1. 1 Dealing with Uncertainties: HIT Standardization Public Health Data Standards Consortium Hyattsville, MD Dina Dickerson, MPH Dina.Dickerson@state.or.us Oregon Health Authority Center for Prevention and Health Promotion 11.21.2013

2. 2 HIE pulse in Oregon Meaningful Use: Stage 1: HIE is live for Immunizations and ELR; syndromic surveillance is piloting in 3 local sites Stage 2: Phase 1 testing of HIE between partner EHR and state newborn hearing screening registry is complete and Phase 2 planning is underway Stage 3: Work is underway to align with PHRI common data elements and to get experience with the HIT tools so that state programs are ready to receive the data from EHRs when available Other: Lots of nonstandard program-to-program data sharing, such as Immunizations to WIC and ELR to CD reporting, but each dedicated interface adds another silo to maintain

3. 3 Other standards-based data sharing initiatives in Oregon Maternal and Child Health and Related Services Race to the Top: integrate and coordinate early childhood data and services across agencies including health, public health, education and mental health Maternal, Infant, Early Childhood Home Visiting: integrate and coordinate home visiting data and services across agencies including health, public health, education and mental health HRSA MCHB Minimum Data Set: align performance measures across programs, identify supporting data elements, harmonize across data elements and value sets, and designate a standard for use by all HRSA MCHB-funded programs

4. 4 Oregon EHDI* CDA Phase 1 Pilot - Lessons Learned Step-1 Setting: Birthing Facility IT Product: Epic 2012 EHR (Test Harness) Report Content: Patient demographic information, NHS results Standards: HL7 CCD, IHE RFD Actor: Content Creator Form Filler Step-2 Setting: HIE IT Product: OZ Form Manager Report Content: NHS Outcome Report Standards: HL7 CDA, IHE EHCP, IHE RFD, IHE XDR Actor: Form Manager Form Receiver Content Creator Document Source Step-3 Setting: Oregon EHDI IT Product: Orion Rhapsody, Filemaker DB Report Content: NHS Outcome Report Standards: HL7 CDA, IHE EHCP, IHE XDR Actor: Content Consumer Document Recipient Interoperability Standards** * Early Hearing Detection and Intervention (EHDI) program. Newborn hearing screening (NHS) is a Stage 2 Meaningful Use objective. ** Public Health Data Standards Consortium EHDI CDA Final Report

5. 5 Oregon EHDI Manual NHS Report Form*

6. 6 EHDI CDA SDC RFD Template* * Public Health Data Standards Consortium EHDI CDA Final Report

7. 7 EHDI CDA Phase 1 Pilot – Lessons Learned Data Exchange Architecture* * Public Health Data Standards Consortium EHDI CDA Final Report

8. 8 EHDI CDA Phase 2 Proposal: Real Data & Systems EHDI User Story – Report Form for Data Capture (RFD)

9. 9 EHDI CDA Phase 2: SDC Template

10. 10 HIE: even more silos? Hospital IT staff fear a proliferation of one-off requests for EHR data Each request requires resources to set up and maintain Can they do this once and address all reporting needs for Public Health? Need to acknowledge and address those fears minimize impact on stakeholders and partners let them know up front what data Public Health requires and in what format Transition to a shared data and workflow model harmonize and standardize data and processes receive standards-based data into shared data model populate silos with shared data until they can be retired use metadata to simplify the structure and process

11. 11 Priority areas to move toward HIT standardization Awareness Flea Pushing a Boulder, 2009 Standards overload can be overwhelming Coordination CCO’s and other clinical providers Local health departments Statewide programs Infrastructure Shared data model Shared workflow tools Funding Workforce No Public Health-wide Informatics in Oregon Need trained Chief Informatics Officer, not Technology Officer Need training in harmonization and standardization

12. 12 Awareness

13. 13 Awareness: standards overload Data standards CPT DSM ICD9, ICD10 LOINC NIC-NOC-NANDA SNOMED NFP and so on Interoperability standards HL7 CCD HL7 CDA IHE RFD IHE EHCP IHE XDR and so on Data models FHIM HL7 European RIM and so on Forms SDC Template RFD and so on

14. 14 Coordination: CCO’s, LHDs, Nonprofits, State Periodically receive a file from partner EHRs that contains all instances of data needed by Public Health for prescribed time frame Parse the data on Public Health side and use it to update shared standards-based data model Public Health silos draw on shared data model for updates and actions Harmonize and standardize the actions occurring in silos Build shared functionality to address needed actions and notifications Provide one stop shopping for providers to access and act on notifications about their patients

15. 15 Infrastructure: standards deployment via a shared data model

16. 16 Infrastructure: standards development using a knowledge builder

17. 17 Workforce IT is still in control today Lack domain knowledge Focus is on project management to acquire/implement a system Little awareness of data and workflow standards Decision-makers are skeptical Burned by repeated IT failures No background in informatics Inroads in MCH, ELR and CD reporting but not integrated Train program side people in harmonization and standardization Data Functionality

18. 18 Standards development and deployment: methodology to move from siloed to shared data InventoryConsolidateHarmonizeStandardizeClassifyUseMonitor Create knowledge base of all forms, data elements and value sets Organize data elements around shared themes Align definitions and value sets for a theme Identify standard representation and permissions Assign metadata tags and user permissions to share data Capture, act on and report the data Track access and evaluate quality Data Level

19. 19 Standards development and deployment: methodology to move from siloed to shared workflow InventoryConsolidateModularizeStandardizePilotImplementMonitor Collect and deconstruct user stories according to workflow requirements Create master user story that includes all workflow requirements Align, simplify and reconstruct workflow requirements Adopt one methodology to address workflow requirements Test and fine tune modular solution and training tools in limited settings Roll out solution Track access and evaluate quality Functionality Level

20. 20 Harmonization of core common data elements* * Public Health Reporting Initiative Data Harmonization Profile

21. 21 Acknowledgements Claudia Bingham John Eichwald Jay Eisenberg Ellen Larsen Nikolai Lipskiy Riki Merrick Steve Modesitt Heather Morrow-Almeida Trong Nguyen Sue Omel Anna Orlova Lari Peterson Matt Pitney Walter Suarez Meuy Swafford Cate Wilcox Patricia Yao Chia-Hua Yu Laura Zukowski