Transcript Links to the Healthcare System for Surveillance

Links to the Healthcare System
for Surveillance
2006 NAPHSIS Annual Meeting
Lois M. Haggard, PhD
Utah Department of Health
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Lois M. Haggard, PhD, Utah Department of Health
National Context
“From nearly anywhere in the world, we can
withdraw money from our bank accounts, pay
bills, apply for a mortgage, book airline tickets
and even order groceries online. But more often
than not, we can’t share an X-ray digitally from
one hospital to another, even if they are on
opposing street corners.”
Michael Leavitt, Secretary for the U.S. Department of Health and
Human Services (Former Utah Governor)
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Lois M. Haggard, PhD, Utah Department of Health
2001 NCVHS Report
The 2001 report from the National
Committee on Vital and Health Statistics,
NHII—Information for Health1
– National information infrastructure (NHII) is a
“standards-based architectural framework to
enable more seamless sharing of person-specific
health information.”2
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Lois M. Haggard, PhD, Utah Department of Health
2004 Executive Order
Presidential Executive order in April 20043
The Office of the National Coordinator for
Health Information Technology (ONC) was
created
Mandate to assure universal interoperable
personal electronic health records by 2014.
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Lois M. Haggard, PhD, Utah Department of Health
2004 Strategic Framework
July 2004, ONC published the “Framework
for Strategic Action,” proposed the NHIN4
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accelerate the use of EHRs
interconnect clinicians
better information for consumers
improve public health surveillance
Lois M. Haggard, PhD, Utah Department of Health
Other National Initiatives
Public Health Information Network
(PHIN), CDC’s initiative
Markle Foundation’s Connecting for
Health5
Public Health Informatics Institute,
Opportunities for Public Health2
Agency for Healthcare Research and
Quality (AHRQ) contracts to facilitate
health information exchanges
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Lois M. Haggard, PhD, Utah Department of Health
Local and State Initiatives
Indiana Health Information Exchange
(IHIE)
Massachusetts e-Health Collaborative
(MAeHC)
Mendocino County, Calif.
Inland Northwest Health Services (INHS)
Spokane, WA.
Utah Health Information Network (UHIN)
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Lois M. Haggard, PhD, Utah Department of Health
Who?
Current exchange partners
– Could begin by exchanging
• the same information we do now,
• with the same partners,
• but ELECTRONICALLY, using standard messages,
interoperable systems.
New exchange partners
– E.g., pharmacies sharing medication history
with physicians
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Lois M. Haggard, PhD, Utah Department of Health
Who?
Personal Health Record
– Some propose that the patient should maintain
it, such as on a smart card or a USB memory
device.
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Lois M. Haggard, PhD, Utah Department of Health
Who?
Payer A Payer B Payer …
Funeral
Home A
Funeral
Home B
Communicable
Disease
Funeral
Home …
Hosp A
Immunization
Hosp B
State Health
Department
Hosp …
Births
Deaths
LHD A
LHD B
NVSS
LHD …
CDC
Pharmacy A
Pharmacy B
Pharmacy …
Lab A
Doc A
Lab B
Doc B
Doc …
Soc.
Security
Admin.
Lab …
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Lois M. Haggard, PhD, Utah Department of Health
What?
Clinical information.
– Information we store and use about individuals
to serve them, to enhance their wellness.
Electronic messages
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Lois M. Haggard, PhD, Utah Department of Health
Electronic Messages
Text message:
– e.g., Email
Hi, Andrea! Jimmy H.
received his OPV at our
clinic yesterday.
XML message:
<patient> Jimmy H. </patient>
<vaccine> OPV </vaccine>
– structured text
<date> 01/15/2006 </date>
– can be machine readable
<provider> clinicA </provider>
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Lois M. Haggard, PhD, Utah Department of Health
Electronic Messages
HL-7 message:
MSH|^~\&||MA0000||GA0000|199705221610||VXR^V03|19970522MA53|T|2.3.1|||AL
MSA|AA|19970522GA40|
QRD|199705221605|R|I|19970522GA05|||25^RD|^KENNEDY^JOHN^FITZGERALD^JR|VXI|^SIIS
QRF|MA0000||||256946789~19900607~MA~MA99999999~88888888~KENNEDY^JACQUELINE^LEE~BOUVIER
~898666725~KENNEDY^JOHN^FITZGERALD~822546618
PID|||1234^^^^SR^~1234-12^^^^LR^~3872^^^^MR~221345671^^^^SS^~430078856^^^^MA^
||KENNEDY^JOHN^FITZGERALD^JR^^^L|BOUVIER^^^^^^M|19900607|M|KENNEDY^BABY BOY^^^^^^
B|W^WHITE^NY8 RACE CODES^W^WHITE^HL70005|123 MAIN ST^APT 3B^LEXINGTON^MA^00210^
^M^MSA CODE^MA034~345 ELM ST^^BOSTON^MA^00314^^BLD~^^^^^^BR^^MA002| |(617) 555-1212
^PRN^PH^^^617^5551212^^||EN^ENGLISH^HL70296^^^|||||||WN^NOT HISPANIC^LOCAL CODE SET^NH^NOT
OF HISPANIC ORIGIN^HL70189|CHILDREN=S HOSPITAL
PD1|||CHILDREN=S HOSPITAL^L^1234^^^^XX~LEXINGTON CLINIC^^1234A^^^^FI |12345^CARE^
PRIMARY^^^DR^MD^^^L^^^DN|||||||03^REMINDER/RECALL - NO CALLS^HL70215|Y|A|19900607
NK1|1|KENNEDY^JACQUELINE^LEE|32^MOTHER^HL70063||||||||||||||||||||||||||||||898666725^^^^SS
NK1|2|KENNEDY^JOHN^FITZGERALD|33^FATHER^HL70063||||||||||||||||||||||||||||||822546618^^^^SS
PV1||R||||||||||||||||||V02^19900607~H02^19900607. . .
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Lois M. Haggard, PhD, Utah Department of Health
What?
Patient-Centered Exchanges
– (pssst… this is the linkage part…)
Master patient index is key.
– Ensure correct ID of patient (make sure you’ve
got the medication history for the CORRECT
John Smith)
– Unduplicated records will be important to
realize gains efficiency
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Lois M. Haggard, PhD, Utah Department of Health
What?
Utah Goals:
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Electronic medical records for all patients
Inter-connected information systems
Timely public health surveillance
Robust Regional Health Information
Organization (RHIO)
Lois M. Haggard, PhD, Utah Department of Health
Where?
Remove geographic barriers to care.
– (i.e., anywhere)
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Lois M. Haggard, PhD, Utah Department of Health
When?
First, we need:
– Electronic medical records
• Clinical data stored in STRUCTURED, UNIFORM,
CODED, electronic formats
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Appropriate, completed HL-7 standards
Data storage structures in public health
Compatible privacy and security practices
Governance structures (what body will set
policy, make decisions?)
Lois M. Haggard, PhD, Utah Department of Health
Percentage of office-based physicians using selected
information technologies: United States, 2003
100%
Percentage of Physicians x
90%
80%
73.2%
70%
60%
50%
40%
30%
17.2%
20%
7.9%
10%
0%
Electronic Billing
Electronic
medical records
Computerized prescription
order entry
Burt CW, Hing E. Use of computerized clinical support systems in medical settings: United States, 2001–03. Advance data from vital
18 statistics; no 353. Hyattsville, Maryland: National CenterLois
M. Haggard,
and health
for Health
Statistics. PhD,
2005 Utah Department of Health
How?
Payer A Payer B Payer …
Funeral
Home A
Funeral
Home B
Communicable
Disease
Funeral
Home …
Hosp A
Immunization
Hosp B
State Health
Department
Hosp …
Deaths
Information
Broker
(RHIO)
LHD A
LHD B
Births
NVSS
LHD …
CDC
Pharmacy A
Pharmacy B
Pharmacy …
Lab A
Doc A
Lab B
Doc B
Doc …
Soc.
Security
Admin.
Lab …
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Lois M. Haggard, PhD, Utah Department of Health
UHIN: Linking Communities
To Salt Lake City
From Southern
Utah
And all points between. . .
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Lois M. Haggard, PhD, Utah Department of Health
Where We Are:
UHIN eCoverage
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3rd Party payers’ claims (450+ payers)
Medicaid and Medicare
Hospitals (100%)
Physicians/clinics (85-90%)
Laboratories (100%)
Local health departments (100%)
Mental health centers (100%)
Chiropractics (90%)
Lois M. Haggard, PhD, Utah Department of Health
Why?
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Lois M. Haggard, PhD, Utah Department of Health
Why?
Access, Quality, Cost
– “To increase the efficiency of existing paper-based and
non-standardized electronic patient information
exchanges among health care organizations.
– “To make complete, timely, and accurate informatin
available to providers in order to improve the quality
and reduce the unnecessary utilization of health care
services.”6
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Lois M. Haggard, PhD, Utah Department of Health
Why?
Facilitate reporting to public health.
“The most obvious immediate benefit … to
public health lies in improving mandated public
health reporting.”2 (p. 8)
•
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•
•
•
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Notifiable disease
Birth and death certificate data
Immunizations
Newborn screening
Public health registries (e.g., birth defects, cancer,
injury, etc.)
Lois M. Haggard, PhD, Utah Department of Health
Value to Public Health2
“More timely and complete receipt of
disease reports
“Analysis and display of geographic
distribution of illness or injury to focus
public health interventions or services
“Improved ability to communicate with
selected provider and patient populations”
“Easier identification and analysis of gaps in
preventive health services …” (p. 7)
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Lois M. Haggard, PhD, Utah Department of Health
10 Essential Health Services
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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Monitor health status
Diagnose and investigate
Inform and educate
Mobilize partnerships
Develop policies and plans
Enforce laws and regulations
Link people to services
Assure competent workforce
Evaluate health programs
Research
Lois M. Haggard, PhD, Utah Department of Health
10 Essential Health Services
Monitor health
health status
status
1. Monitor
and investigate
investigate
2. Diagnose and
3. Inform and educate
4. Mobilize partnerships
5. Develop policies and plans
6. Enforce laws and regulations
7. Link people to services
8. Assure competent workforce
9. Evaluate health programs
10.
10. Research
Research
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Lois M. Haggard, PhD, Utah Department of Health
Filling in the Gaps
Major Life Events
Birth
Hospitalized
Death
Health Surveys
– Self-reported lifestyle, health insurance,
chronic conditions, etc.
Notifiable Diseases
– Selected disease events, variable reporting
completeness
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Lois M. Haggard, PhD, Utah Department of Health
Person-Centric Data Views
New opportunities:
– What happens to people after they go off
Medicaid?
– How many patients “shop” for doctors who will
prescribe desired medications?
– How many suicide victims saw a medical
provider in the months prior to their death?
What kind of a provider was it? What
medications were they on?
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Lois M. Haggard, PhD, Utah Department of Health
Person-Centric Data Views
New opportunities:
– Utilization patterns (medical home, ED use,
prenatal care) of uninsured
– Recommended preventive care at appropriate
intervals (immunizations, cancer, BP,
cholesterol screening, etc.)
– Genetics research on chronic conditions, (e.g.,
depression, asthma, atherosclerosis, etc.)
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Lois M. Haggard, PhD, Utah Department of Health
Person-Centric Data Views
New opportunities:
– How many children seen in the ED for asthma
had been prescribed an asthma medication?
– How many people visit their doctor with a chief
complaint of “fatigue?” What tests are
performed? What is the eventual diagnosis?
– Do women have more doctor visits than men
after accounting for reproductive-related visits?
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Lois M. Haggard, PhD, Utah Department of Health
Current Utah Projects
AHRQ Pilot Projects
– Discharge summaries
• Hospitals to physicians
– History and physical
• Physicians to hospitals; hospitals to physicians,
referrals
– Laboratory results
• Labs to physicians/hospitals,
– Medication histories
• Payers to physicians, hospitals, & pharmacies
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Lois M. Haggard, PhD, Utah Department of Health
Utah’s RWJF Project
Business plan for public health participation in
exchange of clinical health information.
Identify opportunities that provide value to both
the private and public sector partners.
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Immunization registry
Notifiable disease, lab reporting
Newborn screening
Vital events registration (e.g., prenatal care visits from
mom’s medical record to birth certificate)
Lois M. Haggard, PhD, Utah Department of Health
HISPC
Health Information Security and Privacy
Collaboration
34 states funded
Funding from AHRQ, RTI contractual
agreements
Stakeholder review of laws and business
policies that support or inhibit information
exchange.
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Lois M. Haggard, PhD, Utah Department of Health
Thank You
Lois M. Haggard, PhD
Office of Public Health Assessment
Utah Department of Health
801-538-9455
[email protected]
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Lois M. Haggard, PhD, Utah Department of Health
References
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Lois M. Haggard, PhD, Utah Department of Health