Transcript Public Health: Case-Reporting, Biosurveillence, and

MONDAY, 3:30 – 3:50 PM
Public Health:
Case-Reporting, Biosurveillence,
and Immunization Tracking
Bryant T. Karras, MD, Public Health Informatics Officer, Sr Epidemiologist,
State of Washington, Department of Health
Rebecca A. Hills, MSPH, University of Washington
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Meaningful Use to Improve Population and Public
Health (3 of the 27 CMS objectives and measures)
• Hospital Capability to provide electronic submission of reportable lab
results, as required by state or local law, to public health agencies and
actual submission where it can be received
• Capability to provide electronic syndromic surveillance data to public
health agencies and actual transmission according to applicable law
and practice
• Capability to submit electronic data to immunization registries and
actual submission where required and accepted
Source Office of E-Health Standards and Services,
Centers for Medicare & Medicaid Services (CMS)
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Population and Public Health
Scenarios Demonstrated
Case Reporting and Decision Support
Biosurveillance
Immunization
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Introduction
» The HIE project
» Washington State DOH, CDC, INHS
» This presentation
• Public Health’s role in Health Information Exchange (HIE)
• Meaningful Use and Public Health
• The scenarios demonstrated in the Interoperability Showcase
• Case Reporting and Decision Support
• Biosurveillance
• Immunization
» Meaningful use as demonstrated in these scenarios
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Public Health – 10 Essential Services
1. Monitor
2. Diagnose and investigate
3. Inform, educate
4. Mobilize
5. Develop policies and plans
6. Enforce
7. Link
8. Assure
9. Evaluate
10. Research
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Meaningful Use
• Through provisions of ARRA
there will be incentives for
“meaningful use”
• Meaningful use of EHR
technology will improve health
care quality, efficiency and
patient safety.
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Public Health and Meaningful Use
• How can public health leverage
electronic information?
• Many of the meaningful use
criteria are related to public
health functions
• These demos show examples of
how public health can leverage
electronic information
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The HIE Project and the Interoperability Showcase
• HITSP identifies existing standards
• Integrating the Healthcare
Enterprise (IHE)
– Incorporates HITSP standards into
interoperability profiles
• Interoperability Showcase
• WA participating since 2006
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Population and Public Health
Scenarios Demonstrated
Case Reporting and Decision Support
Biosurveillance
Immunization
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Case Reporting and Decision Support
» The story - Patient with influenza-like-illness
visits provider, case is reported to
public health, decision support is offered
» Standards used (RFD, CCD, Xforms)
» Facilitates communication between PH and provider
» Meaningful use
• Record demographics, medications, vital signs
• Capability to provide electronic submission of reportable lab to
public health agencies
• Implement clinical decision support rules
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Case Reporting and Decision Support
• For 2011 MU requirements limited to
electronic submission of reportable lab
results to public health agencies
• By 2013 and 2015 will include more interactive public health
alerts and ultimately more sophisticated epidemiological uses of
the data including automated real-time adverse event reporting,
disease outbreaks, and bioterrorism response.
• Bi-directional communication (Brian Dixon from Regenstrief will
present on this in detail - 12:30 Tuesday)
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Population and Public Health
Scenarios Demonstrated
Case Reporting and Decision Support
Biosurveillance
Immunization
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Biosurveillance
• The story – patient with ILI symptoms visits PCP,
lab is ordered and results recorded in the HIE’s
registry and repository
• The standards used (XDS document sharing)
• PH query developed to identification of results
of interest to public health
• Meaningful use
– Capability to provide electronic syndromic surveillance data
to public health agencies and actual transmission according
to applicable law and practice.
– Electronically record, store, receive and manage
laboratory orders
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International Society for Disease Surveillance (ISDS)
National Level – Distribute
age-specific (TERS)
Temporal Epidemic Response Surface plots
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Biosurveillance
Adding a regional level HIE doubled our surveillance area
Original Surveillance
Combined WA
Biosurveillance
Coverage
Rate
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New INHS
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Population and Public Health
Scenarios Demonstrated
Case Reporting and Decision Support
Biosurveillance
Immunization
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Immunization
» The Story
• A parent accesses her child’s immunization record
using a PHR, and sees the same data as the PCP
• The Immunization Information System (IIS/Registry)
is updated when messages from EHR systems are
sent to the HIE registry repository, and are
transformed to HL7 2.X messages
• Public health accesses the IIS for individual and
population views of the data
» The standards and profiles used
• Cross Enterprise Document Sharing (Immunization Content)
• Patient Demographic Query
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Immunization – Meaningful Use
Meaningful Use
» Improve Population & Public Health
• Capability to submit electronic data to immunization
registries and actual submission where required and
accepted
• Demonstrates two types of immunization content
submission to IIS ( HL7 2.5 and XDS-MS, IC )
» Engage patients and families in their health care
• Provide patients with electronic copies of their health
information
» Improve Care Coordination
• Capability to exchange key clinical information
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Population and Public Health
Scenarios Demonstrated
Case Reporting and Decision Support
Biosurveillance
Immunization
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Demonstrating Meaningful use of EHR
• Often more than one way to satisfy these criteria depending on states
• Important to examine the way work is done now and how workflow
will change if these data are made available
• Public Health systems designed to leverage EHR data will also need to
comply with standards
• We have learned much and continue to learn from our demonstration
and pilot projects in Washington State
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Thank You
• CDC Funding
• Thanks
– Bill Lober, Debra Revere (University of Washington)
– David Dobbs (Contractor)
– Charley Magruder (CDC)
• Contact Information
– Bryant T. Karras MD - [email protected]
– Rebecca Hills - [email protected]
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References
• Hills RA, Lober WB, Painter IS. Biosurveillance,
Case Reporting, and Decision Support: Public
Health Interactions with a Health Information
Exchange. Lect Notes Comput Sci. Biosecure.
5354, pp 10-21, 2008.
• Close N, Lofy K, Sandifer T, Lowe P, Karras BT. Utilization of Washington
State’s Public Health Emerging Event Detection System (PHEEDS) for 2009
H1N1 Surveillance. ISDS conference, 2009
*Participate the population health focused tours offered at the Showcase!
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Thank You
The participation of any company or organization in the NHIN and CONNECT area within the HIMSS Interoperability showcase
does not represent an endorsement by the Office of the National Coordinator for Health Information Technology, the Federal
Health Architecture or the Department of Health and Human Services.
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