1. Solano County Health and Social Services PH Lab HIE project Linking 4 County PH Labs and linking reports to hospitals Stephan Betz, Ph.D. Assistant Director for Operations Solano County Health and Social Services March 21, 2013

2. Solano County Health and Social Services PH Lab HIE project - Overview Link primary care, behavioral health, public health, clinical lab, public health lab data: ~17,000 current patients Regional PH Lab includes Solano, Napa, Yolo, Marin counties. 119,962 potential clients of PHP of California in these four counties Build HIE while building new PH Lab Information system, using Mirth Connect, a data channeling system Engaged in a partnership with Redwood Mednet to build the HIE channels. Unique opportunity for region wide standardized structured reporting

3. Solano County Health and Social Services PH Lab HIE project Purpose: Share developments of Public Health Lab Information System in 3-4 counties Kick off a process to receive input for standardized reporting

4. Solano County Health and Social Services PH Lab HIE project – Why bother?

5. Solano County Health and Social Services PH Lab HIE project - Plan Link County Nextgen system to PH Lab IMS “ Advanced Business Software” Link PH Lab to other Nextgen users: Community Clinics Link PH Lab to Marin clinics using Centricity Meet Meaningful Use Stage 2 criteria Lessons Learned: Keep field and messaging definitions broad and general, use content to dynamically transmit information

6. Solano County Health and Social Services PH Lab HIE project – Plan more Get input from communities of interest: Providers, patients, Care Coordinators, Other County Labs, County Health Officers Develop scenarios in partnership with key stakeholders Develop functional requirements in partnership with key stakeholders Develop message content requirements in partnership with key stakeholders

7. Solano County Health and Social Services PH Lab HIE project – Status

8. Solano County Health and Social Services PH Lab HIE project – Potential Components ABC PHIMS

9. Solano County Health and Social Services PH Lab HIE project – Current Design Steps D evelop a substantial roadmap document resulting in Standardized Structured Data Produce a planning document that specifies PH Lab reporting Work with Nextgen EHR Connect on linking to the bundled interface to achieve a 60% discount Focus on infection report and analysis Test, then re-test, then test again

10. Solano County Health and Social Services PH Lab HIE project – Challenges Implementation guides not adopted Format “Forest” Cost and time for broad adoption too high Customization of interfaces is common creating a need for configuration per interface, Composition of core subsets varies -> issues in decision support and quality reporting. Result-reporting formats must conform to CLIA regulation (42 CFR 493.1291(c)) creating data format rigidity Meaningful Use doesn't provide incentives to change practices. No compelling ROI

11. Solano County Health and Social Services HIE project - Components e-Prescribing to improve medication reconciliation at local acute care facilities Electronic Labs -- Clinic laboratories receive electronic orders from or deliver electronic test results into certified EHRs at clinics Public health laboratory receives electronic orders and posts electronic test results to clinics (present) and local hospitals (future) Care Transition Messaging -- Eligible providers receive care summaries for their patients from specialty care (present) and local hospitals (future); Eligible providers push patient care summaries to other systems via Mirth Connect; IZ Reporting -- Submit immunization reports to the California Immunization Registry (CAIR) (Future) DiSTRIBuTE -- Enable hospitals to publish daily syndromic surveillance signals to CDC / Public Health (future)

12. Solano County Health and Social Services HIE project – Data Fields Demographics Address line 1 Address line 2 City State Zip Code County Country Phone number Patient’s ID 1 Patient’s ID 2 PMISC1 PMISC2 Guarantor Demographics: Name, DOB, Address, Phone (if different from patient) Insurance Company Policy Number Group Number Relationship to Patient Card Holder’s Demographics: Name, DOB, Address, City, State, Zip Code, Phone Policy Begin Date Policy End Date Referral Number

13. Solano County Health and Social Services HIE project – Data Fields Diagnosis, Analysis, Report, Alerts Specimen Collection Date Specimen Collection Time Specimen Source/Container Specimen Information (for specimens in series such as TB) Submitter Specimen Number Submitter Medical Record Number Diagnosis Code Reason for Testing Ordering Physician License Number Submitter Name (Hospital / clinic) Specimen Receive Date Specimen Receive Time Status Code Bill To Copy to (for Public Health notifications)

14. Solano County Health and Social Services PH Lab HIE project – Reporting Data BLOOD LEAD LEVEL 221642.0% MYCOBACTERIUM CULTURE 4869.2% MYCOBACTERIUM MICROSCOPIC 4839.2% T-SPOT.TB 1563.0% NEISSERIA GONORRHOEAE PROBE-TEC 1522.9% CHLAMYDIA TRACHOMATIS PROBE-TEC 1522.9% QUANTIFERON-TB GOLD 1502.8% SERUM RPR QUALITATIVE 1042.0% NITRATE CHEMISTRY TESTING 981.9% HIV EIA SERUM 911.7% MYCOLOGY CULTURE FOR IDENTIFICATION 901.7% HIV 1 EIA ORAL FLUID 871.7% VIRUS PCR TESTING 801.5% MICROSCOPIC EXAMINATION - GCS 761.4% MYCOLOGY PRELIMINARY REPORT 751.4% ENTERIC CULTURE FOR IDENTIFICATION 641.2% PRIMARY CULTURE - ENTERIC 621.2% ENTERIC CULTURE PRELIMINARY 591.1%

15. Solano County Health and Social Services PH Lab HIE project – Reporting Flow Lab System Channels Provider EHR

16. Solano County Health and Social Services PH Lab HIE project – Data Flow Note: Provider and Laboratory use their own systems to pull up reports and requests.

17. Solano County Health and Social Services PH Lab HIE project Questions? Linking 4 County PH Labs and linking reports to hospitals Stephan Betz, Ph.D. sjbetz@solanocounty.com