Applied Research, Community Health Epidemiology, and Surveillance (ARCHES) Update Wayne Enanoria, PhD, MPH Health Commission Meeting March 20, 2018
Overview 1 2 3 A3 Overview Maven Electronic Health Record (EHR)
Current State, 2016
Population Health Division A3 Title: Data to support decision-making to improve population health. Target: Actionable, integrated, person-centered, population-based data pertaining to the social determinants of health and public health conditions that can be readily accessed to support decision-making. PHD A3 is aligned with two initiatives of the SFDPH: Actionable knowledge anytime, anywhere Developing our people
Establishing Priorities, August 2016 Initial Phase: Person-Centered Data Integration Steering Committee meeting in September, 2016 Multi-disciplinary Committee Membership from PHD programs Purpose: to prioritize the PHNIX build given program needs and use. Key Decision to build: Tuberculosis Module Electronic Lab Report Module
Core Functionality Core functions for tuberculosis control and prevention Improved tuberculosis case detection and management Active case finding and targeted testing Evaluation of immigrants and refugees with TB or TB infections Public Health surveillance of tuberculosis cases and case reporting Clinical management and follow-up of active cases Outbreak management and contact investigations Analytics and reporting Program evaluation
Key Contents Maven will contain information on all TB cases in SF and their identified contacts and all patients seen in the clinic (Latent Tuberculosis Infection). Information includes demographic information, epidemiology, genotype, TB testing (serology, skin tests, microbiology, molecular data). Maven will be enhanced to handle outbreak data. Data on infected individuals, their close contacts, treatments/interventions, and health outcomes. Until the new EHR is built, Maven will contain clinical data for clinical decision support.
Understanding Current Work Flows Current State: What Processes Did We Map? Clinical Services» Active TB case» TB case with Class B immigrant designation» TB patient receiving ongoing clinical care Prevention & Control TB disease control investigation Surveillance & Reporting» Pulling sputum results» RVCT» Annual Progress Report» EDN B notification Research TBESC study participant (LTBI cases)
Current vs. Future State: Contact Investigation
Administrative Demographic Immigration and B-Notification Clinical/Medical Evaluation Treatment/Management History Risk Factors Contact Investigation Exposure Site Assessment Maven Question Packages The Maven TB module includes the following question packages: TB Medication Orders DOT/DOPT Treatment Log Care Coordination and Communication Appointments Insurance & Billing
Electronic Lab Reporting Module Electronic Lab Reporting for Public Health is the automatic transmission of all laboratory reports from laboratories to state and local public health departments. Electronic lab reports contain information for Title 17 reportable conditions. Sources of Data Public Health Laboratory, Population Health Division California Reportable Disease Information Exchange (CalREDIE) Clinical Laboratory, ZSFGH
Electronic Lab Reporting Module Two rounds of User Acceptance Testing Validate that Maven can store the ELR data properly; Identify errors that need to be corrected; Verify that the system is functioning as expected; Obtain user feedback and acceptance of the system.
PDSA Cycles for Improvement Image Source: http://sisep.fpg.unc.edu/book/export/html/178
Electronic Health Record Implementation
Acknowledgments Information Systems Michelle Tom Angela Liu Tina Lee Mark Bridge Steve Solnit Tru Vu Ruby (Madhumita) Das Trevor D Sa Tiffany Tsukuda Population Health Division Chris Keh Laura Romo Rocio Agraz-Lara Samira Causevic Felix Crespin Janice Louie Indiana Galarza Taliba Miller Billy Luong TB Clinic Staff Bob Kohn Christiana Toomey Sharon Pipkin Thomas Knoble Amy Nishimura Melissa Ongpin Annie Vu Jennie Chin Dale Gluth Jennifer Grinsdale Priscilla Chu Israel Nieves-Rivera ARCHES Staff
Thank You Questions/Comments?