Transcript Data Exchange for Public Health Presented by

Welcome to the Champ Software
Topical Webinar Series!
Data Exchange for Public Health
Presented by:
Nicole Sowers
To join the audio portion:
Dial toll free: 1-855-244-8681
Enter access code: 664 403 537
Agenda:
• Options for Exchanging Data
– Direct Secure Messaging
– Continuity of Care Documents
– HIE
• CCDs
• ADT feeds
– Immunization Registry Exchange
•
•
•
•
•
Benefits of Exchange
Challenges of Exchange
Kathy Burski – Kanabec County’s Experience
Greta Siegel – Douglas County’s Experience
Questions and Discussion
Direct Secure Messaging
• Direct is the term given to a national encryption
standard for securely exchanging clinical
healthcare data over the internet.
• Direct, in the context that we are using it refers to
sending emails using national standards for
security.
– There are many companies that offer Direct email.
Today, Nightingale Notes is able to display the Inbox
for Inpriva (company name) HDIRECT-MAIL (product
name) email.
Let’s take a look at how this works, starting with a
diagram of the process.
Inpriva has a web site where you can log into you secure email.
From here you can send/receive/delete/move to folders
Available to MN clients
only at this time.
In Nightingale Notes, when you have an Inpriva account, we can help you set it up
to see your Inpriva inbox within NN and from here you can take files you receive
and attach them to a client in NN.
More about Direct
• To send a Direct Secure message, the sender and the
recipient need to be in the Direct email directory. How
many times can you say “direct” in a sentence?  OR
• If the recipient is not in the directory, meaning they
don’t have a Direct secure email OR they are using a
Direct secure email from another vendor (not many
secure email providers share directories yet) then:
– The recipient will get an email message saying you have a
secure email waiting for you. They will get a link with a
temporary login to get to the secure email server and get
the text and any attachments.
Continuity of Care Documents
•
•
•
CDA – Clinical Document Architecture. This is a set of standards that tells us how any clinical document should be
structured for exchange. There are many types of clinical documents that use this CDA standard. One of those is
the Continuity of Care Document (CCD).
Stage I Meaningful Use included a CCD as an acceptable format for clinical care summaries.
A CCD can contain:
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
•
•
•
Header (name, address, demographic information)
Problems
Procedures/Diagnosis
Family History
Social History
Payers
Advance Directives
Alerts
Medications
Immunizations
Medical Equipment
Vital Signs
Functional Stats
Results
Encounters
Plan of Care
It’s easy to read and focuses on sharing the most important patient health information between providers and
because it’s shared, it acts as a history book for the patient, adding history from many providers.
In Nightingale Notes, the CCD contains 6 segments, shown above in green at this time.
A CCD can be sent to another provider or to a Health Information Exchange that accepts them. They can be sent in
XML format or in PDF depending on the ability of the recipient to accept those file formats.
Sample Nightingale Notes CCD
Health Information Exchanges
• Entities that have been certified by the ONC to exchange
health information.
– HIEs can exchange information in a few different ways
depending on their capabilities and the ability of participants to
send and receive information:
• Query – providers can log in and query the HIE, looking for a patient’s
information. This is considered a “pull” of information.
• An EMR can send patient information to the HIE either on demand ( a
user sends a CCD for example) or automatically, behind the scenes
(Admission, Discharge and Transfer information is sent whenever the
EMR detects a change to a patient record, for example). This is a
“push” of information from the EMR to the HIE
• Some HIEs can send patient information from their database to an
EMR where a patient record is stored. This is also a “push” of data.
• Nightingale Notes clients in MN have the methods in green available
to them.
Minnesota Approach to HIE & the Role of
Shared Services
Other NWHIN
Nodes
Other settings
Nationwide Health Information Network
(NWHIN)
Health Data
Intermediary
HIO #1
Hospitals
HIO #2
Statewide Health Information Exchange
Hospitals
Private
Practices
Other settings
Shared HIE Services
w Directory
w Consumer Preference
Management
Direct Exchange
Health Data
Intermediary
Private
Practices
Why Use an HIE
From HealthIT.gov:
Why Health Information Exchange Is Important
• The ability to exchange health information electronically is the foundation of efforts to improve
health care quality and safety. HIE can provide:
• The connecting point for an organized, standardized process of data exchange across statewide,
regional, and local initiatives
• The means to reduce duplication of services (resulting in lower health care costs)
• The means to reduce operational costs by automating many administrative tasks
• Governance and management of the data exchange process
Health Information Exchange Benefits: A Few Examples
• Provides a vehicle for improving quality and safety of patient care
• Provides a basic level of interoperability among EHRs maintained by individual physicians and
organizations
• Stimulates consumer education and patients' involvement in their own health care
• Helps public health officials meet their commitment to the community
• Creates a potential loop for feedback between health-related research and actual practice
• Facilitates efficient deployment of emerging technology and health care services
• Provides the backbone of technical infrastructure for leverage by national and State-level initiatives
Immunization Registry Exchange
• This one is probably the easiest to understand and easiest to
identify as valuable!
– There are challenges though for an EMR. Here’s what we’ve found:
• Each state, uses different parts of the standard HL7 immunization record and
utilizes standard values in different ways.
– For example, Champ utilized the CDC Public Health Information Network (PHIN) code
sets for many fields, including gender. In North Dakota, the registry only utilizes a small
subset of these codes. Champ has 950 race codes, NDIIS accepts 3 of those.
– Even though refusals and contraindications are on the HL7 Immunization standard
record, in Indiana and North Dakota, when Champ passes that information, the registries
are not accepting it or updating their records with that information.
– In Indiana Champ connects directly with the registry. In North Dakota Champ needs to
pass Immunization records through the HIN, which then redirects them to the registry.
– Champ is working to get connected with registries in each state where
we have clients. Each state poses unique requirements and differences
that we have to address. We will be connected to ND in March and
Indiana shortly after that. We do have MN, WI, IA,KS, and WA on our
list to work with in 2014 and 2015. We have several other states in line
after that.
Stolen from a birthday card from my co-workers. We always want
to think outside the box. It might be messy, but it’s worth it!
Why Should Public Health Agencies
Pay Attention to Data Exchange
• Besides the reasons listed on the last slide, please
consider this:
– PH can have easier access to their patient’s records and
more quickly find the most relevant information. Think
about the CCD. An easy-to-read, fast way to get
information about a client walking into your office for the
first time
– Chronic Disease prevention – imagine being able to
analyze and compare your interventions to those of
hundreds of other agencies. Data exchange is one
important step toward that goal.
– What else?? Please imagine the possibilities. Maybe not
yet, but in the future. Dare to think outside the box!
Kanabec County
• Kathy Burski, Quality/Emergency Manager, Kanabec County Public Health
• Kathy is the Project lead for the East Central Region of the Minnesota
Health Data Exchange Project and a member of the grant Executive
Committee
Douglas County
• Greta Siegel, Financial Manager, Douglas County Public Health
• Project lead for the West Central Region, Chair for the Super Committee
and Executive Board for the Minnesota Health Data Exchange Project
Thank You!
for participating in our series of Topical Webinars!
Stay tuned for our next webinar!
If you have any suggestions for other Topical
Webinar subjects please feel free to email:
[email protected]