1. Anna Orlova and Lori Reed-Fourquet
Business Process Analysis (BPA) for Public Health Systems Interoperability: From Business Cases towards Interoperability Standards
Anna Orlova and Lori Reed-Fourquet
Public Health Data Standards Consortium
and
eHealthSign

2. Acknowledgements: Public Health Data Standards Consortium (PHDSC)
National Association of City and County Health Officers (NACCHO), USA
Participants of the NACCHO Workshop on Business Process Analysis in Public Health, Salt Lake City, UT, December 2011
Centers for Disease Control and Prevention (CDC), USA
Quality, Research and Public Health Committee, Integrating the Healthcare Enterprise (IHE)
Public Health and Emergency Response Workgroup, Health Level Seven (HL7)
Structured Documents Workgroup, HL7

3. State Health Department Organizational Chart

4. From Connectivity to Interoperability
TODAY
TOMORROW
Healthcare
Public Health
Healthcare
Public Health

5. Terms and Definitions Term Definition Business Area
Public health roles (objectives) in the society performed by the agency
Domain
Public health program/division/office within an agency that realizes the implementation of a given business area or multiple business areas
Business Process
Activities to support a particular role (objective)
Information System Functions
Functional requirements for information systems to support business processes
Case (or Public Health Case)
A health-related event (condition) that by law is of interest to a particular public health program at the local, state or federal level
Public Health Reporting
An information exchange (send, recieve, retrieve) on a public health case (health-related event (condition, occurence)) that by law is of interest to a particular public health program at the local, state or federal level

6. Harmonizing Public Health Operation across Various Domains/Programs
The operation of local, state and federal public health agencies under the core public health functions (assessment, policy and assurance) is focused on enabling resources and services for the public’s health protection. The public health operates under the following business areas:
Population – Know population to serve
Resources – Know healthcare capacities and other resources to serve the population
Environment – Know the environment in your jurisdiction to prevent and control possible public’s health threat exposure to the served population
Protection – Enable protection of the public in the jurisdiction from diseases and exposure to biohazards, environmental agents and natural disasters
Wellness – Promote wellness for the served population
Direct Care – Enable access to care for underserved population and people with special needs
Agency Operation – Enable program operation to provide services to the population in need
Research – Conduct research to evaluate public health interventions and to develop new interventions

7. Business Processes: Patient & Population Level
Core Public Health Functions
Public Health Business Processes
Patient-level
Population level
ASSESSMENT
Case identification
Outbreak identification
Case investigation
Outbreak investigation
Case management
Outbreak management
ASSURANCE
Case management evaluation
Outbreak management evaluation
POLICY
Mitigation

8. Examples of Interoperability Standards by Information Systems Function
Information System Functions
Examples of Related IHE Profiles and Standards
Collect Data
RFD, XDS, LAB TF (XD*Lab, Lab message), QRPH content (EHDI, PRPH-CA, MCH, DSC), PCC Content (LDS, XDS-MS, XPHR, IC), RPE, RDA, XD* with HL7 CDA for PH Reporting
Reporting Requirements (Pending HL7 work)
Report Criteria
Guideline Manager
Practice Manager
Data Source
Workflow (XDW)
Manage Data (upload, maintain, delete)
Control Access (XUA, ATNA)
Analyze Data
(Statistical Algorithms), Syndromic Surveillance Algorithms (DSUB, MPQ), Retrieve Medical Knowledge QRPH-29
Integrate Data
IT Infrastructure Profiles (PIX, PDQ, XDS, XDR, On-Demand Documents, XDW)
Report Data
PDF, Maps, Send Distribution QRPH-30

9. Public Health Business Areas
NACCHO-PHDSC Business Process Analysis for Pubic Health: Project Findings
Public Health Business Areas

10. NACCHO-PHDSC Business Process Analysis for Pubic Health: Project Findings
Public Health Business Areas
Public Health Business Processes
Individual/Population

11. NACCHO-PHDSC Business Process Analysis for Pubic Health: Project Findings
Public Health Business Areas
Public Health Business Processes
Individual/Population
Information Systems Functions

12. NACCHO-PHDSC Business Process Analysis for Pubic Health: Project Findings
Public Health Business Areas
Public Health Business Processes
Individual/Population
Information Systems Functions
Data Content

13. Information Systems Functions Data Content
Public Health Business Areas
Public Health Business Processes
Individual/Population
Information Systems Functions
Data Content
Population
Resources
Environment
Protection
Wellness
Direct Care
Operations
Research

14. Information Systems Functions Data Content
Public Health Business Areas
Public Health Business Processes
Individual/Population
Information Systems Functions
Data Content
Population
Case/Outbreak Identification
Resources
Case/Outbreak Investigation
Environment
Protection
Case/Outbreak Management
Wellness
Case/Outbreak Management
Evaluation
Direct Care
Operations
Mitigation
Research

15. Information Systems Functions Data Content
Public Health Business Areas
Public Health Business Processes
Individual/Population
Information Systems Functions
Data Content
Population
Case/Outbreak Identification
Collect Data
Resources
Case/Outbreak Investigation
Manage Data
Environment
Integrate Data
Protection
Case/Outbreak Management
Wellness
Analyze Data
Case/Outbreak Management
Evaluation
Direct Care
Report Data
Operations
Mitigation
Research

16. Information Systems Functions Data Content
Public Health Business Areas
Public Health Business Processes
Individual/Population
Information Systems Functions
Data Content
Population
Case/Outbreak Identification
Guidelines
Collect Data
Resources
Case/Outbreak Reports
Case/Outbreak Investigation
Manage Data
Environment
Lab Reports
Integrate Data
Protection
Case/Outbreak Management
Care Plans
Wellness
Alert & Notification
Analyze Data
Case/Outbreak Management
Evaluation
Quality Reports
Direct Care
Report Data
Educational Materials
Operations
Mitigation
Research

17. Public Health Program Examples:
Early Hearing Detection & Intervention (EHDI)
and
Public Health Laboratory

18. Guiding the HIT Standardization for Public Health
Public Health Business Areas
Public Health Business Processes
Individual/Population
Information Systems Functions
Data Content
Use Cases
Workflow Standards
Health IT Standards
Content Standards

19. Business Areas: Early Hearing Detection & Intervention

20. Business Areas: Public Health Laboratory

21. Information Systems Functions Data Content
Public Health Business Areas
Public Health Business Processes
Individual/Population
Information Systems Functions
Data Content
Population
Case/Outbreak Identification
Guidelines
Collect Data
Resources
Case/Outbreak Reports
Case/Outbreak Investigation
Manage Data
Environment
Lab Reports
Integrate Data
Protection
Case/Outbreak Management
Care Plans
Wellness
Alert & Notification
Analyze Data
Case/Outbreak Management
Evaluation
Quality Reports
Direct Care
Report Data
Educational Materials
Operations
Mitigation
Research

22. Early Hearing Detection and Intervention (EHDI) Program
Use Cases
Workflow Standards
Health IT Standards
Content Standards
Population
Case Identification
Labor & Delivery Summary
Labor & Delivery Workflow
Resources
Environment
Newborn Hearing Screening
Workflow
Hearing Screening Order/Results
Protection
Wellness
Hearing Screening Quality Measures
Case Investigation
Direct Care
Newborn Care Workflow
MS: Hearing Risk Factors
Operations
Case Management
Early Hearing
Care Plan
Research
Short-Term Care
Follow-up Workflow
Updated Hearing
Care Plan

23. Communicable Diseases Programs (Lab Data)
Use Cases
Workflow Standards
Health IT Standards
Content Standards
Population
Case Identification
Chief Complaint
Medical Summary
Visit to Provider
Resources
Environment
Laboratory
Workflow
Lab order/ Results
Protection
Wellness
PH Questionnaire
Case Investigation
Direct Care
Case Investigation
Workflow
Risk Factors
Operations
Case Management
Case Management
Plan
Research
Case Management Workflow
Updated
Plan

24. Business Processes, Data Content, Standards:
Early Hearing Detection & Intervention & PH Labs
Business Processes /
Activities
Information Exchange Content by Domain
Examples of
IHE Interoperability Standards
EHDI
PH-Lab
Preparedness (Anthrax)
Surveillance (Influenza)
CASE IDENTIFICATION
Trigger: Due for screening / Present with symptoms
Input:
Notification of birth
Output: Standing order
Input: Medical Summary
Output: Test Order
Input: Medical Summary Output: Test Order
XDS-MS/XPHR/C32 XDS/XDR/Lab-Technical Framework (TF)
PIX/PDQ/QRPH29 – Retrieve medical knowledge/
PCC Care Management TF
Trigger: Order test/Standing order for the test
Consent (or by statute)
Output:
Test order
BPPC
LAB TF
Trigger: Conduct test
Input: Test order
Test results
PCD-01/LAB TF/ RFD/XDR/DSUB/NAV

25. Actors and Information Systems:
Early Hearing Detection & Intervention (EHDI) & PH Labs
Information Systems (Technical Actors)
Business Actors by Domain
EHDI
PH-Lab
Hospital EHR-S
Birthing Facility
ER, Inpatient
Ambulatory EHR-S
Pediatrician
Outpatient
Medical Device
Hearing Screening Device
N/A
LIMS
Public Health Laboratory
Clinical Laboratory
Reference Laboratory
Public Health Information Systems (IS)
EHDI IS
Condition-Specific IS
N/A – Not applicable

26. Interoperability Standards Schema:
Early Hearing Detection & Intervention & PH Labs

27. Business Case: Public Health in HIT Standardization
URL:

28. PHDSC Business Case: HIT Standardization Phases, Products and Entities
Needs
&
Priorities
Development &
Maintenance
Selection
Harmonization
Testing/Trial Implementation
Certification
Deployment
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
SDOs
(e.g.,
HL7, SNOMED (IHTSDO), LOINC,
ASC X12,
NUBC, ISO TC215)
IHE
S&I Harmonization Framework Initiatives
Certification Entities
(CCHIT, Drummond Group, Inc)
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
On-going Activities ( 2008-now)
Developed methodology for public health participation in HIT standards development & harmonization.
New Activities ( )
Develop methodology for public health participation in HIT product testing and certification
Future Activities
Develop methodology for evaluation of standard-based HIT products (standards-based HIT products deployment)

29. Source: Fridsma D. Standards and Interoperability Framework: Principles and Processes. HIT Standards Committee. September 21, URL:

30. Assuring Health IT Standards for Public Health
Use Cases
Standards
Interoperability Standards: Testing & Certification
Proposed
PH Reporting Initiative
HL7 PH Functional Profile
IHE PH Reporting Integration Profile
PH Systems Certification
HL7 PH Reporting Requirements Standard
Interoperability Showcase™

31. HITSP Projects PHDSC 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
PH-Lab
Hearing
HITSP Projects
PHDSC Projects
Admin Data
ONC
Standards and Interopera-bility Framework

32. QUESTIONS?
URL: