Public Health Data Standards Consortium http://www.phdsc.org
CDC PHIN-09, Atlanta GA Session G-8:Standards and Data Sharing September 2, 2009 Business Case for Public Health Participation in Health Information Technology (HIT) Standardization Anna O Orlova, PhD PHDSC and Johns Hopkins University aorlova@jhsph.edu
Acknowledgements Project Team: Walter Suarez, Vicki Hohner, Noam Arzt, Harold Lehmann, and Sacchi Girde Business Case Development Expert Team: Kathleen Cook, Art Davidson, Julia Gunn, Tracy Lockard, Corey Smith, Lesliann Helmus, David Lawton, Marcy Parykaza, BethAnn Posey, Eileen Underwood, Cecil Lynch, Jason Siegel, Lisa Spellman, and Sherry Weingart Business Case Document Reviewers: Marjorie Greenberg, Missy Jamisson, Michael Fitzmaurice, Starla Ledbetter, Bill Brand, Robert Aseltine, Shaun Grannis, Brook Dupree, Alex Hathaway, Neil Calman, James Golden, David Ross, and members of the PHDSC Data Standards Committee
Acknowledgements CDC 5-year Cooperative Agreement Assure HIT Standards for Public Health. Started in June 2008 Goal: Represent public health interests in the national HIT standardization process Year 1 Develop a Business Case for Public Health Participation in National HIT Standardization and Launch the Web-pages on HIT Standards Year 2 Develop a Web-based Interactive Model on the Business Case Implementation
Business Case on the Role of Public Health in the National HIT Standardization Objectives: Define the public health role in the HIT standardization process Help build an understanding across the public health community of this role and of the need for participation of local and state public health agencies in the national HIT standardization entities and Describe the strategy for public health participation in the HIT standardization entities with an organized voice
Why Standards
Why Standards Where We Now
State Health Department: Organizational Chart
Use of IT in Public Health: Where We Now All public health activities are supported by customized information systems (databases, registries) developed to address the programmatic needs.
HIT Standards in Public Health: Where We Now AND Our information systems do support our programmatic needs BUT Our information systems cannot exchange data between programs within and across public health agencies and with clinical information systems
Why Standards - National Context Towards a Nationwide Health Information Network Where Should We Be in 2014
US Nationwide Health Information Network (NHIN) in 2014 Source: Dr. Peter Elkin, Mayo Clinic, MN
Source: Dr. Peter Elkin, Mayo Clinic, MN, 2006 RHIEs as NHIN Components
Vision: PH Surveillance under NHIN Percent of Children Tested for Lead with BLL>10 µg/dl in the USA Source: Eileen Koski. Quest Diagnostics. PHIN-2004, May, Atlanta GA
Building a NHIN Information Systems Interoperability for Public Health Where Should We Be in 2014
Building a NHIN Information Systems Interoperability for Public Health What Would It Take. Building the Roadmap for Health Information Systems Interoperability for Public Health. PHDSC White Paper. 2007. URL: http://static.ihe.net/technical_framework/upload/ihe-phdsc_public_health_white_paper_2008-07-29.pdf
HIT Standards in Public Health: Where We Now Extensive experience in developing standards Focus on data standards, ie, data sets, and messaging standards, ie, HL7 Program-specific approach, eg, immunization, vital statistics, infectious diseases, occupational health, etc. Jurisdiction-specific approach Top-down approach, ie, federal agencies lead in the program-specific standardization efforts AND
HIT Standards in Public Health: Where We Now AND Our information systems do support our programmatic needs BUT Our information systems cannot exchange data between programs within and across public health agencies and with clinical information systems
HIT Standards in Public Health What Is Needed
HIT Standards in Public Health: What Is Needed Learn about the World of Standards and Standardization Process Participate in Standardization Process Enable bottom-up approach, ie, assure that needs of local and state public health agencies are met
HIT Standards in Public Health: What Is Needed Learning about the World of Standards
HIT Standards in Public Health: What Is Needed Learning about the World of Standards: HIT Standards Categories
Health IT Standards Categories 1. Data Standards, eg, vocabularies and terminologies 2. Information Content Standards, eg, Reference Information Models (RIMs) 3. Information Exchange Standards, eg, messaging standards 4. Identifiers Standards, eg, National Provider Identifier (NPI) 5. Privacy and Security Standards 6. Functional Standards, eg, processes/workflow 7. Other, eg, IT infrastructure standards This classification of Health IT standards types has been developed by the Health Information Technology Standards Panel (HITSP, www.hitsp.org) in 2006
National Biosurveillance Use Case Charge: Transmit essential data from electronically enabled healthcare to authorized public health agencies in real-time.
Biosurveillance Use Case 1. Data Standards - 28 2. Information Content Standards - 17 3. Information Exchange Standards - 46 4. Identifiers Standards - 11 5. Privacy and Security Standards - 5 6. Functional Standards - 0 7. Other 0 TOTAL = 107 standards This classification of HIT standards types has been developed by the Health Information Technology Standards Panel (HITSP, www.hitsp.org) in 2006
HIT Standards in Public Health: What Is Needed Learning about the World of Standards: HIT Standardization Process
HIT Standardization Process Priority Setting Standard Development Standards Maintenance Standards Harmonization Standards Certification Standards Adoption
HIT Standardization Process & Entities Priority Setting Standard Development Standards Maintenance Standards Harmonization Standards Certification Standards Adoption Past: AHIC Now: HIT Policy Committee & HIT Standards Committee Standards Development Organizations, eg, HL7, LOINC, IHE, etc. Health Information Technology Standardization Panel (HITSP) Certification Commission for Health Information Technology (CCHIT) US
Health Information Technology Standardization Phases, Products and Entities HIT Standardization Phases Priorities & Needs Development & Maintenance Selection & Harmonization Trial Implementation Certification Deployment Goals What to accomplish What are the standards What standards to use Showcase what can be accomplished Certify standardsbased products Deploy standardsbased products HIT Standardization Entities HIT Standards Committee HIT Policy Committee (Formerly AHIC) SDOs (e.g., HL7, SNOMED (IHTSDO), LOINC, ASC X12) HITSP IHE NHIN IHE CCHIT Proposed IHE & PHDSC Deployment Workshops Standards Documents Use Cases (Description of the health information exchanges) Standards Interoperability Specifications Integration Profiles & Technical Frameworks Implementation Reports Certification Criteria Deployment Reports
HIT Standards in Public Health: What Is Needed Participation in HIT Standardization Process
Public Health in HIT Standardization Entities Entities Number of Organizations Number of Public Health Organizations HIT Standards Committee 23 0 HIT Policy Committee 20 2 HL7 503 27 HITSP 641 30 IHE 251 7 CCHIT 341 3 Total 1779 69
Public Health in HIT Standardization Entities
Public Health in HIT Standardization Entities Challenges for Public Health Participation in HIT Standardization Process
Challenges for Public Health Participation in National HIT Standardization lack of awareness for the need to participate and where to participate limited ability for local and state public health practitioners to be involved in the national efforts as they serve particular jurisdictions lack of technical knowledge and informatics skills to participate, and lack of funding to support basic participation, e.g., travel to meetings
Standards World Where to Participate
Skills and Knowledge Needed Standards are Technical Documents ADT Order Placer Register J.Doe Department System Scheduler/ Order Filler Image Manager/ PPS Manager Acquisition Modality Patient Registration [RAD-1] One or the other methods of creating an order is used Placer Order Management New [RAD-2] Filler Order Management - New [RAD-3] Schedule Procedure White Papers Technical Frameworks Interoperability Specifications Requirements Specifications Integration Profiles Content Profiles Certification Criteria Procedure Scheduled [RAD-4] Query Modality Worklist [RAD-5] Modality Procedure Modality Procedure Filler Order Step In Progress Step In Progress ADT Mgmt - Status [CARD-1] [CARD-1] Pt. Registration [RAD-1] Update [RAD-3] Patient Update [RAD-12] Pt. Registration [RAD-1] Patient Update [RAD-12] Placer Order Management [RAD-2] Modality Procedure Modality Procedure Filler Order Management [RAD-3] Patient Reconciliation Filler Order Step Completed Step Completed DSS/ Order Filler Order Placer J.Doe -> Mgmt - Status [RAD-7] [RAD-7] Update [RAD-3] J.Smith Modality PS in Progress [CARD-1] Procedure Scheduled [RAD-4] Modality PS Completed [RAD-7] Patient Update [RAD-12] Patient Update/ Procedure Updated [RAD-13] Patient Update/ Merge [RAD-12] Instance Availability Notification [RAD-49] Merge [RAD-12] Evidence Image Display Modality PS in Progress [CARD-1] Creator Modality PS Completed [RAD-7] Query Images [RAD-14] Storage Modality Image/Evidence Retrieve Images/Evidence [CARD-4] Performed Commitment Stored [CARD-2] Procedure [CARD-3] Step Manager Image Image Manager Archive Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Storage Modality Image/Evidence Commitment Stored [CARD-2] [CARD-3] Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Acquisition Modality Query Modality Worklist [RAD-5] Perform Acquisition
Public Health in HIT Standardization: Cost Qualifications: Deep Understanding of Public Health Ability to Review HIT Standards Documents Time: 25-30% FTE (calls, meetings, document review) Travel: 3-4 meetings/year (3-5 days each) TOTAL ~ $40,000 per person/entity
Public Health in HIT Standardization Proposed Strategy (a) (b) maximize the impact of those who can participate on behalf of Public Health in the national HIT standardization process, and inform/educate and obtain input, as best as possible, from those who cannot.
What to Achieve? National HIT standardization process requires collective input from Public Health on what public health issues need to be addressed in national interoperable HIT standards. This input needs to be collaboratively developed, put through the national HIT standardization process and uniformly implemented. Public Health s Organized Voice on HIT Standards will have to take on a character reflective of this reality.
What to Achieve? We define Public Health s Organized Voice on HIT Standards as an open, transparent, participatory process of harmonizing program-specific and jurisdictional needs with national HIT interoperability standards by working with HIT standardization entities on various phases of HIT standardization
Business Case: Public Health in HIT Standardization Target Audience: National HIT leadership Governors State and Local Health Commissioners Federal Agencies Leadership Leadership of Professional Associations Leadership of Schools of Public Health
Building Public Health s Organized Voice on HIT Standards Why Participate? Where to Participate? Who Should Participate and How to Participate? Role of Local and State Agencies Role of Professional Organizations Need for Coordination Resources for Participation educational and informational resources funding
Why Participate? or Risks of Non-participation threaten public health data gathering activities diminish effectiveness of public health interventions diminish efficiency of public health operations reduce ability to communicate public health information back to clinicians electronically jeopardize adoption of modern interoperable HIT applications in Public Health jeopardize achieving population-level goals of Nationwide Health Information Network minimize the potential of state and local Public Health to receive funding from Federal and other sources that will likely mandate the use of interoperable HIT products
Where to Participate? Entities Number of Organizations Number of Public Health Organizations HIT Standards Committee 23 0 HIT Policy Committee 20 2 HL7 503 27 HITSP 641 30 IHE 251 7 CCHIT 341 3 Total 1779 69
How to Participate: State and Local Agencies Recognize HIT standardization efforts as a distinct role for senior program staff, senior informaticians and/or IT professionals in the agency Devote one or more staff members in a leadership position to carry out an agency s HIT standardization activities For smaller agencies, outsource HIT standardization efforts where possible to experts-consultants with extensive knowledge of public health Recognize the need for continuing education in public health informatics and HIT standards for agency s workforce Band together within a region and share the costs associated with the deployment of professionals to represent agency on HIT standardization efforts Participate in and leverage memberships in public health professional associations involved in standardization activities as a way of providing input into the HIT standardization process, and Participate in coordination activities for building Public Health s Organized Voice on HIT Standards.
How to Participate: Role of Professional Associations Immunization American Immunization Registry Association (AIRA) Laboratory Association of Public Health Laboratories (APHL) Epidemiology & Disease Reporting Cancer Vital Statistics Newborn Screening Healthcare Management Council for State and Territorial Epidemiologists (CSTE) North-American Association of Central Cancer Registries (NAACCR) National Association of Public Health Statistics and Information Systems (NAPHSIS) Public Health Informatics Institute, Maternal and Child Health Bureau, HRSA National Association of Health Data Organization (NAHDO) & American Health Information Management Association (AHIMA)
Public Health in HIT Standardization: Need for Coordination Facilitate public health involvement in various HIT standardization entities Coordinate activities of professional organizations Assist local, state and federal agencies Help identify new public health areas for developing new standards and carry out activities needed to initiate standards development efforts in these areas; Conduct outreach activities on public health participation in HIT standardization Educate public health workforce on HIT standards and Help identify and secure resources needed to support the participation of public health professionals in HIT standardization entities
Resources Participate in HIT standardization and learn PHDSC Web-based Resource Center New HIT Standards Web-pages launched in June 2009 (http://www.phdsc.org/standards/health-informationtech-standards.asp) PHDSC Quarterly Standard e-newsletter (http://www.phdsc.com)
Business Case: Public Health in HIT Standardization Join our efforts to launch Coordinated Public Health Action Plan on HIT Standards
Get Involved! Anna Orlova, PhD, Executive Director 624 N. Broadway Room 325 Baltimore MD 21205 Phone: 410-614-3463 Fax: 410-614-3097 E-mail: aorlova@jhsph.edu
Business Case: Public Health in HIT Standardization Coordinated, collective action is required at almost every level of the healthcare system to realize the full benefits of HIT. This makes it unlikely that individual actors, pursuing their own self-interests, would be able to take the full advantage of HIT. The importance of collective action is most apparent in securing effective communication so-called interoperability across providers of care in the United States David Blumenthal, National Coordinator for HIT.
Questions?