Nationwide Health Information Network Update Johns Hopkins SchooI of Medicine Division of Health Sciences Informatics March 23, 2007 Nationwide Health Information Network Update Anna O. Orlova, PhD aorlova@jhsph.edu Public Health Data Standards Consortium & Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland, USA

Towards a Nationwide Health Information Network (NHIN) Where Should We Be in 2014 Building a NHIN NHIN-2004 NHIN-2005-2006 NHIN-2007

US National HIT Strategic Plan On July 21, 2004 the Department of Health and Human Services (DHHS) announced the decade of health information technology for “delivering consumer–centric and information-rich health care.” The vision is to build a National* Health Information Network (NHIN) of regional health information exchanges formed by health care providers who will utilize electronic health record systems. * Original term “National” has been changed on “Nationwide” in January 2006 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.

DHHS’ Framework for Health Information Technology: Building a NHIN NHIN will be based on: Electronic Health Record Systems (EHRS) that will enable Regional Health Information Exchanges (RHIEs) organized via Regional Health Information Organizations (RHIOs) 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.

President’s Strategic Framework for HIT

Authorized RHIO Inquiry Patient data to other RHIO US Nationwide Health Information Network Provider Record Laboratory Results Specialist Record Records Returned Requests for Records RHIO Authorized RHIO Inquiry Index of where patients have records Another RHIO Temporary Aggregate Patient History Patient data to other RHIO Source: Jennie Harvell. The Decade of Health Information Technology – Framework for Strategic Actions. MMIS Conference, September 2004

US Health Information Network - 2014 Source: Dr. Peter Elkin, Mayo Clinic, MN

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

Healthcare purchasers and payers Nationwide Health Information Network (NHIN) Emerging data shows the value that standardized health information exchange will provide to all stakeholders: Healthcare purchasers and payers Hospitals and other healthcare providers Laboratories Practicing clinicians Public health Source: John Glaser, Janet Marchibroda, Jim Schuping. CCBH. Washington, D.C. December 6-7, 2004 URL: www.ehealthinitiative.com

Building a NHIN

THE REQUEST FOR INFORMATION (RFI) Building a NHIN On November 15, 2004 Office of National Coordinator for Health Information Technology (ONC), Department of Health and Human Services (DHHS), released THE REQUEST FOR INFORMATION (RFI) on the Development and Adoption of a “National” Health Information Network Over 500 responses from various healthcare stakeholders has been submitted. URL: http://www.dhhs.gov

Public Health Data Standards Consortium PHDSC RESPONSE TO THE RFI on the Development and Adoption of a “National” Health Information Network was submitted to DHHS on January 18, 2005 URL: http://phdatastandards.info or http://www.phdsc.org

PHDSC Model for Electronic Health Record-based Data Exchange RHIO EHR-PH Info Exchange

NHIN Development Process In October 2005 DHHS Office of National Coordinator (ONC) awarded several NHIN contracts ($65M) as follows: Standards Harmonization EHR Certification NHIN Architecture Prototypes Health Information Security and Privacy URL: http://www.hhs.gov/healthit/ahic.html

DHHS NHIN Contracts Standards Harmonization - Harmonize the health care and technology standards used in health information interchange to address gaps and conflicts in current standards EHR Certification - Set forth certification criteria for the many electronic health care record products and technologies currently available on the market NHIN Prototypes - Develop and evaluate prototypes for the network architecture to assess the feasibility of developing a national health information network prototype Privacy - Address privacy and security policy questions affecting the exchange of health information. Work resulting from each of these projects will be used by HHS to develop and refine the business case for establishing the network.

A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability The Community is a federally-chartered commission that provides input and recommendations to DHHS on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected in a smooth, market-led way. Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network (NHIN) Architecture Projects The Health Information Security and Privacy Collaboration (HISPC) The Certification Commission for Healthcare Information Technology (CCHIT) American Health Information Community (Community)

NHIN Development Process The Community is chartered for two years, with the option to renew and duration of no more than five years. The DHHS intends for the Community to be succeeded within five years by a private-sector health information community initiative that, among other things, would set additional needed standards, certify new health information technology, and provide long-term governance for health care transformation. * AHIC URL: www.hhs.gov/healthit/ahiccharter.pdf

A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network (NHIN) Architecture Projects The Health Information Security and Privacy Collaboration (HISPC) The Certification Commission for Healthcare Information Technology (CCHIT) American Health Information Community (Community)

HITSP includes 206 member organizations: Discussion Document Standards Harmonization Technical Committees Update Report to the Healthcare Information Technology Standards Panel HITSP includes 206 member organizations: 17 SDOs (8%) 161 Non-SDOs (79%) 18 Govt. bodies (8%) 10 Consumer groups (5%) Contract HHSP23320054103EC Arlington, VA September 20, 2006

HITSP Standards Categories Data Standards (vocabularies and terminologies) Information Content Standards (RIMs) Information Exchange Standards Identifiers Standards Privacy and Security Standards Functional Standards Other HITSP definition

HITSP Framework for Interoperability Specification Development HITSP receives Use Cases and Harmonization Requests from external sources, such as Community and ONC. The Use Case or Request defines scenarios, business actors, and business and functional/interoperability requirements. HITSP develops Interoperability Specifications supporting the Use Cases: technical actors, transactions, content and terminology. Source: HITSP Meeting, Arlington VA, September 20, 2006

HITSP Framework for Interoperability Specification Development HITSP identifies constructs which are logical groupings of base standards that work together, such as message and terminology. These constructs can be reused like building blocks. While reuse is a HITSP goal, it is established in the context of a use case and its functional/interoperability requirements. HITSP constructs are version controlled and, if reused, will be uniquely identified. Source: HITSP Meeting, Arlington VA, September 20, 2006

The standards harmonization process is a series of steps taken by industry stakeholders Harmonization Process Steps Receive Request I Harmonization Request II Requirements Analysis III Identification of Candidate Standards IV Gaps, Duplications and Overlaps Resolution V Standards Selection VI Construction of Interoperability Specification VII Inspection Test VIII Interoperability Specification Release and Dissemination IX Program Management Begin Support Source: HITSP Meeting, Arlington VA, September 20, 2006

HITSP Framework Source: HITSP Meeting, Arlington VA, September 20, 2006

Standard Harmonization Process The Community identified 3 breakthrough areas for the NHIN development process in 2006: Biosurveillance Consumer Empowerment Electronic Health Record * AHIC URL: www.hhs.gov/healthit/ahiccharter.pdf

Consumer Empowerment Use Case Allow consumers to establish and manage permissions access rights and informed consent for authorized and secure exchange, viewing, and querying of their linked patient registration summaries and medication histories between designated caregivers and other health professionals.  Source: HITSP Meeting, Arlington VA, September 20, 2006

Electronic Health Record Use Case Allow ordering clinicians to electronically access laboratory results, and allow non-ordering authorized clinicians to electronically access historical and other laboratory results for clinical care. Source: HITSP Meeting, Arlington VA, September 20, 2006

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. Source: HITSP Meeting, Arlington VA, September 20, 2006

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

Biosurveillance Technical Committee Recommendations

AHIC-ONC BIO Consolidated Use Case Biosurveillance Patient-level data to Public Health Message-based Submission AHIC-ONC BIO Consolidated Use Case HITSP Biosurveillance – Patient-level and Resource Utilization Interoperability Specification Transaction Package Consumer/Patient Id X-ref Transaction Pseudonymize Base Std HL7 QBP^Q23 RSP^K23 IHE XDS Message-based Scenario IHE PIX PDQ Component Anonymize Component Encounter Msg Component Lab Report Message Component Radiology Msg Component Lab Terminology Terminology Standards Base Std ISO DTS/ 25237 Base Std HL7V2.5 ADT^xxx Base Std ISO 15000 ebRS 2.1/3.0 Base Std HL7 V2.5 Base Std HL7V2.5 ORU^R01 Base Std LOINC HCPCS HL7 V3 CPT HL7 V2.5 CCC SNOMED-CT HIPAA ICD 9/10 LOINC DICOM SNOMED-CT NCCLS UCUM UB-92 URL FIPS 5-2 HAVE

AHIC-ONC BIO Consolidated Use Case Biosurveillance Patient-Level Data to Public Health Document-based Submission AHIC-ONC BIO Consolidated Use Case HITSP Biosurveillance – Patient-level and Resource Utilization Interoperability Specification Transaction Package Consumer/Patient Id X-ref Transaction Package Manage Sharing of Docs Document-based Scenario Transaction Notif of Doc Availability Transaction Pseudonymize Base Std HL7 QBP^Q23 RSP^K23 IHE XDS IHE XDS-I IHE PIX PDQ IHE NAV Component Lab Report Document Component Anonymize IHE XDS-MS IHE XDS-LAB Component Lab Terminology Terminology Standards Base Std HL7 CDA r2 Base Std ISO DTS/ 25237 Base Std ISO 15000 ebRS 2.1/3.0 Base Std HL7 V2.5 Base Std DICOM Base Std LOINC HCPCS HL7 V3 CPT HL7 V2.5 CCC SNOMED-CT SNOMED-CT ICD 9/10 LOINC HIPAA NCCLS UCUM DICOM UB-92 URL FIPS 5-2 HAVE

A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network (NHIN) Architecture Projects The Health Information Security and Privacy Collaboration (HISPC) The Certification Commission for Healthcare Information Technology (CCHIT) American Health Information Community (Community)

Health Information Security and Privacy Collaborative (HISPC) RTI International coordinates assessment of health information exchange among states In May 2006, RTI established the National Health Information Security and Privacy Collaboration (HISPC) by announcing the 34 states and U.S. territories who signed agreements to join this project. The project is a national collaboration created to address privacy and security policy questions affecting the exchange of health information. The project is being managed by RTI in cooperation with the National Governors Association under a contract from the Department of Health and Human Services (HHS), Agency for Healthcare Research and Quality. RTI's project team includes multidisciplinary experts in privacy and security law and in health care management together with state and territorial governments. URL: http://www.rti.org/page.cfm?nav=7&objectid=6D0A81F4-6A6D-44A5-BD5E14B2A7077ED6

Review of State Findings Health Information Security and Privacy Collaborative (HISPC) Review of State Findings 34 states and U.S. territories signed agreements to join HISPC project Source: Walter G. Suarez. Advancing State Approaches Towards Solutions and Implementation. Health Information Security and Privacy Collaborative. Regional Meeting, November 17, 2006 – Boston, MA

Health Information Security and Privacy Collaborative (HISPC) - Scenarios Purposes of Health Information Exchange Relevant Scenarios Treatment Scenarios 1-4 Payment Scenario 5 RHIO Scenario 6 Research Scenario 7 Law Enforcement Scenario 8 Prescription Drug Use/Benefit Scenarios 9 and 10 Healthcare Operations/Marketing Scenarios 11 and 12 Bioterrorism Scenario 13 Employee Health Scenario 14 Public Health Scenarios 15-17 State Government Oversight Scenario 18

Nine Domains of Privacy and Security User and entity authentication to verify that a person or entity seeking access to electronic personal health information is who they claim to be. Information authorization and access controls to allow access only to people or software programs that have been granted access rights to electronic personal health information. Patient and provider identification to match identities across multiple information systems and locate electronic personal health information across enterprises. Information transmission security or exchange protocols (i.e., encryption, etc.) for information that is being exchanged over an electronic communications network. Information protections so that electronic personal health information cannot be improperly modified. Information audits that record and monitor the activities of health information systems. Administrative or physical security safeguards required to implement a comprehensive security platform for health IT. State law restrictions about information types and classes, and the solutions by which electronic personal health information can be viewed and exchanged. Information use and disclosure policies that arise as health care entities share clinical health information electronically.

Health Information Security and Privacy Collaborative (HISPC) – Design Nov.- Dec. 06 March 2007

Review of State Findings: Variation Analysis Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA

Review of State Findings Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA

Review of State Findings Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA

Review of State Findings Source: Walter G. Suarez. Health Information Security and Privacy Collaborative. Regional Meeting, Nov. 17, 2006 – Boston, MA

A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network (NHIN) Architecture Projects The Health Information Security and Privacy Collaboration (HISPC) The Certification Commission for Healthcare Information Technology (CCHIT) American Health Information Community (Community)

A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network (NHIN) Architecture Projects The Health Information Security and Privacy Collaboration (HISPC) The Certification Commission for Healthcare Information Technology (CCHIT) American Health Information Community (Community)

Role of Public Health in a NHIN NEXT STEPS

Providers and Software Developers Working Together to Deliver W W W . I H E . N E T Providers and Software Developers Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings

Integrating the Healthcare Enterprise (IHE) Overview Presented by Dan Russler, M.D., IHE PCC Co-chair IHE Workshop – June 19, 2006

Why IHE? Cheaper than a new phone line! 1970’s—Mainframe Era--$100,000 per interface 1990’s—HL7 2.x--$10,000 per interface 2000’s—IHE Implementation Profiles— Cheaper than a new phone line! How? IHE Eliminates Options Found in Published Standards

Who is IHE? IHE is a joint initiative among: American College of Cardiology (ACC) Radiological Society of North America (RSNA) Healthcare Information Management Systems Society (HIMSS) GMSIH, HPRIM, JAHIS (laboratory) American Society of Ophthalmology American College of Physicians (ACP) American College of Clinical Engineering (ACCE) And many more…. Began in 1997 in Radiology (RSNA) and IT (HIMSS) International effort: IHE- Europe and IHE-Asia Additional sponsors for Cardiology including ASE, ESC, ASNC, SCA&I, HRS and more -for IHE-Europe, mention IHE-Spain, IHE-France, IHE-Germany, IHE-Norway, etc. -for IHE-Asia, mention IHE-Japan, IHE-Korea -for additional sponsors, mention that we are looking for additional official participation, especially as we move into additional areas such as Stress can could use input from groups such as HRS

IHE 2006 – Nine Active Domains Over 100 vendors involved world-wide, 5 Technical Frameworks 37 Integration Profiles, Testing at Connectathons Demonstrations at major conferences world-wide 15 Active national chapters on 4 continents

IHE Standards-Based Integration Solutions Prof essional Societies Sponsorship Healthcare Providers & Software Developers Healthcare IT Standards General IT Standards HL7, DICOM, etc. Internet, ISO, etc. IHE Process Interoperable Healthcare IT Solution Specifications Interoperable Healthcare IT IHE Integration Profile Solution Specifications Interoperable Healthcare IT IHE Integration Profi Solution Specifications le Interoperable Healthcare IT IHE Integration Profile Solution Specifications IHE Integration Profile

IHE in 2006 – 18 Month Development Cycles First Cycle: Planning Committee Proposals: November, 2005* Technical Committee Drafts: June, 2006* Public Comment Due: July 2006 Trial Implementation Version: August 2006 Mesa Tool Test Results Due: December 2006 IHE Connectathon: January 2007 HIMSS Demo: February 2007 Participant Comments Due: March 2007 Final Implementation Version: June 2007

IHE Technical Frameworks Detailed standards implementation guides

HIMSS IHE Interoperability Showcase February 2006 Participants Leadership Level Blue Ware Cerner GE Healthcare +IDX IBM Initiate Systems InterSystems MiSys Healthcare Quovadx Siemens Implementer Level Allscripts Canon CapMed Cardiac Science CGI-AMS CompassCare CPSI Dictaphone DR Systems Eastman Kodak Eclipsys Epic Systems HIPAAT HX Technologies INFINITT Technology Kryptiq McKesson MedAccess Plus Medical Informatics MediNotes MNI National Institute of Sci & Tech NextGen Healthcare Philips Medical ScImage Witt Biomedical Supporter Level: Acuo Bond Carefx Clearcube Dairyland EMC Identrus Intel Mediserve Medkey Motion Comp. Picis Pulse Sentillion Organizational participant: American Coll. of Clinical Eng. Catholic Healthcare West US Dept of Defense US Dept of Veterans Affairs DMP–French Natl. Personal EHR Health Level 7 HTP IEEE Midmark Diagostics Group HIMSS RHIO Federation Liberty Alliance Univ. of Washington

IHE Connectathon, January 2006 300+ participants, 120+ systems 60+ systems developers Four Domains: Cardiology, IT Infrastructure, Patient Care Coordination, Radiology 2800+ monitored test cases

Clinical and PHR Content IHE Integration Profiles for Health Info Nets What is available and has been added in 2005 and is for 2006 Clinical and PHR Content Security Patient Id Mgt Emergency Referrals Format of the Document Content and associated coded vocabulary PHR Extracts/Updates ECG Report Document Lab Results Document Content Scanned Documents Format of the Document Content Imaging Information Medical Summary (Meds, Allergies, Pbs) and associated coded vocabulary Patient Demographics Query Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Consistent Time Coordinate time across networked systems Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Basic Patients Privacy Consents Establish Consents & Enable Access Control Document Digital Signature Attesting “true-copy and origin Health Data Exchange Other Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Cross-enterprise Document Point-Point Interchange Media-CD/USB & e-mail push Notification of Document Availability Notification of a remote provider/ health enterprise Request Form for Data Capture External form with custom import/export scripting

AHIC-ONC BIO Consolidated Use Case Biosurveillance Patient-Level Data to Public Health Document-based Submission HITSP AHIC-ONC BIO Consolidated Use Case Biosurveillance – Patient-level and Resource Utilization Interoperability Specification Transaction Package Consumer/Patient Id X-ref Transaction Package Manage Sharing of Docs Document-based Scenario Transaction Notif of Doc Availability Transaction Pseudonymize Base Std HL7 QBP^Q23 RSP^K23 IHE XDS IHE XDS-I IHE PIX PDQ IHE NAV Component Lab Report Document Component Anonymize IHE XDS-MS IHE XDS-LAB Component Lab Terminology Terminology Standards Base Std HL7 CDA r2 Base Std ISO DTS/ 25237 Base Std ISO 15000 ebRS 2.1/3.0 Base Std HL7 V2.5 Base Std DICOM Base Std LOINC HCPCS HL7 V3 CPT HL7 V2.5 CCC SNOMED-CT SNOMED-CT ICD 9/10 LOINC HIPAA NCCLS UCUM DICOM UB-92 URL FIPS 5-2 HAVE

PHDSC was Invited to Sponsor Public Health Domain at IHE Providers and Software Developers Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings

IHE 2006 – Nine Active Domains TEN: Public Health IHE 2006 – Nine Active Domains Over 100 vendors involved world-wide, 5 Technical Frameworks 37 Integration Profiles, Testing at Connectathons Demonstrations at major conferences world-wide 15 Active national chapters on 4 continents

PHDSC was Invited to Sponsor Public Health Domain at IHE Public Health Efforts at IHE – due July 2007 White Paper on Public Health PHDSC-sponsored White Paper on Quality Siemens-sponsored White Paper on Aggregate Data Retrieval from Document-Sharing Resource Siemens- and Oracle-sponsored Profile Proposal on Laboratory Data Exchanges IBM-sponsored

IHE White Paper on Public Health: Goal To describe the organization and functions of public health in the US in order to inform the development of the IHE integration profiles for interoperable clinical and public health information systems.

Knowledge Management in Public Health WHAT IS PUBLIC HEALTH?

State Health Department Organizational Chart

Clinical-Public Health Paper-based Health Data Exchanges Genetic Disorders Communicable Diseases Provider 1 On average 49% of cases got reported (CDC, 2006). Immunization Provider 2 Vital Records Provider 3 Injury Control Provider 4 School Health Chronic Care Biosurveilance, BT, Preparedness Provider X HEDIS

State Health Department EHR-PH System Prototype for Interoperability in 21st Century Health Care System Clinical Care Public Health Surveillance Hospital of Birth State Health Department ADT- Birth Record Newborn Screening Registry HL7 2.4 HL7 3.0 Newborn Screening Test HL7 3.0 EHR-PH Info Exchange Hearing Screening Registry HL7 3.0 HL7 3.0 Hearing Screening Test HL7 2.4 Immunization Registry HL7 2.4 HL7 3.0 Immunization Administration HL7 2.4 Communicable Disease Registry J2EE HTB External Laboratory J2EE Wrtwertghghgghhghg Wtrwtrghgg Wrtwrtghghghghgh Wrtwrtghghgh Aadkalfjkaldkfjalkdjflajhjkhjkhjkhk flkdjghghghghghghghgh Wrtwertghghgghhghg Wtrwtrghgg Wrtwrtghghghghgh Wrtwrtghghgh Aadkalfjkaldkfjalkdjflajkflkdjghghghghghghghg fhjfghjfh Healthcare Transaction Viewer HTB – Health Transaction Base Source: Orlova, et al. HIMSS 2005,Dallas TX, February 13-17, 2005 and AMIA, Washington DC, November, 2005

WHERE TO START? WE NEED TO HARMONIZE: DATA FORMS WORKFLOW POLICIES

WHERE TO START? WE NEED TO HARMONIZE: DATA FORMS WORKFLOW POLICIES

EHR-PH Data Exchange: Clinical & Public Health Systems Forms NBS Genetic Disorders CDA2 Communicable Diseases TB, STD. …… Provider 1 IHE LAB IR Immunization Provider 2 VR Vital Records Provider 3 NCPDP Injury Control ECIC Provider 4 School Health SH CVD, Asthma Diabetes Chronic Care X12 Biosurveilance, BT, Preparedness, Syndromic Surveillance Provider X BT HEDIS HEDIS

WHERE TO START? WE NEED TO HARMONIZE: DATA FORMS WORKFLOW POLICIES

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

Event Monitoring Hospital Ambulatory Care Neighboring Jurisdictions Hospital EHRS State Public Health Surveillance System 3 - Monitor ER visits & hospitalizations data from EMRs 1 – Send health alert 2 - Monitor newly diagnosed cases & vaccination data from EMRs 9 – Send updates on the event Ambulatory Care 4 – Order pathogen test 6 – Send order to activate emergency vaccination Local Public Health Surveillance System 5 – Report test results 10 – Send health alert to the public DHHS P U B L I C 7 – Order/ Supply vaccine Media 8 – Monitor vaccine supplies Lab Response Team Pharmacy

Event Management Hospital Ambulatory Care Neighboring Jurisdictions EHRS Hospital State Public Health Surveillance System 3 - Monitor ER visits, hospitalizations data from EMRs & utilization data 1 – Send Outbreak updates 2 - Monitor newly diagnosed cases & vaccination data from EMRs 9 – Send outbreak updates Ambulatory Care 4 – Order pathogen test 6 – Send Rapid Flu Test Kits 10 – Send outbreak updates to the public Local Public Health Surveillance System 5 – Report test results DHHS P U B L I C 9 – Activate coordinated response 7 – Deliver vaccine Media 8 – Monitor vaccine supplies Lab Response Team Pharmacy

Cardiovascular Disease (CVD) Surveillance Payor Hospital EHRS State Public Health Surveillance System 9 - Monitor ER visits, hospitalizations data from EMRs & utilization data 1 – Conduct Routine Check-ups 4 – Prescribe Medication and Treatment Plan 11 – Send reports Ambulatory Care 12– Conduct Surveys (BRFSS) 5 – Monitor Treatment 2 – Order cholesterol test 7 – Report Data to Schools Local CVD Surveillance System 3 – Report test results 10 – Conduct Health Education DHHS P U B L I C 6 – Fill Prescription 8– Coordinate Care Media Laboratory School Pharmacy

Asthma Surveillance Hospital Ambulatory Care Payor EHRS State Public Health Surveillance System 9 - Monitor ER visits, hospitalizations data from EMRs & utilization data 1 – Conduct Routine Check-ups 4 – Prescribe Medication and Treatment Plan 11 – Send reports Ambulatory Care 5 – Monitor Treatment 12– Conduct Surveys (BRFSS) 2 – Order allergen test 7 – Report Data to Schools Local Asthma Surveillance System 3 – Report test results 10 – Conduct Health Education DHHS P U B L I C 6 – Fill Prescription 8– Coordinate Care Media Laboratory School Pharmacy

WHERE TO START? WE NEED TO HARMONIZE: DATA FORMS WORKFLOW POLICIES

Examples of Notifiable/Reportable Conditions by Selected States Notifaible/Reportable Diseases (in alphabetical order) CDC CA FL IN MA MD MN NC Lab Acquired Immunodeficiency Syndrome (AIDS) a -   Alcohol Related Birth Defects Amebiasis Anaplasmosis Anisakiasis Animal bites Animal bites for which rabies prophylaxis is given, Anthrax Arboviral neuroinvasive and neuroinvasive diseases, all California group Eastern equine encephalitis virus

SELECT PUBLIC HEALTH DOMAINS TO BEGIN WITH WHERE TO START? SELECT PUBLIC HEALTH DOMAINS TO BEGIN WITH

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