahesta'on via State/HMS Emphasis on hospital EDs No funding to support onboarding for outpa'ent providers 17

18 Example: Use of ED- based Syndromic Surveillance for Influenza- Like Illness in Combina'on with Other Data hhps://hip.phila.gov/xv/ 18

19 Repor'ng to Cancer Registry Menu Op'on in Stage 2 Managed by state cancer registry hhp:// 19

20 CMS Quality of Care Measures Align with Public Health Objec'ves Adults Controlling High Blood Pressure Tobacco Use: Screening and Cessa'on Interven'on Screening for Clinical Depression and Follow- Up Plan Body Mass Index (BMI) Screening and Follow- Up Children Weight Assessment and Counseling for Nutri'on and Physical Ac'vity Chlamydia Screening, 16+ Childhood Immuniza'on Status Appropriate Treatment for URI Children who have dental decay or cavi'es hhp:// and- Guidance/Legisla'on/EHRIncen'vePrograms/2014_ClinicalQualityMeasures.html 20

21 American Reinvestment & Recovery Act, 2009 Health InformaBon Technology for Economic and Clinical Health Act (HITECH) $33 Billion CMS NTIA DoA ONC HRSA AHRQ SSA I H S VA Source: hhp://

22 Government public health represents 3% of U.S. health spending NaBonal Health Expenditures, 2014, $3.1 Trillion Government Public Health All other Source: Centers for Medicare and Medicaid Services. Na'onal Health Expenditure Projec'ons hhp:// Sta's'cs- Data- and- Systems/Sta's'cs- Trends- and- Reports/Na'onalHealthExpendData/ Na'onalHealthAccountsProjected.html

23 Will Meaningful Use be meaningful for public health? Required repor'ng easier for providers Easier for public health staff- - allows shiq of ahen'on from collec'ng to using informa'on Fulfills a clear PH need for informa'on Informa'on provided back to providers and public Value and impact of informa'on is apparent Strengthens healthcare- public health collabora'on 23

24 24

25 Stages PDPH Implemen'ng EHR in network of 8 primary care clinics Prac'ce management system Medical record Interfaces & connec'ons, including regional HIE Analysis capabili'es Issues: QI & performance measures Research (data- use policies) Planning, training, accommoda'ons, legacy data, upgrades Cultural alignments Informa'cs IT Clinical Public Health Integra'on with STD & TB clinics Opportunity to model new healthcare- public health collabora'on 25

26 Affordable Care Act: Not just health insurance Alignment of clinical and public health priori'es Importance of chronic diseases Emphasis on con'nuity of care Among healthcare providers Between healthcare & the community Example: Role of Community Health Workers Community health needs assessment (CNHA), response implementa'on plans Not- for- profit hospitals, repor'ng to IRS CNHA: Requires engagement of state/local PH agency (new) Allows for collabora'on and sharing of community- wide assessments Response/implementa'on Most emphasize un- reimbursed care or training Small percentage of investments for outside- hospital community benefit ac'vi'es New opportuni'es for Healthcare & PH collabora'on Example: Phila. Community Health Improvement Plan 26

27 Mul'ple Chronic Diseases Aging of baby boomers Impact on healthcare use and costs Leading contributor to premature death & preventable morbidity Poverty strong determinant of poor outcomes Outcomes affected by: Healthcare Home & community situa'ons 1980 &

28 CDC strategic directions Improve health security at home and around the world Better prevent the leading causes of illness, injury, disability, and death Health Care Public Health Strengthen public health/ health care collaboration CDC, 2014,

29 Example: New CDC- funded Project to Improve Healthcare & Public Health Collabora'on Learning collabora'on: PDPH + 40 prac'ces FQHCs: Health Federa'on of Philadelphia Hospital- based: Health Care Improvement Founda'on Set common goals (HEDIS- based) Disease iden'fica'on, medica'on adherence, disease control Use EHRs to monitor care, based on MU requirements Pa'ent educa'onal resources Explore models for engaging community health workers Primary preven'on Diabetes Preven'on Program to Medicaid beneficiaries at discount (~$25) Partnership with YMCA CDC- designed 16- week program for people at high risk for diabetes. Educa'on on diet and physical ac'vity Reduces the incidence of diabetes 29

30 Conclusions Kinship between healthcare and public health views of popula'on health Accelerated by Meaningful Use and ACA Progress and challenges in achieving aims of Meaningful Use Increasing importance of healthcare & public health collabora'on 30

31 For addi'onal informa'on hhp:// medicalassistancehealthinforma'ontechnologyini'a've/meaningfuluse/index.htm hhp:// Philadelphia Immuniza'ons Amira Elhagmusa, MPH Tel: Syndromic José Lojo, MPH Tel: Claire Newbern, PhD MPH Tel: Pennsylvania Immuniza'ons Frank Caniglia Syndromic Kirsten Waller Hospital Lab Results Mark Dihman HIMS syndromic (outpa'ent) Ben Luffey Cancer Registry Wendy Aldinger