1. NAPHSIS Annual Meeting 2014Slide 1 NAPHSIS ANNUAL MEETING | Seattle | June 8-11, 2014 VITAL RECORDS: A CULTURE OF QUALITY Navigating a Vital Records Future in an e-Health Era Bill Brand, MPH Director, Informatics Science Public Health Informatics Institute

2. NAPHSIS Annual Meeting 2014Slide 2 Basic premises Today’s EHR systems are struggling to met the demands being placed on them New generation of public health information systems will be required Increased focus on population health improvement brings opportunities and challenges for health departments

3. NAPHSIS Annual Meeting 2014Slide 3 About PHII Transforming health practitioners’ ability to apply information effectively to improve health outcomes worldwide. Informatics Academy Requirements Laboratory Practice Support Part of the non-profit Task Force for Global Health in Decatur, Georgia

4. NAPHSIS Annual Meeting 2014Slide 4 EHR SYSTEMS: EQUAL TO THE TASK? Slide 4

5. NAPHSIS Annual Meeting 2014Slide 5 EHR Systems: Equal to the task? Current adoption rates Impact of Meaningful Use and EHR certification programs Current limitations in e-health and health reform era

6. NAPHSIS Annual Meeting 2014Slide 6 EHR Adoption by US Hospitals ONC Data Brief ■ No. 16 ■ May 2014 Adoption of Electronic Health Record Systems among U.S. Non-federal Acute Care Hospitals: 2008-2013

7. NAPHSIS Annual Meeting 2014Slide 7

8. NAPHSIS Annual Meeting 2014Slide 8 Physician adoption of EHRs

9. NAPHSIS Annual Meeting 2014Slide 9 Impact of MU and Certification Meaningful Use (MU) accelerated trends already underway EHR certification – Standardized functionality – Increased buyer confidence (somewhat)

10. NAPHSIS Annual Meeting 2014Slide 10 Future of MU in doubt? Only four hospitals had attested successfully for stage 2 (as of May 13)! Predictions that ~80% will apply for hardship exemptions – Many may just leave the program Increasing pressure to slow down MU process Certification may shift away from complete EHR systems Source: John Halamka, MD, Keynote at Boston Health IT Summit, May 13, 2014

11. NAPHSIS Annual Meeting 2014Slide 11 EHR limitations Major dissatisfaction with usability – Don’t match workflows – Increasingly seen as patient safety concern Not designed as health care improvement and population health management tools Still too many proprietary codes and other idiosyncrasies to be effectively interoperable Need to be re-designed for today’s goals

12. NAPHSIS Annual Meeting 2014Slide 12 INTEROPERATING WITH EHR SYSTEMS Slide 12

13. NAPHSIS Annual Meeting 2014Slide 13 Public health reporting in an e-health era Data reported to HDs increasingly being collected for other purposes – “Enter once, use many times” – Public health as secondary user – No longer control the information value chain – Must understand the who, what, why Decreasing interest/ability to interact with stand-alone, external systems

14. NAPHSIS Annual Meeting 2014Slide 14 Implications for public health Must work within the world of healthcare standards – Must be proactive in developing standards needed for public health functions – Example: eVitals using HL7 and IHE Make functionality seamlessly available to EHR or others systems – Increasingly “behind the scenes” Contribute to getting social determinant data in EHRs

15. NAPHSIS Annual Meeting 2014Slide 15 Issues for Vital Registration Will data be structured in EHR as needed for VR? Will EHR support additional data entry for VR? Will EHR data systems support data quality checks for VR? Will EHR support needed accountability for VR reporters? Will the process support providers’ and VRs’ business needs? Source: Seth Foldy, MD, 2013 NAPHSIS Conference

16. NAPHSIS Annual Meeting 2014Slide 16 Vital Registrar/NCHS/PH perspective BETTER? – Data received more accurate/appropriate/precise? – Data received more complete? – Data elements meet processing requirements? – DEPEND ON ADEQUACY OF EHR CERTIFICATION FASTER – Delivered to EVRS faster? – Registration accomplished faster? – Transmitted to NCHS faster? – Certificates available to individuals faster? – Statistics and tools (e.g. death index) available for use faster? – DEPEND ON PROVIDER BEHAVIOR, EVRS SYSTEM CAPABILITY CHEAPER – Less labor per record? – Less labor for follow-ups? – Simplified workflow for record completion? – EVRS cheaper to produce, procure, maintain, replace? – DEPEND ON EVRS SYSTEMS LEVERAGING EHR STANDARDS Source: Seth Foldy, MD, 2013 NAPHSIS Conference

17. NAPHSIS Annual Meeting 2014Slide 17 Tentative Conclusion IF certified EHRs capture well-defined data elements using standardized vocabulary, and IF EHRs present said data for validation, supplementation, and certification by the health care provider, and IF this occurs timely in a clinical-friendly workflow, and IF EVRS systems build toward ONE clear standard for receiving and processing this data, THEN semi-automated EHR reporting could be better, faster AND cheaper for both clinicians and VR offices Source: Seth Foldy, MD, 2013 NAPHSIS Conference

19. NAPHSIS Annual Meeting 2014Slide 19 OPPORTUNITIES AND CHALLENGES IN POPULATION HEALTH IMPROVEMENT Slide 19

20. NAPHSIS Annual Meeting 2014Slide 20 What’s in a name? ‘Population’ and ‘population health’ mean different things to different sectors – Public health: Focus is on all people who live, work or play within jurisdictional boundaries – ACOs: The population of patients for whom they are responsible – Healthcare: A patient panel of, for example, hypertensives or diabetics

21. NAPHSIS Annual Meeting 2014Slide 21 Assumptions Regardless of how ACA gets implemented, the focus on improving health outcomes in populations will continue Much greater focus on ‘big data’ analytics to better understand social and other determinants of health

22. NAPHSIS Annual Meeting 2014Slide 22 Gartner Hype Cycle for HIT

23. NAPHSIS Annual Meeting 2014Slide 23 Assumptions Regardless of how ACA gets implemented, the focus on improving health outcomes in populations will continue Much greater focus on ‘big data’ analytics to better understand social and other determinants of health Healthcare is unlikely to embark on widespread sharing of chronic disease data with public health Access to data and analytic capabilities will be through partnerships

24. NAPHSIS Annual Meeting 2014Slide 24 Key Capacities and Elements of an Informatics-Savvy Health Department Informatics Vision & Governance Skilled Workforce Well-designed & effectively used systems Well-articulated informatics vision for how the agency uses information and IT Organization-wide approach to interoperability Effective relationship with community partners and with central IT Policies to ensure confidentiality, security, integrity of data Training strategies for improving informatics knowledge and skills across a broad range of staff Informatics unit with agency-wide responsibilities Information systems effectively meet the information needs, workflows and practices of staff and programs. Systems are interoperable with other internal & external systems

25. NAPHSIS Annual Meeting 2014Slide 25 Opportunities for eVital Records Initiative Get Ready Develop an informatics-savvy program and workforce Become familiar with the VR standards Become familiar with hospital-EHR workflows Learn from the pilots (MN and UT) Conduct a readiness assessment of state and local partners Get Involved Participate in standards development and testing activities Contribute to national policy and standards discussion Get Going! Start an eVital Records Initiative Adapted from Michelle Williamson, CDC/NCHS

26. NAPHSIS Annual Meeting 2014Slide 26 NAPHSIS ANNUAL MEETING| Seattle | June 8-11, 2014 VITAL RECORDS: A CULTURE OF QUALITY Thank You Bill Brand Public Health Informatics Institute bbrand@phii.org