Reengineering the BioSense Data Feed to Support State Notifiable

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					     Reengineering the BioSense Data Feed
     to Support State Notifiable Conditions
       Reporting Requirements in Texas


                                                     Doug Hamaker
                                                       NEDSS Coordinator
                                            Division for Prevention and Preparedness
                                 Texas Department of State Health Services



                                                                                       May 28, 2008

Texas Department of State Health Services
NEDSS Project Office
                                                                                                      Page 1
                              Project Beginnings
Would it be possible to tap into an existing
   BioSense data stream
in order to leverage data originally supporting
   biosurveillance
and re-purpose it to provide electronic
   laboratory reporting (ELR) of notifiable test
   results ? ? ? ?
If so, could it provide a proof-of-concept
   pathway for other States to benefit from?
   Texas Department of State Health Services
   NEDSS Project Office
                                                   Page 2
                          Project Partnership
• Christus Health
• CDC
      • BioSense
      • NEDSS
• SAIC
• Constella Group
• Texas DSHS


Texas Department of State Health Services
NEDSS Project Office
                                                Page 3
                        Christus BioSense/ELR
                                           Project Overview
• Dual Use of Data
  • Biosurveillance extended to promote Case Reporting
• Data sources
  • Foundational, Clinical, Laboratory, Pharmacy, and
    Radiology
• BioSense Integration engine
  • Converts heterogeneous messages from multiple facilities
• Infrastructure – Christus BioSense
  • 11 Hospitals enrolled, 4 sending lab result data
• Standards employed
  • HL7 v2.5
  • PHINMS for message transport
   Texas Department of State Health Services
   NEDSS Project Office
                                                              Page 4
                                   System Attributes
       of Biosurveillance and Traditional Case Surveillance
                                                 Traditional Disease
Biosurveillance                                  Case Surveillance
• Secondary use of data already                  • Makes use of pre-specified
  collected within a healthcare                    definitions of notifiable conditions
  organization, such as diagnosis                • Includes data collection of
  codes, free-text chief complaints,               positive laboratory and clinical
  laboratory orders/results                        findings.
• Assigned to one or more disease                • Reporting mandated by state
  syndromes.                                       law/regulation,
• Counts of records in the various               • Personally identifiable
  syndrome groups are analyzed                   • Health care providers,
  to determine when excess                         laboratories report to local HD
  numbers are reported.                            (county or regional)
• Obvious patient identifiers                    • County HD submits notifiable
  excluded; data is anonymized                     reports to State, State to CDC
  prior to transmission

     Texas Department of State Health Services
     NEDSS Project Office
                                                                                      Page 5
   Project Purpose and Benefits
• Extends existing infrastructure developed via
  BioSense
• Builds/expands electronic laboratory
  reporting of lab results indicative of notifiable
  conditions
• BioSense integration exists at a healthcare
  system level -- connects multiple facilities for
  ELR reporting

   Texas Department of State Health Services
   NEDSS Project Office
                                                      Page 6
          ELR Message Mechanics

                     Message Creation


                     Message Transport


                     Message Consumption


Texas Department of State Health Services
NEDSS Project Office
                                            Page 7
         Texas ELR Messaging Flow
• ELR message is received from Laboratory
• Native format is transformed to HL7 v2.3.1
• Vocabularies are validated and/or used to
  transform local codes to standard codes,
  which are dependent on
  •      HL7 specification
  •      ELR Implementation Guide
  •      PHIN VADS
  •      Program Area addendums

      Texas Department of State Health Services
      NEDSS Project Office
                                                  Page 8
                            Texas ELR Routing
• Message payload is interrogated and routed to
  appropriate systems according to matching criteria
  • HIV/STD test results to HIV/STD system
  • Core communicable disease results to NBS
• Further transformation may occur immediately prior
  to final routing in order to meet individualized
  requirements of each system (STD*MIS, NBS,
  etc.), such as
  • Format (HL7 versus ASCII)
  • Content (Use of standard versus local codes)

   Texas Department of State Health Services
   NEDSS Project Office
                                                       Page 9
                                Texas ELR Route
Providers
             Planned (Pending)
 LabCorp                                                                        NBS
                                                           eWebIT                                 NBS
                                                                             Message-IN

                             HL7 v2.31
   CPL

                        Current                                        HL7 v2.3.1
                       Production
  ARUP
                      Convert                  Map to                 Standardize
                    Excel to Tab              Common     HL7 2.3.1      Content           Route
                     Delimited                Standard               (Test Results)



   DSHS
  State Lab
                     Ascii         Text
          Planned (Pending)
                                                                                 Standardized Ascii Text

                                                                                                  HIV/STD
                                                                                                  Program




  Texas Department of State Health Services
  NEDSS Project Office
                                                                                                            Page 10
   Preparation for BioSense Project
             “The MOU”
• Describes the relationship between the
  healthcare system and the public health
  agency
• Addresses HIPPA concerns
• Clearly states the legal authority for the
  provision of data public health reporting




   Texas Department of State Health Services
   NEDSS Project Office
                                               Page 11
Comparison of Message Content
• Gap analysis showed numerous (minor) differences
  in the HL7 content
  • Patient name/demographic is a very important
    component within ELR, and is missing in the standard
    BioSense message
  • Requires a circle-back for those messages fitting the
    BioSense ELR filter of results indicative of a notifiable
    condition
• Beyond patient/demographics, differences can be
  handled within the mapping layer within ELR
  message processing system located at the State
  DOH office.

   Texas Department of State Health Services
   NEDSS Project Office
                                                                Page 12
       Defining What is Reportable
      from the BioSense Data Feed
• State and local reporting rules extend
  beyond the list of nationally notifiable
  conditions
• Determine the list of tests performed within
  the health care system indicative of a
  notifiable condition
• Microbiology test results



Texas Department of State Health Services
NEDSS Project Office
                                             Page 13
                         Programmatic Tasks
• Review Federal and State rules and
  regulations
• MOU between Hospital and CDC
• MOU between Hospital and State Health
  Department
• Established list of required data fields and
  data content
  • NEDSS ELR Messaging Guide vs. BioSense
    Specification Guide


   Texas Department of State Health Services
   NEDSS Project Office
                                                 Page 14
                                      Technical Tasks
• Determine data flow
• Split data stream in the BioSense Integrator
• Filtering Positive Microbiology Test Results
• Re-Identifying de-identified data
• Implement standards-based transmission of
  data from BioSense to State NEDSS
• State consumption of ELR messages from
  the BioSense Integrator

    Texas Department of State Health Services
    NEDSS Project Office
                                                        Page 15
Behold the Benefits of Standards!
 BioSense and NBS both use:
 • Industry Standards and Industry Tools
           • HL7 2.5 Message Standard
           • Orion Rhapsody integration broker toolset
 • Common Messaging Transport
           • PHINMS – send/receive
           • Message security is paramount
 • Standardized vocabulary



Texas Department of State Health Services
NEDSS Project Office
                                                         Page 16
                                               Status
• BioSense data flowing to CDC
• BioSense lab results reporting:
  • Message mapping for State consumption
         • Successful routing of “test” data through the mapping
           process and into the NEDSS data system
  • Initial development of evaluation process
         • Timeliness, completeness
         • Changes to the Business Process /Reporting
           Efficiency


   Texas Department of State Health Services
   NEDSS Project Office
                                                                   Page 17
                          Findings (thus far…)
• Emphasizes the adoption and promotion of
  standards-based Electronic Laboratory Reporting
• Fosters integration of public health case
  surveillance and health information systems
• Facilitates a ready exchange of data
• Opportunistic implementation of ELR for traditional
  case surveillance
• Supports the development of a “Proof of Concept”
  that would be readily adoptable in other states with
  NEDSS-compliant data systems


   Texas Department of State Health Services
   NEDSS Project Office
                                                         Page 18
                                        One Final Note:
            A huge THANKS to

                       Scott Danos
Senior Advisor, Division of Integrated Surveillance
                Systems & Services
    National Center for Public Health Informatics

                   and
           congratulations on
             his retirement!

     Texas Department of State Health Services
     NEDSS Project Office
                                                          Page 19