1. MONDAY, 3:30 – 3:50 PM Bryant T. Karras, MD, Public Health Informatics Officer, Sr Epidemiologist, State of Washington, Department of Health Rebecca A. Hills, MSPH, University of Washington Public Health: Case-Reporting, Biosurveillence, and Immunization Tracking 1

2. Meaningful Use to Improve Population and Public Health (3 of the 27 CMS objectives and measures) Hospital Capability to provide electronic submission of reportable lab results, as required by state or local law, to public health agencies and actual submission where it can be received Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice Capability to submit electronic data to immunization registries and actual submission where required and accepted HIMSS 20102 Source Office of E-Health Standards and Services, Centers for Medicare & Medicaid Services (CMS)

3. Population and Public Health Scenarios Demonstrated Case Reporting and Decision Support HIMSS 20103 Biosurveillance Immunization

4. Introduction »The HIE project »Washington State DOH, CDC, INHS »This presentation Public Health’s role in Health Information Exchange (HIE) Meaningful Use and Public Health The scenarios demonstrated in the Interoperability Showcase Case Reporting and Decision Support Biosurveillance Immunization »Meaningful use as dem onstrated in these scenarios 4HIMSS 2010

5. Public Health – 10 Essential Services 5HIMSS 2010 1. Monitor 2. Diagnose and investigate 3. Inform, educate 4. Mobilize 5. Develop policies and plans 6. Enforce 7. Link 8. Assure 9. Evaluate 10. Research

6. Meaningful Use Through provisions of ARRA there will be incentives for “meaningful use” Meaningful use of EHR technology will improve health care quality, efficiency and patient safety. 6HIMSS 2010

7. Public Health and Meaningful Use 7HIMSS 2010 How can public health leverage electronic information? Many of the meaningful use criteria are related to public health functions These demos show examples of how public health can leverage electronic information

8. The HIE Project and the Interoperability Showcase HITSP identifies existing standards Integrating the Healthcare Enterprise (IHE) – Incorporates HITSP standards into interoperability profiles Interoperability Showcase WA participating since 2006 HIMSS 20108

9. Population and Public Health Scenarios Demonstrated Case Reporting and Decision Support HIMSS 20109 Biosurveillance Immunization

10. Case Reporting and Decision Support 10HIMSS 2010 »The story - Patient with influenza-like-illness visits provider, case is reported to public health, decision support is offered »Standards used (RFD, CCD, Xforms) »Facilitates communication between PH and provider »Meaningful use Record demographics, medications, vital signs Capability to provide electronic submission of reportable lab to public health agencies Implement clinical decision support rules

11. Case Reporting and Decision Support For 2011 MU requirements limited to electronic submission of reportable lab results to public health agencies By 2013 and 2015 will include more interactive public health alerts and ultimately more sophisticated epidemiological uses of the data including automated real-time adverse event reporting, disease outbreaks, and bioterrorism response. Bi-directional communication (Brian Dixon from Regenstrief will present on this in detail - 12:30 Tuesday) HIMSS 201011

12. Population and Public Health Scenarios Demonstrated Case Reporting and Decision Support HIMSS 201012 Biosurveillance Immunization

13. Biosurveillance 13HIMSS 2010 The story – patient with ILI symptoms visits PCP, lab is ordered and results recorded in the HIE’s registry and repository The standards used (XDS document sharing) PH query developed to identification of results of interest to public health Meaningful use – Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice. – Electronically record, store, receive and manage laboratory orders

14. International Society for Disease Surveillance (ISDS) National Level – Distribute age-specific (TERS) Temporal Epidemic Response Surface plots HIMSS 201014

15. Biosurveillance Adding a regional level HIE doubled our surveillance area HIMSS 201015 Original Surveillance Combined WA Biosurveillance Coverage New INHS Rate

16. Biosurveillance Adding a regional level HIE doubled our surveillance area: HIMSS 201016 Original Surveillance Combined WA Biosurveillance Coverage New INHS

17. Population and Public Health Scenarios Demonstrated Case Reporting and Decision Support HIMSS 201017 Biosurveillance Immunization

18. 18HIMSS 2010 »The Story A parent accesses her child’s immunization record using a PHR, and sees the same data as the PCP The Immunization Information System (IIS/Registry) is updated when messages from EHR systems are sent to the HIE registry repository, and are transformed to HL7 2.X messages Public health accesses the IIS for individual and population views of the data »The standards and profiles used Cross Enterprise Document Sharing (Immunization Content) Patient Demographic Query

19. Immunization – Meaningful Use Meaningful Use »Improve Population & Public Health Capability to submit electronic data to immunization registries and actual submission where required and accepted Demonstrates two types of immunization content submission to IIS ( HL7 2.5 and XDS-MS, IC ) »Engage patients and families in their health care Provide patients with electronic copies of their health information »Improve Care Coordination Capability to exchange key clinical information HIMSS 201019

20. Population and Public Health Scenarios Demonstrated Case Reporting and Decision Support HIMSS 201020 Biosurveillance Immunization

21. Demonstrating Meaningful use of EHR Often more than one way to satisfy these criteria depending on states Important to examine the way work is done now and how workflow will change if these data are made available Public Health systems designed to leverage EHR data will also need to comply with standards We have learned much and continue to learn from our demonstration and pilot projects in Washington State HIMSS 201021

22. Thank You CDC Funding Thanks – Bill Lober, Debra Revere (University of Washington) – David Dobbs (Contractor) – Charley Magruder (CDC) Contact Information – Bryant T. Karras MD - Bryant.Karras@DOH.WA.GOV – Rebecca Hills - hillsr@uw.edu HIMSS 201022

23. References Hills RA, Lober WB, Painter IS. Biosurveillance, Case Reporting, and Decision Support: Public Health Interactions with a Health Information Exchange. Lect Notes Comput Sci. Biosecure. 5354, pp 10-21, 2008. Close N, Lofy K, Sandifer T, Lowe P, Karras BT. Utilization of Washington State’s Public Health Emerging Event Detection System (PHEEDS) for 2009 H1N1 Surveillance. ISDS conference, 2009 *Participate the population health focused tours offered at the Showcase! HIMSS 201023

24. Thank You 24 The participation of any company or organization in the NHIN and CONNECT area within the HIMSS Interoperability showcase does not represent an endorsement by the Office of the National Coordinator for Health Information Technology, the Federal Health Architecture or the Department of Health and Human Services.

25. Meaningful Use to Improve Population and Public Health (3 of the 27 CMS objectives and measures) Capability to submit electronic data to immunization registries and actual submission where required and accepted Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice Hospital Capability to provide electronic submission of reportable lab results, as required by state or local law, to public health agencies and actual submission where it can be received HIMSS 201025 Source Office of E-Health Standards and Services, Centers for Medicare & Medicaid Services (CMS)

27. Public Health Alert (Salmonella) HIMSS 201027

28. Continuity of Care Document (CCD) HIMSS 201028 CCD

29. Public Health Form Receiver Form Manager CCD Provider Form Archiver Retrieve Form Request Form Delivery Form Submission Form Filler Alert or prepopulated Case Report Form How RFD Works, Actors and Transactions HIMSS 201029

30. HIMSS 201030 HIMSS 09 Biosurveillance IHE Interoperability Showcase 2. Laboratory Confirmation Care Community IHE Repository XDS-MS XDS-LAB 4. Generate Alert XDS-MS RFD/T-81/ Docs-4-Docs 6. Distribute 5. EMR Alerting (5a, 5b, 5c) RFD (Case Report) Summarized Data 1. Patient Visit with GI Symptoms Public Health Alert Repository XDS 3. Public Health Surveillance

31. 3. Gateway Services (PHR) Health Information Exchange - IHE Infrastructure Immunization Information System (IIS) Immunization Infrastructure Public Health Immunization Scenario Yellow Card Service Immunization Gateway The child is now getting ready to enter school. The parent double checks the immunization record to make sure the child is up-to-date. Parent uses the Immunization Gateway immunization services. Parent views the child’s records and sees that one shot is missing. 1. PHR A parent is preparing to go to a Primary Care Provider for a well-child visit. The parent views the child’s current immunizations using a Personal Health Record, which retrieves the information from the Health Information Exchange (HIE) using IHE’s XDS profile. In a rush, the parent makes an appointment for the child at a different clinic. The EHR queries the HIE using IHE’s XDS profile. The EHR retrieves the same immunization data the parent saw via PHR. The provider reviews the immunizations and administers vaccines. The provider enters the new immunizations into his EHR. EMR updates the HIE using IHE’s XDS, and simultaneously, updates the immunization registry (IIS) using HL7 Version 2. 4. Primary Care Provider 5. Schools and Public Health Predictions of an especially severe flu season cause the child’s school to implement a school located vaccination program School nurse accesses the child’s record in the IIS School nurse administers H1N1 vaccine and updates the IIS HIE and IIS are updated with the new immunization Population View of immunization data - Epidemiologist views individual or population-level immunization data. Immunization Decision Support Service The 5-year-old patient and the parent visit the provider, who uses an EHR system. The EHR queries the HIE using IHE’s XDS profile. The EHR retrieves the same immunization data the parent saw via PHR. The provider reviews the immunizations and administers vaccines. The provider enters the new immunizations into his EHR. EMR updates the HIE using IHE’s XDS, and simultaneously, updates the immunization registry (IIS) using HL7 Version 2. 2. Primary Care Provider HIMSS 201031