Standards and Interoperability Public Health Tiger Team (PHTT) Our call will begin 3 minutes after the hour Jim Daniel, MPH John Saindon, DrHSc, MT Public Health Lead Health Scientist ONC CDC 1

This meeting is being recorded and will be available via the S&I PHTT Wiki r+Team+Meeting+Archives or via the following link 2

Agenda Request for member support Behind the Scenes – Further collaboration with PHRi – Working with NIH to map EHDI CDE to the SDC CDE IG – Engaging with the Public Health Community Platform – PHI Conference Further development of the project charter – Challenge Statement – Scope – Value Statement – Success Criteria Request for Scenarios – NCHS, EHDI, IIS, PHTT 3

Proposed Scenarios from PHTT April 1 How does public health integrate with EHRs? Ability to send a referral directly Ability to close loop on a referral Screening and assessments done in a clinical setting, where they fail want that information to come back to be able to act Protocols that in place to anticipate screenings to prompt a referral to state Care coordination (many providers engaged in care and communicate and share between all): monitor that a patient is complying, reminders, cross-agency, cross-program, cross- provider. Public Health equivalent of co-morbidity. 4

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S&I: Public Health Tiger Team (PHTT) 6 Standards and Interoperability: Public Health Tiger Team Data Access Framework Structured Data Capture Health eDecisions

Why consolidate into PHTT? Best use of resources and time Assurance that these initiatives will have Public Health Representation Strengthened partnership between community and vendor based partners SDC/DAF/HeD work in parallel with each other 7

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S&I Framework Overview Specific health interoperability initiatives guide the design and development of a fully integrated and connected health information system. An S&I Initiative focuses on a single challenge with a set of value-creating goals and outcomes, and the development of content, technical specifications and reusable tools and services. Call for Participation: The overall success of the S&I Framework is dependent upon volunteer experts from the healthcare industry and we welcome any interested party to get involved in S&I Framework Initiatives, participate in discussions and provide comments and feedback by joining the Wiki: 9

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Community Partners- (crowd sourcing) ONC CMS FDA NLM NIH Vendors Local Public Health Organizations State Public Health Organization CDC Public Health Organizations 11

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5 2 xx John Doe x x x x x Selects form/template Inputs data Stores/ transmits data Finds form/template Caches data 3 Converts, populates & displays form 7 Extract, Transform, & Load Data by form/ template EHR System Provider/ End User Actor Key Structured Data Capture Conceptual Workflow

Structured Data Capture Data Architecture Infrastructure will consist of four new standards that will enable EHRs to capture and store structured data: 1.Standard for the CDEs that will be used to fill the specified forms or templates 2.Standard for the structure or design of the form or template (container) 3.Standard for how EHRs interact with the form or template 4.Standard to auto-populate form or template 14 Standards will facilitate the collection of data so that any researcher, clinical trial sponsor, reporting and/or oversight entity can access and interpret the data in electronic format Will leverage existing standards such as XML and CDISC Retrieve Form for Data Capture (RFD) Standards will facilitate the collection of data so that any researcher, clinical trial sponsor, reporting and/or oversight entity can access and interpret the data in electronic format Will leverage existing standards such as XML and CDISC Retrieve Form for Data Capture (RFD) 14

EHR PH Form Sample Types of Reporting Quality Research Public Health Case Reporting (Pilot CDA) EHR and SDC Model ELR Immunization Cancer CDA Forms Repository Request Form (CDISC RFDC) Deliver Form Deliver data from form {Format Type, TBD} Example Types of Reporting CDEs Meta Data Business Logic Define Forms 15

Pilots Potential Pilots – Case Reports (STD, TB, Pertussis?) – EHDI – EP Cancer Reporting Next Steps – Common Data Element Formatting – Mapping to SDC IG – Identify Partners/Funding

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Transport Layer —establishing a protocol for getting patient data from one place to another. Security Layer —ensuring that patient data will only be accessible to authorized parties. Query Structure —making sure the “question” being asked is phrased appropriately for the data to answer it. “Questions” could include “what were the pathology results of this patient’s last test” and “how many immunizations has this clinic provided each month in the past year.” Query Results —appropriately formatting the “answer” to the question posed. Pathology results may need to conform to clinical document architecture, while an answer about immunization counts could be presented as a simple bar graph. Data Model to Support Queries —information models that define concepts used in clinical care.

Query Health Pilots PilotFocusRI Queries RI Policy Layer Data SourcesKickoff NYC & NYS Depts. of Public Health Diabetes (NYC) Hypertension (NYS) i2b2PMNRHIOs EHR Vendor May 2012 FDA Mini- Sentinel Use of clinical data sources for FDA questions PMN i2b2/Beth Israel June 2012 CDCNational / regional: - Disease syndromes - Situation awareness i2b2PMNBio-Sense 2July 2012 Mass. Dept. of Public Health DiabetesPMN MDPHNetJuly 2012 CQMQuality MeasureshQueryPMNEHR VendorAugust 2012

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HeD - Use Case 1

Pilots Planned – Pertussis reporting triggers Potential – Trigger SDC Report – Trigger Community Resource Referral (in conjunction with SDC)

Where can you support? PHTT: Participate in weekly collaborative meetings SDC-PH: – mapping of CDEs into SDC format – Pilot site for proposed use case DAF-PH: HeD-PH 25

PH TT Contact Information ONC Public Health Lead: Jim (James) Daniel CDC Public Health Lead: John M. Saindon PHTT Wiki Page: SDC Wiki Page: DAF Wiki Page: HeD Wiki Page: Weekly PHTT Meeting Info (Tuesdays): Time: 2:00pm - 3:00pm Eastern URL: Dial-In Number: Access Code:

Thank you for your support. Q/A 27 Standards and Interoperability: Public Health Tiger Team Data Access Framework Structured Data Capture Health eDecisions