Page 1 Texas Department of State Health Services NEDSS Project Office Reengineering the BioSense Data Feed to Support State Notifiable Conditions Reporting Requirements in Texas Doug Hamaker NEDSS Coordinator Division for Prevention and Preparedness Texas Department of State Health Services May 28, 2008

Page 2 Texas Department of State Health Services NEDSS Project Office Project Beginnings Would it be possible to tap into an existing BioSense data stream in order to leverage data originally supporting biosurveillance and re-purpose it to provide electronic laboratory reporting (ELR) of notifiable test results? ? ? ? If so, could it provide a proof-of-concept pathway for other States to benefit from?

Page 3 Texas Department of State Health Services NEDSS Project Office Project Partnership Christus Health CDC BioSense NEDSS SAIC Constella Group Texas DSHS

Page 4 Texas Department of State Health Services NEDSS Project Office Christus BioSense/ELR Project Overview Dual Use of Data Biosurveillance extended to promote Case Reporting Data sources Foundational, Clinical, Laboratory, Pharmacy, and Radiology BioSense Integration engine Converts heterogeneous messages from multiple facilities Infrastructure – Christus BioSense 11 Hospitals enrolled, 4 sending lab result data Standards employed HL7 v2.5 PHINMS for message transport

Page 5 Texas Department of State Health Services NEDSS Project Office System Attributes of Biosurveillance and Traditional Case Surveillance Biosurveillance Secondary use of data already collected within a healthcare organization, such as diagnosis codes, free-text chief complaints, laboratory orders/results Assigned to one or more disease syndromes. Counts of records in the various syndrome groups are analyzed to determine when excess numbers are reported. Obvious patient identifiers excluded; data is anonymized prior to transmission Traditional Disease Case Surveillance Makes use of pre-specified definitions of notifiable conditions Includes data collection of positive laboratory and clinical findings. Reporting mandated by state law/regulation, Personally identifiable Health care providers, laboratories report to local HD (county or regional) County HD submits notifiable reports to State, State to CDC

Page 6 Texas Department of State Health Services NEDSS Project Office Project Purpose and Benefits Extends existing infrastructure developed via BioSense Builds/expands electronic laboratory reporting of lab results indicative of notifiable conditions BioSense integration exists at a healthcare system level -- connects multiple facilities for ELR reporting

Page 7 Texas Department of State Health Services NEDSS Project Office Message Creation Message Transport Message Consumption Message Creation Message Transport Message Consumption Message Creation Message Transport Message Consumption Message Creation Message Transport Message Consumption ELR Message Mechanics BioSense Integrator PHINMS Texas ELR System

Page 8 Texas Department of State Health Services NEDSS Project Office Texas ELR Messaging Flow ELR message is received from Laboratory Native format is transformed to HL7 v2.3.1 Vocabularies are validated and/or used to transform local codes to standard codes, which are dependent on HL7 specification ELR Implementation Guide PHIN VADS Program Area addendums

Page 9 Texas Department of State Health Services NEDSS Project Office Texas ELR Routing Message payload is interrogated and routed to appropriate systems according to matching criteria HIV/STD test results to HIV/STD system Core communicable disease results to NBS Further transformation may occur immediately prior to final routing in order to meet individualized requirements of each system (STD*MIS, NBS, etc.), such as Format (HL7 versus ASCII) Content (Use of standard versus local codes)

Page 10 Texas Department of State Health Services NEDSS Project Office Texas ELR Route

Page 11 Texas Department of State Health Services NEDSS Project Office Preparation for BioSense Project “The MOU” Describes the relationship between the healthcare system and the public health agency Addresses HIPPA concerns Clearly states the legal authority for the provision of data public health reporting

Page 12 Texas Department of State Health Services NEDSS Project Office Comparison of Message Content Gap analysis showed numerous (minor) differences in the HL7 content Patient name/demographic is a very important component within ELR, and is missing in the standard BioSense message Requires a circle-back for those messages fitting the BioSense ELR filter of results indicative of a notifiable condition Beyond patient/demographics, differences can be handled within the mapping layer within ELR message processing system located at the State DOH office.

Page 13 Texas Department of State Health Services NEDSS Project Office Defining What is Reportable from the BioSense Data Feed State and local reporting rules extend beyond the list of nationally notifiable conditions Determine the list of tests performed within the health care system indicative of a notifiable condition Microbiology test results

Page 14 Texas Department of State Health Services NEDSS Project Office Programmatic Tasks Review Federal and State rules and regulations MOU between Hospital and CDC MOU between Hospital and State Health Department Established list of required data fields and data content NEDSS ELR Messaging Guide vs. BioSense Specification Guide

Page 15 Texas Department of State Health Services NEDSS Project Office Technical Tasks Determine data flow Split data stream in the BioSense Integrator Filtering Positive Microbiology Test Results Re-Identifying de-identified data Implement standards-based transmission of data from BioSense to State NEDSS State consumption of ELR messages from the BioSense Integrator

Page 16 Texas Department of State Health Services NEDSS Project Office Behold the Benefits of Standards! BioSense and NBS both use: Industry Standards and Industry Tools HL7 2.5 Message Standard Orion Rhapsody integration broker toolset Common Messaging Transport PHINMS – send/receive Message security is paramount Standardized vocabulary

Page 17 Texas Department of State Health Services NEDSS Project Office Status BioSense data flowing to CDC BioSense lab results reporting: Message mapping for State consumption Successful routing of “test” data through the mapping process and into the NEDSS data system Initial development of evaluation process Timeliness, completeness Changes to the Business Process /Reporting Efficiency

Page 18 Texas Department of State Health Services NEDSS Project Office Findings (thus far…) Emphasizes the adoption and promotion of standards-based Electronic Laboratory Reporting Fosters integration of public health case surveillance and health information systems Facilitates a ready exchange of data Opportunistic implementation of ELR for traditional case surveillance Supports the development of a “Proof of Concept” that would be readily adoptable in other states with NEDSS-compliant data systems

Page 19 Texas Department of State Health Services NEDSS Project Office One Final Note: A huge THANKS to Scott Danos Senior Advisor, Division of Integrated Surveillance Systems & Services National Center for Public Health Informatics and congratulations on his retirement!