Public Health Data Standards Consortium

PHDSC Nationwide Health Information Network Committee Activities PUBLIC HEALTH DATA STANDARDS CONSORTIUM ~ 2007 BUSINESS MEETING OF MEMBERS ~ October 2-3, 2007, Hyattsville, MD

Purpose: To foster awareness, partnerships and collaboration at the local, state and national levels in the development of the regional health information exchanges. PHDSC NHIN Committee

The Nationwide Health Information Network (NHIN) is a health information technology strategy that will provide the foundation for an interoperable, standards- based network for the secure exchange of health care information. PHDSC NHIN Committee

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

DHHS’ Framework for Health Information Technology: Building a NHIN NHIN will be based on: u Electronic Health Record Systems (EHRS) that will enable u Regional Health Information Exchanges (RHIEs) Thompson TG and Brailer DJ. The Decade of Heath Information Technology to Deliver Consumer-centric and Information-rich Health Care. Framework for Strategic Action. US DHHS, July 21, 2004.

RHIEs as NHIN Components Source: Dr. Peter Elkin, Mayo Clinic, MN, 2006

Health IT Standards In February 2006 the Health Information Technology Standards Panel (HITSP) developed the classification of health information technology standards HITSP URL:

HITSP Standards Categories 1. Data Standards (vocabularies and terminologies) 2. Information Content Standards (Reference Information Models (RIMs)) 3. Information Exchange Standards, e.g., messaging standards 4. Identifiers Standards, e.g. National Provider Identifier (NPI)) 5. Privacy and Security Standards 6. Functional Standards, e.g. processes/workflow 7. Other, e.g. IT standards

1. Data Standards (vocabularies and terminologies) 2. Information Context Standards (Reference Information Models (RIMs)) 3. Information Exchange Standards, e.g. messaging standards 4. Identifiers Standards, e.g. National Provider Identifier (NPI)) 5. Privacy and Security Standards 6. Functional Standards, e.g. processes/workflow 7. Other, e.g. IT standards HITSP Standards Categories – New Stds Types

To date, the main focus of standard development activities has been on  data standards  information context standards  messaging standards and  infrastructure standards HITSP Standards Categories

National Biosurveillance Use Case Transmit essential ambulatory care and emergency department visit, resource utilization, and lab result data from electronically enabled health care delivery and public health systems in standardized and anonymized format to authorized Public Health Agencies with less than one day lag time. HITSP URL:

HITSP Interoperability Specification, 2006: Number of standards by category: (1) Terminology 28 (2) Context Information Model 17 (3) Information Exchange 46 (4) Identifier (Individual and Organization) 5 (5) Privacy and Security 11 (6) Functionality and Process (Workflow) 0 (7) Other 0 National Biosurveillance Use Case

Ambulatory Care Pharmacy Response Team State Public Health Surveillance System Biosurveillance Use Case Workflow DHHS 1- Report/retrieve symptoms, diagnosis & medication prescription data from EMRs 2 – Data mining of EMR notes 3 – Notify on increased number of cases & recommend to order pathogen test 6 – Report positive test result electronically & by phone 7 – Report on the positive case electronically & by phone Media Public Health Biosurveillance System Hospital Neighboring Jurisdictions PUBLICPUBLIC Laboratory 4 – Order pathogen test 5 – Report test results EHRS

To date, there is no consensus on the format, content, and approach for how to specify functional standards. Functional Standards

Developing a Vision for Functional Standard for Electronic Data Exchange Between Clinical and Public Health Settings – NYC Examples: Examples of School Health Syndromic Surveillance Contract # 05-S from Health Resources and Services Administration 2005 PHDSC-HRSA Project

Study Methodology: Requirement Elicitation: interviews with clinicians and public health practitioners on the work processes and data exchanges Study Outcome: Functional Requirement Analysis Documents (FRADs) for NYC School Health and Syndromic Surveillance Programs 2005 PHDSC-HRSA Project

Functional Requirements Analysis Document (FRAD): Outline 1.Introduction (Problem Overview) 1.1 Purpose of the Proposed System 1.2 Actors and Scope of the Proposed System 1.3 Objectives and Success Criteria of the Project 2. System Requirements 2.1 Functional requirements 2.3 Non-functional requirements 3. System Models 3.1 Use Case Description 3.2 Use Case Models Use Case Diagram Work Flow and Data Flow Model 3.3 High-Level System Architecture 4. Project Development Timeline 5. Testing / Evaluation Plan

PHDSC/HRSA EXPERT PANEL IN ELECTRONIC DATA EXCHANGES December 5-6, 2006, Washington DC Contract # HHSH P from Health Resources and Services Administration 2006 PHDSC-HRSA Project

Goal The goal of the Panel is to build consensus among leaders in public health and clinical electronic health information exchanges towards formalizing a vision for a standard representation of public health work processes for the electronic health information exchanges with clinical care, i.e. functional standard. PHDSC / HRSA EXPERT PANEL IN ELECTRONIC DATA EXCHANGES

HRSA Project Officers: Ms. Jessica Townsend Dr. Michael Millman PHDSC / HRSA EXPERT PANEL IN ELECTRONIC DATA EXCHANGES

PANELISTS: Dr. Oxiris Barbot, NYC Department of Health and Mental Hygiene, NY Dr. Neil Calman, Institute for Urban Family Health, NYC, NY Ms. Kathleen Cook, Lincoln-Lancaster County Health Deptment (City of Lincoln, County of Lancaster), NE Dr. Art Davisson, Denver Public Health, CO Dr. Peter Elkin, Mayo Clinic, Rochester, MN Dr. Martin LaVenture, Minnesota Health Department, MN Dr. David Lawton, Nebraska Health and Human Services System, NE Dr. Farzad Mostashari, NYC Dept. of Health & Mental Hygiene, NYC Dr. Anna Orlova, Public Health Data Standards Consortium Dr. David Ross, Public Health Informatics Institute Dr. Tom Savel, Centers for Disease Control & Preventions (CDC) Dr. Walter Suarez, Public Health Data Standards Consortium PHDSC / HRSA EXPERT PANEL IN ELECTRONIC DATA EXCHANGES

Meeting Objectives: Share experiences in building health information exchanges in panelists’ jurisdictions to date Discuss national initiatives on the development of functional standards in health information exchanges Discuss the Functional Requirements Analysis Documents for health information exchanges on School Health and Syndromic Surveillance in New York City as prototypes of functional requirements specifications, i.e., functional standards Develop recommendations for the roadmap on developing functional standards on health information exchanges between clinical care and public health PHDSC / HRSA EXPERT PANEL IN ELECTRONIC DATA EXCHANGES

QUESTIONS FOR DISCUSSION Does the NYC documents adequately describe user needs in terms of system goal, actor, function, workflow and dataflow? Does it include necessary elements needed to build the user requirements? What is missing? Is it reusable for other public health domains/programs/jurisdictions? What is the right name for this document – Functional Requirements Specification? Use Case Description? Functional Standard? Functional Requirement Analysis Document (FRAD)? Other? PHDSC / HRSA EXPERT PANEL IN ELECTRONIC DATA EXCHANGES

Recommendations Use the NYC Functional Requirement Analysis Documents (FRADs) for School Health and Syndromic Surveillance as working documents towards the development of the functional standard document Expand the NYC specifications by describing other public health domains/programs in the FRAD format to facilitate the development of the software applications in the EHR systems to transmit/report/exchange data across clinical and public health information systems Form public and private partnerships with clinical and vendor communities to develop interoperable clinical-public health information systems and Educate public health and clinical communities about their roles in the development of the functional standards and overall standards development and harmonization processes. PHDSC / HRSA EXPERT PANEL IN ELECTRONIC DATA EXCHANGES

Towards a Functional Standard on Electronic Data Exchange between Clinical Care and Public Health Draft Final Report will be Presented for Committee Review in October Contract # HHSH P from Health Resources and Services Administration (HRSA) 2006 PHDSC-HRSA Project

NHIN Committee Members Members: Noam Arzt Kathleen Cook Michael Davisson Terese Finitzo Marjorie Greenberg Lawrence Hanrahan David Hollar Hetty Khan Glenda Kelly Christopher Kinabrew Denise Love Carol Quinsey Robert Rej Susan Salkowitz Perry Smith Steven Steindel Walter Suarez Walter Tsou Co-Chairs: Anna Orlova David Ross