1. Public Health Data Standards Consortium http://www.phdsc.org http://www.phdsc.org

2. The Consortium is a unique entity made up of federal, state and local agencies, professional associations, academia, health IT vendors and individuals that collectively represent the interests of public health in the health IT standardization.

3. Public Health Reporting Repository Functional Requirements and Design Working Meeting at CDC, January 19, 2012

4. Outline Context for this project: Business Case PHDSC Web Resource Center  HIT Standards Resources  Public Health Participation in HIT Standardization  HIT Adoption Stories  Public Health Needs for HIT Standardization S&I PH Reporting Initiative and PHIN Resources Building PH Reporting Resource Repository 4

5. Supported through a CDC Cooperative Agreement. Business Case: Public Health in HIT Standardization URL: http://www.phdsc.org/standards/pdfs /PHDSC_Business_Case_Public_H ealth_HIT-Standardization.pdf 5

6. Business Case: Public Health in HIT Standardization 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. 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 public health stakeholders and HIT standardization entities on various phases of HIT standardization. 6

7. What do we want to achieve? National Health IT adoption strategies have created unprecedented interest in using population-level data. Such data can be available if public health information systems successfully interoperate, i.e., receive and send data between clinical information systems; and across health information systems at all levels of government. We propose a business strategy that Maximizes the impact of those who participate on behalf of public health in the national Health IT standardization process, and Obtains input from, informs, and educates other public health stakeholders. Through this collaborative public health effort, we could achieve meaningful interoperability across public health information systems as well as between public health and clinical information systems. 7

8. How will we want to achieve? Implementing the Business Case through Developing a methodology for Public Health Participation in HIT Standardization Efforts Educating Public Health Community about Health Informatics and HIT Standards 8

9. PHDSC Business Case: HIT Standardization Phases, Products and Entities HIT Standardization Phases Needs & Priorities Development & Maintenance Selection & Harmonization Testing/Trial Implementation CertificationDeployment Goals What should be accomplished ? What are the standards? What standards to use? Show what can be accomplished Certify standards- based products Deploy standards- based products HIT Standards and Interoperability Framework Development Entities HIT Policy Committee HIT Standards Committee (Formerly AHIC) SDOs (e.g., HL7, SNOMED (IHTSDO), LOINC, ASC X12, NUBC, ISO TC215) IHE HITSP ONC Standards & Interoperability Framework NwHIN IHE Certification Entities (CCHIT, Drummond Group, Inc) Proposed IHE & PHDSC Deployment Workshops Standards Documents Use Cases (Description of the health information exchanges) Standards Interoperability Specifications Technical Frameworks Integration Profiles Test Reports Functional Profiles Certification Criteria Deployment Reports Developing a methodology… 9

10. …and working on projects HIT Standardization and PHDSC Projects HIT Standardiza- tion Phases Needs & Priorities Development & Maintenance Selection & Harmonization Testing /Trial Implemen- tation Certification Deploy- ment Goals What should be accomplished? What are the standards? What standards to use? Show what can be accomplished Certify standards- based products Deploy standards -based products Public Health Domains Undergoing HIT Standardiza- tion AHIC / MU: Biosurveillance Immunization ELR Public Health Reporting Newborn Screening Vital Records Biosurveillance Immunization PH-Lab Public Health Reporting Newborn Screening Vital Records Biosurveillance Immunization PH-Lab Public Health Reporting Newborn Screening Vital Records PH-Lab Public Health Reporting Hearing Vital Records PH-Lab Public Health Reporting Hearing Vital Records PH-Lab Hearing PHDSC Projects HITSP Projects 10

11. Source: Fridsma D. Standards and Interoperability Framework: Principles and Processes. HIT Standards Committee. September 21, 2010. URL: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1817&parentname=CommunityPage&parentid=28&mode=2&in_hi_userid=11673&cached=true

12. 12 ONC Standards and Interopera- bility Framework PHDSC Projects HITSP Projects Admin Data

13. PHDSC Webinars:  Series of Webinars on Meaningful Use of Health IT for Public Health in partnership with JPHIT  HIT Standards for Early Hearing Detection and Intervention  Re-evaluation of HL7 EHR-S Functional Model from Public Health Perspectives  HL7 Ambassador Presentation on Syndromic Surveillance and Meaningful Use of Health IT University-based Health Informatics Training in partnership with Johns Hopkins University Health Information Technology Standards Web- Resource (http://www.phdsc.org/standards/health-information-tech-standards.asp)http://www.phdsc.org/standards/health-information-tech-standards.asp Educate Public Health and Clinical Professionals about HIT Standards 13

14. Public Health IT Standardization Resource Center Four module website: 14

15. Public Health IT Standardization Resource Center Four module website: 15

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19. Public Health IT Standardization Resource Center Four module website: 19

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23. Public Health IT Standardization Resource Center Four module website: 23

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26. 26 CDC Domains 15 Public Health Essential Function x 17 Informatics function x 6 Standardization phase x 6 Standardization Activities x 12 = a lot!

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32. Public Health IT Standardization Resource Center Four module website: 32

33. Outline Context for this project: Business Case PHDSC Web Resource Center  HIT Standards Resources  Public Health Participation in HIT Standardization  HIT Adoption Stories  Public Health Needs for HIT Standardization S&I PH Reporting Initiative and PHIN Resources Building PH Reporting Resource Repository 33

34. PHRI Goal The goal of the S&I Framework Public Health Reporting Initiative is to harmonize HIT standards and implementation guides for bi-directional interoperable communication between clinical care and public health entities for selected use cases

35. PHRI Work Process and Deliverables Work process overview:  The Initiative will examine several reporting use cases that share similar business processes, information exchange requirements and data requirements.  The Initiative will then select and harmonize: HIT standards Develop harmonized implementation guide(s) Establish reference implementations for standards testing, certification criteria, and processes Make recommendations for these use cases to be considered for Stage 3 of Meaningful use

36. Workgroup Statistics Approximately 90 active members from a wide variety of stakeholder organizations:  Federal/State PH reporting programs  Standards Development Organizations  Vendors  Professional Associations Five (5) co-leads, Two (2) Liaisons for Stakeholder Communications and Outreach, Two (2) Facilitators and an ONC Liaison Weekly meetings (Wednesdays 4-5P EST)

37. PHRI Use Case: Initial PH Report A use case is the foundation for identifying and specifying the standards required to support the data exchange and developing reference implementations and tools to ensure consistent and reliable adoption of the data exchange standards: The PHRI use case describe:  The operational context for PH reporting data exchange  The stakeholders with an interest in PH reporting  The information flows that must be supported by the PH reporting data exchange  The types of PH data and their specifications required in the data exchange

38. Use Case with Multiple User Stories 30 user stories were submitted and classified into 5 reporting domains:  Adverse Event Reporting  Child Health  Chronic Diseases  Communicable Diseases  Infrastructure/Quality/Research

39. PHRI User Story User stories summarize the interaction between the actors of the use case, and specify what information is exchanged from a contextual perspective. User stories describe the real world application as an example of the PH reporting scenario

40. Consolidation of User Stories User story templates provided a starting point to begin harmonization within a PH reporting domain and across PH reporting domains:  Actors and Interactions: human and computer  Data elements and/or datasets  Standards and vocabulary

41. Consolidated User Story: Child Health, Birthing Facility 1.Child is delivered. If live birth follows steps 3-9, 2.Clinician conducts initial physical exam 3.Newborn is due for 4.Clinician orders an 5.Hospital staff administers and conducts and collects and conducts 6.Hospital staff enter data on the in the EHR database 7.EHR pre-populate information to the Birth/Fetal Death Facility Worksheet 8.Hospital staff and clinician review the Birth/Fetal Death Facility Worksheet 9.Information is electronically sent on to the PH IS directly or via HIE 10.PH program IS receives notification of report availability 11.PH programs’ staff reviews the report and create PH IS record on a child in 12.PH IS sends Acknowledgement of Receipt of the Report to EHR directly or via HIE. Use Case Name: Actors: Flow of Events: Data Categories 1&2 Demographics, Antepartum Record, Prenatal record, Labor & Delivery Record, Postpartum record, Newborn EHR 3. Consent (not for birth registration) 4. Test Order or Standing Order 5. Immun. Record, Test Results, Birth Defect Record 6. Immun. Record, Hearing Test Results, Birth Defect Record, Birth Record, Heelstick Lab Order 7&8. Birth/Fetal Death Facility Worksheet 9. Initial PH Report 10. Notification of Report Availability 11. Updated PH Record 12. Acknowledgement of receipt Vital Records, Hearing, Immunization, Birth Defects, Metabolic Screening Newborn, Caregiver, Clinician, Hospital staff, Public health program staff Pre-Conditions: Post-Conditions: Preferred Timing EHR System, Health Information Exchange (HIE) Public Health Information System Daily updates

42. Use Case Diagram Examples High level representation of the information exchange requirements:

43. Phase 1 (September-December 2011) Charter has been finalized All participants work together on - assessment of needs for the process - building a consensus on public health reporting definitions - building a consensus on a scope of the Public Health Reporting HIT Standardization Framework - development of criteria and selection use cases - defining a list of WGs Forming workgroups and starting assessment of existing artifacts in a scope of the initiative Development of detailed work plan AugustSeptembe r OctoberNovembe r DecemberJanuaryFebruaryMarchApril Initiation S&I PH Reporting Roadmap User Story Validation / Consolidation Final version of the Charter FR / Modeling Stds Harm Phase 2 (January-May 2012) Harmonization of selected use cases into a single use case Identification of core data elements and data classes Working on harmonization of FHA and segment enterprise architecture for public health reporting Working on terminology Identification and Harmonization of vocabulary / content exchange Standards Development of implementation documentation Completion of assessment of business process, policy barriers Proposing public health objectives for Stage 3 MU Environmental scan of existing shared utilities for public health reporting and development of a vision on a public health hub for collection, sharing and maintenance Development of a vision on a purpose and scope of testing and certification of systems for public health reporting Use Case Documentation Spec Development / Pilot Planning

44. Potential Artifacts for Phase 2 44

45. Outline Context for this project: Business Case PHDSC Web Resource Center  HIT Standards Resources  Public Health Participation in HIT Standardization  HIT Adoption Stories  Public Health Needs for HIT Standardization S&I PH Reporting Initiative and PHIN Resources Building PH Reporting Resource Repository 45

46. PH Reporting Resource Repository Functional Requirements and Design 46

47. PHIN Strategic Planning Mission: To establish and support shared policies, standards, practices, and services that facilitate efficient public health information access, exchange, use, and collaboration among public health agencies and with their clinical and other partners.  Goal I. Provide leadership in the selection and implementation of shared policies, standards, practices, and services for nationwide public health information exchange  Goal II. Define, advocate for, and support public health needs and roles in national health information technology and exchange initiatives  Goal III. Perform key public health information exchange and standards management roles Nationwide public health information exchange Shared policies Shared standards Shared practices Shared services 47

48. PH Reporting Resource Repository Goal is to support participation of public health professionals in health IT standardization activities under the S&I PH Reporting Initiative and beyond 48

49. PH Reporting Resource Repository Support US Health IT Infrastructure:  Nationwide Health Information Network (NwHIN)  Regional Health Information Exchanges (HIEs)  Public Health Information Systems  Clinical Information Systems (EHR-S, LIMS, Pharmacy IS, etc.) 49

50. US Health Information Network Source: Dr. Peter Elkin, Mayo Clinic, MN

51. HIEs as NwHIN Components Source: Dr. Peter Elkin, Mayo Clinic, MN, 2006

52. PH Reporting Resource Repository Target Audience:  Public Health Practitioners  Public Health Informaticians  Standards Developers  Health IT Vendors 52

53. PH Reporting Resource Repository Meeting Information Needs of Stakeholders (Repository’s Views):  Public Health Practitioners  Public Health Informaticians  Standards Developers  Health IT Vendors 53

54. State Health Department Organizational Chart

55. Source: Eileen Koski. Quest Diagnostics. PHIN-2004, May, Atlanta GA Percent of Children Tested for Lead with BLL>10 µg/dL in the USA Vision for Public Health Surveillance under NHIN PH Practitioner View

56. Meeting Information Needs of Stakeholders (Repository’s Views):  Public Health Practitioners 56 ResourcesTools HIT Adoption Story 1PHDSC HIT Adoption Stories Module HIT Adoption Story 2PHIN …….TBD HIT Adoption Story NTBD

57. PH Reporting Resource Repository Meeting Information Needs of Stakeholders (Repository’s Views):  Public Health Practitioners  Public Health Informaticians  Standards Developers  Health IT Vendors 57

58. System Architecture for Environmental Health Risk Detection, Assessment & Management System Architecture for Environmental Health Risk Detection, Assessment & Management GIS/Spatial EpidemiologyRisk AnalysisData Mining & Knowledge DiscoveryStatistical Models Exposure Detection9 & Risk Analysis Track health, disease, and exposure risk/trends Detect & evaluate risk of exposure to env. hazards Develop & evaluate public health & environmental stewardship policies & programs Develop rapid-response mechanisms to investigate outbreaks and clusters Develop prevention guidelines/standards Generate hypotheses and initiate applied research Environmental Stewardship & Public Health Actions Source: Nabil Issa, CDC/NCEH, Brussels, Belgium June 2002. (*) Based on risk assessment and national priorities Environmental Hazards, Ecology and Disease Data Collection Systems Disease Tracking * Hospital Discharge Birth Defects BRFSS Cancer Registries Health Surveys Vital Statistics Population Demographi cs * Census Data Exposure Tracking * Human Exposure to Environmental Chemicals Toxic Exposure Surveillance Hazards Tracking * Hazardous Substances- Emergency Event Surveillance Toxic Release Inventory Ecological Tracking * Marine Life Animals Plants Population Disease Indicators Population Demography Health Outcomes Exposure Profile Environmental Hazard Hazardous Material Profile Exposure Integrated Environmental Health Indicators Data Warehouse Biomonitoring Natural Accidental Intentional Ecological Indicators Data Linking/IntegrationMetadataData StandardizationData Quality Assurance Data Integration, Transformation & Geocoding Geocoding Informatician View

59. 59 Informatician View PH-Lab Reporting Use Cases

60. Consolidated User Story: Child Health, Birthing Facility 1.Child is delivered. If live birth follows steps 3-9, 2.Clinician conducts initial physical exam 3.Newborn is due for 4.Clinician orders an 5.Hospital staff administers and conducts and collects and conducts 6.Hospital staff enter data on the in the EHR database 7.EHR pre-populate information to the Birth/Fetal Death Facility Worksheet 8.Hospital staff and clinician review the Birth/Fetal Death Facility Worksheet 9.Information is electronically sent on to the PH IS directly or via HIE 10.PH program IS receives notification of report availability 11.PH programs’ staff reviews the report and create PH IS record on a child in 12.PH IS sends Acknowledgement of Receipt of the Report to EHR directly or via HIE. Use Case Name: Actors: Flow of Events: Data Categories 1&2 Demographics, Antepartum Record, Prenatal record, Labor & Delivery Record, Postpartum record, Newborn EHR 3. Consent (not for birth registration) 4. Test Order or Standing Order 5. Immun. Record, Test Results, Birth Defect Record 6. Immun. Record, Hearing Test Results, Birth Defect Record, Birth Record, Heelstick Lab Order 7&8. Birth/Fetal Death Facility Worksheet 9. Initial PH Report 10. Notification of Report Availability 11. Updated PH Record 12. Acknowledgement of receipt Vital Records, Hearing, Immunization, Birth Defects, Metabolic Screening Newborn, Caregiver, Clinician, Hospital staff, Public health program staff Pre-Conditions: Post-Conditions: Preferred Timing EHR System, Health Information Exchange (HIE) Public Health Information System Daily updates

61. Use Case Diagram Examples High level representation of the information exchange requirements:

62. Meeting Information Needs of Stakeholders (Repository’s Views):  Informaticians 62 ResourcesTools Policy documentsPHIN, PHDSC, ASTHO, NACCHO, etc. web-sites Business Process Analysis Documentation PHDSC Online Requirements Survey Use Cases Requirements Documentation Implementation GuidesPHIN Standards-related documentation PHDSC HIT Standards Module

63. PH Reporting Resource Repository Meeting Information Needs of Stakeholders (Repository’s Views):  Public Health Practitioners  Public Health Informaticians  Standards Developers  Health IT Vendors 63

64. 64 Standard Developer View

65. Meeting Information Needs of Stakeholders (Repository’s Views):  Standards Developers 65 ResourcesTools Standards Development Documentation PHDSC HIT Standards Module, MDHT, PHIN Implementation Guides Standards Testing Documentation Testing Statements, PHIN-PHIX Certification of Standards- based Products Documentation Certification Statements

66. PH Reporting Resource Repository Meeting Information Needs of Stakeholders (Repository’s Views):  Public Health Practitioners  Public Health Informaticians  Standards Developers  Health IT Vendors 66

67. 67 Health IT Vendor View

68. Meeting Information Needs of Stakeholders (Repository’s Views):  HIT Vendors 68 ResourcesTools Standards Development Documentation PHDSC HIT Standards Module, MDHT, PHIN Implementation Guides Standards Testing Documentation Testing Statements Certification of Standards- based Products Documentation Certification Statements Deployment Documentation

69. PH Reporting Resource Repository Design 69

70. PHDSC Business Case: HIT Standardization Phases, Products and Entities HIT Standardization Phases Needs & Priorities Development & Maintenance Selection & Harmonization Testing/Trial Implementation CertificationDeployment Goals What should be accomplished ? What are the standards? What standards to use? Show what can be accomplished Certify standards- based products Deploy standards- based products HIT Standards and Interoperability Framework Development Entities HIT Policy Committee HIT Standards Committee (Formerly AHIC) SDOs (e.g., HL7, SNOMED (IHTSDO), LOINC, ASC X12, NUBC, ISO TC215) IHE HITSP ONC Standards & Interoperability Framework NwHIN IHE Certification Entities (CCHIT, Drummond Group, Inc) Proposed IHE & PHDSC Deployment Workshops Standards Documents Use Cases (Description of the health information exchanges) Standards Interoperability Specifications Technical Frameworks Integration Profiles Test Reports Functional Profiles Certification Criteria Deployment Reports PH Reporting Resource Repository Content 70

71. Source: Fridsma D. Standards and Interoperability Framework: Principles and Processes. HIT Standards Committee. September 21, 2010. URL: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1817&parentname=CommunityPage&parentid=28&mode=2&in_hi_userid=11673&cached=true

72. HIT Standardization and PHDSC Projects HIT Standardiza- tion Phases Needs & Priorities Development & Maintenance Selection & Harmonization Testing /Trial Implemen- tation Certification Deploy- ment Goals What should be accomplished? What are the standards? What standards to use? Show what can be accomplished Certify standards- based products Deploy standards -based products Public Health Domains Undergoing HIT Standardiza- tion AHIC / MU: Biosurveillance Immunization ELR Public Health Reporting Newborn Screening Vital Records Biosurveillance Immunization PH-Lab Public Health Reporting Newborn Screening Vital Records Biosurveillance Immunization PH-Lab Public Health Reporting Newborn Screening Vital Records PH-Lab Public Health Reporting Hearing Vital Records PH-Lab Public Health Reporting Hearing Vital Records PH-Lab Hearing PHDSC Projects HITSP Projects 72 PH Reporting Resource Repository Content

73. PHDSC Web Resource Center: Public Health in IT Standardization Four module website: 73

74. Health Information Technology Standardization Phases, Products, Entities Deployment module ADOPTION STORIES - evidence - metrics Resources module STANDARDS - education - information Involvement module PARTICIPATION - monitor - coordinate Requirements module STANDARDS NEEDS - identify - support PH REPORTING RESOURCE REPOSITORY TOOLS & SERVICES 1 Needs & Priorities 1 Needs & Priorities 2 Develop Standards 2 Develop Standards 3 Select Standards 3 Select Standards 4 Implement Standards 4 Implement Standards 5 Certify Standards 5 Certify Standards 6 Adoption 6 Adoption PUBLIC HEALTH REPORTING RESOURCE REPOSITORY 1.0 Use Cases Standards Interop Spec, Tech Fwk Int. Prof Interop Spec, Tech Fwk Int. Prof Implementation Reports Certification Criteria Adoption User Stories DB Newsletter User Stories DB Newsletter CDA templates Implementation Guides Training documents CDA templates Implementation Guides Training documents Participation reports Cost-benefit analysis Participation reports Cost-benefit analysis Questionnaires Surveys Use cases/Stories DB Questionnaires Surveys Use cases/Stories DB

75. Health Information Technology Standardization Phases, Products, Entities Deployment module ADOPTION STORIES - evidence - metrics Resources module STANDARDS - education - information Involvement module PARTICIPATION - monitor - coordinate Requirements module STANDARDS NEEDS - identify - support PH REPORTING RESOURCE REPOSITORY TOOLS & SERVICES 1 Needs & Priorities 1 Needs & Priorities 2 Develop Standards 2 Develop Standards 3 Select Standards 3 Select Standards 4 Implement Standards 4 Implement Standards 5 Certify Standards 5 Certify Standards 6 Adoption 6 Adoption PUBLIC HEALTH REPORTING RESOURCE REPOSITORY 1.0 Use Cases Standards Interop Spec, Tech Fwk Int. Prof Interop Spec, Tech Fwk Int. Prof Implementation Reports Certification Criteria Adoption User Stories DB Newsletter User Stories DB Newsletter CDA templates Implementation Guides Training documents CDA templates Implementation Guides Training documents Participation reports Cost-benefit analysis Participation reports Cost-benefit analysis Questionnaires Surveys Use cases/Stories DB Questionnaires Surveys Use cases/Stories DB PHINPHIN PHDSCPHDSC

76. Standards WorldPublic Health World Common Definitions Participan tActor Action Workflow PHProduct/ Report Guideline Rule Standard Standardizati onActivity Implementatio nGuidance HITProduct Participant Narrative Domain/ Program PH Reporting Resource Repository Conceptual Data Model

77. 77 PH Reporting Resource Repository: PHDSC Web Resource Reference Information Model

78. PH Reporting Resource Repository Timeline:  Draft Requirements (PHDSC Team) – Feb 15, 2012  Final Requirements with Phased Approach for Deployment (PHDSC+PHIN Teams) – April 15, 2012  Design (PHDSC+PHIN Teams) – May 2012  Phase 1 Development – July 2012  Phase 1 Launch – September 2012 78

79. PH Reporting Resource Repository Public health needs to “find its voice” in HIT standardization We need to engage and education public health on HIT standardization issues We need to encourage public health to participate and show them how Repository will help! 79