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

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

State Health Department Organizational Chart

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Business Areas: Early Hearing Detection & Intervention

Business Areas: Public Health Laboratory

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

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

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

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

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

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

Business Case: Public Health in HIT Standardization URL: http://www.phdsc.org/standards/pdfs/PHDSC_Business_Case_Public_Health_HIT-Standardization.pdf

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 (2010-11) 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)

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

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™

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

QUESTIONS? URL: http://www.phdsc.org/standards/pdfs/PHDSC_Business_Case_Public_Health_HIT-Standardization.pdf