1. Version 2.1 10-9-07 1 Building an Interoperable Public Health Framework: Enabling Data Exchange Donald George, CEO PRISM Communication Systems, Inc. 135 th American Public Health Association: November 6, 2007 Advancing Health Care Through the Adoption of EHR/PHR

2. Version 2.1 10-9-07 2 Public Health Challenges Today Why does Public Health need transformation? Disasters

3. Version 2.1 10-9-07 3 Public Health Challenges Today Why does Public Health need transformation? Diseases

4. Version 2.1 10-9-07 4 Public Health Challenges Today Why does Public Health need transformation? Terrorism

5. Version 2.1 10-9-07 5 Public Health Challenges Today Why does Public Health need transformation? Healthcare

6. Version 2.1 10-9-07 6 Communicable Disease Reporting CDC Base System Pharmacies Veterinarian MIS & Veterinarian Labs Environmental Health Hospitals LIS (Labs) HIS Emergency Rooms RSVP EMS Run Data Forms MVT 911 Medical Dispatch CAD Clinics & Physicians PMS RSVP Third Party Labs Poison Control Centers State Public Health Lab Health Information Model [HL 7] Response Assessment & Evaluation Detection Outbreak Disease Models Resource Planning Alert & Early Warning Modeling & Investigation Functions Duplicate Patient Identification Record Merging (Manual & Auto) Inline Geocoding & Address Cleaning Reporting & Web-based GIS Reporting & Statistical Tools Automated User Feedback Data Translation Tools Common Tools HL7 Standards Enable Data Exchange

7. Version 2.1 10-9-07 7 Types of Data: Personal vs. Population Adult Immunizations Childhood Immunizations Tuberculosis Testing STD Testing and Counseling HIV Testing and Counseling EPSDT Family Planning WIC Prenatal Care Dental Care HIV Treatment Primary Care Communicable Disease Control Health Education Epidemiology and Surveillance High Blood Pressure Screening Tobacco Use Reduction Cancer Screening Diabetes Screening Cardiovascular Disease Screening Injury Control Violence Prevention Occupational Safety and Health Personal Health Data Population Health Data

8. Version 2.1 10-9-07 8 Hospitals Clinical-Public Health Data Exchanges: Local / State / Federal Health Agencies Source: Beitsch et.al AJPH, January, 2006. Local State Federal Clinics Labs Pharmacy Other Providers Health Education/Risk Reduction Communicable Diseases Immunization EPSDT Injury Control School Health Chronic Care Biosurveilance, BT, Preparedness WIC Occupational Safety and Health Genetic Disorder Vital Statistics Communicable Diseases Immunization Lead Registry Injury Control School Health Chronic Care Biosurveilance, BT, Preparedness WIC Public Health Laboratory HEDIS Cancer CDC HRSA AHRQ

9. Version 2.1 10-9-07 9 Clinical Care ADT- Birth Record Newborn Screening Test Hearing Screening Test Immunization Administration External Laboratory Hospital of Birth HL7 2.4 HL7 3.0 HL7 2.4 Data Hub Newborn Screening Registry Hearing Screening Registry Immunization Registry Communicable Disease Registry Public Health Department HL7 3.0 HL7 2.4 Creating an Interoperable EHR for Public Health HL7 2.5 EHR-PHR HL7 CDA Release 2

10. Version 2.1 10-9-07 10 How do we transform Public Health? Connect the Information Systems Integrated Health Framework Standards for Enabling an Integrated Public Health Systems SOA HL7 IEEE ASTM NCPDP DICOM ANSI ASC X12N HL7 ICD-9-CM CPT-4 SNOMED CT LOINC CCR/CCD CDISC CAP EDXL HAVE Standardized collaboration processes help bring about interoperability. 1. Health Level Seven (HL7) 2. Integrated Health Enterprise (IHE) Profiles Federal Health Standard Groups 1. HITSP 2. AHIC 3. HISPC

11. Version 2.1 10-9-07 11 Building EHR and PHR Clinics Specialty care Laboratory Emergency care Pharmacies Hospitals Other Providers Process Workflow DATADATA DATADATA Secure, trusted aggregated data to build Patient Summary Record (CCD) and EHR/PHR. Healthcare Enterprise EHR provider-centric Summary EHR data-centric Personal EHR patient-centric Reports, Audits, Research, Billing, Clinical Trials Unique IdentifierData StandardsTransport Standards Data set Standards: CCR, CDA, CCD, NCPDP Evidence-based Medicine EHR Architecture EHR Functionality PHR Architecture PHR Functionality Clinical events stored as HL7 CDA(R2) compliant documents Genetic Disorders Communicable Diseases Immunization Vital Records Injury Control School Health Chronic CareBiosurveilance, Preparedness, Syndromic SurveillanceHEDIS

12. Version 2.1 10-9-07 12 Achieving a Continuum of Care - Public Health EHR-PH Patient Centric Care  Portable patient health record  Risk monitoring/ better access  Service delivery to all health systems and devices Consumer Empowerment  Patient choice/ risk assessment  Engaged with Health Care Coordinator  Competition drives price/market Population Health  Security & Surveillance  Understanding of Health threats  Wellness, Preventive Care, Health Risks Single View of Care

13. Version 2.1 10-9-07 13 Integrate HL7 standards Transform the public health business model across multiple functional health domains How do we transform Public Health? Connect the Information Systems The business needs will be met by using the Service Oriented Modeling and Architecture (SOMA) to:

14. Version 2.1 10-9-07 14 How do we transform Public Health? Move from Strategy to Implementation Health Services Model Building an EHR-PH Component Services Model For Health Information Exchange  Start with a “hot” component area – product identification  Define a model of the component to be transformed  Identify and design the required supporting infrastructure  Understand the underlying applications infrastructure and how it needs to change

15. Version 2.1 10-9-07 15 Service-oriented Modeling and Architecture (SOMA) CBM Top-down: business-driven Process, event and variation analysis Bottom-up: Leverage Legacy thru understanding and transformation Business Services linked To Business Goals Model driven development is key. Specify IT Components, their services and flow Legacy Business Vision Map components & Services to best technology, Service-oriented Architecture 1 2 345 SOMA combines Business Vision with Modern and Legacy assets to achieve an enterprise services architecture. How do we transform Public Health?

16. Version 2.1 10-9-07 16 Service Requirements Service Design Service Build The best practices of service orientation which is the process and practices that guide the delivery of a SOA is in the early stages of adoption for many organizations Service Oriented Analysis How do you understand the business as services? How do you enable business agility? Service Oriented Design What is the precise behavior of services? How do you ensure scalability, reliability, etc? How do you enable technical agility? Service Oriented Provisioning How do you determine which Services to use? How do you choose Service Providers? Service Oriented Programming How do you reduce effort to code Web Services? Service Development How do we transform Public Health? Intro to Service Oriented Architecture Modeling

17. Version 2.1 10-9-07 17 How do we transform Public Health? Connect the Information Systems Integrated Health Framework Case Study: Public Health Information Network Ancillary Data & Services Registries Data & Services EHR Data & Services Data Warehouse Outbreak Management PHS Reporting Shared Health Record Drug Information Diagnostic Imaging Laboratory Health Information POINT OF SERVICE Hospital, LTC, CCC, EPR Physician Office EMR Business Rules EHR Index Message Structures Normalization Rules Security Mgmt Data Privacy DataConfiguration Physician/ Provider Lab System (LIS) Lab Clinician EMS Systems Radiologist Pharmacy System Pharmacist Public Health Services Public Health Provider Longitudinal Record Services HIAL Communication Bus Common Services Client Registry Provider Registry Location Registry Terminology Registry Get Client ID Resolution List Laboratory Orders Get Laboratory Result List Laboratory Results Get Prescription List Medications Stream DI Image List DI Results Get DI Report Get Outbreak Case Data List CD Report Events Get Provider Information List Service Delivery Locations List Encounter Events Get Encounter Summary Get Clinical Dashboard Get Client Demographic Integrated Health Services

18. Version 2.1 10-9-07 18 PHIN Functional Architecture

19. Version 2.1 10-9-07 19 Benefits of Interoperability Integrated services improve data exchange and, ultimately, service delivery Provides an integrated view across the continuum of health situations Creates an integrated process framework that connects health and all medical services to improve quality of care and health outcomes Builds common, reusable services

20. Version 2.1 10-9-07 20 Summary Without an Enterprise Services and Information Roadmap for Public Health, today’s public health services will remain siloed An Enterprise Services and Information Roadmap is essential to moving toward achieving Interoperability Make data exchange real by tackling cross- enterprise processes Service oriented modeling is essential to effective architecture design to achieve interoperability

21. Version 2.1 10-9-07 21 More Information http://www.prismsolution.com Donald George Chief Executive Officer PRISM Communication Systems, Inc. 1701 Barrett Parkway - Kennesaw, Georgia 30144 dgeorge@prismsolution.com

22. Version 2.1 10-9-07 22 Building an Interoperable Public Health Framework: Enabling Data Exchange Donald George, CEO PRISM Communication Systems, Inc. 135 th American Public Health Association: November 6, 2007 Advancing Health Care Through the Adoption of EHR/PHR