Maximizing EHR Data for Public Health Reporting Nedra Garrett, MS Centers for Disease Control & Prevention February 21, 2017
The Interoperability Dream Technology that bridges the divide between families, clinicians, communities & public health Patient collect & return useful, timely information Provider prompt best practices, improve work flow Care Manager e-referrals to community resources Community receipt/transfer of patient information Reporting - structured data for - Clinical quality improvement Local surveillance Program evaluation
National Vital Statistics System 6.5 million events processed per year 4.0 million birth records per year 2.5 death records per year 50,000 fetal death records
evital Standards Initiative Using HL7 and IHEbased standards Improving the timeliness, accuracy, and completeness of vital records data
National Standards for Vital Records Reporting Birth and Fetal Death Reporting HL7 V2.5.1 Birth and Fetal Death Reporting (BFDR) IG HL7 Clinical Document Architecture (CDA) BFDR IG Integrating the Healthcare Enterprise (IHE) BFDR-E (Enhanced) Content Profile https://www.cdc.gov/nchs/nvss/evital/accessing_evital_standards.htm
National Standards for Vital Records Reporting Death Reporting HL7 V2.6 Death Reporting Vital Records Death Reporting (VRDR) IG HL7 Clinical Document Architecture (CDA) VRDR IG IHE VRDR Content Profile Death Fast Healthcare Interoperability Resource (FHIR) Profiles https://www.cdc.gov/nchs/nvss/evital/accessing_evital_standards.htm
CDC Healthy Weight (HW) and Occupational Data for Health (ODH) Electronic Health Information Initiatives Quality Improvement Data Body Mass Index (BMI), Physical Activity, Nutrition, and Work Data Community Health Data HEALTHCARE PROVIDERS Supporting clinical decisions Capturing quality weight, behavior, & work data PUBLIC HEALTH & COMMUNITY/PRACTICE GROUPS Informing & improving health programs Improving local surveillance
The Gap EHR-based Healthy Weight clinical management and collection of Body Mass Index (BMI) and work information are inadequate & inefficient: EHRs are underutilized to support clinical care & functionality is insufficient In 2013, <10% report advanced functions such as referral to community resources Interoperability is poor: multiple approaches to communicate information Multiple methods of data exchange: dual data entry & multiple interfaces Data extraction for research, evaluation & surveillance difficult 2011 IOM Letter Report, Incorporating Occupational Information in Electronic Health Records. Advances in incorporating occupational information in EHRs could lead to more informed clinical diagnosis and treatment plans as well as more effective policies, interventions, and prevention strategies to improve the overall health of the working population. Work information could contribute to fully realizing the meaningful use of EHRs in improving individual and population health care.
IHE Healthy Weight profile HL7 v2.5.1 standard Achieving the Dream Occupational Data for Health (ODH) CDA template SMART on FHIR proof-of-concept applications
Central Cancer Registries in the US by Federal Funding Source 1992 Cancer Registry Amendment Act, Public Law 102-515, authorized CDC to establish National Program of Cancer Registries (NPCR) Nationally reportable disease; required by state law Population-based longitudinal data from multiple sources on all diagnosed cancers including diagnosis, treatment and vital status data Highly standardized data collection system
Cancer Program Accomplishments Physician Electronic Health Record (EHR) Reporting: IHE Physician Reporting to a Public Health Repository Cancer Registry (PRPH-Ca), based on HL7 Clinical Document Architecture (CDA) Developed HL7 CDA Release 2 Implementation Guide: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1; DSTU Release 1.1 - US Realm ( Cancer IG ) Meaningful Use (MU) Cancer Reporting for Eligible Professionals: Stage 2 menu item (2014 implementation) Stage 3 optional item (2018 implementation) Standards (PRPH-Ca and Cancer IG) published in ONC 2014 and 2015 Certification Rules emarc Plus Physician Reporting Module 35+ states using Processes IHE PRPH-Ca and Cancer IG data
Cancer Program Accomplishments Electronic Pathology and Biomarker (epath) Reporting: IHE Anatomic Pathology Reporting to Public Health Cancer Registry (ARPH) profile based on HL7 2 messaging: 46 state cancer registries receive live epath data 25 laboratories reporting to state cancer registries 40+ states use emarc Plus epath Module to receive and process epath reports IHE Structured Data Capture (SDC) Profile to report College of American Pathologists (CAP) Electronic Cancer Checklist (ecc) pathology and biomarker data to cancer registries Implemented in the California Cancer Registry HL7 Fast Healthcare Interoperability Resources (FHIR) SDC to report cancer data to state cancer registries
Public Health Cancer Reporting Solutions IHE *SDC, IHE ARPH Pathology Report indicates patient has cancer Anatomic Pathology Laboratory Pathology Report indicates cancer IHE *SDC State Public Health Agency Primary Care Provider/Specialist Physician diagnoses cancer *NOTE: IHE SDC and RFD require a Form Manager to maintain a repository of forms Cancer Registry System
Improving Clinical Care and Public Health with Electronic Case Reporting A Public Health-Clinical Collaborative
Digital Bridge ecr Approach An interoperable, scalable, and multi-jurisdictional approach to ecr. Not a new technology product. The Digital Bridge approach is based on existing ecr tools and standards, and seeks to support their development and adoption. ecr is incorporated into the EHR as a background operation requiring little or no effort on the part of the clinical end user. The approach will be tested through at least five implementation sites in 2017. The implementation sites technical solution will remain EHR vendor-agnostic so that any vendor can adopt the solution and pass on this functionality to their clients.
Benefits to This Approach A unified approach to information exchange will ease the burden and costs for all stakeholder groups. Advances greater consistency across public health and health care interoperability cases. Lays the foundation for greater bidirectional exchange of data between health care and public health so that clinicians can be more easily informed, and collaborate with public health during outbreaks. Bidirectional data exchange can eventually encompass noncommunicable diseases.
ecr Process (High Level) Health Care Import Trigger Criteria Provide Patient Care Match Trigger Criteria Send Case Report Follow-Up Activity Decision Support (AIMS/RCKMS) Provide Trigger Criteria Compare to Reporting Criteria Match Reporting Criteria Send Case Report Send Response Public Health Define Reporting Criteria Process Case Report Send Response
Envisioned ecr Architecture Using AIMS & RCKMS
Contacts: Sandy Jones SFJones@cdc.gov (Cancer reporting) Michelle Williamson MWilliamson@cdc.gov (Vital Records reporting) Genny Luensman GLuensman@cdc.gov (Occupational Health data) Aly Goodman AGoodman@cdc.gov (Healthy Weight) Laura Conn LConn@cdc.gov (ecr) Ninad Mishra Nmishra@cdc.gov (STD ecr)