Riki Merrick, APHL

1. The Standards and Interoperability Framework Public Health-Reporting Initiative Establishing collaboration on harmonization of standards for electronic public health reporting Riki Merrick, APHL Anna Orlova, PhD, PHDSCLise Stevens, FDANikolayLipskiy, MD, DrPH, MBA – CDC CSTE Conference June 5th, 2012 The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of CDC , FDA or APHL.

2. About ONC S&I Framework National Coordinator for Health IT Deputy National Coordinator for Programs & Policy Office of Economic Analysis & Modeling Office of the Chief Privacy Officer Deputy National Coordinator for Operations Office of the Chief Scientist Office of Policy & Planning • The Standards and Interoperability (S&I) Framework is a forum –enabled by integrated functions, processes, and tools – for implementers and experts to achieve harmonized interoperability for healthcare information exchange • It represents one investment and approach adopted by the Office of Standards & Interoperability to fulfill its charge of enabling harmonized interoperability specifications to support national health outcomes and healthcare priorities, including Meaningful Use, the Nationwide Health Information Network, etc. Office of Standards & Interoperability Office of Provider Adoption Support Office of State & Community Programs

3. ONC S&I Framework Source: http://wiki.siframework.org/S%26I+Framework+Functions

4. ONC S&I Framework • Every S&I Initiative focuses on a single challenge • Using a set of value-creating goals and outcomes • Creating of content, technical specifications and reusable tools and services • Enhance efficiency, quality and effectiveness of the delivery of healthcare Growing number of S&I initiatives since 2011 http://wiki.siframework.org

5. PHRI - Origins and Focus • ORIGIN: Public Health Reporting Initiative (PHRI) first community led initiative grew out of the Laboratory Reporting Initiative • FOCUS: • Provider-Initiated Reports of Individual-level Electronic Health Records (EHR) information to Public Health Agencies …as opposed to Query of EHRs • Harmonization / alignment of data elements across different Public Health Agencies (domain specific) Provider - Initiated Report Local/State/ Federal PH Provider EHR http://wiki.siframework.org/Public+Health+Reporting+Initiative

6. PHRI - Goals • Reduce variability in data exchange specifications across public health programs and jurisdictions • Improve interoperability and data exchange between healthcare and public health • Reduce burden on senders • Reduce burden on public health to receive, extract, translate, load and analyze • Core date elements for most ready PH programs possibly by Stage 3 (October 2015; testing 2012) • Possibly after Stage 3 (later phase of initiative)

7. PHRI – Workgroup Statistics • Over 100 members from a wide variety of stakeholder organizations: • Federal/State PH reporting programs • Standards Development Organizations • Vendors • Professional Associations • Five (5) co-leads, Two (2) Liaisons for Stakeholder Communications and Outreach, Two (2) Facilitators and an ONC Liaison • Bi-Weekly meetings (Wednesdays 4-5P EST) http://wiki.siframework.org/Public+Health+Reporting+Initiative

8. PHRI - Approach • Over 30 user stories contributed from local, state and Federal agencies and from PH associations • Identify Core data elements for all reports • Harmonize data elements to simplify reporting process • Created 5 domains: • Communicable disease • Chronic disease • Newborn/Child health • Adverse event reporting • Infrastructure/quality/research (not in first phase) http://wiki.siframework.org/PH+Reporting+User+Stories#User Stories

9. PHRI – User stories already in MU • Immunization reporting to immunization registries (MU stage 1) • Electronic laboratory reporting of reportable condition lab results (MU stage 1) • Syndromic surveillance reports (MU stage 1) • Cancer registry reports (proposed MU stage 2)

10. PHRI - In Scope • Describing stakeholders, actors, triggers • ID core data elements • Harmonize vocabularies • Analyze existing standards (e.g., HL7 2.5.1 or Clinical Document Architecture (CDA)) OUT OF SCOPE (among other things): • Defining reportable events in a jurisdiction • Extensive bi-directional communication (beyond acknowledgments) • Defining transport protocols

11. PHRI - Deliverables • PHRI - Charter – Completed • User Stories - Completed • Domain specific • Consolidated across Domains • Use Case – Completed • Data Element Harmonization Profile – June • Domain specific • Consolidated for Common Core Elements across Domains • User Story Readiness Assessment – June • Functional Requirement Analysis and Standards Selection – June • Technical Specification (Implementation Guide) – August • Pilots – September

12. PHRI - Discoveries • Data mapping/harmonization: • Defining core common data elements for PH and mapping to EHR data model – most of them exist already! • Adding data elements to MU stage 3, if required • occupational data elements, smoking status value sets • Modeling PH data elements to clinical care using Federal Health Information Model (FHIM) • Reconciling PH programs • Occupational data elements use across programs • Different stages of readiness of the programs

13. PHRI - Next Steps • Assessment of potential readiness of user stories by Stage 3 of Meaningful • Selection of appropriate message/document format(s) • Creation of Implementation Guide • Reference implementation and pilot test • Consideration by HIT Standards Committee (4thQtr)

14. PHRI – Use Case /Standards Harmonization / Specification 8/1 1/3 4/25 5/23 5/9 2/1 6/20 2/29 3/14 3/28 4/11 6/6 7/4 7/18 8/15 2/15 1/17 You Are Here User Story / Use Case Development Public Comment - CLOSED Functional Requirements / Data Element Requirements / IE Requirements Public Comment Standards Analysis and Selection; Data Dictionary; DAM Public Comment Implementation Guide Development Pilot Readiness Assessment Communication / Outreach Courtesy of John Stinn

15. PHRI - Roadmap Evaluation for Certification User Story Validation Use Case Documentation FR / Modeling Stds Harm Initiation Spec Develop. Reference Implementation Pilot 2012 2011 • Phase 2 & 3 • (January-May; May - October) • Harmonization of selected use cases into a single use case • Identification of core data elements and data classes • Working on harmonization of FHA and segment enterprise architecture for public health reporting • Working on terminology • Identification and Harmonization of vocabulary / content Exchange Standards • Development of implementation documentation • Completion of assessment of business process, policy barriers • Open source reference implementation • Pilot Demonstration • Phase 1 • (September-December 2011) • Charter has been finalized • All participants work together on • - assessment of needs for the process • - building a consensus on public health reporting definitions • - building a consensus on a scope of the Public Health Reporting HIT Standardization Framework • - development of criteria and selection use cases • - defining a list of WGs • Forming workgroups and starting assessment of existing artifacts in a scope of the initiative • Development of detailed work plan Courtesy of John Stinn

16. Questions? For current status and to participate, visit the wiki: http://wiki.siframework.org/Public+Health+Reporting+Initiative To contact the speaker: rmerrick@iconnectconsulting.com