Public Health Data Standards Consortium http://www.phdsc.org by KL19o9

VIEWS: 10 PAGES: 93

									Public Health Data Standards Consortium
           http://www.phdsc.org
PHDSC / HRSA EXPERT PANEL IN ELECTRONIC DATA
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    PHDSC/HRSA EXPERT PANEL
 IN ELECTRONIC DATA EXCHANGES

          December 5-6, 2006,
            Washington DC
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Goal
The goal of the meeting is to build
 consensus among leaders in public health
 towards formalizing a vision for a standard
 representation of public health work
 processes for the electronic health
 information exchanges with clinical care,
 i.e. functional requirements specifications.
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Meeting Objectives
 Share experiences in building health information
  exchanges in panelists’ jurisdictions to date
 Discuss national initiatives on the development of
  functional standards in health information exchanges
 Discuss the functional specifications for health information
  exchanges on school health and on syndromic
  surveillance in New York City as prototypes of functional
  requirements specifications
 Develop recommendations for the roadmap on developing
  functional requirements on health information exchanges
  between clinical care and public health
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PANELISTS
Dr. Oxiris Barbot, NYC Department of Health and Mental Hygiene, NY
Dr. Neil Calman, Institute for Urban Family Health, NYC, NY
Ms. Kathleen Cook, Lincoln-Lancaster County Health Deptment (City of
   Lincoln, County of Lancaster), NE
Dr. Art Davisson, Denver Public Health, CO
Dr. Peter Elkin, Mayo Clinic, Rochester, MN
Dr. Shaun Grannis, Regenstrief Institute, IN
Dr. Laurence Hanrahan, Wisconsin Department of Health and Family
   Services, WI
Dr. Martin LaVenture, Minnesota Health Department, MN
Dr. David Lawton, Nebraska Health and Human Services System, NE
Dr. Farzad Mostashari, NYC Dept. of Health & Mental Hygiene, NYC
Dr. Anna Orlova, Public Health Data Standards Consortium
Dr. David Ross, Public Health Informatics Institute
Dr. Tom Savel, Centers for Disease Control & Preventions (CDC)
Dr. Walter Suarez, Public Health Data Standards Consortium
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HRSA Project officers

Ms. Jessica Townsend
Dr. Michael Millman
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                 DAY 1
             December 5, 2006
 PHDSC / HRSA EXPERT PANEL IN ELECTRONIC DATA
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                           AGENDA
        DAY 1 – Tuesday, December 5, 2006 (3.30-6.15pm)


WELCOME AND INTRODUCTIONS
Dr. Michael Millman, HRSA and Dr. Walter Suarez, PHDSC

BUILDING PUBLIC HEALTH /CLINICAL HEALTH INFORMATION
  EXCHANGES: THE EXPERIENCE TO DATE: Efforts in Colorado,
  Indiana, Minnesota, Nebraska, New York City, and Wisconsin
Moderator: Dr. Walter Suarez, PHDSC
Participants: Invited Panelists and Guests

ROUNDTABLE DISCUSSION
Moderator: Dr. Anna Orlova, PHDSC
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SESSION 1:
  eHealth Data Exchanges between Public Health and Clinical
    Settings: Stories/Experience from Panelists Jurisdictions
                   QUESTIONS FOR DISCUSSION

1. Community eHealth Data Exchanges: Purpose/Value
   Proposition for Public Health and Clinical Providers in the
   Community
      Role of the Health Department in Being a Resource for Providers
      Engaging Providers in the Public Health Mission of Protecting the
       Public from Health Threats and Improving the Effectiveness of Primary
       Care
      Examples of Emerging eHealth Exchanges and How They are Bringing
       Together Public Health and Providers
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SESSION 1:
  eHealth Data Exchanges between Public Health and Clinical
    Settings: Stories/Experience from Panelists Jurisdictions

               QUESTIONS FOR DISCUSSION

2. Key Implementation Activities, Choices, and Problems

3. Accomplishments and Lessons Learned

4. Building a Shared Vision - Suggestion for the Roadmap on
   Building eHealth Data Exchanges between Public Health and
   Clinical Setting
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Day 1 Key Messages

1.   Public Health Agencies efforts presented are targeted to specific
     programs, e.g., immunization.
2.   Engaging primary care was challenging and not done broadly because
     to do it well requires significant workflow redesign and business cases
     does not hold up. Adoption of health IT and interoperability between
     systems are the key issues.
3.   Functional requirements and other standards are needed to move things
     along.
4.   Involve consumers as the key stakeholder for our efforts. Consumers
     should be involved to better understand their needs and improve our way
     of communication with them.
5.   Public health activities discussed: immunization, registries.
6.   Business cases are not only about monetary value.
7.   Every solution should work with other solutions, this requires mind /
     process change. Solutions should be sustainable overtime.
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                DAY 2
            December 6, 2006
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                      AGENDA
           DAY 2 – Wednesday, December 6, 2006 (9.00am-12.00pm)

THE CASE FOR ELECTRONIC HEALTH INFORMATION EXCHANGES IN PUBLIC
  HEALTH AND THE NEED FOR FUNCTIONAL STANDARDS
Moderator: Lori Fourquet, Healthsign Systems
Panelists Presentations:
The Need for a Functional Requirements Standards in Public Health
 Dr. David Ross, Public Health Informatics Institute

Electronic Health Record System in Community Health Center in NYC
 Dr. Neil Calman, Institute for Urban Family Health, NYC

School Health Functional Requirements: NYC Case Study
 Dr. Oxiris Barbot, NYC Department of Health & Mental Hygiene

Syndromic Surveillance Functional Requirements: NYC Case Study
 Dr. Farzad Mostashari, NYC Department of Health & Mental Hygiene

A Functional Requirement Standard: National Efforts and User Role
 Dr. Anna Orlova, PHDSC
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                       AGENDA
    DAY 2 – Wednesday, December 6, 2006 (1.00-4.00pm)

RESPONSES TO THE NYC FUNCTIONAL REQUIREMENTS:
  ROUNDTABLE DISCUSSION
 Moderator: Dr. David Ross, Public Health Informatics Institute
  (PHII)

ROADMAP FOR PUBLIC HEALTH FUNCTIONAL
  REQUIREMENTS STANDARDS: ROUNDTABLE
  DISCUSSION
 Moderators: Dr. David Ross, PHII and Dr. Anna Orlova,
  PHDSC
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SESSION 3:
Responses to the NYC Functional Requirements:
  Roundtable Discussion

              DRAFT QUESTIONS FOR DISCUSSION

   Does the NYC specifications framework adequately describe user needs
    in terms of system goal, actor, function, workflow and dataflow?

   Does it include necessary elements needed to build the user
    requirements? What is missing?

   Is it reusable for other public health domains/programs/jurisdictions?

   What is the right name for this document – Functional Requirements
    Specification? Use Case Description? Functional Standard?
    Requirement Analysis Document (RAD)? Other?
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SESSION 4:
Roadmap for Public Health Functional Requirements Standards:
  Roundtable Discussion
              DRAFT QUESTIONS FOR DISCUSSION

   Next steps (continued):

       Facilitate a dialog between clinical and public health communities on
        the development of the interoperability specifications for clinical -
        public health data exchanges, e.g., participation in HITSP, CCHIT,
        IHE, etc.

       Develop a Panel summary document on the meeting outcomes
        for AHIC, NCVHS, ONC, RWJ and broader public health and clinical
        communities
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SESSION 4:
Roadmap for Public Health Functional Requirements Standards:
  Roundtable Discussion
              DRAFT QUESTIONS FOR DISCUSSION

   Next steps (continued):

       Work with PHDSC member organizations to organize education
        sessions on user functional requirements for information systems at
        their annual meetings, e.g., NACCHO, CDC PHIN, RWJ, Public Health
        Summit

       Work with CDC and RWJ / NLM public health informatics program to
        include user functional specification development in the public health
        informatics training curriculum.
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  A Functional Requirement Standard:
     National Efforts and User Role

               Dr. Anna Orlova
                   PHDSC
US Health Information Network - 2014




                                  Source: Dr. Peter Elkin, Mayo Clinic, MN
     DHHS’ Framework for Health Information
     Technology: Building a NHIN

      NHIN will be based on:

      Electronic          Health Record Systems (EHRS) that
      will enable
      Regional Health Information Exchanges (RHIEs)
      organized via
      Regional Health Information Organizations
      (RHIOs)


Thompson TG and Brailer DJ. The Decade of Heath Information Technology to Deliver Consumer-centric
and Information-rich Health Care. Framework for Strategic Action. US DHHS, July 21, 2004.
    Source: Dr. Peter Elkin, Mayo Clinic, MN, 2006

RHIOs as NHIN Components
PHDSC Involvement


     The Certification                        Healthcare
     Commission for                          Information
        Healthcare                           Technology
       Information                         Standards Panel
       Technology                              (HITSP)
         (CCHIT)
                         American Health
                           Information
                           Community
                          (Community)        Nationwide
        The Health
       Information                             Health
      Security and                          Information
         Privacy                           Network (NHIN)
      Collaboration                         Architecture
         (HISPC)                              Projects
       NHIN Development Process
In October 2005 DHHS Office of National
    Coordinator (ONC) awarded several
    NHIN contracts ($65M) as follows:
 Standards Harmonization
 EHR Certification
 NHIN Architecture Prototypes
 Health Information Security and Privacy



 URL: http://www.hhs.gov/healthit/ahic.html
   US Health Care System Standardization: 2005-now

               Discussion Document

                Standards Harmonization Technical
                Committees Update
                Report to the Healthcare Information Technology
                Standards Panel
                 Contract HHSP23320054103EC



                                                 HITSP includes 206
                                               member organizations:
                                                    17 SDOs (8%)
                                                161 Non-SDOs (79%)
                                                18 Govt. bodies (8%)
                                              10 Consumer groups (5%)
Arlington, VA
September 20, 2006
   HITSP Standards Categories – Feb 2006


   1.    Data Standards (vocabularies and
         terminologies)
   2.    Information Content Standards (RIMs)
   3.    Information Exchange Standards
   4.    Identifiers Standards
   5.    Privacy and Security Standards
   6.    Functional Standards
   7.    Other
HITSP definition
        Standard Harmonization Process

The Community identified 3 breakthrough
   areas for the NHIN development process
   in 2006:

   Biosurveillance
   Consumer Empowerment
   Electronic Health Record



 * AHIC URL: www.hhs.gov/healthit/ahiccharter.pdf
  Biosurveillance Use Case
  Transmit essential ambulatory care and
    emergency department visit, resource
    utilization, and lab result data from
    electronically enabled health care delivery
    and public health systems in standardized
    and anonymized format to authorized
    Public Health Agencies with less than one
    day lag time.
Source: HITSP Meeting, Arlington VA, September 20, 2006
AHIC Biosurveillance Use Case
     Event Detection
                               Neighboring           Hospital
                               Jurisdictions
                                                                         State Public Health
                                                                         Surveillance System
               4- Report/retrieve of symptoms,diagnosis
               & medication prescription data from EHRS
                                                                13 – Report on the positive case
                                                                   electronically & by phone
 Ambulatory        4 – Data mining
   Care             of EMR notes

                     7 – Notify on
                  increased number
   9 – Order          of cases &
      test          recommend to              Local                                   DHHS
                  order specific tests     Public Health
                                           Surveillance                                            P
                                             System                                                U
                    11 – Report
                      test result                                                                  B
                    electronically                                                                 L
                     & by phone                                                                    I
                                                                                     Media
  Laboratory                                                                                       C
                                                            Response
                                         Pharmacy            Team
                          AHIC-ONC BIO Consolidated Use Case
                                                                                                        Biosurveillance
                                                                                           Patient-level data to Public Health
HITSP                                                                                            Message-based Submission

        Biosurveillance – Patient-level and Resource Utilization Interoperability Specification


                                                                     Transaction Package
                                                                     Consumer/Patient Id X-ref




                                                                                            Base
                                             Transaction                                     Std
                                             Pseudonymize                                    HL7                        IHE
                                                                                           QBP^Q23                             IHE
          Message-based                                                                    RSP^K23
                                                                                                                        XDS    PIX
            Scenario                                                                                                           PDQ



                                                                                            Component
  Component                            Component
                                                                                            Anonymize
  Encounter Msg                        Lab Report Message
                           Component
                                                    Component
                           Radiology Msg            Lab Terminology

   Terminology                                                                             Base
    Standards                 Base                                                          Std
                               Std                                                          ISO                   Base          Base
                                        Base                  Base                                                 Std
                             HL7V2.5                                                       DTS/                                  Std
 HCPCS HL7 V3                            Std                   Std
                             ADT^xxx                                                       25237                ISO 15000     HL7 V2.5
     CPT HL7 V2.5                      HL7V2.5               LOINC                                             ebRS 2.1/3.0
                                       ORU^R01                                               HIPAA
   CCC SNOMED-CT
    ICD 9/10 LOINC                                                                              DICOM
                                                           SNOMED-
      NCCLS      UCUM                                        CT
        UB-92      URL
        FIPS 5-2   HAVE
                       AHIC-ONC BIO Consolidated Use Case
                                                                                                         Biosurveillance
                                                                                      Patient-Level Data to Public Health
HITSP                                                                                      Document-based Submission

         Biosurveillance – Patient-level and Resource Utilization Interoperability Specification


                                                                                Transaction Package
                                                                                Consumer/Patient Id X-ref
                                       Transaction Package
                                       Manage Sharing of
                                       Docs


             Document-based       Transaction                                                          Base
                                                                      Transaction
                Scenario          Notif of Doc Availability                                             Std
                                                                      Pseudonymize                      HL7              IHE
                                                                                                      QBP^Q23                   IHE
  IHE                                                                                                                    XDS    PIX
                                                IHE                                                   RSP^K23
 XDS-I                                                                                                                          PDQ
                                                NAV



         Component
         Lab Report Document                                                                Component
                                                                                            Anonymize
                                     IHE           IHE
         Component
                                   XDS-MS        XDS-LAB
         Lab Terminology

                                                        Terminology
                                     Base                Standards                         Base
                                      Std                                                   Std                    Base          Base
 Base                   Base                                                                                        Std
                                     HL7                                                    ISO                                   Std
  Std                    Std                          HCPCS HL7 V3
                                    CDA r2                                                 DTS/                  ISO 15000     HL7 V2.5
DICOM                  LOINC                              CPT HL7 V2.5                                          ebRS 2.1/3.0
                                                                                           25237
                                                        CCC SNOMED-CT
                                                         ICD 9/10 LOINC                      HIPAA
                     SNOMED-
                       CT                                  NCCLS      UCUM                      DICOM
                                                             UB-92      URL
                                                             FIPS 5-2   HAVE
Biosurveillance Technical Committee Recommendations
 cd Bio Interoperability Specification

                «component»                                             «interoperability specification»
             Resource Utilization                                                                                                             «transaction»                                «transactions»
                                                 contains                      Bio-surv eillance
                  Message                                                                                              contains               Pseudonimize             contains             Anonymize
                                                                        +       docId: = IS-02
             +    docId: = ISC-47                                                                                                       +    docId: = IST-24                      +       docId: = IST-25


                                contains
                                                                                                                                                                      contains
                                                                                                                                                                                   «transaction package»
                                             contains
                                                                                                                       contains              contains                             Retriev e Form for Data
                                                             contains                  contains                                                                                           Capture

                                                                                                                                                                                  +       docId: = ISTP-50
                                            «component»                     «transaction package»                       «component»                 «component»
                                                                            Encounter Document                           Lab Report              Acknow ledgements                           constrains
                                         Encounter Message
                                                                                                                          Message
                                         +     docId: = ISC-39              +    docId: = ISTP-48                                               +   docId: = ISC-45
                                                                                                                  +     docId: = ISC-36
                                                                                                                                                                                      «composite standard»
                                                               contains                                                                             references                             IHE RFD
                      «component»                                                                    contains
                   Radiology Message                                                                                      contains
                                                        «transaction package»
                   +   docId: = ISC-41                                                                                                         «transaction»                                  constraints
                                                         Manage Sharing of                          «component»
                                                             Documents                                                                        Patient ID Cross-
                                                                                                     Lab Report                                 Referencing
         «transaction package»                      +    docId: = ISTP-13                        Document Structure
                                                                                                                                                                                          «base standard»
           Radiology Report                                                                                                             +    docId: = IST-22
                                                                                                 +   docId: = ISC-37                                                                          XForms
               Document                                         constrains                                                                       constrains
         +       docId: = ISTP-49                                                   constrains

                                                          «composite standard»                   «composite standard»                       «composite standard»
                  implements                                                                                                                                                               «component»
                                                               IHE XDS                              IHE XDS-MS                                   IHE PIX
                                                                                                                                                                                             EHR Lab
                                                                                                                                        -    PIX Query: ITI-9                               Terminology
         «composite standard»                                                                                            constrains
             IHE XDS-I                                                          implements                                                                                            +    docId: = ISC-35
                                                constrains                                                                                              references

                                                                                                                                                                                                   constrains
                  implements                                                       «base standard»                         «composite standard»
                                                  «composite standard»                                                                                                       «base standard»
                                                                                     ISO 15000                                IHE XDS Lab                                        LOINC
                                                       IHE NAV                      ebRS 2.1/3.0
              «base standard»                                                                              +      Provide & Register Document Set: ITI-15
               DICOM 2003
                                                                                                                                                                                                      constrains
                                                                                                                                                                             «base standard»
                                                                                                                          constrains            constrains                    HL7 2.5 Code
                                                                                                     constrains                                                                   Sets

                                                                                                                      «base standard»         «base standard»                                         constrains
                                                                                                                                                                             «base standards»
                                                                                                                        HL7 CDA r2              HL7 V3 Lab
                                                                                                                                                                              HL7 3.0 Code
                                                                                                                                                                                  Sets


                                                                                        constrains                                                                           «base standard»              constrains
                                                                                                                      «base standard»         constrains                      SNOMED-CT
                                                                                         constrains                      HL7 2.5              constrains
                                                                                                                         Message
                                                                                         constrains                                          constrains
System Development Process




         USER ROLE
     System Development Process
System development activities
 Requirements Elicitation
 Design
     Analysis
     System  design
     Object design
 Pilot testing
 Implementation
 Evaluation
   Requirements Elicitation – User Role
During Requirements Elicitation, the user and
 developer define the purpose of the system, i.e.
 identify a problem area and define a system that
 addresses the problem, and describe the system in
 terms of actors and use cases.

Such a definition is called a requirements
  specification.

The requirements specification is written in a natural
  language and supports communication between
  developers and client and users and serves as a
  contract between the client and the developers.
        Requirements Elicitation
Requirements Elicitation includes the following
  activities:
 Specifying problem/domain where system is needed
 Identifying goals for the system
 Identifying actors
 Identifying functional requirements
 Identifying use cases
 Modeling user workflow and dataflow
 Identify high level of system architecture
 Identifying non-functional requirements
 Stating project timeline and deliverables
Requirement Elicitation
Functional requirements examples:

-   Support data collection (e.g., send data)
-   Store data
-   Manage data
-   Analyse data
-   Generate reports
Requirement Elicitation
A nonfunctional requirement is a
  constraint on the operation of the system
  that is not related directly to a function of
  the system.

Non-functional requirements have as
 much impact on the system as functional
 requirements.
Non-Functional Requirements
Nonfunctional requirements falls into two
  categories – quality requirements and
  constraints or pseudo requirements.
                 Quality Requirements
 Usability
 Reliability, dependability, robustness, safety
 Performance (response time, throughput,
  availability, accuracy)
 Supportability, adaptability, maintainability,
  portability
Non-Functional Requirements
    Constraints or Pseudo Requirements

 Implementation requirements
 Interface requirements
 Operation requirements
 System security requirements
 Packaging requirements
 Legal requirements
         Work Products: Deliverables

Requirement Analysis Document (RAD) is a
 product of the requirement elicitation process.

RAD is a document (deliverable) that describes the
 system from the user’s point of view.

RAD specifies a set of requirements for features that
 a system must have.

RAD is used as a contractual document between
 the developer and the client.
System Requirements Specification Document: Outline

    1. Introduction (Problem Overview)
        1.1 Purpose of the Proposed System
        1.2 Actors and Scope of the Proposed System
        1.3 Objectives and Success Criteria of the Project
    2. System Requirements
        2.1 Functional requirements
        2.3 Non-functional requirements
    3. System Models
        3.1 Use Case Description
        3.2 Use Case Models
            3.2.1 Use Case Diagram
            3.2.2 Work Flow and Data Flow Model
        3.3 High-Level System Architecture
    4. Project Development Timeline
    5. Testing / Evaluation Plan
     Timeline and Deliverables
                          Month
                          1 2 3 4      5 6 7 8 9 10 11 12 1 2 3 4 5 6


Requirement Elicitation    Requirement Analysis Document (RAD)


System Development
                                      System Development Specification Document


Pilot Testing
                                                        Pilot Testing Protocol & Report


System Implementation
                                                                     System Documentation Prototype


System Evaluation                                                            System Evaluation
                                                                             Protocol & Report

System Operation
                                                                              System Documentation &
                                                                              Operational Manual
  Developing a Vision for Functional
Requirements Specification for Electronic
 Data Exchange between Clinical and
Public Health Settings – NYC examples:
     Examples of School Health
       Syndromic Surveillance
                                              Community Health Center (CHC) &
                                Automated Student Health Record (ASHR) System Data Exchange

                                                 Conduct pre-school physical
                                                    examination at CHC

                                            Input exam data into CHC Electronic
                                             Health Record System (EHRS) that
                                                  populates the 211S Form                      Primary Care Provider
                                                                                                     (PCP) &
                                                      Verify 211S Form                        Community Health Center
                  Billy                                                                               (CHC)
          (Patient, Consumer,
                                                      Print 211S Form
                Student)

                                           Update Personal Health Record (PHR) -
                                                        My Chart

                                              Export 211S Form into ASHR


                                           Receive 211S Form from CHC EHRS


                                               Send 211S Form to a School                        Automated School
                                                                                                  Health Record
                                                                                                     (ASHR)
                                              Receive 211S Form from ASHR


                                                   Review student data

                 Billy’s                          File student data into a
            Parent/Guardian                      School Records System

                                         Communicate to a Guardian and PCP via
Italic font &                             ASHR and CHC EHRS regarding student
represent future functions of                       health concern
                                                                                                  School Nurse &
electronic data exchange                                                                          School Record
                                                                                                     System


                                Fig 1. UML Use Case Diagram – Scenario 1: Healthy Child
                                     Community Health Center (CHC) &
                       Automated Student Health Record (ASHR) System Data Exchange

                               Conduct pre-school physical examination at CHC

                             Input exam data into CHC Electronic Health Record
                                System (EHRS) that populates the 211S Form
                                              Verify 211S Form
                             Verify the Request for Educational Services (RES)
                                                    Form                              Primary Care Provider
                                                                                            (PCP) &
                                Verify the Multi-Use Medication (MUM) Form           Community Health Center
         Amy
                                                                                             (CHC)
 (Patient, Consumer,                        Sign Consent Form
       Student)
                                     Print 211S, RES and MUM Forms

                             Update Personal Health Record (PHR) - My Chart

                             Export 211S, RES and MUM Forms and Consent to
                                                 ASHR
                           Receive 211S, RES and MUM Forms and Consent from
                                              CHC EHRS
                             Send 211S, RES and MUM Forms and Consent to a              Automated School
                                                School
                                                                                         Health Record
                           Receive 211S, RES and MUM Forms and Consent from                 (ASHR)
                                                 ASHR

       Amy’s                                 Review student data
  Parent/Guardian
                              Store 211S, RES and MUM Forms and Consent in
                                          Special Needs Database

                                      Administer medication to student

                             Update student’s record on the use of medication in         School Nurse &
Italic font &                            Special Needs Database                          School Record
represent future                                                                           System &
functions of                  Submit student record to CHC EHRS via ASHR                 Special Needs
electronic data                                                                            Database
                           Communicate to a Guardian and PCP via ASHR and
exchange                         CHC EHRS regarding student health
   School Health: Current Work Flow and Data Flow Model:
   Scenario 1- Healthy Child

 Child with            Provider             Parent              School nurse           DOHMH Reports
parent visits         completes          deliver 211S          enter 211S data         maintains
  provider               211S              to school              into ASHR             ASHR

            Patient               211S                  211S         211S
                                                                                            211S
            Record                Form                  Form         Form
                                                                                            Form




                                                                                           ASHR
                                                                  School DB

                EHR




         CHC EHRS                                                                Reports
    School Health: Current Work Flow and Data Flow Model:
    Scenario 2- Child Has Asthma
                                  Consent         Consent
                        Parent     Form            Form
                      completes
                       Consent         Parent               School nurse
 Child with                                                                     DOHMH Reports
                         Form          deliver               enter Forms
parent visits                                                                   maintains
                       Provider        Forms                     data
  provider                                                                       ASHR
                      completes       to school               into ASHR
                      211S Form                                                      School
                                                                School
                                                                                     Forms
                                    211S           211S         Forms

                                    Form           Form
                                                                                    ASHR
            Patient                                           School DB
                                    RES            RES
            Record                  Form           Form


                EHR                 MUM            MUM
                                    Form           Form
                                                                          Reports
         CHC EHRS
Community Health Centers                            New York City
        (CHC)                  New York City          Schools
                           Department of Health &
          EHR
                              Mental Hygiene            School
                                                        Forms

         CHC-I
         EHRS                        School            School-I
                                     Forms             System

          EHR
                                  211S   Consent         School
                                  Form   Form            Forms

         CHC-II                   RES    MUM
         EHRS                     Form   Form          School-II
                                                       System

                                   Automated
                                 Student Health
           EHR                      Record               School
                                    (ASHR)               Forms
                                     System
          CHC-N                                        School-N
          EHRS                                          System
  PHDSC / HRSA EXPERT PANEL IN ELECTRONIC DATA
                      EXCHANGES
SESSION 3:
Responses to the NYC Functional Requirements:
  Roundtable Discussion

              DRAFT QUESTIONS FOR DISCUSSION

   Does the NYC specifications framework adequately describe user needs
    in terms of system goal, actor, function, workflow and dataflow?

   Does it include necessary elements needed to build the user
    requirements? What is missing?

   Is it reusable for other public health domains/programs/jurisdictions?

   What is the right name for this document – Functional Requirements
    Specification? Use Case Description? Functional Standard?
    Requirement Analysis Document (RAD)? Other?
Functional Requirements Specifications for
    Electronic Data Exchange between
       Clinical Care and Public Health

          WHERE TO START?
Knowledge Management in Public Health




       WHAT IS PUBLIC HEALTH?
Public Health Organization

Public health nowadays is:
 Agency
 Healthcare provider
 Laboratory
 Purchaser
 Payor
 Pharmacy
 Research
Public Health Organization

Public health nowadays is:
 Agency
 Healthcare provider        Publicly-delivered
 Laboratory
                             Healthcare Care

 Purchaser
 Payor
 Pharmacy
 Research
Public Health Organization

Public health nowadays is:

   Agency: Assessment, Policy Development and
    Assurance

There are local, state, and federal public health
  agencies.

Their activities are organized by services and/or
  disease-specific programs as indicated in the
  tables that follow.
Public Health Information Systems


   Local and State Public Health Systems, e.g.,
    immunization registry, blood lead registry,
    asthma registry, trauma registry, communicable
    diseases registry, syndromic surveillance, etc.

   CDC National Electronic Disease Surveillance
    System (NEDSS)

   CDC Environmental Public Health Tracking
    Network (EPHTN)

   CDC Public Health Information Network (PHIN)
    State Health Agencies Functions
    Responsibilities of State Health Agencies: 2001

           Responsibilities                     %              Responsibilities                    %
   State public health authority                97     Medical examiner                            21
   Public health laboratory                     79     State mental health authority               19
   Rural health                                 79     State public health licensing agency        17
   Children with special healthcare             77     State mental institution or hospital        17
   needs
   Minority health                              72     Partial/split responsibility for            17
                                                       Medicaid
   Institutional licensing agency               60     Medicaid state agency                       15
   State health planning & development          53     Lead environmental agency                   15
   agency
   Partial/split leadership of                  51     State tuberculosis hospital                 15
   environmental agency
   Public health pharmacy                       34     Health insurance regulation                 15
   State nursing home                           28

Source:Beitsch LM et al. Structure and functions of state public health agencies. APHA. 2006:96(1):167-72
   Local Health Agencies Public Health Agencies
  Responsibilities of LocalFunctions

      Personal Health Services              (%)       Population Level Services               (%)
     Adult Immunizations                    91     Communicable Disease Control               94
     Childhood Immunizations                89     Health Education                           87
     Tuberculosis Testing                   88     Epidemiology and Surveillance              84
     STD Testing and Counseling             65     High Blood Pressure Screening              81
     HIV Testing and Counseling             64     Tobacco Use Reduction                      68
     EPSDT                                  59     Cancer Screening                           58
     Family Planning                        58     Diabetes Screening                         53
     WIC                                    55     Cardiovascular Disease Screening           50
     Prenatal Care                          41     Injury Control                             37
     Dental Care                            30     Violence Prevention                        22
     HIV Treatment                          25     Occupational Safety and Health             13
     Primary Care                           18



Source: Scutchfield, F.D., & Keck, C.W. Principles of public health practice, 2nd ed. 2003. Thomson/Delmar
Learning: Clifton Park, NY.
All public health activities are supported by
  customized information systems
  (databases, registries) developed to
  address the programmatic needs.
Number of Public Health Programs/Systems

On average, there are
23 programs in the Local Health Departments (HDs)
19 programs in the State Health Departments

There are 3000 local HDs and 50 State HDs in the US

23 x 3000 (Local HD) = 69000 local programs/systems
19 x 50 (State HD) = 950 state programs/systems
So roughly, there are over 70 thousands public health
   information systems -- all of them are customized,
   siloed systems.
Clinical – Public Health Data Exchanges: Local Health Agencies
                 Health Education/Risk
                       Reduction
    Provider 1
                    Communicable
                      Diseases

    Provider 2       Immunization

                        EPSDT
    Provider 3       Injury Control

                    School Health
    Provider 4
                     Chronic Care

                  Biosurveilance, BT,
                    Preparedness

                         WIC
    Provider X    Occupational Safety
                     and Health
    Clinical – Public Health Data Exchanges: State Health Agencies
                                                                            Genetic Disorder
                                                                              Vital Statistics

                                                                             Communicable
         Provider 1                                                            Diseases

                                                                              Immunization

                                                                                Lead and
         Provider 2                                                           Environmental
                                                                              Epidemiology
                                                                              Injury Control
         Provider 3
                                                                              School Health

         Provider 4                                                           Chronic Care

                                                                           Biosurveilance, BT,
                                                                             Preparedness

                                                                                   WIC

                                                                              Public Health
         Provider X                                                            Laboratory
                                                                                  HEDIS

                                                                                  Cancer
Source: Beitsch et.al Structure and Function of State Public Health Care Agencies” / AJPH, January, 2006.
      Clinical-Public Health Data Exchanges: Local / State / Federal
      Health Agencies                  Genetic Disorder
                                                           Vital Statistics
                                 Health Education/Risk                         CDC
                                       Reduction           Communicable
                                                             Diseases
       Provider 1                                                              HRSA
                                      Communicable         Immunization
                                        Diseases                               AHRQ
                                                           Lead Registry
       Provider 2                     Immunization

                                             EPSDT
                                                           Injury Control
       Provider 3                      Injury Control
                                                           School Health
                                      School Health        Chronic Care
       Provider 4
                                       Chronic Care      Biosurveilance, BT,
                                                           Preparedness
                                   Biosurveilance, BT,
                                     Preparedness               WIC

                                              WIC          Public Health
      Provider X                                            Laboratory
                                   Occupational Safety
                                      and Health               HEDIS

                                                              Cancer
Source: Beitsch et.al AJPH, January, 2006.
Paper-based Health Data Exchanges
                         Genetic Disorders

                        Communicable
Provider 1                Diseases
                                             On average
                                             49% of cases
                        Immunization         got reported
Provider 2
                                             (CDC, 2006).
                        Vital Records
Provider 3
                        Injury Control
Provider 4              School Health

                        Chronic Care

                         Biosurveilance,
Provider X                    BT,
                         Preparedness

                           HEDIS
       Reasons for Underreporting to Public Health Agency
       Lack of Knowledge of the Reporting Requirement
          Unaware of responsibility to report
          Assume that someone else (e.g., a laboratory) would report
          Unaware of which disease must be reported
          Unaware of how and whom to report
       Negative Attitude Towards Reporting
          Time consuming
          Too much hassle (e.g., unwieldy report form or procedure)
          Lack of incentive
          Lack of feedback
          Distrust of government
       Misconceptions that Result from Lack of Knowledge or Negative
        Attitude
          Compromises patient-physician relationship
          Concern that report may result in a breach of confidentiality
          Disagreement with need to report
          Judgment that the disease is not that serious
          Belief that no effective public health measures exist
          Perception that health department does not act on the report
Source: Centers for Disease Control and Prevention. Lesson Five: Public Health Surveillance. Principles of
Epidemiology in Public Health Practice. 3rd Ed. 336-409. Available at: http://www.cdc.gov/training/products/ss1000/s
                    EHR-PH System Prototype for Interoperability
                                                      Public Health
              Clinical Care in 21st Century Health Care System Surveillance

           Hospital of Birth                                                         State Health Department

              ADT-                                                                                Newborn
              Birth Record                                                                        Screening
                                           HL7 2.4                        HL7 3.0
                                                                                                  Registry
              Newborn
              Screening                 HL7 3.0
                                                                                                  Hearing
              Test
                                                        EHR-PH
                                                                             HL7 3.0              Screening
                                                     Info Exchange                                Registry
                                      HL7 3.0
             Hearing
                                                                             HL7 2.4
             Screening
                                      HL7 2.4
                                                                                                  Immunization
             Test
                                                                                                  Registry
                                                            HL7 3.0
             Immunization                                                                        Communicable
                                      HL7 2.4
             Administration                                                                      Disease
                                                                                    J2EE
                                                                                                 Registry

             External                                    HTB                         J2EE   Wrtwertghghgghhghg

             Laboratory                                                                     Wrtwrtghghghghgh
                                                                                            Wtrwtrghgg
                                                                                                       Wrtwertghghgghhghg
                                                                                            Wrtwrtghghgh

                                                                                            jkhjkhjkhk
                                                                                                       Wrtwrtghghghghgh
                                                                                            Aadkalfjkaldkfjalkdjflajh
                                                                                                       Wtrwtrghgg
                                                                                                                                   Healthcare
                                                                                                       Wrtwrtghghgh
                                                                                            flkdjghghghghghghghgh
                                                                                                       Aadkalfjkaldkfjalkdjflajk
                                                                                                       flkdjghghghghghghghg
                                                                                                                                   Transaction
                                                                                                       fhjfghjfh
                                                                                                                                   Viewer
      HTB – Health Transaction Base
Source: Orlova, et al. HIMSS 2005,Dallas TX, February 13-17, 2005 and AMIA, Washington DC, November, 2005
EHR-PH System Prototype for Interoperability
          EHR-PH System Prototype for Interoperability
in 21st Century Health Care System Health Surveillance
                                            Public
    Clinical Care in 21st Century Health Care System

Our Prototype
   Shows how interoperability between healthcare
    systems can be achieved with a standards-based
    infrastructure
   Is built upon existing systems in clinical care and
    public health programs
   Enables electronic data reporting from a clinical
    setting to multiple public health systems
   Enables translation of customized standards into
    HL7 3.0 messaging standard
   Links clinical and public health systems to provide
    a continues view of the patient record across the
    systems involved
Towards EHR-PH Data Exchange: Clinical Care & Public Health
                            Genetic Disorders

                           Communicable
   Provider 1                Diseases

                            Immunization
   Provider 2

                            Vital Records
   Provider 3
                            Injury Control

   Provider 4               School Health

                            Chronic Care

                               Biosurveillance, BT,
   Provider X               Preparedness, Syndromic
                                  Surveillance

                               HEDIS
Towards EHR-PH Data Exchange: Clinical Care & Public Health
                EHR

                          EHR          Genetic Disorders
                          CDA
                         (Clinical     Communicable
          Provider 1       Data          Diseases
                       Architecture)
                                       Immunization
          Provider 2
                           IHE         Vital Records
          Provider 3   (Integrated
                       Healthcare      Injury Control
                       Enterprise)
          Provider 4       LAB         School Health

                                       Chronic Care

                                         Biosurveilance, BT,
          Provider X                       Preparedness,
                                       Syndromic Surveillance

                                          HEDIS
   HITSP Registration & Medication History Document
          ASTM/HL7 CCD Based Document
                                          CDA Rel2
                                           CDA Level 1 Header

                                           HL7 CCD/CRS Implementation Guide

                                           CDA Level 2 Human Rendering

                                                (CCD Loinc Section Codes)

           X12 X271
                                          CDA Level 3 Coded Entries
                                                      (CCD/MS Entries)
                                          •• Personal Information
          NCPDP Script                    •• Healthcare Provider
                                          •• Insurance Provider
                                          •• Allergies and Drug Sensitivity
                                          •• Condition
                                          •• Medications
           ASTM/CCR                       •• Pregnancy
                                          •• Advance Directives



CCD - Clinical Care Document, CDA Rel2– Clinical Data Architecture, Release 2,
CCR – Continuity Care Record
EHR-PH Data Exchange: Clinical & Public Health Systems
                EHR       Genetic Disorders

                         Communicable
 Provider 1                Diseases
                CDA2
                          Immunization
 Provider 2

                          Vital Records
 Provider 3
               X12        Injury Control

 Provider 4              School Health

                          Chronic Care
               NCPDP
                            Biosurveilance, BT,
 Provider X                   Preparedness,
                IHE       Syndromic Surveillance
                LAB          HEDIS
FORMS
EHR-PH Data Exchange: Clinical & Public Health Systems
                   EHR       Forms

                                     Genetic Disorders

                   CDA2
                                     Communicable
    Provider 1
                                       Diseases
                    IHE
    Provider 2      LAB              Immunization

                                     Vital Records
    Provider 3
                                     Injury Control
    Provider 4   NCPDP
                                     School Health
                               SH

                                     Chronic Care

                                        Biosurveilance, BT,
    Provider X     X12
                               BT    Preparedness, Syndromic
                                           Surveillance
                                        HEDIS
EHR-PH Data Exchange: Clinical & Public Health Systems
                   EHR       Forms

                               NBS Genetic Disorders

                   CDA2
                                TB,     Communicable
    Provider 1                 STD.       Diseases
                               ……
                    IHE
    Provider 2      LAB         IR      Immunization

                                VR      Vital Records
    Provider 3
                               ECIC Injury Control
    Provider 4   NCPDP
                                         School Health
                                SH
                              CVD,      Chronic Care
                             Asthma
                             Diabetes
                                           Biosurveilance, BT,
    Provider X     X12
                               BT       Preparedness, Syndromic
                                              Surveillance
                              HEDIS
                                          HEDIS
Functional Requirements Specifications for
 Electronic Data Exchange between Clinical
           Care and Public Health

WORKING WITH VENDOR COMMUNITY
    Providers and Software Developers
       Working Together to Deliver
Interoperable Health Information Systems
             in the Enterprise
         and Across Care Settings


          WWW.IHE.NET
Integrating the Healthcare Enterprise (IHE)
Overview




Presented by Dan Russler, M.D., IHE
PCC Co-chair
IHE Workshop – June 19, 2006
Why IHE?
   1970’s—Mainframe Era--$100,000 per interface
   1990’s—HL7 2.x--$10,000 per interface
   2000’s—IHE Implementation Profiles—
      Cheaper than a new phone line!

How? IHE Eliminates Options Found in
        Published Standards
    Who is IHE?
   IHE is a joint initiative among:
      American College of Cardiology (ACC)
      Radiological Society of North America (RSNA)
      Healthcare Information Management Systems Society (HIMSS)
      GMSIH, HPRIM, JAHIS (laboratory)
      American Society of Ophthalmology
      American College of Physicians (ACP)
     American    College of Clinical Engineering (ACCE)
      And many more….
   Began in 1997 in Radiology (RSNA) and IT (HIMSS)
   International effort: IHE- Europe and IHE-Asia
   Additional sponsors for Cardiology including ASE, ESC, ASNC,
    SCA&I, HRS and more
       IHE 2006 – Nine Active Domains
       Over 100 vendors involved world-wide, 5 Technical Frameworks
              37 Integration Profiles, Testing at Connectathons
              Demonstrations at major conferences world-wide
                 15 Active national chapters on 4 continents

                             Electronic Health Record


    Radiology                                                          Cardiology
14 Integration Profiles                                               4 Integration Profiles
                                         IHE                        Patient Care
      Laboratory
                                  IT Infrastructure                 Coordination
    5 Integration Profiles
                                      13 Integration Profiles        1 Integration Profile
               Future                                           Patient Care
              Domains                                             Devices
                          Pathology                      Oncology
                                         Eye Care
   IHE Standards-Based Integration Solutions

          Professional Societies Sponsorship
      Healthcare Providers & Software Developers
Healthcare IT Standards                                     General IT Standards
     HL7, DICOM, etc.                                              Internet, ISO, etc.

                                        IHE
                                       Process

        Interoperable Healthcare IT
          Solution Specifications Healthcare IT
                       Interoperable
            IHE Integration Profile
                          Solution Specifications Healthcare IT
                                       Interoperable
                            IHE Integration Profile
                                          Solution Specifications Healthcare IT
                                                       Interoperable
                                            IHE Integration Profile
                                                          Solution Specifications
                                                            IHE Integration Profile
    IHE in 2006 – 18 Month Development Cycles

•    First Cycle:
     •   Planning Committee Proposals:   November, 2005*
     •   Technical Committee Drafts:     June, 2006*
     •   Public Comment Due:             July 2006
     •   Trial Implementation Version:   August 2006
     •   Mesa Tool Test Results Due:     December 2006
     •   IHE Connectathon:               January 2007
     •   HIMSS Demo:                     February 2007
     •   Participant Comments Due:       March 2007
     •   Final Implementation Version:   June 2007
  IHE Technical Frameworks


                                                                                                                               Order           Department System           Image
                                                                                                      ADT                                         Scheduler/                                     Acquisition
                                                                                                                               Placer                                     Manager/
                                                                                                                                                  Order Filler           PPS Manager              Modality

                                                                                                             Register J.Doe

                                                                                                       Patient
                                                                                                       Registration [RAD-1]
                                                                                                                                        Placer Order
                                                                                                                                        Management–
                                                                                                         One or the                     New [RAD-2]
                                                                                                         other methods
                                                                                                         of creating an
                                                                                                         order is used                  Filler Order
                                                                                                                                        Management -         Schedule
                                                                                                                                        New [RAD-3]          Procedure

                                                                                                                                                         Procedure
                                                                                                                                                         Scheduled [RAD-4]

                                                                                                                                                              Query Modality Worklist [RAD-5]
                                                                                                                                                         Modality Procedure     Modality Procedure        Perform
                                                                                                                                    Filler Order         Step In Progress       Step In Progress          Acquisition
                                                                                                                                    Mgmt - Status        [CARD-1]               [CARD-1]
                                                                                                                                    Update [RAD-3]


                                                                                                                                                        Modality Procedure        Modality Procedure
                                                                                                      Patient Reconciliation        Filler Order        Step Completed            Step Completed
                                                                                                             J.Doe ->               Mgmt - Status       [RAD-7]                   [RAD-7]
                                                                                                                                    Update [RAD-3]
                                                                                                             J.Smith

                                                                                  ADT                       Patient Update/
                                    Pt. Registration [RAD-1]                                               Merge [RAD-12]
                                                                                                                                                        Patient Update/
                                    Patient Update [RAD-12]                                                               Pt. Registration [RAD-1]    Merge [RAD-12]
                                                                                                                           Patient Update [RAD-12]
                                                                        Placer Order Management [RAD-2]
                                                                        Filler Order Management [RAD-3]
                                                   DSS/ Order Filler                                                  Order Placer

                                     Modality PS in Progress [CARD-1]             Procedure Scheduled [RAD-4]
                                     Modality PS Completed [RAD-7]                Patient Update [RAD-12]
                                                                                   Procedure Updated [RAD-13]
                                                                                   Instance Availability Notification [RAD-49]

                                                                                                         Evidence
                                                                                                                                             Image Display
                                            Modality PS in Progress [CARD-1]                             Creator
                                            Modality PS Completed [RAD-7]

                                                                                                                                                        Query Images [RAD-14]
                                                                                             Storage                Modality Image/Evidence           Retrieve Images/Evidence [CARD-4]
                                     Performed                                           Commitment


Detailed standards implementation
                                                                                                                      Stored [CARD-2]
                                     Procedure                                             [CARD-3]
                                    Step Manager

                                                                                                    Image           Image
                                                                                                   Manager          Archive



guides
                                         Modality PS in Progress [CARD-1]
                                         Modality PS Completed [RAD-7]

                                                                                             Storage                Modality Image/Evidence
                                                                                         Commitment                 Stored [CARD-2]
                                                                                           [CARD-3]
                                         Modality PS in Progress [CARD-1]
                                         Modality PS Completed [RAD-7]
                                                                                                         Acquisition
                                                                                                          Modality
                                         Query Modality Worklist [RAD-5]
HIMSS IHE Interoperability Showcase
February 2006 Participants
 Leadership Level              Implementer Level
                               Allscripts                  HX Technologies
 Blue Ware                     Canon                       INFINITT Technology
 Cerner                        CapMed                      Kryptiq
 GE Healthcare +IDX            Cardiac Science             McKesson
                               CGI-AMS                     MedAccess Plus
 IBM
                               CompassCare                 Medical Informatics
 Initiate Systems              CPSI                        MediNotes
 InterSystems                  Dictaphone                  MNI
 MiSys Healthcare              DR Systems                  National Institute of Sci & Tech
                               Eastman Kodak               NextGen Healthcare
 Quovadx                       Eclipsys                    Philips Medical
 Siemens                       Epic Systems                ScImage
                               HIPAAT                      Witt Biomedical
 Supporter                            Organizational participant:     DMP–French Natl. Personal
                         Medkey                                           EHR
    Level:   Dairyland
                         Motion       American Coll. of Clinical Eng. Health Level 7   HTP
             EMC                                                          IEEE
 Acuo                         Comp.   Catholic Healthcare West
             Identrus                                                 Midmark Diagostics Group
 Bond                    Picis        US Dept of Defense
             Intel                                                    HIMSS RHIO Federation
 Carefx                  Pulse                                        Liberty Alliance
             Mediserve                US Dept of Veterans Affairs
 Clearcube
IHE Connectathon, January 2006
        •300+ participants, 120+ systems
        •60+ systems developers
        •Four Domains: Cardiology, IT Infrastructure,
              Patient Care Coordination, Radiology
        •2800+ monitored test cases
   Results
     Over  3000 attendees visited the HIMSS RHIO
      Showcase
     37 vendors demonstrated 48 systems
     700 attendees created and tracked their own
      health record
     63 educational sessions were presented
     5 International delegations
     3 VIP tours
     16 clinical scenarios were demonstrated
IHE Integration Profiles for Health Info Nets
What is available and has been added in 2005 and is for 2006
  Clinical and PHR                                    Security                           Patient Id Mgt
       Content
               Emergency Referrals                                                         Patient Demographics
              PHR Extracts/Updates                                                                 Query
             Format of the Document Content       Basic Patients Privacy
           Format of the Document
         ECG ReportDocumentvocabulary
            and associated coded Content
                                                        Consents
          and associated coded vocabulary
       Lab ResultsDocument Content
                         Document                   Establish Consents & Enable              Patient Identifier
         Format of the
                                                           Access Control                   Cross-referencing
                 Content
      Scanned Documents
        and associated coded vocabulary
       Format of the Document Content                                                      Map patient identifiers across
     Imaging Information
      and associated coded Content
    Format of the Document vocabulary                                                       independent identification
    Medical Summary                                    Document Digital                              domains
   Format of the Document Content
      (associated coded vocabulary
   and Meds, Allergies, Pbs)                              Signature
  Format of the Document Content                   Attesting “true-copy and origin
  and associated coded vocabulary



Health Data Exchange                                 Audit Trail & Node
                                                      Authentication                             Other
                                              Centralized privacy audit trail and node
      Cross-Enterprise                          to node authentication to create a            Request Form
     Document Sharing                                    secured domain.
                                                                                             for Data Capture
  Registration, distribution and access
                                                                                            External form with custom
  across health enterprises of clinical
                                                                                             import/export scripting
     documents forming a patient
        electronic health record                      Consistent Time
                                                Coordinate time across networked              Notification of
  Cross-enterprise Document                                  systems                       Document Availability
    Point-Point Interchange                                                                  Notification of a remote
                                                                                            provider/ health enterprise
      Media-CD/USB & e-mail push
                                                                                                         Biosurveillance
HITSP                  AHIC-ONC BIO Consolidated Use Case
                                                                                      Patient-Level Data to Public Health
                                                                                           Document-based Submission

         Biosurveillance – Patient-level and Resource Utilization Interoperability Specification


                                                                                Transaction Package
                                                                                Consumer/Patient Id X-ref
                                       Transaction Package
                                       Manage Sharing of
                                       Docs


             Document-based       Transaction                                                          Base
                                                                      Transaction
                Scenario          Notif of Doc Availability                                             Std
                                                                      Pseudonymize                      HL7              IHE
                                                                                                      QBP^Q23                   IHE
  IHE                                                                                                                    XDS    PIX
                                                IHE                                                   RSP^K23
 XDS-I                                                                                                                          PDQ
                                                NAV



         Component
         Lab Report Document                                                                Component
                                                                                            Anonymize
                                     IHE           IHE
         Component
                                   XDS-MS        XDS-LAB
         Lab Terminology

                                                        Terminology
                                     Base                Standards                         Base
                                      Std                                                   Std                    Base          Base
 Base                   Base                                                                                        Std
                                     HL7                                                    ISO                                   Std
  Std                    Std                          HCPCS HL7 V3
                                    CDA r2                                                 DTS/                  ISO 15000     HL7 V2.5
DICOM                  LOINC                              CPT HL7 V2.5                                          ebRS 2.1/3.0
                                                                                           25237
                                                        CCC SNOMED-CT
                                                         ICD 9/10 LOINC                      HIPAA
                     SNOMED-
                       CT                                  NCCLS      UCUM                      DICOM
                                                             UB-92      URL
                                                             FIPS 5-2   HAVE
    Providers and Software Developers
       Working Together to Deliver
Interoperable Health Information Systems
             in the Enterprise
         and Across Care Settings


     PHDSC was Invited to Sponsor
      Public Health Domain at IHE
    PHDSC was Invited to Sponsor
           Public Health Domain at IHE
               Public Health Efforts at IHE

 White Paper on Public Health Case Management Profile –
  due July 2007
Can be PHDSC-sponsored

 Profile Proposal on Aggregate Data Retrieval from
  Document-Sharing Resource
Siemens- and Oracle-sponsored

 Profile Proposal on Public Health Reporting
IBM-sponsored
  PHDSC / HRSA EXPERT PANEL IN ELECTRONIC DATA
                      EXCHANGES
SESSION 3:
Responses to the NYC Functional Requirements:
  Roundtable Discussion

              DRAFT QUESTIONS FOR DISCUSSION

   Does the NYC specifications framework adequately describe user needs
    in terms of system goal, actor, function, workflow and dataflow?

   Does it include necessary elements needed to build the user
    requirements? What is missing?

   Is it reusable for other public health domains/programs/jurisdictions?

   What is the right name for this document – Functional Requirements
    Specification? Use Case Description? Functional Standard?
    Requirement Analysis Document (RAD)? Other?
    PHDSC / HRSA EXPERT PANEL IN ELECTRONIC DATA
                    EXCHANGES
SESSION 4:
Roadmap for Public Health Functional Requirements Standards:
  Roundtable Discussion
              DRAFT QUESTIONS FOR DISCUSSION
   Our recommendations
       Accept the specification as a working document

   Next steps:
       Work with public health (States, HRSA, CDC), clinical (AAFP, AAP,
        AMA) communities and vendors (HIMSS’s IHE) to finalize the
        representation of the public health functional requirements for
        interoperable clinical-public health systems

       Expand the proposed specifications by describing other domains (use
        cases) of clinical – public health data exchanges
    PHDSC / HRSA EXPERT PANEL IN ELECTRONIC DATA
                    EXCHANGES
SESSION 4:
Roadmap for Public Health Functional Requirements Standards:
  Roundtable Discussion
              DRAFT QUESTIONS FOR DISCUSSION

   Next steps (continued):

       Facilitate a dialog between clinical and public health communities on
        the development of the interoperability specifications for clinical -
        public health data exchanges, e.g., participation in HITSP, CCHIT,
        IHE, etc.

       Develop a Panel summary document on the meeting outcomes
        for AHIC, NCVHS, ONC, RWJ and broader public health and clinical
        communities
    PHDSC / HRSA EXPERT PANEL IN ELECTRONIC DATA
                    EXCHANGES
SESSION 4:
Roadmap for Public Health Functional Requirements Standards:
  Roundtable Discussion
              DRAFT QUESTIONS FOR DISCUSSION

   Next steps (continued):

       Work with PHDSC member organizations to organize education
        sessions on user functional requirements for information systems at
        their annual meetings, e.g., NACCHO, CDC PHIN, RWJ, Public Health
        Summit

       Work with CDC and RWJ / NLM public health informatics program to
        include user functional specification development in the public health
        informatics training curriculum.

								
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