1. NYS Department of Health Bureau of Healthcom Network Systems Management

2. Agenda Clinical Document Architecture (CDA) Standards for Public Health Pilot NYSDOH Mission and Strategic Plan Current State of Public Health Reporting Pilot Overview

3. Pilot Project Background The Health IT (HIT) Standards Federal Advisory Committee has recommended the use of the Clinical Document Architecture (CDA) as a future direction for electronic data exchanges between clinical and public health information systems for public health reporting. November 2011: Public Health Data Standards Consortium (PHDSC) launched CDA for Public Health Pilot

4. Pilot Project Background PHDSC seeking Local and State Health Departments and the HIT vendor community (clinical EHR vendors and Public Health HIT vendors), Design and implement pilot projects to demonstrate electronic data exchanges between clinical EHR systems and public health agencies information systems using CDA standards.

5. Pilot Project Background Participants: 3 State and local public health departments’ communicable disease programs EHR vendors Public Health HIT vendors. Pilot projects focused on communicable diseases reporting NYSDOH participated by piloting Pertussis CDA case reporting

6. NYSDOH Organizational Mission and Strategic Plan Since 2006, New York State has been investing in technology, operational capacity and collaborative governance structures and processes to support adoption of the Electronic Health Record technology and to mobilize statewide health information exchange to improve the quality, safety, efficiency and affordability of health care.

7. NYSDOH Organizational Mission and Strategic Plan The approach designated in the pilot aligns directly with the NYSDOH Strategic Plan to: Adopt technologies to increase program effectiveness and efficiency Optimize community-wide efforts to improve outcomes and reduce costs Facilitate integrated, efficient, accessible healthcare and public health systems

8. Current State of Public Health Case Reporting in NYS Positive Pertussis labs reports sent electronically to NYSDOH Electronic Clinical Laboratory Reporting System (ECLRS) or Written form faxed or mailed to NYSDOH Data from ECLRS report populates the Communicable Disease Electronic Surveillance System (CDESS) Cases are assigned to the Local Health Department based on the county in NYS that matches the patient’s zip code

9. Current State of Public Health Case Reporting in NYS The local health unit of each county is responsible for investigating the cases assigned to that county and possibly for follow up on the case Verification of facts Completion of supplemental forms for specific diseases Follow up of patient care Investigation of possible outbreaks

10. Opportunities for Improvement of Current State of Reporting The lack of a standardized reporting structure causes duplication of efforts, increased costs, and case definition inconsistency across systems Lab work results can take 7-10 days to be received from a commercial laboratory The inconsistence exchange of information limits the ability of public health officials to quickly respond to public health emergencies and effectively coordinate integrated healthcare services

11. NYS Pilot Project Overview Pilot demonstration would include implementation within the participants department to receive a public health report using the CDA standard by May 2012. Disease Selection NYS selected Pertussis case reporting Vendor Recruitment Oz Systems participated as Forms Manager Office Practicum participated as EHR Vendor

12. NYS Pilot Project Overview Three Participant Roles: EHR Vendor – Had to contain the capability to produce a CCD document. Forms Manager – Interact with the EHR by digesting the CCD document Present the user with a data entry form where data elements not included in the CCD can be entered or included data elements can be modified Translate the CCD document with any additions modifications into a CDA document Interact with Public Health to electronically send the CDA document to Public Health Public Health – Must have the ability to electronically exchange data using the CDA standard

13. NYS Pilot Project Overview Template Development The Tuberculosis template was used as a starting point NYS provided NYS case report forms to the template developer. Transport Selection XDR was selected as the transport mechanism Supports a direct push model from sender to receiver using Web Services transport XDR is part of the Direct Messaging Specification Many EHR vendors had built or are planning to build this standard into their EHR system

14. NYS Pilot Project Overview Testing Process Internal changes to accept XDR Testing process was completed in the development and QA environments. External echo testing was done with Oz Systems using a generic document to test the transport On June 8 a Pertussis CDA document was successfully received into NYSDOH systems. On June 11 a full test was scheduled with observers from the National team

15. Benefits to Stakeholders Electronic transfer of a CDA to public health offers the ability to improve timeliness of communicable disease reporting Would allow local health departments to: Begin investigations earlier Make appropriate control recommendations to the providers Offer preventative measures to contacts

16. Next Steps NYSDOH discussing future possibilities for CDA reporting in NYS Data analysis of the incoming data and integration steps Possibility of incorporating this type of data stream into existing data systems Review of the NYS required and requested data elements Understanding the contents of EMR along with how the EMR system populates the CCD

17. Recognizing the Project Team Shannon Kelley Linh Le Kathleen Brousseau Hwa-Gan Chang Geraldine Johnson Sarah Goff Kathryn Schmit Zhaohui Yang Jacquelin Griffin Frank Murphy Cynthia Schulte

18. Questions and Contact Information Contact info: Kathleen Brousseau, PMP Project Manager Bureau of Healthcom Network Systems Management New York State Department of Health (518) 473-1809 email: ksb01@health.state.ny.us