1. Public Health Data Standards Consortium http://www.phdsc.org http://www.phdsc.org

2. PUBLIC HEALTH DATA STANDARDS CONSORTIUM ~ NIOSH Site Visit ~ August 29, 2012, Morgantown WV Assure Health IT Standards for Public Health: HIT Standards for Occupational Health Data Exchanges Anna O. Orlova, PhD aorlova@jhsph.edu Executive Director Public Health Data Standards Consortium Baltimore, Maryland, USA

3. Outline PHDSC Projects on HIT Standardization for Public Health: Efforts to Date Occupational Health Project  Goals  Objectives, Activities, Timeline and Deliverables  Outcomes Next Steps

4. Outline PHDSC Projects on HIT Standardization for Public Health: Efforts to Date Occupational Health Project  Goals  Objectives, Activities, Timeline and Deliverables  Outcomes Next Steps

5. PHDSC’s Mission Improved Health Information Health Data Standards Enhanced Health and Health Care Improved Health Information Health Data Standards Enhanced Health and Health Care Improved Health Information Health Data Standards Enhanced Health and Health Care Improved Health Information Health Data Standards Enhanced Health and Health Care Improved Health Information Health Data Standards Enhanced Health and Health Care Improved Health Information Health Data Standards Enhanced Health and Health Care Improved Health Information Health Data Standards Enhanced Health and Health Care Improved Health Information Health IT Standards Enhanced Population Health PHDSC is committed to bring a common voice from the public health community to the national efforts of standardization of health and healthcare information

6. Represent public health interests (local, state and federal agencies and research communities) in the standards development, harmonization and maintenance activities by participation in the standard development (SDOs), data content committees (DCCs), standard harmonization entities and other healthcare standardization- related efforts Promote interoperability of health-related data systems to meet the health data needs of public and private organizations, agencies and individuals Educate clinical and public health professionals about standards and systems interoperability, and vendors and clinicians about public health Enhance membership services PHDSC Goals

7. Assuring Health IT Standards for Public Health PHDSC Projects under CDC Cooperative Agreement 2008-2013 PHDSC Activities

8. Supported through the CDC Cooperative Agreement. Business Case: Public Health in HIT Standardization

9. Assuring Health IT Standards for Public Health

10. PHDSC Business Case: HIT Standardization Phases, Products and Entities HIT Standardization Phases Needs & Priorities Development & Maintenance Selection & Harmonization Testing/Trial Implementation CertificationDeployment Goals What should be accomplished ? What are the standards? What standards to use? Show what can be accomplished Certify standards- based products Deploy standards- based products HIT Standards and Interoperability Framework Development Entities HIT Policy Committee HIT Standards Committee (Formerly AHIC) SDOs (e.g., HL7, SNOMED (IHTSDO), LOINC, ASC X12, NUBC, ISO TC215) IHE HITSP ONC Standards & Interoperability Framework NwHIN IHE Certification Entities (CCHIT, Drummond Group, Inc) Proposed IHE & PHDSC Deployment Workshops Standards Documents Use Cases (Description of the health information exchanges) Standards Interoperability Specifications Technical Frameworks Integration Profiles Test Reports Functional Profiles Certification Criteria Deployment Reports On-going Activities ( 2008-now) Developed methodology for public health participation in HIT standards development & harmonization. Develop methodology for public health participation in HIT product testing and certification New Activities (2012-2013) Develop methodology for evaluation of standard-based HIT products (HIT adoption)

11. Source: Fridsma D. Standards and Interoperability Framework: Principles and Processes. HIT Standards Committee. September 21, 2010. URL: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1817&parentname=CommunityPage&parentid=28&mode=2&in_hi_userid=11673&cached=true

12. 2009 PHDSC HIT Standardization Process is fully aligned with the 2010 ONC S&I Framework

13. HIT Standardization and PHDSC Projects HIT Standardiza- tion Phases Needs & Priorities Development & Maintenance Selection & Harmonization Testing /Trial Implemen- tation Certification Deploy- ment Goals What should be accomplished? What are the standards? What standards to use? Show what can be accomplished Certify standards- based products Deploy standards -based products Public Health Domains Undergoing HIT Standardiza- tion AHIC / MU: Biosurveillance Immunization ELR Public Health Reporting Newborn Screening Vital Records Biosurveillance Immunization PH-Lab Public Health Reporting Newborn Screening Vital Records Biosurveillance Immunization PH-Lab Public Health Reporting Newborn Screening Vital Records Admin Data Occup.Health PH-Lab Public Health Reporting Hearing Vital Records PH-Lab Public Health Reporting Hearing Vital Records PH-Lab Hearing ONC Standards and Interopera- bility Framework PHDSC Projects HITSP Projects Public Health Domains Undergoing HIT Standardi- zation Case Report Hearing Screening Report Hearing Quality Measures

14. PHDSC Health Information Technology Standards Web-Resource Center (http://www.phdsc.org/standards /resource-center.asp)http://www.phdsc.org/standards /resource-center.asp

15. Assuring Health IT Standards for Public Health

18. Project 1: Assure HIT Standards for Public Health (Business Case: Role of Public Health in National HIT Standardization) Project 2: PHDSC Participation in Health Data Standards Development for Administrative Data Exchanges Project 3: Public Health Functional Requirements Project Project 4: Standards for Early Hearing Detection and Intervention (EHDI) Program Project 5: Standards for Public Health Laboratory (PH-Lab) Data Exchange Project 6: Clinical Document Architecture (CDA) for Public Health Project 7: Knowledgebase for ONC S&I Public Health Reporting Initiative Project 8: Standards for Occupational Health Data Exchanges Project 9: University-based Public Health Informatics Training PHDSC Projects: Assuring Health IT Standards for Public Health

19. Project 1: Assure HIT Standards for Public Health (Business Case: Role of Public Health in National HIT Standardization) Project 2: PHDSC Participation in Health Data Standards Development for Administrative Data Exchanges Project 3: Public Health Functional Requirements Project Project 4: Standards for Early Hearing Detection and Intervention (EHDI) Program Project 5: Standards for Public Health Laboratory (PH-Lab) Data Exchange Project 6: Clinical Document Architecture (CDA) for Public Health Project 7: Knowledgebase for ONC S&I Public Health Reporting Initiative Project 8: Standards for Occupational Health Data Exchanges Project 9: University-based Public Health Informatics Training PHDSC Projects: Assuring Health IT Standards for Public Health

20. PHDSC Projects on HIT Standardization Assuring Health IT Standards for Public Health HIT Policy Committee & HIT Standards Committee

21. PHDSC Business Case: HIT Standardization Phases, Products and Entities HIT Standardization Phases Needs & Priorities Development & Maintenance Selection & Harmonization Testing/Trial Implementation CertificationDeployment Goals What should be accomplished ? What are the standards? What standards to use? Show what can be accomplished Certify standards- based products Deploy standards- based products HIT Standards and Interoperability Framework Development Entities HIT Policy Committee HIT Standards Committee (Formerly AHIC) SDOs (e.g., HL7, SNOMED (IHTSDO), LOINC, ASC X12, NUBC, ISO TC215) IHE HITSP ONC Standards & Interoperability Framework NwHIN IHE Certification Entities (CCHIT, Drummond Group, Inc) Proposed IHE & PHDSC Deployment Workshops Standards Documents Use Cases (Description of the health information exchanges) Standards Interoperability Specifications Technical Frameworks Integration Profiles Test Reports Functional Profiles Certification Criteria Deployment Reports On-going Activities ( 2008-now) Developed methodology for public health participation in HIT standards development & harmonization. Develop methodology for public health participation in HIT product testing and certification New Activities (2012-2013) Develop methodology for evaluation of standard-based HIT products (HIT adoption)

22. Implementing PHDSC Methodology on HIT Standardization for Public Health Phase 1: Defining Needs and Priorities for HIT Standards for Public Health Assuring Health IT Standards for Public Health

23. Completed Project  2011 Public Health Surveillance Summer Camp developed recommendations for selecting information exchange standards for public health objectives in Meaningful Use Stage 1 and beyond as follows: HL7 V.2.5.1 message standard for MU Stage 1 (immunization, laboratory reporting to public health, syndromic surveillance) Clinical Data Architecture (CDA) – structured document- based standard as a future direction for Public Health Assuring Health IT Standards for Public Health HIT Policy Committee & HIT Standards Committee

24. Completed Project Business Processes of Local Health Departments project has developed a Public Health HIT Standardization Framework based on the common business areas, business processes, information system functions and data content  Resulted from the 2010 PHDSC Annual Meeting  Currently under review by the ONC S&I Public Health Reporting Initiative’s participants as a potential common framework for Public Health HIT Standardization Assuring Health IT Standards for Public Health NACCHO-funded Project

25. Event/Outbreak Identification Event/Outbreak Investigation Public Health Business Processes Individual/Population Information Systems Functions Data Content Event/Outbreak Management Evaluation Mitigation Collect Data Manage Data Integrate Data Analyze Data Report Data Guidelines Event/Case/Outbre ak Reports Alert & Notification Quality Reports Educational Materials Lab Reports Care Plans Population Resources Environment Protection Wellness Direct Care Operations Research Public Health Business Areas Public Health HIT Standardization Framework

26. On-going Projects  Laboratory Reporting Interface Initiative  Laboratory Result Reporting to Public Health  ONC S&I Public Health Reporting Initiative – Community-based Initiative Started in July 2011 Assuring Health IT Standards for Public Health

27. Emerged from the S&I LRI Initiative Developed by the public health community at large during July-September 2011 Described in the Charter Document as follows: Charge The S&I Public Health Reporting Initiative will develop and implement a standardized approach to electronic public health reporting from EHR systems to local, state and federal public health programs that addresses the needs of various public health programs Scope Initial Public Health Event Report from EHR system (inpatient and or outpatient) to public health agency (local or state or federal) Deliverable ONE Implementation Specification (Guide) for Initial Report that defines core data elements across multiple public health programs Timeline 12 month starting October 1, 2011 ONC S&I Public Health Reporting Initiative

28. By December 2011 Consensus-based PH Reporting HIT Standardization Framework Consensus-based PH Reporting Definitions Consensus-based Use Case Selection Criteria Consensus-based One PH Reporting Use Case of the Initial PH Report with Multiple User Stories, e.g., Child Health (Hearing, Vital Records, Birth Defects, Others) Communicable Diseases (Lab Reports and Case Reports) Chronic Diseases (Lab Reports and Case Reports) Adverse Event Reports (FDA Reporting) By September 2012 One Implementation Specification (Guide) for Initial PH Report that defines core data elements across multiple public health programs 28 ONC S&I Public Health Reporting Initiative

29. Phase 1 (September-December 2011) 1.Charter has been finalized 2. Building a consensus on PH Reporting definitions PH Reporting HIT Standardization Framework Use Case Selection Criteria Selection of Use Case(s) 3. Development of detailed 9mos work plan (January - September 2012) Define Tasks/Deliverable/Timeline Form Workgroups as needed AugSeptOctNovDecJanuary-MayJune-September Initiation Final version of the Charter 1.PH Reporting Definitions 2.PH Reporting Standardization Framework 3.PH Reporting Use Case with Use Stories 1. Func Reqs Analysis on the PH Reporting Use 2. Standards Selection 3. Guide Development 4. Guide’s Public Review 5. Final Guide Phase 2 (January-May 2012) 1. Conduct functional requirements analysis for the PH Reporting Use Case Workflow and dataflow modeling Core data elements mapping 2. Select Standards (gap/overlap analysis) 3. Develop PH Reporting Implementation Guide 4. Public Review of the Implementation Guide 5. Test PH Reporting Implementation Guide (reference implementation) 7. Conduct Assessment of Resources (Tools) for PH Reporting 6. Establish PH Reporting Certification Process 7. Propose Public Health Objectives for Stage 3 MU 5. Guide Testing 6. Resources (Tools) for PH Reporting 7. PH Reporting Certification 8. MU Stage 3 Proposed Objectives for PH Reporting Milestones/Deliverables/Timeline ONC S&I Public Health Reporting Initiative

30. Implementing PHDSC Methodology on HIT Standardization for Public Health Phase 2: Developing HIT Standards for Public Health Assuring Health IT Standards for Public Health

31. On-going Project  Participate in standards development activities: Next version of the Health Care Service: Data Reporting Guide. Continue to make the public health reporting vehicle compatible with the HIPAA mandated standards: Source of Payment Typology included Preferred Language spoken included Support added for Occupation, Industry, and Functional Status added. Updated examples from ICD-9-CM coding to ICD-10-CM or ICD-10-PCS coding. Collaboration with AHRQ and ANSI X12 to populate USHIK with All Payer Claims Database metadata IHE White Paper on Populating Administrative datasets from EHR systems Assuring Health IT Standards for Public Health

32. On-going Project - PHDSC EHR-PH Task Force  Public Health Functional Profile of the HL7 EHR-S Functional Model Release 1.1 that includes  Vital Record  Early Hearing Detection & Intervention (EHDI)  Cancer  Public Health Laboratory  Birth Defects  Occupational Health  HL7 Public Health Reporting Requirements Standard based on HL7 Healthcare Quality Measure Framework (HQMF) standard Assuring Health IT Standards for Public Health

33. Implementing PHDSC Methodology on HIT Standardization for Public Health Phase 3: Harmonizing HIT Standards for Public Health Assuring Health IT Standards for Public Health

34. On-going Projects  Public Health Reporting Integration Profile  Content Profiles: Vital Records, Early Hearing Detection & Intervention (EHDI) Public Health Laboratory Assuring Health IT Standards for Public Health

35. Implementing PHDSC Methodology on HIT Standardization for Public Health Phase 4: Testing HIT Standards for Public Health Assuring Health IT Standards for Public Health

36. On-going Projects  Develop HIT Testing Methods and Tools for Public Health Vital Record Early Hearing Detection & Intervention (EHDI) Public Health Laboratory Public Health Case Reporting Assuring Health IT Standards for Public Health

37.  EHR-Public Health Interoperability Showcase Vital Record Early Hearing Detection & Intervention (EHDI) Public Health Case Reporting  Lab Reports  Case Reports Assuring Health IT Standards for Public Health HIMSS Interoperability Showcase™

38. Implementing PHDSC Methodology on HIT Standardization for Public Health Phase 5: Certifying Standards-based HIT Solutions for Public Health Assuring Health IT Standards for Public Health

39. On-going Project - PHDSC EHR-PH Task Force  Public Health Functional Profile (PHFP) mapping to the HL7 EHR-S Functional Model Release 2.0 for  Vital Record  Early Hearing Detection & Intervention (EHDI)  Cancer  Public Health Laboratory  Birth Defects  Occupational Health  Establish Certification Process for EHR Systems Reporting to Public Health based on the updated PHFP. Assuring Health IT Standards for Public Health

40. Implementing PHDSC Methodology on HIT Standardization for Public Health Phase 6: Deploying Standards-based HIT Solutions in Public Health Assuring Health IT Standards for Public Health

41.  On-going Project  Deploy HL7 Clinical Document Architecture Standard (CDA) for Public Health Reporting Public Health Case Reporting  Completed May 2012 Early Hearing Detection & Intervention (EHDI)  Started August 2012;  Will be completed by December 2012 Assuring Health IT Standards for Public Health

42. Header Social History Section Clinical Information Section Treatment Information Section Encounters Section Relevant Diagnostics and Laboratory Section Immunizations Section HL7 CDA Standards for Public Health Case Report

43. URL: https://www.projects.openhealthtools.org/sf/projects/mdht © 2012 Lisa R. Nelson Open Source Model Driven Health Tool - MDHT Building CDA Public Health Reports (Templates)

44. © 2012 Lisa R. Nelson Model Driven Health Tool - MDHT The MDHT automatically generates the CDA templates, validation is built-in. Building CDA Public Health Reports in MDHT

45. CDA Public Health Case Reports https://wiki.phdsc.org/index.php/PH-Lab https://wiki.phdsc.org/index.php/PH-Lab Header Social History Section Clinical Information Section Treatment Information Section Encounters Section Relevant Diagnostics and Laboratory Section Immunizations Section Example: Case Report Documentation: Pertussis Case Reports Pertussis - Data Definitions xlsData Definitions xls Pertussis - Implementation Guide pdfImplementation Guide pdf Pertussis - Case Report 1 (XML File) (JPG Image) 12-05/10(XML File)(JPG Image) Pertussis - Case Report 2 w/Labs (XML File) (JPG Image) 12-05/10(XML File)(JPG Image) CDA for PH Pilot Project: Case Reporting

46. HIE Form Manager (Oz Systems) CDA Pertussis Case Report Provider EHR (Connexin) CCD Content to Pre- populate Pertussis Case Report New York State Public Health Information System (UPHN) CDA-based Actor Diagram Public Health Reporting Schema: New York State CDA for PH Pilot Project: Case Reporting

47. Health Information Exchange (HIE) Or Public Health Gateway (Vendors?) CDA EHDI Report Birthing Facility EHR (Vendors?) CDA EHDI Report State EHDI Information System (Vendors?) CDA-based Actor Diagram CDA EHDI Pilot Project – New Project Proposed Public Health Reporting Schema: EHDI

48. HIT Standardization and PHDSC Projects HIT Standardiza- tion Phases Needs & Priorities Development & Maintenance Selection & Harmonization Testing /Trial Implemen- tation Certification Deploy- ment Goals What should be accomplished? What are the standards? What standards to use? Show what can be accomplished Certify standards- based products Deploy standards -based products Public Health Domains Undergoing HIT Standardiza- tion AHIC / MU: Biosurveillance Immunization ELR Public Health Reporting Newborn Screening Vital Records Biosurveillance Immunization PH-Lab Public Health Reporting Newborn Screening Vital Records Biosurveillance Immunization PH-Lab Public Health Reporting Newborn Screening Vital Records Admin Data Occup.Health PH-Lab Public Health Reporting Hearing Vital Records PH-Lab Public Health Reporting Hearing Vital Records PH-Lab Hearing ONC Standards and Interopera- bility Framework PHDSC Projects HITSP Projects Public Health Domains Undergoing HIT Standardi- zation Case Report Hearing Screening Report Hearing Quality Measures

49. Outline PHDSC Projects on HIT Standardization for Public Health: Efforts to Date Occupational Health Project  Goals  Objectives, Activities, Timeline and Deliverables  Outcomes Next Steps

50. PHDSC Occupational Health Project Goals

51. Capture OH Data - Define how to represent consistently demographic information about occupation across information content standards (Health Level Seven (HL7) Clinical Document Architecture (CDA) standard, and IHE Content Profiles) Use OH Data - Define how to use demographic information about occupation to create consistently information related to occupation demographic data, such as occupational risk factors Raise Awareness of the public health community about HIT interoperability standards for occupational health data exchanges PHDSC Occupational Health Project

52. Objectives, Activities, Timeline and Deliverables

53. Objective 1: Establish a common representation for occupation demographic information Activities 1.1Conduct analysis of current representation of OH data across existing interoperability standards (Aug-Sept. 2012) PHDSC Occupational Health Project

54. Objective 1: Establish a common representation for occupation demographic information Activities (continued) 1.2 Develop proposal(s) for the IHE 2012- 2013 development cycle to assure consistent representation of OH data across IHE interoperability standards (Integration Profiles and Content Profiles (Sept.2012) PHDSC Occupational Health Project

55. Objective 1: Establish a common representation for occupation demographic information Activities (continued) 1.3 Meet at NIOSH in Morgantown, West Virginia with NIOSH leadership (Aug 2012) PHDSC Occupational Health Project

56. Objective 1: Establish a common representation for occupation demographic information Activities (continued) 1.4. Update existing ITI, PCC and QRPH Profiles to enable consistent representation of OH data (Oct. 2012 – March 2013) 1.5. Publish updated profiles developed under Activity 1.4 for public comments (May 2013) PHDSC Occupational Health Project

57. Objective 2 Establish a standard method for using occupation and industry data to construct dependent information, such as occupational risk factors. Activities 2.1 Develop a template for representing occupational risk factors for utilizing occupation and industry demographic data within CDA documents (Nov-Dec 2012) PHDSC Occupational Health Project

58. Objective 3: Provide the public health community with information about HIT standardization for OH data exchanges Activities 3.1. Develop content about OH standards in the PHDSC Web-resource Center: Public Health in HIT Standardization (on-going). 3.2. Conduct one Webinar on HIT Standardization for OH data exchanges (May 2012) PHDSC Occupational Health Project

59. Objective 3: Provide the public health community with information about HIT standardization for OH data exchanges Activities (continued) 3.3. Develop presentations on HIT Standardization for OH data exchanges at the national forums (professional associations, PHDSC annual meeting, and meetings of HIT vendors, e.g. HIMSS (Nov.2012, March 2013) PHDSC Occupational Health Project

60. Objective 3: Provide the public health community with information about HIT standardization for OH data exchanges Activities (continued) 3.4 Publish project briefs in four quarterly PHDSC e-Standard Newsletter (July, October 2012 and January, April 2013) PHDSC Occupational Health Project

61. Deliverables  Summary of the Analysis of current representation of OH data across existing interoperability standards  Updated IHE Profile(s) with OH data  Updated IHE Profile(s) with the template for representing risk factors based on the utilization of occupation/industry data

62. PHDSC Occupational Health Project Deliverables (continued)  Informational and educational web-based resources about OH interoperability HIT standards Presentation at NIOSH meeting, Aug 2012 Web-page(s) on OH interoperability Standards in the PHDSC Web-resource Center: Public Health in HIT Standardization Webinar on Interoperability Standards for OH Data Exchanges (May 2013) Presentation(s) at the national forums on Interoperability Standards for OH Data Exchanges Project Briefs in four quarterly PHDSC e-Standard Newsletter (July, October 2012 and January, April 2013

63. PHDSC Occupational Health Project Outcomes  Consistent representation of industry and occupation data in the national HIT interoperability standards  Consistent representation of risk factors based on industry and occupation data in the national HIT interoperability standards  Informational and educational web-based resources about OH interoperability HIT standards

64. PHDSC Occupational Health Project Project Wiki Pages https://wiki.phdsc.org/index.php/NIOSH#.C2.A0Standards_for_O ccupational_Health_Data_Exchanges

65. Outline PHDSC Projects on HIT Standardization for Public Health: Efforts to Date Occupational Health Project  Goals  Objectives, Activities and Timeline  Outcomes Next Steps

66. PHDSC Occupational Health Project Next Steps  Current Project (June 1, 2012-May 31, 2013)  Beyond the Current Project (after May 31, 2013)