Public Health Tiger Team we will start the meeting 3 min after the hour DRAFT Project Charter June 10, 2014

Agenda Finalization of PHTT Charter (update requests have been included) Defining roles and selecting persons to lead individual initiatives: DAF/SDC/CQF Request for future content and updates for upcoming meetings. –DAF/CQF/SDC Update –Matrix of possible use cases from DAF/CQF/SDC –Education and engaging at interoperability showcases Funding opportunities?

Public Health Tiger Team– Project Charter Challenge - (A statement of how a standards and interoperability challenge currently limits the achievement of a national health goal) Public Health is comprised of utilizes multiple technologies and standards to support business activities, and identify challenges in aligning them within the context of clinical partners and local, state, and federal public health within and across jurisdictions and with health care stakeholders.

Scope Statement: In Scope –By participating in S&I Framework Initiatives, the Public Health Tiger Team will advocate for public health interoperability needs, seek to harmonize standards across public health use cases and programs, and educate the larger public health community on informatics issues. Priority S&I Framework activities include but not limited to: SDC, DAF, HeD, CQF, and PHRI. (PHTT will not be) Creating Standards –If we identify standards related gaps or issues outside of the scope of PHTT then we will inform relevant entities.

Draft In Scope Leverage existing and newly-developed Standards and Interoperability Initiatives to include SDC/DAF/HeD/CQF/PHRi activities and influence the standards development producing organizations. Public Health Stakeholders will benefit from data standardization efforts aimed to: –Educate and Promote –Incorporate –Harmonize –Develop a Shared Data Model

Draft Out of Scope

Public Health Tiger Team– Project Charter Value Statement (provides the high level description of the value and/or benefit of this activity to the healthcare community) Be a trusted source to the Public Health community by advocating S&I Framework initiatives to: –Effectively communicate with stakeholders –Strategically implement best practices to Common workflow tools –Consolidate Resources –Advocate for standards –Facilitate Data and Process Integration –Trusted source to other health care stakeholders e.g. EHR Vendors

Draft Value Statement Context Statement: Public Health is comprised of utilizes multiple technologies and standards to support business activities and faces challenges in aligning them within the context of local, state, and federal public health. (include clinical and partners) There are data sharing processes between public health and direct care that includes the capture of data (that may not be standardized in EHRs), sharing data with public health, public health conversion of the data to knowledge, and providing the knowledge as clinical decision support. End State: Overall goals of promoting healthier communities for example, occupational health, environmental health, etc. Value Statement: Ensure standards related to these processes meet public health needs to facilitate information sharing for the benefit of patient care and public health practice.

(what are the criteria for knowing when the initiative has met its goal(s) Improve interoperability between public health and partner systems. –Validate and support Public Health S&I Pilots –Identify Resources for S&I Pilots (moving towards adoption) –Leverage Use Cases to support S&I Initiatives –Increase Collaboration- ( S&I, PHCP, JPHIT, HL7, IHE, HIMSS Vendor assoc, internal CDC) –Engage Stakeholders (e.g: Healthcare Professionals) Leverage Population and Public Health best practices to share data among public health stakeholders. –Advocate S&I standards for best practices –Identify issues and find real world S&I solutions Public Health Tiger Team– Project Charter Draft Success Criteria

Public Health Tiger Team– Project Charter Scope - Draft Scenario Examples SDC- EHDI Pilot –(cost estimate) (Dina) NIOSH (CDS) CQF/SDC/DAF (Genny) HeD/CQF/CDS: Chlamydia (Shu Magarey) I2B2e Profile UT DOH: (Shu/Bryant Karras, Catherine, Jon Reid) Environmental Health (Gonza)

Public Health Tiger Team– Project Charter Stakeholders S&I, PHCP, JPHIT, HL7, IHE, HIMSS Vendor assoc, internal CDC APHL, CSTE, ASTHO, NACCHO, JPHIT, PHII, PHDSC, AMIA Public Health Programs Health Information Exchanges (HIE) Hospitals Payers Medicaid Indian Health Centers/Clinics VA/DoD Healthcare State/County/City Health Officials Health Care Providers Early Education (Pre-K) K-12 Schools & Colleges University (R&D) Patients/Clients Retail Pharmacies Pharmaceutical Manufacturers Electronic Health Record Vendors Public health software vendors HHS: CDC, but also AHRQ, CMS, NLM, NIH, OPA, FDA, USDA, HRSA, etc. WIC Programs Informatics Education Programs NASCIO WHO

Public Health Tiger Team – Project Charter Target Outcomes Recommendation of available standards that promote interoperability consistent with S&I Initiatives Promote the deployment of S&I standards for adoption and utilization (e.g. use cases, pilots) Development of S&I Public Health Training (T) and Education (E) –State and Local Health Departments (Implementers and Users) (E) (T) –Vendors (E) –Providers (E)

Public Health Tiger Team – Project Charter Expected Deliverables Participation in S&I initiatives Artifacts and activities Public Health related use cases for S&I initiatives Public Health related use cases that span multiple S&I initiatives S&I Initiatives dependencies Key public health focused leads for each S&I initiative including policy, practice, and technical level leads as needed Revisions to standards that incorporate emerging technologies (e.g. FHIR as the standards become developed and available) PHTT standards, guidance, approaches, and recommendations for promotion Final reports and recommendations on the outcome of at least one pilot for each initiative with a public health related use case Documented processes for ensuring public health objectives are communicated to S&I leads and PHTT standards document are maintained

Public Health Tiger Team– Project Charter Potential Risks (list of risks and mitigations - Addressing these items up front will help prompt discussion amongst workgroup members who may suspect that these risks will be a hindrance to the Initiative) Resources – not only having the workforce to complete the pilots but also to include the technical expertise needed Funding in order to complete pilots Timeframe – small window of opportunity to complete pilots before relevant initiatives end Dependencies on other initiatives to complete work Too many S&I Framework activities resulting in dilution of PHTT resources.

Propose to place the following in a living document (outside of charter) Public Health Standards, Guidance, and Approaches Proposed Use Cases Pilots PHTT Workgroup Leads/ Liaisons –Practical –Technical

Public Health Tiger Team– Project Charter Leads: Structure Data Capture Practice Lead: Knowing how the workflow takes place “practice”

Public Health Tiger Team– Project Charter Leads: Data Access Framework Practice Lead: Knowing how the workflow takes place “practice”

Public Health Tiger Team– Project Charter Leads: Clinical Quality Framework Practice Lead: Knowing how the workflow takes place “practice”

Request for future content and updates for upcoming meetings.

Public Health Tiger Team– Project Charter Public Health Standards, Guidance, and Approaches Standards that we may consider for our use cases and pilots: Messaging and document standards HL7 v2 HL7 FHIR (currently draft, first version will be published in January 2015 includes message-based and document, transport standard. possibly a Wednesday education series) HL7 CDA HL7 CCD HITSP C-32 CCS HL7 C-CDA Transport Standards IETF TLS/SSL Direct protocol SOAP-based Web Services HTTP POST REST Security Standards BPPC XACML SAML Relevant Semantic and Terminology Standards, including CVX/MVX ICD-9/ICD-10 (CM and PCS) SNOMED-CT CPT LOINC RxNorm NDC Omaha (standards that nurses use) EHR Functional System Standards (9) The HL7 Electronic Health Records System Functional Model Release 2 (HL7 EHR-S FM R2) The HL7 EHR-S Public Health Functional Profile Release 2 (HL7 EHR-S PHFP R2) Usability and Design Quality Standards QRDA (3 levels) - PHI level 3 HQMF Implementation Guidance eHealth exchange specification IHE Profiles Architecture Guidance UML Federal Health Architecture (FHA) PHIN NIEM FHIMS MITA Additional Nursing (from Marcus) NANDA International (NANDA-I)/Nursing Interventions Classification (NIC)/Nursing Outcomes Classification (NOC) Clinical Care Classification System (CCC) Perioperative Nursing Data Set (PNDS) International Classification for Nursing Practice (ICNP) X12 Transactions Omaha System

Public Health Tiger Team– Project Charter Draft Scenarios ScenarioScenario DescriptionExisting Standards Implementation Profiles Environmental Health 1. Asthma Asthma exacerbations are triggered by many factors including allergic and irritant triggers, changes in medication adherence, stress and emotions, as well as inherent fluctuations in the disease itself. Although worsening of outdoor air quality appears to be associated with an increase in asthma exacerbations, other factors contributing to poor asthma control should be controlled for when analyzing this association. The use of electronic health records facilitates linking these other causal factors as well as air quality measures, with the frequency of exacerbations on a population level. Types of data that could be in EHRs: a.Information that would indicate an allergic cause of an asthma exacerbation: e.g., allergy testing, and non-asthma diagnoses such as rhinitis and allergic conjunctivitis b.Indication of the severity and level of control of the disease: e.g., ED visit or hospitalization for asthma, level of asthma control, and medications Information needs: query across primary care and relevant specialists (allergists and pulmonologists). Also, from the lab or pharmacy systems ICD 9/10

ScenarioScenario DescriptionExisting Standards Implementation Profiles Environmental Health 2. Radiation The most common source of man-made radiation exposure is medical radiation which includes exposure from CT scans, x-rays, and nuclear medicine. Children can be more vulnerable to radiation injuries than adults, and therefore limiting the radiation dose they receive is a public health concern. Limiting childhood radiation exposure can reduce the risk of adverse health outcomes later in life e.g., cancer. Though it is difficult to measure the dose of radiation received during a procedure, one way of estimating radiation dose is through the number of medical radiation procedures performed. Electronic health records can be an excellent source of information on the number and types of medical radiation procedures performed on children that can be aggregated for public health surveillance on radiation exposures. Types of data that could be in EHRs: a.Types of medical radiation procedures: e.g., CT scans, X-rays, nuclear medicine Information needs: query across different pediatric hospital systems ICD 9/10 Public Health Tiger Team– Project Charter Draft Scenarios