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

2. Business Case for Public Case Participation in Health Information Technology (HIT) Standardization Anna O Orlova, PhD PHDSC aorlova@jhsph.edu PUBLIC HEALTH DATA STANDARDS CONSORTIUM ~ 2009 BUSINESS MEETING OF MEMBERS ~ November 12-13, 2009, Hyattsville, MD

3. Project Team: Walter Suarez, Vicki Hohner, Noam Arzt, Harold Lehmann, and Sacchi Girde Business Case Development Expert Team: Kathleen Cook, Art Davidson, Julia Gunn, Tracy Lockard, Corey Smith, Lesliann Helmus, David Lawton, Marcy Parykaza, BethAnn Posey, Eileen Underwood, Cecil Lynch, Jason Siegel, Lisa Spellman, and Sherry Weingart Business Case Document Reviewers: Marjorie Greenberg, Missy Jamisson, Michael Fitzmaurice, Starla Ledbetter, Bill Brand, Robert Aseltine, Shaun Grannis, Brook Dupree, Alex Hathaway, Neil Calman, James Golden, David Ross, and members of the PHDSC Data Standards Committee Acknowledgements

4. CDC 5-year Cooperative Agreement “Assure HIT Standards for Public Health”. Started in June 2008 Goal: Represent public health interests in the national HIT standardization process Year 1 Develop a Business Case for Public Health Participation in National HIT Standardization and Launch the Web-pages on HIT Standards Year 2 Develop a Web-based Interactive Model on the Business Case Implementation Acknowledgements

5. Objectives: Define the public health role in the HIT standardization process Help build an understanding across the public health community of this role and of the need for participation of local and state public health agencies in the national HIT standardization entities and Describe the strategy for public health participation in the HIT standardization entities with an organized voice Business Case on the Role of Public Health in the National HIT Standardization

6. Why Standards

7. Where We Now Why Standards

8. State Health Department: Organizational Chart

9. All public health activities are supported by customized information systems (databases, registries) developed to address the programmatic needs. Use of IT in Public Health: Where We Now

10. Our information systems do support our programmatic needs Our information systems cannot exchange data between programs within and across public health agencies and with clinical information systems AND…… HIT Standards in Public Health: Where We Now BUT……

11. Towards a Nationwide Health Information Network Where Should We Be in 2014 Why Standards - National Context

12. US Nationwide Health Information Network (NHIN) in 2014 Source: Dr. Peter Elkin, Mayo Clinic, MN

13. RHIEs as NHIN Components Source: Dr. Peter Elkin, Mayo Clinic, MN, 2006

14. Source: Eileen Koski. Quest Diagnostics. PHIN-2004, May, Atlanta GA Percent of Children Tested for Lead with BLL>10 µg/dL in the USA Vision: PH Surveillance under NHIN

15. Information Systems Interoperability for Public Health Where Should We Be in 2014 Building a NHIN

16. Information Systems Interoperability for Public Health What Would It Take…. Building a NHIN Building the Roadmap for Health Information Systems Interoperability for Public Health. PHDSC White Paper. 2007. URL: http://static.ihe.net/Technical_Framework/upload/IHE-PHDSC_Public_Health_White_Paper_2008-07-29.pdf

17. HIT Standards in Public Health: Where We Now Extensive experience in developing standards Focus on data standards, ie, data sets, and messaging standards, ie, HL7 Program-specific approach, eg, immunization, vital statistics, infectious diseases, occupational health, etc. Jurisdiction-specific approach Top-down approach, ie, federal agencies lead in the program-specific standardization efforts AND……

18. Our information systems do support our programmatic needs Our information systems cannot exchange data between programs within and across public health agencies and with clinical information systems AND…… HIT Standards in Public Health: Where We Now BUT……

19. HIT Standards in Public Health What Is Needed

20. HIT Standards in Public Health: What Is Needed Learn about the World of Standards and Standardization Process Participate in Standardization Process Enable bottom-up approach, ie, assure that needs of local and state public health agencies are met

21. HIT Standards in Public Health: What Is Needed Learning about the World of Standards

22. HIT Standards in Public Health: What Is Needed Learning about the World of Standards: HIT Standards Categories

23. Health IT Standards Categories 1. Data Standards, eg, vocabularies and terminologies 2. Information Content Standards, eg, Reference Information Models (RIMs) 3. Information Exchange Standards, eg, messaging standards 4. Identifiers Standards, eg, National Provider Identifier (NPI) 5. Privacy and Security Standards 6. Functional Standards, eg, processes/workflow 7. Other, eg, IT infrastructure standards This classification of Health IT standards types has been developed by the Health Information Technology Standards Panel (HITSP, www.hitsp.org) in 2006www.hitsp.org

24. Charge: “Transmit essential data from electronically enabled healthcare to authorized public health agencies in real-time”. National Biosurveillance Use Case

25. Biosurveillance Use Case 1. Data Standards - 28 2. Information Content Standards - 17 3. Information Exchange Standards - 46 4. Identifiers Standards - 11 5. Privacy and Security Standards - 5 6. Functional Standards - 0 7. Other – 0 TOTAL = 107 standards This classification of HIT standards types has been developed by the Health Information Technology Standards Panel (HITSP, www.hitsp.org) in 2006www.hitsp.org

26. HIT Standards in Public Health: What Is Needed Learning about the World of Standards: HIT Standardization Process

27. Priority Setting Standard Development Standards Maintenance Standards Harmonization Standards Certification Standards Adoption

28. HIT Standardization Process & Entities Priority Setting Standard Development Standards Maintenance Standards Harmonization Standards Certification Standards Adoption Standards Development Organizations, eg, HL7, LOINC, IHE, etc. Health Information Technology Standardization Panel (HITSP) Certification Commission for Health Information Technology (CCHIT) Past: AHIC Now: HIT Policy Committee & HIT Standards Committee US

29. Health Information Technology Standardization Phases, Products and Entities HIT Standardization Phases Priorities & Needs Development & Maintenance Selection & Harmonization Trial Implementation CertificationDeployment Goals What to accomplish What are the standards What standards to use Showcase what can be accomplished Certify standards- based products Deploy standards- based products HIT Standardization Entities HIT Standards Committee HIT Policy Committee (Formerly AHIC) SDOs (e.g., HL7, SNOMED (IHTSDO), LOINC, ASC X12) HITSP IHE NHIN IHE CCHIT Proposed IHE & PHDSC Deployment Workshops Standards Documents Use Cases (Description of the health information exchanges) Standards Interopera- bility Specifications Integration Profiles & Technical Frameworks Implementation Reports Certification Criteria Implementa- tion Reports

30. HIT Standards in Public Health: What Is Needed Participation in HIT Standardization Process

31. Public Health in HIT Standardization Entities EntitiesNumber of Organizations Number of Public Health Organizations HIT Standards Committee230 HIT Policy Committee202 HL750327 HITSP64130 IHE2517 CCHIT3413 Total177969

32. Public Health in HIT Standardization Entities

33. Challenges for Public Health Participation in HIT Standardization Process

34. Challenges for Public Health Participation in National HIT Standardization lack of awareness for the need to participate and where to participate limited ability for local and state public health practitioners to be involved in the national efforts as they serve particular jurisdictions lack of technical knowledge and informatics skills to participate, and lack of funding to support basic participation, eg, travel to meetings

35. Standards World – Where to Participate

36. Skills and Knowledge Needed  White Papers  Technical Frameworks  Interoperability Specifications  Requirements Specifications  Integration Profiles  Content Profiles  Certification Criteria Standards are Technical Documents

37. Public Health in HIT Standardization: Cost Qualifications: Deep Understanding of Public Health Ability to Review HIT Standards Documents Time: 25-30% FTE (calls, meetings, document review) Travel: 3-4 meetings/year (3-5 days each) TOTAL~ $40,000 per person/entity

38. Public Health in HIT Standardization Proposed Strategy (a) maximize the impact of those who can participate on behalf of Public Health in the national HIT standardization process, and (b) inform/educate and obtain input, as best as possible, from those who cannot.

39. What to Achieve? National HIT standardization process requires collective input from Public Health on what public health issues need to be addressed in national interoperable HIT standards. This input needs to be collaboratively developed, put through the national HIT standardization process and uniformly implemented. Public Health’s “Organized Voice on HIT Standards” will have to take on a character reflective of this reality.

40. What to Achieve? We define Public Health’s Organized Voice on HIT Standards as an open, transparent, participatory process of harmonizing program-specific and jurisdictional needs with national HIT interoperability standards by working with HIT standardization entities on various phases of HIT standardization

41. Business Case: Public Health in HIT Standardization Target Audience: National HIT leadership Governors State and Local Health Commissioners Federal Agencies Leadership Leadership of Professional Associations Leadership of Schools of Public Health

42. Building Public Health’s Organized Voice on HIT Standards Why Participate? Where to Participate? Who Should Participate and How to Participate?  Role of Local and State Agencies  Role of Professional Organizations  Need for Coordination Resources for Participation  educational and informational resources  funding

43. Why Participate? or Risks of Non-participation threaten public health data gathering activities diminish effectiveness of public health interventions diminish efficiency of public health operations reduce ability to communicate public health information back to clinicians electronically jeopardize adoption of modern interoperable HIT applications in Public Health jeopardize achieving population-level goals of Nationwide Health Information Network minimize the potential of state and local Public Health to receive funding from Federal and other sources that will likely mandate the use of interoperable HIT products

44. Where to Participate? EntitiesNumber of Organizations Number of Public Health Organizations HIT Standards Committee230 HIT Policy Committee202 HL750327 HITSP64130 IHE2517 CCHIT3413 Total177969

45. How to Participate: State and Local Agencies Recognize HIT standardization efforts as a distinct role for senior program staff, senior informaticians and/or IT professionals in the agency Devote one or more staff members in a leadership position to carry out an agency’s HIT standardization activities For smaller agencies, outsource HIT standardization efforts where possible to experts-consultants with extensive knowledge of public health Recognize the need for continuing education in public health informatics and HIT standards for agency’s workforce Band together within a region and share the costs associated with the deployment of professionals to represent agency on HIT standardization efforts Participate in and leverage memberships in public health professional associations involved in standardization activities as a way of providing input into the HIT standardization process, and Participate in coordination activities for building Public Health’s Organized Voice on HIT Standards.

46. How to Participate: Role of Professional Associations ImmunizationAmerican Immunization Registry Association (AIRA) LaboratoryAssociation of Public Health Laboratories (APHL) Epidemiology & Disease Reporting Council for State and Territorial Epidemiologists (CSTE) CancerNorth-American Association of Central Cancer Registries (NAACCR) Vital StatisticsNational Association of Public Health Statistics and Information Systems (NAPHSIS) Newborn Screening Public Health Informatics Institute, Maternal and Child Health Bureau, HRSA Healthcare Management National Association of Health Data Organization (NAHDO) & American Health Information Management Association (AHIMA)

47. Public Health in HIT Standardization: Need for Coordination Facilitate public health involvement in various HIT standardization entities Coordinate activities of professional organizations Assist local, state and federal agencies Help identify new public health areas for developing new standards and carry out activities needed to initiate standards development efforts in these areas; Conduct outreach activities on public health participation in HIT standardization Educate public health workforce on HIT standards and Help identify and secure resources needed to support the participation of public health professionals in HIT standardization entities

48. Participate in HIT standardization and learn PHDSC Web-based Resource Center New HIT Standards Web-pages launched in June 2009 (http://www.phdsc.org/standards/health-information- tech-standards.asp)http://www.phdsc.org/standards/health-information- tech-standards.asp PHDSC Quarterly Standard e-Newsletter (http://www.phdsc.com)http://www.phdsc.com Resources

50. Business Case: Public Health in HIT Standardization Join our efforts to launch Coordinated Public Health Action Plan on HIT Standards

51. Anna Orlova, PhD, Executive Director 624 N. Broadway Room 325 Baltimore MD 21205 Phone: 410-614-3463 Fax: 410-614-3097 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!

52. Business Case: Public Health in HIT Standardization “…Coordinated, collective action is required at almost every level of the healthcare system to realize the full benefits of HIT. This makes it unlikely that individual actors, pursuing their own self-interests, would be able to take the full advantage of HIT. The importance of collective action is most apparent in securing effective communication – so-called interoperability – across providers of care in the United States” – David Blumenthal, National Coordinator for HIT.

53. Questions?