Centers for Disease Control and Prevention (CDC)

1. Centers for Disease Control and Prevention (CDC) Electronic Public Health Data Exchange: Right Time, Right Place Presenter: John Eichwald, MA March 4, 2013

2. CDC Programs Represented Today Meaningful Use Public Health Technical Assistance Public Health Reporting Initiative Cancer Registries Early Hearing Detection and Intervention Vital Records Immunization Information Systems PHIN Vocabulary Services National Healthcare Safety Network Public Health Clinical Decision Support

3. Supporting Meaningful Use Implementation by CDC Programs and Jurisdictional Public Health Agencies Meaningful Use Public Health Technical Assistance (TA) Team Team’s Purpose and Goals • Assist in resolving issues and problems preventing successful achievement of the Meaningful Use public health objectives • Provide focused policy and technical expertise • Identify successful methods used to resolve similar issues • Rapidly resolve misunderstandings and simple problems • Document and learn from the real problems occurring the field

4. MU TA Team Support: Request Statistics Technical Assistance Request Totals meaningfuluse@cdc.gov

5. In 2012 CDC actively participated in the Office of National Coordinator (ONC) Standard and Interoperability (S&I) PHRI. PHRI Goal : Harmonize HIT standards and implementation guides for interoperable communication between clinical care and public health for public health reporting Minimize unnecessary modification of EHRs and their certification by harmonizing with other ONC-certification criteria and other S&I Framework activities Develop implementation guides to maximize future extensibility and re-usability for multiple public health domains Minimize impact on established Stage 1 MU public health reporting objectives while potentially simplifying such reporting in the future Develop implementation guides while accounting for the needs of subsequent inter-jurisdictional communication (e.g., transfer of cases between jurisdictions and national notification requirements) and population-level reporting. Facilitate future certification of public health information systems that are interoperable with ONC-certified EHRs Supporting Harmonization of Electronic Data Exchange through the Public Health Reporting Initiative (PHRI)

6. 2012 PHRI: Processes and Results

7. The US Requires Reporting of Cancer to the National Cancer Programs

8. Cancer Program Accomplishments • Electronic Health Record (EHR) reporting to central cancer registries (CCRs) • Cancer Reporting is a new menu item for Eligible Professionals (EPs) for Meaningful Use (MU) Stage 2 (2014 implementation) • Development of Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries (“Cancer IG”), based on IHE Physician Reporting to a Public Health Repository – Cancer Registry (PRPH-Ca) • Two Comparative Effectiveness Research (CER) projects pilot testing provider EHR cancer reporting (KY and MO) • Electronic pathology reporting (ePath) to CCRs • Based on IHE Anatomic Pathology Reporting to Public Health – Cancer Registry (ARPH) profile • 42 states are live with ePath reporting • 7 anatomic pathology laboratories reporting to CCRs • 30 states use eMaRC Plus, CDC-developed software tool, for receiving and processing ePath reports

9. CMS Meaningful Use Stage 2 Final Rule, August 2012: “Capability to identify and report cancer cases to a State cancer registry “ ONC 2014 Edition EHR Certification Criteria Final Rule: Requires use of Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries (“Cancer IG”) for EHRs to create and transmit cancer reports to cancer registries Change proposal approved in December 2012 to align IHE PRPH-Caprofile with the Cancer IG. Both use HL7 Clinical Document Architecture (CDA). CDC-developed software tool, eMaRC Plus, is freely available to all states for receiving and processing CDA reports Sets stage for other public health (case) reporting For more information, please contact the Meaningful Use Public Health Technical Assistance Team Cancer and Meaningful Use

10. Early Hearing Detection and Intervention Information System (EHDI-IS) • CDC’s EHDI Team, as part of the National Center on Birth Defects and Developmental Disabilities , supports state and territorial EHDI programs working to advance surveillance capability and interoperable data systems. • Newborn screening can potentially capture the entire newborn population, providing one of the first meaningful interoperability opportunities in an individual’s healthcare lifespan • EHDI provides an opportunity to establish bi-directional information exchange between clinical care and public health in a relatively simple and feasible way

11. EHDI Standards-based Information Exchange Medical Home IHE Early Hearing Care Plan (EHCP) Labor & Delivery HL7 CDA R2 HL7 v2 IHE Newborn Admission Notification Information (NANI) IHE EHDI Cross-enterprise Workflow Document Specialist State EHDI Program Care Tasks & States IHE Quality Measure Execution (QME-EH) Newborn Screening HL7 v2 HL7 QRDA Federal Reporting HL7 EHDI Messaging Data Standard Trial Use (DSTU) e-Measure Definition HL7 HQMF CQM EHDI Clinical Quality Measure (CMS 31v1/NQF 1354)

12. Care Theme: Maternal & Newborn Health Vital Registration and Care Coordination for Newborn Hearing Screening Us Case 5 Interoperability Showcase In collaboration with IHE Use Case 16

13. Electronic Health Record (EHR) and Vital Record (VR) Systems Information Exchange • Background • The National Vital Statistics System (NVSS) provides essential data on all U.S. births and deaths • Over six million vital events are reported annually • Information collected includes a wide range of demographic, medical, and geographic data derived from 4 million birth certificates and from about 2.4 million death certificates and fetal death reports • Events are registered by 57 registration areas: 50 states, 2 cities, and 5 U.S. territories • Vital statistics data are widely used to monitor and improve the nation’s health, e.g., track and explain trends in cesarean delivery, preterm and low birth weight births, causes of infant death and disparities in health among populations groups • Detailed data on all events are transmitted to the Center for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) • Much of the information collected for birth and death certificates and fetal death reports are captured in hospital medical records • Vital statistics and standards communities have collaborated to build upon more than a century’s effort in standardization to encourage EHRs to capture medical and health information in a format consistent with the vital statistics requirements GOALis to improve the timeliness, accuracy, and completeness of vital records data

14. Electronic Health Record (EHR) and Vital Record (VR) Systems Information Exchange Capturing birth and death data in electronic health record systems Improving the timeliness, accuracy, and completeness of vital records data Electronic exchange using HL7 and IHE-based standards

15. Electronic Health Record (EHR) and Vital Record (VR) Systems Information Exchange

16. Thank You!!!!! Special thanks to those who collaborated with us during the IHE 2013 Connectathon interoperability testing to support the Vital Records and EHDI standards development work

17. Immunization Interoperability:2012 Successes Indicators • CDC provided funding to eligible state/city/local Immunization Information Systems (IIS) to enhance EHR-IIS interoperability using HL7 • 96% of IIS or their designee are now able to send and receive HL7 2.3.1 and/or HL7 2.5.1 messages • Simple Object Access Protocol(SOAP) web services for immunization data transport according to CDC Expert Panel’s recommended Web Services Definition Language (WSDL) implemented by more than 43% of IIS • Published HL7 Version 2.5.1 Implementation Guide for Immunization Messages, Release 1.4 • Worked with NIST to develop certification testing for MU2 based on the Implementation Guide • New effort to use MU2 testing with IIS to improve conformance

18. Immunization Interoperability: 2012 Successes Indicators (cont.) • Release of 2D Barcode on Vaccines and Vaccine Information Statements (VIS) • Pilot testing underway in 10 states and ~220 provider sites • 2D Barcoded Vaccines • Current: Havrix, Pediatric DT, Menactra, Adacel, Fluzone, IPOL • Release Soon: Daptacel, Tenivac, Pentacel • 12/25 VIS have 2D barcodes: edition date & type of VIS • CDSi (Clinical Decision Support for Immunizations) • Released Logic Specification – computable and consistent representation of childhood vaccine recommendations and schedules • Resources include logic tables, business rules, supporting data • For use in clinical EMR and IIS

19. Vocabulary Access and Distribution System (VADS): A Web-Based PH Enterprise Vocabulary System • In 2004, CDC developed a web-based enterprise vocabulary system called the Public Health Information Network Vocabulary Access and Distribution System (PHIN VADS) for accessing, searching, and distributing HL7 messaging value sets used within the PHIN and NHIN. • Provides all the vocabulary metadata needed for HL7 messaging. • Promotes sharing and reusing of the value sets. • Hosts multiple versions of value sets that allow implementers to have access to the current, past and the future versions of value sets and value set collections • Provides web services (API) that allows HL7 interface engines, medical and public health applications to obtain the value sets as well as validate the vocabulary present in HL7 messages. • Provides detailed code system metadata for value set concepts such as context, hierarchy, synonyms and alternate codes. This will facilitate the implementation of value sets and improve the quality of local vocabulary mapping to standards. • PHIN VADS can be accessed at a public web site - http://phinvads.cdc.gov • CDC Vocabulary and Messaging team manages the PHIN VADS.

20. VADS: Developing a Sustainable Approach for Supporting Partners

21. Electronic Reporting to the National Healthcare Safety Network (NHSN) via Clinical Document Architecture (CDA) NHSN and CDA Capability • Currently accepting CDA files for: • Central line associated bloodstream infection (CLABSI) • Catheter associated urinary tract infection (CAUTI) • Surgical site infection (SSI) • Multi-drug Resistant Organism and C. dfficile laboratory identified (LabID) events • Central line insertion practices (CLIP) • Dialysis events • Antimicrobial use • Approximately 500 hospitals are reporting to NHSN via CDA – over 5000 hospitals report to NHSN

22. Public Health Clinical Decision Support (CDS) • Decision Support • Providing public health alerts/guidelines to providers in EHR systems • GE, Alliance of Chicago & Lehigh Valley • Working with CDC programs to deliver public health information at the point of care for screening, diagnostic evaluation, treatment & education • HIV/STD & Million Hearts programs • CDS Partnerships • CDS Consortium, Federal CDS Collaboratory, ONC Health eDecisions S&I Initiative • Development of Geospatial Community Health Record • Engaging HD in Memphis & Methodist Le Bonheur Hospital Dashboard of health indicators e.g. obesity, heart disease & stroke • Working with Million Hearts program & others in OSELS

23. FB Outbreak Identified FB Message Created States/CDC monitoring public health discover foodborne outbreak Symptoms Locations Event Information Guidance e.g. Consumption history message sits on a standalone knowledge repository Managing Emerging Events: Public Health EHR Alerting Flow

24. Visit the CDC Public Health Use Case Interoperability Demonstrations Use Case #3 – Biosurveillance Monitoring and Detection: “Updating and Leveraging National Healthcare Registries in Care Delivery” Use Case #4: Immunizations Registry Updating and Utilization - “Updating and Leveraging National Healthcare Registries in Care Delivery” Use Case #7 – “Cancer Care Coordination and Ambulatory Care Reporting to a Central Cancer Registry” Use Case #16: Maternal & Newborn Health – “Birth Event Reporting and Care Coordination for Newborn Hearing Screening” Us Case 5 Interoperability Showcase In collaboration with IHE

25. Thank You • Contacts: • CDC Standards & Interoperability: Nikolay Lipskiy, NLipskiy@cdc.gov • Cancer Reporting: Wendy Blumenthal, WBlumenthal@cdc.gov • Early Hearing Detection and Intervention: John Eichwald, JEichwald@cdc.gov • Vital Records Standards: Michelle Williamson, MWilliamson@cdc.gov • Immunization Information Systems: Warren Williams, WWilliams1@cdc.gov • PHIN VADS: Roochi Sharma, RSharma@cdc.gov • Email: phinvs@cdc.gov • Online Forum: http://www.phconnect.org/group/phinvads • National Healthcare Safety Network: Daniel Pollock, DPollock@cdc.gov • Clinical Decision Support: Nedra Garrett, NGarrett@cdc.gov • The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the • views of the Centers for Disease Control and Prevention For more CDC information please contact Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.atsdr.cdc.gov