Transcript How do we transform Public Health?

135th American Public Health Association: November 6, 2007
Building an Interoperable Public Health
Framework: Enabling Data Exchange
Advancing Health Care Through the Adoption of EHR/PHR
Donald George, CEO
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PRISM Communication Systems, Inc.
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Public Health Challenges Today
Why does Public Health need transformation?
Disasters
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Public Health Challenges Today
Why does Public Health need transformation?
Diseases
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Public Health Challenges Today
Why does Public Health need transformation?
Terrorism
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Public Health Challenges Today
Why does Public Health need transformation?
Healthcare
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HL7 Standards Enable Data Exchange
State
Public
Health
Lab
Communicable
Disease
Reporting
CDC Base
System
Pharmacies
Veterinarian
MIS &
Veterinarian
Labs
Poison
Control
Centers
Response
Assessment &
Evaluation
[HL 7]
Resource
Planning
Functions
Clinics &
Physicians
PMS
Environmental
Health
Hospitals
LIS (Labs)
HIS
Reporting &
Statistical Tools
RSVP
911
Medical
Dispatch
CAD
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Inline Geocoding
& Address Cleaning
Health
Information
Model
Third
Party
Labs
Common Tools
Emergency
Rooms
RSVP
EMS Run
Data Forms
MVT
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Types of Data: Personal vs. Population
Population Health Data
Personal Health Data
Adult Immunizations
Childhood Immunizations
Tuberculosis Testing
STD Testing and Counseling
HIV Testing and Counseling
EPSDT
Family Planning
WIC
Prenatal Care
Dental Care
HIV Treatment
Primary Care
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Communicable Disease Control
Health Education
Epidemiology and Surveillance
High Blood Pressure Screening
Tobacco Use Reduction
Cancer Screening
Diabetes Screening
Cardiovascular Disease Screening
Injury Control
Violence Prevention
Occupational Safety and Health
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Labs
Clinics
Hospitals
Clinical-Public Health Data Exchanges:
Local / State / Federal Health Agencies
Local
• Health Education/Risk
Reduction
• Communicable
Diseases
• Immunization
• EPSDT
• Injury Control
• School Health
Other
Providers Pharmacy
• Chronic Care
• Biosurveilance, BT,
Preparedness
• WIC
• Occupational Safety
and Health
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Source:
State
Federal
• Genetic Disorder
• CDC
• Vital Statistics
• HRSA
• Communicable
Diseases
• AHRQ
• Immunization
• Lead Registry
• Injury Control
• School Health
• Chronic Care
• Biosurveilance, BT,
Preparedness
• WIC
• Public Health
Laboratory
• HEDIS
• Cancer
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Creating an Interoperable EHR for Public Health
Clinical Care
Hospital of Birth
Public Health Department
HL7 2.4
Newborn
Screening
Test
Hearing
Screening
Test
Immunization
Administration
HL7 3.0
HL7 3.0
HL7 3.0
Data
Hub
HL7 3.0
Newborn
Screening
Registry
Hearing
Screening
Registry
HL7 2.4
Immunization
Registry
HL7 2.4
HL7 2.5
HL7 2.4
Communicable
Disease
Registry
EHR-PHR HL7 CDA Release 2
ADTBirth Record
External
Laboratory
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How do we transform Public Health?
Integrated Health Framework
Connect the Information Systems
Standards for Enabling an Integrated Public Health Systems
HL7
IEEE
ASTM
NCPDP
DICOM
ANSI ASC X12N
SOA
HL7
ICD-9-CM
CPT-4
SNOMED CT
LOINC
CCR/CCD
CDISC
1. Health Level Seven (HL7)
2. Integrated Health Enterprise
(IHE) Profiles
Standardized collaboration
processes help bring about
interoperability.
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CAP
EDXL
HAVE
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Federal Health Standard Groups
1. HITSP
2. AHIC
3. HISPC
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Building EHR and PHR
Building EHR and PHR
Genetic Disorders Communicable Diseases
Pharmacies
Other Providers
Summary EHR
data-centric
Personal EHR
patient-centric
Reports, Audits,
Research, Billing,
Clinical Trials
Secure, trusted aggregated data to build
Patient Summary Record (CCD) and EHR/PHR.
School Health
Transport Standards
Laboratory
Transport Standards
Emergency care
Data Standards
Specialty care
Unique Identifier
Clinics
Healthcare Enterprise
EHR provider-centric
Immunization
Vital Records Injury Control
Data set Standards:
CCR, CDA, CCD, NCPDP
Hospitals
DATA
Evidence-based
Medicine
EHR Architecture
EHR Functionality
PHR Architecture
PHR Functionality
Process Workflow
Chronic Care Biosurveilance, DATA HEDIS Preparedness, Syndromic Surveillance
Clinical events stored as HL7 CDA(R2)
compliant documents
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Achieving a Continuum of Care - Public Health EHR-PH
Patient Centric Care
Single View of Care
 Portable patient health
record
CDA, CCR, CCD, HL7
CDA,CCD, CCD
EHR
Patient
Patient
Demographics
Demographics
Family
Family
History
History
Immunizations
Immunizations
SNOMED-CT,
ICD-9, ICD-10
Clinical Loinc,
DSM4, ISO
Encounter
Encounter
Problem
List
Problem List
Allergies
Allergies
Treatments
Treatments
Interventions
Interventions
Diagnostic
Diagnostic
Images
Images
Loinc,
SNOMED-CD,
X.12N-Billing Codes
HL7
CurrentMeds
Meds
Current
Past
Meds
Past Meds
Diagnostic
Diagnostic
History
History
Data Standards for EHR
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 Service delivery to all
health systems and
devices
Consumer Empowerment
Physical
Physical
Findings
Findings
LabTest
Test
Lab
LabResult
Result
Lab
 Risk monitoring/ better
access
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 Patient choice/ risk
assessment
 Engaged with Health Care
Coordinator
 Competition drives
price/market
SNOMED CT,
HL7,
Population Health
X.12N-Billing
 Security & Surveillance
Codes
 Understanding of Health
threats
 Wellness, Preventive Care,
Health Risks
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How do we transform Public Health?
Connect the Information Systems
The business needs will be met by using the Service Oriented
Modeling and Architecture (SOMA) to:
• Integrate HL7 standards
• Transform the public health business model
across multiple functional health domains
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How do we transform Public Health?
Move from Strategy to Implementation
Health Services Model
Building an EHR-PH Component Services Model For Health Information Exchange
Application Services
U
S
E
R
Component
Business
Services
User Access
Services
Business
Service
Adaptation
User Interaction
Services
Business
Process Choreo
graphy Services
Common
Services
Business
Function
Services
Information
Management
Services
Reporting
Information
Integration
Information
Access
Interaction
Collaboration
Choreography
Packaged
Applications
Acquired Services
Connectivity
Presentation
Business Rules
Custom
Applications
Personalization
Analytics
Business
Service
…
…
…
…
…
Metadata
…
Mediation, Messaging, Events
 Start with a “hot” component area –
product identification
 Define a model of the component
to be transformed
 Understand the underlying
applications infrastructure and how
it needs to change
B
U
S
I
N
E
S
S
Business
Performance
Management
Enterprise Service Bus
Business Connections
Business
Service
Metering
Services
Utility Business Services
Rating
Billing
Peering
Settlement
…
Service Level Automation and Orchestration Services
Problem
Management
Security
Services
Server
Storage
Business
Service
Workload
Services
Configuration
Services
Availability
Services
Data
Placement
…
Resource Virtualization Services
Network
Resource Mapping
Information
…
Infrastructure Services
 Identify and design the required
supporting infrastructure
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How do we transform Public Health?
Service-oriented Modeling and Architecture (SOMA)
CBM
3
Top-down: business-driven
Process, event and
variation analysis
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SOMA combines Business
Vision with Modern and
Legacy assets
to achieve an enterprise
services architecture.
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Business Services linked Specify IT Components,
Map components &
their services and flow Services to best technology,
To Business Goals
2
Service-oriented Architecture
Model driven development is key.
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Business Vision
Bottom-up:
Leverage Legacy thru
understanding and transformation
Legacy
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How do we transform Public Health?
Intro to Service Oriented Architecture Modeling
Service Oriented Analysis
How do you understand the business as
services?
How do you enable business agility?
Service
Design
Service
Requirements
Service Oriented Design
What is the precise behavior of services?
How do you ensure scalability, reliability, etc?
How do you enable technical agility?
The best practices of
service orientation
which is the process
and practices that
guide the delivery of a
SOA is in the early
stages of adoption for
many organizations
Service
Build
Service
Development
Service Oriented Provisioning
How do you determine which Services to
use?
How do you choose Service Providers?
Service Oriented Programming
How do you reduce effort to code Web
Services?
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How do we transform Public Health?
Integrated Health Framework
Connect the Information Systems
Case Study: Public Health
Information
Network
Integrated
Health
Services
Ancillary Data
& Services
Registries Data
& Services
Client
Get Client ID
Registry
Resolution
Get Outbreak
Case PHS
Data
Outbreak
Management
List CD Report
Shared Events
Health Record
Reporting
Provider
Registry
Location
Registry
EHR Data
& Services
List Laboratory
Results
List Encounter
Events
Get Provider
Information
Business
Rules
EHR
Index
Terminology
List Service
Registry Delivery
List DI Results
Diagnostic
Imaging
Drug
Information
Message
Structures
Laboratory
Get DI Report
Health
Information
Stream DI Image
Normalization
Rules
List Laboratory
Orders Record Services
Longitudinal
Get Laboratory Result
List Medications
Locations
Get Encounter
Summary
HIAL
Data
Warehouse
Get Clinical
Dashboard
Security Mgmt
Data
Get Client
Demographic
Common Services
Privacy Data
Configuration
Get Prescription
Communication Bus
Public Health
Services
Public Health
Provider
Pharmacy
System
Pharmacist
EMS
Systems
Lab System
(LIS)
Radiologist
Lab Clinician
POINT OF SERVICE
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Hospital, LTC,
CCC, EPR
Physician/
Provider
Physician
Office
EMR
Physician/
Provider
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PHIN Functional Architecture
Tier 2
Lab
Order
Pharmacy
Order
RMI
SOAP
GEO Mapping SNOMED
NEDSS
HL7
IIOP
MQ
SMTP
Clinical
Systems
Manage OID LOINC
Validate
Vocabulary
Reporter
Info
Adverse Substance CMR
Event
Admin
Referral
V.XML
NCPDP
X12 N
Other
CAP1.0
Existing Systems
Patient Diagnosis Investigation Complaint
Encounter
Exposure Treatment
Countermeasure
Response
HL7 v2.x
HL7 v3.0
HL7 CDA
PHINMS
HTTP
External Services
Web Services
Track
Lab
Sample Result
CAP
Alert
Application
Persistence & Connectivity
HL7
WEB EOC
Service Control Functions
SOAP
Presentation Functions
HTTP
Devices
Tier 3
Resource Functions
SOAP
Tier 1
Internal Services
Environmental
Health Information
System
GHIN XML
CMR
Follow Up
Outbreak Management System
Org
Notifiable
Condition
Case Management
System
Specimen Outbreak
Notification
GIS
Incident Command System
Web / Gateways
Server
Integration Server
Choreography
Multi-device
Transformation
Infrastructure
IVR
Multi-device
Message Service
Directory Server
Connection
Management
UDDI
Adaptor ToolKit
RDBMS
Custom Adaptors
Fax
CICS
UNIX
GIS Server
Vocabulary Server
Windows
IMS
DBMS
Portal Server
State Persistence
Application Server
Transaction
Manager
Application Mgt
Search
System Monitor
Business Rules
SAS
Analysis &
Visualization
PHIN Portal
Application
SSO
Enterprise Application Server
Enterprise Resource Planning
Business Intelligence
Demand Planning
Enterprise Asset Management
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Supply Chain
Management
Service
Utilities
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Benefits of Interoperability
• Integrated services improve data exchange
and, ultimately, service delivery
• Provides an integrated view across the
continuum of health situations
• Creates an integrated process framework
that connects health and all medical
services to improve quality of care and
health outcomes
• Builds common, reusable services
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Summary
• Without an Enterprise Services and Information
Roadmap for Public Health, today’s public health
services will remain siloed
• An Enterprise Services and Information Roadmap
is essential to moving toward achieving
Interoperability
• Make data exchange real by tackling crossenterprise processes
• Service oriented modeling is essential to effective
architecture design to achieve interoperability
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More Information
http://www.prismsolution.com
Donald George
Chief Executive Officer
PRISM Communication Systems, Inc.
1701 Barrett Parkway - Kennesaw, Georgia 30144
[email protected]
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135th American Public Health Association: November 6, 2007
Building an Interoperable Public Health
Framework: Enabling Data Exchange
Advancing Health Care Through the Adoption of EHR/PHR
Donald George, CEO
10-9-07
PRISM Communication Systems, Inc.
Version 2.1
22