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

2. Towards a Functional Standard on Electronic Data Exchange between Clinical Care and Public Health Contract # HHSH250200616198P from Health Resources and Services Administration (HRSA) Anna Orlova, PhD Executive Director 2006 PHDSC-HRSA Project: PUBLIC HEALTH DATA STANDARDS CONSORTIUM ~ 2007 BUSINESS MEETING OF MEMBERS ~ October 2-3, 2007, Hyattsville, MD

3. This presentation contains preliminary findings that have not been reviewed by the PHDSC NHIN Committee

4. 2006 PHDSC-HRSA Project Towards Interoperability of Clinical & Public Health Information Systems

5. 2006 PHDSC-HRSA Project To integrate the public health information systems into the emerging electronic health information exchanges there is a need to:  Re-examine the ways the information systems in public health have been built to date  Introduce a ‘disciplined’ informatics approach into the public health information systems design and  Develop a common methodology of structured analysis of information needs at the user level that will guide the HIT projects

6. Built upon the PHDSC/HRSA Panel discussions we would like to propose a structured approach in developing interoperable electronic health information exchanges between clinical and public health information systems. 2006 PHDSC-HRSA Project

7. Interoperability is defined as the ability of two or more systems or components to exchange information and to use the information that has been exchanged. Defining a Problem Sources: 1. Institute of Electrical and Electronics Engineers. IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries. New York, NY: 1990. Coming to Terms: 2. Health Level Seven (HL7). EHR Interoperability Work Group. Coming to Terms: Scoping Interoperability for Health Care. Draft. January 16, 2007. 35p.

8. Solving a Problem of Non-Interoperability DHHS HIT standardization efforts are carried out by:  American Health Information Community (AHIC)  Office of National Coordinator for HIT (ONC)  Health Information Technology Standards Panel (HITSP)  Certification Commission for HIT (CCHIT)  NHIN Developers ProblemSolution Non-Interoperable Health Information Systems Interoperable Health Information Systems

9. DHHS Framework for Achieving Health Information Systems Interoperability  Step 1 - Identify National Use Cases  Step 2 - Develop Use Case Document in a standardized template  Step 3 - Develop and Test Use Case Interoperability Specification in a standardized specification template  Step 4 - Develop Certification Criteria for Use Case Interoperability Specification for EHRS products  Step 5 - Implement Use Cases

10. Problem IdentifiedProblem CharacterizedProblem ManagedProblem Evaluated AHIC Identify Use Cases ONC Develop Use Cases HITSP Develop Interoperability Specification CCHIT Develop Certification Criteria ProblemSolution NHIN Developers Implement Use Cases Non-Interoperable Health Information Systems Interoperable Health Information Systems DHHS Framework for Achieving Health Information Systems Interoperability

11. DHHS National Use Cases 2006 Biosurveillance Consumer Empowerment (CE) Electronic Health Record (EHR) 2007 Quality EHR-Emergency Response CE-Access to Information 2008 6 more Use Cases DHHS Framework for Achieving Health Information Systems Interoperability

12. Questions for Consideration: How are National Use Cases selected? Are we creating again stand-alone, Use Case-specific systems? Will the national Use Case interoperability specifications meet local/state/regional health information needs? Is there a process that may prevent us from designing stand-alone system while using the Use Case approach? DHHS Framework for Achieving Health Information Systems Interoperability

13. To address these Questions w e propose to incorporate Business Process Analysis and Information Systems Functional Requirement Analysis methodologies into the development of the interoperability specifications for HIT applications. DHHS Framework for Achieving Health Information Systems Interoperability

14. Business Process Analysis will be used to identify national Use Cases based on the strategic goals for HIT adoption. Functional Requirement Analysis will be used to refine the national interoperability specifications to address local/state/regional needs for health information exchanges. DHHS Framework for Achieving Health Information Systems Interoperability

15. Business Process Analysis (BPA) Components Enterprise analysis - strategic direction and goals; solutions that will allow to meet those strategic goals Requirements planning and management - planning the requirements development process and managing change Requirements elicitation - techniques for collecting requirements from stakeholders Requirements analysis - techniques for specifying requirements Requirements communication - techniques for ensuring shared understanding of the requirements Solution assessment and validation – verification of correctness of a proposed solution

16. Business Process Analysis (BPA) Outcomes An improvement of information management may be identified via BPA among other solutions to meet organization’s strategic goals. For this solution, there may be a need to develop (or improve) an information system. The description of this solution can be done in a format of a Use Case.

17. Functional Requirement Analysis for Information System Design In the information system design, Functional Requirement Elicitation and Analysis (FRA) are used to specify end user work processes and data exchange needs that the information system will support. The Functional Requirement Analysis Document (FRAD) is a product of FRA, i.e., functional standard.

18. Functional Requirements Analysis Document (FRAD) Components Problem/Domain (Use Case) Description for which Information System is needed Information System (IS) Goals Actors – end users in information exchange that IS will support Functional Requirements – list of end user functions that IS will support Storyboard – examples of life-situations in end user work that IS will support Diagrams of end user interactions with the IS High Level System Architecture – graphic representation of end user view of IS operation Non-functional Requirements - list of IS features, e.g., privacy & security IS Development Timeline and Deliverables

19. W e propose to incorporate Business Process Analysis and Information Systems Functional Requirement Analysis methodologies into the development of the interoperability specifications for HIT applications. DHHS Framework for Achieving Health Information Systems Interoperability

20. AHIC Biosurveillance Consumer Empowerm: Pt registration Meds History EHR-Lab EMS Quality ONC Develop Use Cases Develop & Test Interoperability Specification CCHIT Develop Certification Criteria Biosurveillance Consumer Empowerm: Pt registration Meds History EHR-Lab EMS Quality HITSP Biosurveillance Consumer Empowerm: Pt registration Meds History EHR-Lab EMS Quality Identify Use Cases NHIN Developers Implement Use Cases Step 1 Step 3Step 2Step 4 Step 5 DHHS Framework for Achieving Health Information Systems Interoperability

21. BPA / AHIC Business Process Analysis of Domains/Programs Biosurveillance Consumer Empowerm.: Pt registration Meds History EHR-Lab EMS Quality ONC Develop Use Cases Develop & Test Interoperability Specification CCHIT Develop Certification Criteria Biosurveillance Consumer Empowerm. Pt registration Meds History EHR-Lab EMS Quality HITSP Biosurveillance Consumer Empowerm: Pt registration Meds History EHR-Lab EMS Quality Identify Use Cases NHIN Developers Implement Use Cases FRAD Develop Functional Requirements Analysis Document (FRAD) Biosurveillance School Health Inform Certification Criteria Development Step 1 Step 3Step 2Step 4 Step 5 Step 7Step 8 Step 6 Pilot Test Enhancing DHHS Framework for Achieving Health Information Systems Interoperability

22. Recommendations 1. Work with the Public Health Informatics Institute to refine the proposed approach of integrating BPA and information systems FRA into the national interoperability specification development efforts; and 2. Present the proposed approach to the successor of the American Health Information Community as a methodology for selecting national Use Cases, and refining the national Use Case interoperability specifications to address local, state and regional needs of health information exchanges 2006 PHDSC-HRSA Project