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

2. CDC PHIN Vocabulary and Messaging Community of Practice ~ Webinar ~ May 15, 2012, Atlanta, GA Clinical Document Architecture (CDA) for Public Health Anna O. Orlova, PhD aorlova@jhsph.edu Executive Director Public Health Data Standards Consortium Baltimore, Maryland, USA

3. CDA for PH Project: Outline History CDA Public Health Case Reports CDA for PH Pilot Project

4. CDA for PH Project: Acknowledgements Project Partners Public Health Data Standards Consortium (PHDSC) Council for State and Territorial Epidemiologists (CSTE) Association of Public Health Laboratories (APHL) Delaware Department of Public Health New York State Department of Health San-Diego County Health Department IBM Research OZ Systems Core Solutions Labware Connexin Atlas Public Health HLN Consulting Supported by CDC Office of Surveillance, Epidemiology, and Laboratory Services (OSELS)

5. History CDA for PH Project

6. CDA R2 2005 CDA for PH Project Source: Renly S, Krueger J. What’s Next? Why HL7 Messages and HL7 CDA Documents are in our Future. Presentation at the CDC PHIN Vocabulary and Messaging Community of Practice, February 21, 2012

7. HL7 Messages. URL: http://www.ringholm.de/docs/04200_en.htmhttp://www.ringholm.de/docs/04200_en.htm Messages are generally used to support an ongoing process in a real-time fashion. They convey status information and updates related to one and the same dynamic business object. Messages are about "control" - they can represent requests that can be accepted or refused by the system and there are clear sets of expectations about what the receiver must do.  In such situations the latest version of the data is of importance to support an ongoing process, historic versions of one and the same object are generally not of importance apart from regulatory (e.g. auditing) purposes.  Messages by and large contain “current” data.  The more interactive and tightly coupled your communication process is, the more the use of messages is applicable. CDA for PH Project Source: Renly S, Krueger J. What’s Next? Why HL7 Messages and HL7 CDA Documents are in our Future. Presentation at the CDC PHIN Vocabulary and Messaging Community of Practice, February 21, 2012

8. HL7 Documents. URL: http://www.ringholm.de/docs/04200_en.htmhttp://www.ringholm.de/docs/04200_en.htm Documents are persistent in nature, have “static” content and tend to be used “post occurrence”, i.e. once the actual process is done. Documents are about persisting "snapshots" as understood at a particular time.  Documents contain data “as it was” when the document was originally created. For documents such as referrals and discharge summaries, it may be more appropriate to see the data as it was understood at the time the referral or summary was constructed rather than viewing the data as it exists now.  Documents are "passive". They capture information and allow that information to be shared, but do not in and of themselves drive any activity. Documents can be superseded and corrected, but they are still "static documents" rather than dynamic objects.  The more passive and loosely coupled your communication process is, the more the use of documents is applicable. CDA for PH Project Source: Renly S, Krueger J. What’s Next? Why HL7 Messages and HL7 CDA Documents are in our Future. Presentation at the CDC PHIN Vocabulary and Messaging Community of Practice, February 21, 2012

9. Laboratory Use Case Messages  Orders  Results Documents  Final Report  Summaries MSH|^~\&|LABWARE.DE.STAG^2.16.840.1.114222.4.3.3.2.23.2^ISO|DE.Smyrna.SPHL^2.16.840.1.114222.4.1.44596^ISO|US WHO Collab Labsys^2.16.840.1.114222.4.3.3.7^ISO|CDC-EPI Surv Branch^2.16.840.1.114222.4.1.10416^ISO|20111212201328+1900||ORU^R01|20111212201328- 000014085|P|2.3.1|||||||||PHLIP_ORU_v1.0.2^PHIN_Profile_ID^2.16.840.1.114222.4.10.3^ISO PID|1||1038239^^^LABWARE.DE.STAG&2.16.840.1.114222.4.3.3.2.23.2&ISO^PI||^^^^^^S||19980926|M|||304 W 37TH ST^^Wilmington^DE^19802^^^^10003|||||||||||2135-2^Non-Hispanic^CDCREC^NON_HISP^Non Hispanic^L ORC|RE||14085^DE.Smyrna.SPHL^2.16.840.1.114222.4.1.44596^ISO||CM||||||||||||||||AI Du Pont Hospital and Christiana Care Med Ctr|1600 Rockland Road^^Wilmington^DE^19899^^O|^WPN^PH^^^302^6515658 OBR|1||31804^LABWARE.DE.STAG^2.16.840.1.114222.4.3.3.2.23.2^ISO|243365003^ Acid-Fast bacillus ^LN^PCR_Tuberculosis^Tuberculosis PCR^L|||20111108154032+1900|||||||20111108154030+1900|LAVG&Lavage, Bronhial&HL70070&BAL&Bronchial Alveolar Lavage&L|MAREK^Marek^Liz^^^^^^^U|^WPN^PH^^^302^6515658|||||20111108161839+1900|||F OBX|1|CE|38379-4^M TB Cmplx DNA XXX Ql PCR^LN^Tuberculosis^Tuberculosis^L||260373001^Detected^SCT^POS^Positive; Nucleic Acid detected^L|||N|||F|||20111108161839+1900 OBR|2||14085^LABWARE.DE.STAG^2.16.840.1.114222.4.3.3.2.23.2^ISO|PLT40^Epidemiologically Important Information - Tuberculosis^NND|||20111108154032+1900|||||||20111108154030+1900|LAVG&Lavage, Bronchial&HL70070&BAL&Bronchial Alveolar Lavage&L||||||||||F OBX|1|CX|LAB202^Unique Specimen ID^PHINQUESTION||14085^^^LABWARE.DE.STAG&2.16.840.1.114222.4.3.3.2.23.2&ISO||||||F|||20111108161 640+1900 TB Sample from the 2012 HIMSS Interoperability Showcase Use Case Source: Renly S, Krueger J. What’s Next? Why HL7 Messages and HL7 CDA Documents are in our Future. Presentation at the CDC PHIN Vocabulary and Messaging Community of Practice, February 21, 2012 CDA for PH Project

10. Continuity of Care Document Lab Result … … CDA for PH Project

11. Meaningful Use of Health IT Stage I – HL7 messages v2.3.1 or v2.5.1  Syndromic Surveillance –Electronically record, modify, retrieve, submit v2.3.1 or v2.5.1  Laboratory Results Reporting to Public Health  Electronically record, modify, retrieve, submit v2.5.1  Reporting to Immunization Registries  Electronically record, modify, retrieve, submit v2.3.1 or v2.5.1 Stage II – HL7 CDA  Reporting to State Cancer Registries  Reporting of Early Hearing Detection and Intervention (EHDI) Quality Measures to Public Health CDA for PH Project

12. CDA Public Health Case Reports CDA for PH Project

13. Goal Develop CDA-based Public Health Case Reports for 15 selected conditions CDA for PH Project

14. CDA Public Health Case Report Social History Section Clinical Information Section Treatment Information Section Encounters Section Relevant Diagnostics and Laboratory Section Immunizations Section TB Sample from the 2012 HIMSS Interoperability Showcase Use Case CDA for PH Project

15. CDA Public Health Case Report Social History Occupation: Healthcare Support Occupations HEADER BODY L2 HUMAN READABLE BODY L3 MACHINE PROCESSABLE CDA for PH Project Source: Renly S, Krueger J. What’s Next? Why HL7 Messages and HL7 CDA Documents are in our Future. Presentation at the CDC PHIN Vocabulary and Messaging Community of Practice, February 21, 2012

16. Section Analysis across Continuity of Care Document (CCD) and Public Health Case Reports (PHCR) Prototypes © 2012 Lisa R. Nelson CDA for PH Project PHCR Relevant Diagnostic Tests and/or Laboratory Results Anthrax PHCR Relevant Diagnostic Tests and/or Laboratory Results CCD Continuity of Care Document All Sections: PHCR Clinical Information PHCR Social History CCD Immunization PHCR Encounters PHCR Treatment Information Anthrax PHCR Clinical Information Anthrax PHCR Social History Anthrax PHCR Encounters Anthrax PHCR Treatment Information PHCR Public Health Case Report All Sections: Anthrax PHCR Anthrax Public Health Case Report All Sections: Acute Hepatitis B Tuberculosis Tularemia Alerts Payers Advance Directives Support Problems Functional Status Vital Signs Medications Medical Equipment Procedures Family History Social History Results Immunization Encounters Plan of Care Based on HL7 CDA R2 Implementation Guide for Public Health Case Reporting

17. Selected Conditions 1.Anthrax 2.Chlamydia trachomatis genital infection (& Gonorrhea, Syphilis) 3.Coccidioidomycosis 4.Haemophilus Influenzae, invasive disease, all ages, serotypes 5.Hepatitis B, Acute (& Hepatitis C) 6.Influenza 7.Meningococcal disease, all serogroups 8.Pertussis 9.Silicosis 10.Salmonellosis (& Shigella) 11.Streptococcus pneumoniae, invasive disease 12.Toxic-shock syndrome 13.Tuberculosis 14.Tularemia 15.West Nile virus (& Lyme) CDA for PH Project

18. Selected Conditions 1.Anthrax 2.Chlamydia trachomatis genital infection (& Gonorrhea, Syphilis) 3.Coccidioidomycosis 4.Haemophilus Influenzae, invasive disease, all ages, serotypes 5.Hepatitis B, Acute (& Hepatitis C) 6.Influenza 7.Meningococcal disease, all serogroups 8.Pertussis 9.Silicosis 10.Salmonellosis (& Shigella) 11.Streptococcus pneumoniae, invasive disease 12.Toxic-shock syndrome 13.Tuberculosis 14.Tularemia 15.West Nile virus (& Lyme) CDA for PH Project Conditions included in the HL7 CDA R2 Implementation Guide for Public Health Case Reporting

19. URL: https://www.projects.openhealthtools.org/sf/projects/mdht © 2012 Lisa R. Nelson Open Source Model Driven Health Tool - MDHT CDA for PH Project

20. © 2012 Lisa R. Nelson Model Driven Health Tool - MDHT The MDHT automatically generates the CDA templates, validation is built-in. CDA for PH Project

21. CDA PH Case Report Templates for Selected Conditions URL: https://wiki.phdsc.org/index.php/PH-Lab#PH-CDA_Templates_Work_Listhttps://wiki.phdsc.org/index.php/PH-Lab#PH-CDA_Templates_Work_List 1.Anthrax 2.Chlamydia trachomatis genital infection (& Gonorrhea, Syphilis) 3.Coccidioidomycosis 4.Haemophilus Influenzae, invasive disease, all ages, serotypes 5.Hepatitis B, Acute (& Hepatitis C) 6.Influenza 7.Meningococcal disease, all serogroups 8.Pertussis 9.Silicosis 10.Salmonellosis (& Shigella) 11.Streptococcus pneumoniae, invasive disease 12.Toxic-shock syndrome 13.Tuberculosis 14.Tularemia 15.West Nile virus (& Lyme) CDA for PH Project

22. CDA Public Health Case Reports Social History Section Clinical Information Section Treatment Information Section Encounters Section Relevant Diagnostics and Laboratory Section Immunizations Section CDA for PH Project 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)

23. CDA for Public Health Pilot Project CDA for PH Project

24. Goal Demonstrate feasibility to receive a CDA-based Public Health Case Report by a Public Health Information System in two jurisdictions CDA for PH Project

25. Timeframe Nov-Dec 2011 – Recruitment and Pilot Design  3 participants (DE, NYS and San-Diego)  6 observers (MA, MI, OK, SC, WA and NIOSH) Jan 2012 – IHE Connectathon Testing Feb 2012 – HIMSS Interoperability Showcase (Lab/Case Reports for TB) March-April 2012 – Development May 2012 – Pilot July 2012 – Project Report CDA for PH Project

26. Conditions Selected for the Pilot Project 1.Anthrax 2.Chlamydia trachomatis genital infection (& Gonorrhea, Syphilis) 3.Coccidioidomycosis 4.Haemophilus Influenzae, invasive disease, all ages, serotypes 5.Hepatitis B, Acute (& Hepatitis C) 6.Influenza 7.Meningococcal disease, all serogroups 8.Pertussis CDA (URL: https://wiki.phdsc.org/index.php/CDA-Template_Pertussis)https://wiki.phdsc.org/index.php/CDA-Template_Pertussis 9.Silicosis 10.Salmonellosis (& Shigella) 11.Streptococcus pneumoniae, invasive disease 12.Toxic-shock syndrome 13.Tuberculosis CDA (URL: https://wiki.phdsc.org/index.php/CDA-Template_Tuberculosis)https://wiki.phdsc.org/index.php/CDA-Template_Tuberculosis 14.Tularemia 15.West Nile virus (& Lyme) CDA for PH Project

27. Provider EHR laboratory LIMS Local or State PH Program IS HIE Or PH Communicati on Server For HL7 2.x messages: Rhapsody to translate 2.x messages and CDA For CDA: RFD NHIN Connect XDS DSUB NAV Pseudonymize Test Result Case Report CDC PH Program IS Test Result Case Report Test Order CDA for PH Project Design

28. Provider EHR laboratory LIMS Local or State PH Program IS HIE Or PH Communicati on Server For HL7 2.x messages: Rhapsody to translate 2.x messages and CDA For CDA: RFD NHIN Connect XDS DSUB NAV Pseudonymize Test Result Case Report CDC PH Program IS Test Result Case Report Test Order 1 Scope: 1 CDA for PH Project Design

29. Provider EHR laboratory LIMS Local or State PH Program IS HIE Or PH Communicati on Server For HL7 2.x messages: Rhapsody to translate 2.x messages and CDA For CDA: RFD NHIN Connect XDS DSUB NAV Pseudonymize Test Result Case Report CDC PH Program IS Test Result Case Report Test Order 1 2 Scope: 1,2 CDA for PH Project Design

30. Provider EHR laboratory LIMS Local or State PH Program IS HIE Or PH Communicati on Server For HL7 2.x messages: Rhapsody to translate 2.x messages and CDA For CDA: RFD NHIN Connect XDS DSUB NAV Pseudonymize Test Result Case Report CDC PH Program IS Test Result Case Report Test Order 1 2 3 Scope: 1,2,3 3 CDA for PH Project: Design

31. Provider EHR laboratory LIMS Local or State PH Program IS HIE Or PH Communicati on Server For HL7 2.x messages: Rhapsody to translate 2.x messages and CDA For CDA: RFD NHIN Connect XDS DSUB NAV Pseudonymize Test Result Case Report CDC PH Program IS Test Result Case Report Test Order 1 2 3 4 Scope: 1,2,3,4 3 CDA for PH Project Design

32. Proposed Pilot Schema: DELAWARE Provider EHR (Core Solutions CX360) CCD Content to Pre- populate TB Case Report Delaware PH Communicati on Server/Router (Orion Rhapsody) Laboratory LIMS (Labware) TB Lab Report Form Manager (OZ) CDA TB Case Report TB Lab Report CDA for PH Project

33. Form Manager (OZ) Pertussis CDA Case Report Provider HER (Connexis) CCD Content to Pre- populate Pertussis Case Report NYS PH System (UPHN) Proposed Pilot Schema: New York State CDA for PH Project

34. User Story: State-Specific Story, Condition-Specific, Setting Specific Communicable Diseases, Outpatient Flow Patient, Provider/Physician, Laboratory, PH agency 1.Patient comes to Physician with symptoms of a disease. 2.Physician provides clinical examination and assesses medical history. If patient’s symptoms require PH reporting w/o waiting for lab results, sends a report to PH agency. 3.Physician orders lab and any diagnostic tests. Office staff takes samples and sends them to Laboratory. Any diagnostic tests are performed. 4.Laboratory performs ordered tests on received specimens. 5.Laboratory send results to Physician and PH agency (if needed) 6.Physician re-examines clinical findings/diagnostic results and lab results; sends report to a PH agency. 7.Electronic message validated by PH agency/information system 8.Electronic confirmation was sent from PH agency to Provider 9.PH agency links lab report and case report to single individual. User Story Names: Actors: Flow of Events: Pre-condition Post-condition Preferred Timing for Each Event Type EHR System Public Health Agency’s Information System CDA for PH Project

35. For more information, please go to PHDSC Project Wiki pages at https://wiki.phdsc.org/index.php/PH-Lab CDA for PH Project

36. Anna Orlova, PhD, Executive Director 111 Market Place Suite 850 Baltimore MD 21202 Phone: 410-223-1608 Fax: 410-659-6387 E-mail: aorlova@jhsph.edu 2008 PHDSC Annual Busines s Meeting Users Guide for Source of Payment Typolog y PHDSC- IHE Public Health Task Force June 18, 2008 March 17, 2008 PHDSC Committees Communications and OutreachCommunications and Outreach Data Standard sData Standard s Exte rnal Caus e of Injur y Cod esExte rnal Caus e of Injur y Cod es Hea lth Care Servi ces Data Rep ortin g Guid eHea lth Care Servi ces Data Rep ortin g Guid e Pay er Typo logyPay er Typo logy Nationwi de Health Informati on NetworkNationwi de Health Informati on Network Privacy, Security and Data SharingPrivacy, Security and Data Sharing Professi onal Educatio nProfessi onal Educatio n Welcome to the Public Health Data Standards Consortium The Public Health Data Standards Consortium is committed to bringing a common voice from the public health community to the national efforts of standardization of health information technology and population health. To fulfill this commitment the Consortium: Identifies priorities for the new national standards for population health; Promotes the integration of health-related data systems to meet the health data needs of public and private organizations, agencies and individuals; Participates in national and international efforts on the standardization of health-related information; Represents public health interests in standards development organizations, data content committees & standards harmonization entities; and Educates the public health community about health information technology standards and the health information technology community about public health. Home Listserv Site Map Contact Us Copyright 2008 © Public Health Data Standards Consortium - All Rights Reserved Click here to review the PHDSC's Legal and Privacy StatementLegal and Privacy Statement HOM E About the Consortium Standards Development & Harmonization Health Information Exchanges Privacy & Security Workforce Developmen t Resource s PHDSC Product s Get Involved!