Public Health Reporting Initiative

1. Public Health Reporting Initiative January 4, 2012

2. Agenda

3. Consolidated User Story 1: Communicable Diseases, Reporting from EHR • Initial report from the EHR system (Communicable Diseases) • Patient, Provider (Hospital, Physician’s office), Laboratory, PH agency • Patient was admitted to a hospital ER or came to a provider’s office • Provider provided clinical examination and assessed medical history. (same info used for reporting to 2 different programs) • [trigger: all ED records sent] If clinician assessment indicates that Patient has symptoms that should be reported through Syndromic Surveillance (SS) system, a SS report was sent to PH agency. Electronic confirmation was sent from PH agency /SS system to Provider. • [trigger: clinically significant symptoms of reportable communicable disease – sent before lab results are obtained] If patients’ symptoms require a specific communicable disease PH reporting w/o waiting lab results, a preliminary report was sent to PH agency • Provider ordered lab tests. Provider staff took samples and sent them to Laboratory. • 4. Laboratory performed the ordered tests on received specimens. Laboratory send results to Provider and PH agency (if needed) • Provider re-examined clinical findings and lab results; he sent a communicable disease preliminary report to a PH agency (some initial reports require clinical and lab component). • Electronic message was validated by PH agency/information system • Electronic confirmation was sent from PH agency to Provider User Story Names: Actors: Flow of Events: EHR System, Health Information Exchange (HIE) Pre-condition Post-condition Public Health Agency’s Information System Preferred Timing for Each Event Type

4. Consolidated User Story 2: Communicable Diseases, Reporting from Electronic Laboratory System User Story Names: • Initial report from the Laboratory system (Communicable Diseases) • Laboratory, PH agency, Provider • 1. Laboratory performed the ordered tests on received specimens. Laboratory send results to Provider and positive results to PH agency • 2. Electronic message was validated by PH agency/information system • 3. Electronic confirmation was sent from PH agency to Laboratory Actors: Flow of Events: Pre-condition Electronic Laboratory System Post-condition Public Health Agency’s Information System Preferred Timing for Each Event Type

5. Consolidated User Story: Child Health, Birthing Facility Use Case Name: Vital Records, Hearing, Immunization, Birth Defects, Metabolic Screening Newborn, Caregiver, Clinician, Hospital staff, Public health program staff Data Categories Actors: Flow of Events: • Child is delivered. If live birth follows steps 3-9, • Clinician conducts initial physical exam • Newborn is due for <immunization, hearing test, metabolic test, birth defect assessment, birth registration, etc.> • Clinician orders an <immunization, hearing test, metabolic test, additional birth defect testing, etc.> • Hospital staff administers <immunization> and conducts <hearing test> and collects <blood specimen> and conducts <birth defect testing> • Hospital staff enter data on the <immunization, hearing test, birth defects, lab order> in the EHR database • EHR pre-populate information to the Birth/Fetal Death Facility Worksheet • Hospital staff and clinician review the Birth/Fetal Death Facility Worksheet • Information is electronically sent on <immunization, hearing test, metabolic test order, birth defect, birth registration/fetal death registration, etc.> to the PH IS directly or via HIE • PH program IS <IIS, EHDI IS, Metabolic IS (LAB), Birth Defect IS, Vital Records> receives notification of report availability • PH programs’ staff reviews the report and create PH IS record on a child in <IIS, EHDI IS, Genetic IS, Birth defect IS, Vital records> • PH IS sends Acknowledgement of Receipt of the Report to EHR directly or via HIE. 1&2 Demographics, Antepartum Record, Prenatal record, Labor & Delivery Record, Postpartum record, Newborn EHR 3. Consent (not for birth registration) 4. Test Order or Standing Order 5. Immun. Record, Test Results, Birth Defect Record 6. Immun. Record, Hearing Test Results, Birth Defect Record, Birth Record, Heelstick Lab Order 7&8. Birth/Fetal Death Facility Worksheet 9. Initial PH Report 10. Notification of Report Availability 11. Updated PH Record 12. Acknowledgement of receipt Pre-Conditions: EHR System, Health Information Exchange (HIE) Post-Conditions: Public Health Information System <IIS, EHDI IS, Birth Defect, Vital Records, Metabolic Screening, etc.> Preferred Timing Daily updates

6. Consolidated User Story: Child Health, Inpatient Setting Use Case Name: • Child Health <Immunization, EHDI> • Patient, physician, clinician, public health program staff • Patient comes to Physician for a general check-up and he/she is due for <immunization, hearing test, etc.> • Physician orders <immunization, hearing test, etc.> • Clinicianadministers an immunization or conducts hearing test> • Clinician enter data on the <immunization, hearing test> in the EHR database • Clinician sends <immunization, hearing test> report to the PH IS directly or via HIE • PH program IS <IIS, EHDI IS, etc.> receives notification of report availability • PH program staff reviews the report and updated PH IS <IIS, EHDI IS> • PH IS sends Acknowledgement of Receipt of the Report to provider EHR directly or via HIE. Data Categories Actors: Flow of Events: 1. Demographics, Consent 2. Test Order, Referral 3. Test Results 4. Test Results 5. Initial PH Report 6. Notification of Report Availability 7. Updated PH Record 8. Acknowledgement of receipt Pre-Conditions: EHR System, Health Information Exchange (HIE) Post-Conditions: Public Health Information System <IIS, EHDI IS, etc.> Preferred Timing for Data exchange Daily updates

7. Consolidated User Story 1: Chronic Diseases (cancer, occupational health) User Story Names: • Chronic Diseases, Outpatient Flow • Patient, Provider/Physician, Laboratory, PH agency • 1. Patient comes to Physician with symptoms of a disease or for a check up • 2. Physician provides clinical examination and assesses medical history. • 3. Physician orders lab (clinical or pathology) and any diagnostic tests. Office staff takes samples and sends them to Laboratory. Any diagnostic tests are performed. • Laboratory performs ordered tests on received specimens. • TRIGGER: reportable condition identified/diagnosed • 5. Laboratory send results to Physician and PH agency for reportable conditions • Physician re-examines clinical findings/diagnostic results and lab results • TRIGGER: reportable condition identified/diagnosed • 7. Physician sends report to a PH agency for reportable conditions • 8. Electronic report validated by PH agency/information system • 9. Electronic confirmation/acknowledgement was sent from PH agency to Provider Actors: Flow of Events: Pre-condition EHR System Post-condition Public Health Agency’s Information System Preferred Timing for Each Event Type Varies, prefer real-time

8. Consolidated User Story 2: Chronic Diseases (Quality, NCHS, NE CVD) User Story Names: Chronic Diseases Patient, Provider/specific healthcare facility, PH agency 1. Patient comes to a specific healthcare facility TRIGGER: Patient admitted to specific healthcare facility 2. Physician orders tests, counsels and or treats patient 3. Providers/data entry clerks add lab results to the orders, medications, imaging results, history of some of these results, based on the diagnosis code TRIGGER: Patient is discharged from specific healthcare facility 4. (a) (from specific healthcare facility) and preferred Billing personnel sends discharge claim record to PHAgency or (b) (from clearing house) 1. Billing personnel sends discharge claim record to clearing house 2. Clearing House personnel sends discharge claim records to PHAgency 5. Electronic message was validated by PH agency/information system 6. Electronic confirmation/acknowledgement was sent from PH agency to Provider/facility Actors: Flow of Events: Pre-condition EHR System Post-condition Public Health Agency’s Information System Preferred Timing for Each Event Type Admit – 5 days after admit and 24 hours after billing code Discharge – preferred quarterly (accepted monthly or 24 hours)

9. Consolidated User Story 3: Chronic Diseases (MI genetic counseling) User Story Names: • Chronic Diseases • Patient, Provider/specific healthcare facility, PH agency • Patient comes to a genetic counselor • Patient undergoes genetic counseling for BRCA gene, Lynch syndrome, or for cardiac death in the young • Counselor may request physician to order genetic testing • Counselor may receive genetic test results • Counselor may have follow up visit with patient to discuss results • TRIGGER: Counseling process is completed • 6. Counselor send report to PHAgency • 7. Electronic message was validated by PH agency/information system • 8. Electronic confirmation/acknowledgement was sent from PH agency to Provider/facility Actors: Flow of Events: Pre-condition EHR System Post-condition Public Health Agency’s Information System Preferred Timing for Each Event Type varies

10. Issues / Clarification - Lise • Workflow items • Stakeholder requirements agreements • Open decision points: scope (lab reporting, billing data)

11. Use Case Schedule/Development Check out the “User Stories” page on the wiki for more information about the consolidated use case

12. Discussion • Definitions Sub-Working Group – Riki Merrick • Standardization Framework Narrative – Anna Orlova • Other?