1. Public Health Reporting Initiative June 13, 2012

2. Agenda TopicTime Allotted Welcome / Agenda Overview - John Stinn4:00 - 4:05 Functional Requirements Update - John Stinn4:05 – 4:15 Data Mapping Update – Nikolay Lipskiy4:15 – 4:25 Stage 3 Readiness Update – Seth Foldy4:25 – 4:45 NwHIN Governance RFI Discussion4:45 – 5:00 Adjourn5:00

3. Functional Requirements Draft of the functional requirements document, including graphics depicting the public health reporting workflow, has been posted to the wiki ( http://wiki.siframework.org/PHRI+Functional+Requirements ) for public comment http://wiki.siframework.org/PHRI+Functional+Requirements – Immunization comments Comments due by Friday, June 15,2012 using the discussion board or by emailing lrbrown@cdc.govlrbrown@cdc.gov Next Steps – Update current document – Post updated document for public comment (note: to be released in a package including the data elements)

4. Data Mapping Update Working with user story submitters to refine and finalize – User Story / Domain specific data elements – Core / consolidated initiative-level data elements Next steps – Public Comment for domain-level data elements (note: to be released in a package with the functional requirements) – Continue work on data modeling – Complete data harmonization document with both domain-level and initiative-level data elements

5. Public Health Reporting Initiative Stage 3 Readiness and Stage 3 Implementation Specification Sprint These slides represent an interpretation of Readiness Self-Assessments and do not necessarily represent the position of any agency or organization. Proposals are for discussion purposes only.

6. Observations ELR and Syndromic user stories did not reply IIS felt questions were unresponsive to HL7 2.5.1 IIS systems primarily interested in bidirectional exchange Many unclear on 2015 implementation funds

7. Interpretation Guide Focus on unidirectional reporting from EHR to PH? Consensus about data element standards (elements, terminology, value sets?) Preferred exchange standard (2.x vs. CDA vs. other) Primary (potential) federal agency identified Primary stakeholder association identified Capability for pilot in Summer/Fall 2012? Likely receiving capability in Oct. 2015 Number of receiving systems Source of report: ambulatory versus hospital National scope of reporting

8. User StoryUnidirectionalConsensus Standards Data exch. standard Reportable condition case reportingYes CDA or 2.x† Healthcare acquired infection reportingYes CDA or 2.x† Cancer registry reporting**Yes CDA or 2.x† Early Hearing reporting*Yes CDA or 2.x† Birth and fetal death reportingYes CDA or 2.x Drug adverse event reportingYes CDA or 3.x? Medical device adverse event reportingYes CDA or 3.x? Vaccine adverse event reportingYesOldCDA/2.x/3.x? Natl. Hospital Care SurveyYesNo‡CDA or 2.x Immunization registry exchangeNoYes2.x only Tobacco quit line exchangeNo None BRCA counselling registry reportingYesNoNeither * Considering outbound components only †preference for CDA? ** Considering ambulatory case report only ‡single Federal user

9. User StoryUSG programStakeholder Assn. Pilot 2012 Reportable condition case reportingCDC/DNDHICSTEYes Healthcare acquired infection reportingCDC/DHQP/ NHSN CSTE/SHEA/ APIC Yes Cancer registry reportingCDC/DCPCNAACCRYes Early Hearing reporting*CDC/DHDDJCIH/DHSPSHWAFeb 13 Birth and fetal death reportingCDC/NCHS/DVSNAPHSISYes Drug adverse event reportingFDA/CDERInt. Conf HarmYes Medical device adverse event reportingFDA/CDRH‡none‽Yes Vaccine adverse event reportingCDC/DHQP/ISO†ICH?? Natl. Hospital Care SurveyCDC/NCHS/DHCSnone‽Yes? Immunization registry exchangeCDC/IISSBAIRA?? Tobacco quit line exchangeCDC/OSHN.AmQLConsNo ¶ BRCA counselling registry reportingCDC/DCPCnoneNo *Considering outbound components only ** Considering amb. Case report only ¶ Proprietary approach pilot †also FDA ‡also reported via PSOs to AHRQ ‽One user only

10. User StoryImplement 2015 Number Receivers Hosp/Amb Reportable condition case reportingYes?55 (18 NBS)Both Healthcare acquired infection reportingYes1Hosp Cancer registry reporting**Yes63Amb Early Hearing reporting*Yes?59Both Birth and fetal death reportingYes?57Hosp‡ Drug adverse event reportingYes1Both Medical device adverse event reportingYes1/also PSOsBoth Vaccine adverse event reportingUnk57 vs 1?†Both Natl. Hospital Care SurveyYes?1Hosp Immunization registry exchange??57?Both Tobacco quit line exchangeUnsure16 (53 jurisd)Both BRCA counselling registry reportingUnsure2Amb *Considering outbound components only **ambulatory case report only †may use IIS’s ‡ Could also include outpatient records

11. User StoryBreadthProposed Tier Reportable condition case reportingNationwide1 Healthcare acquired infection reportingNationwide1 Cancer registry reporting**Nationwide1 Early Hearing reporting*Nationwide1 Birth and fetal death reportingNationwide1 Drug adverse event reportingNationwide1 Medical device adverse event reportingNationwide1 Vaccine adverse event reportingNationwide2 Natl. Hospital Care Survey500 hosps (10%)2 Immunization registry exchangeMost states2 Tobacco quit line exchangeMost states?2 BRCA counselling registry reporting2 states2 * Considering outbound components only **ambulatory case report only †may use IIS’s

12. Proposal Tier 1: 7 stories appear with relatively high level of readiness; focus on unidirectional; broad national scope Tier 2: 5 stories with either less readiness and/or focus on bidirectional and/or lesser scope Venders: want to recruit industry reps Goal: a process that permits all to benefit while maximizing chance for pilot-tested Stage 3 Impl. Spec. by November

13. Proposal Tier 1 Agencies and Associations EHR & PH System and Intermediary Vendors Tier 2 Agencies and Associations All attempt to achieve consensus. If Tier 2 issues threaten timely consensus on an issue they agree to withdraw on that issue.

14. Possible Process 1.Ground rules 2.Consensus on common “core” elements 3.Consensus on HL7 2.x or CDA or both formats 4.Address how “core” elements and different “extension” elements are managed 5.Address how “trigger” and “filter” knowledge base should function.

15. NwHIN RFI Public Comment Period Extended until Friday, June 29th In response to requests from the public for additional time, ONC has extended the comment period for the Nationwide Health Information Network: Conditions for Trusted Exchange Request for Information (RFI) until to Friday, June 29th. Comments will be accepted through regulations.gov up until 11:59PM Eastern Daylight Time. To comment on the RFI please go to http://www.regulations.gov/#!documentDetail;D=HHS-OS-2012- 0006-0001. http://www.regulations.gov/#!documentDetail;D=HHS-OS-2012- 0006-0001 Can contact Bbrand@phii.org for JPHIT FAQ sheetsBbrand@phii.org