Public Health: Case-Reporting, Biosurveillence , and Immunization Tracking

1. MONDAY, 3:30 – 3:50 PM Public Health: Case-Reporting, Biosurveillence, and Immunization Tracking Bryant T. Karras, MD, Public Health Informatics Officer, Sr Epidemiologist, State of Washington, Department of Health Rebecca A. Hills, MSPH, University of Washington

2. Meaningful Use to Improve Population and Public Health (3 of the 27 CMS objectives and measures) • Hospital Capability to provide electronic submission of reportable lab results, as required by state or local law, to public health agencies and actual submission where it can be received • Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice • Capability to submit electronic data to immunization registries and actual submission where required and accepted Source Office of E-Health Standards and Services,Centers for Medicare & Medicaid Services (CMS) HIMSS 2010

3. Population and Public Health Scenarios Demonstrated Case Reporting and Decision Support Biosurveillance Immunization HIMSS 2010

4. Introduction • The HIE project • Washington State DOH, CDC, INHS • This presentation • Public Health’s role in Health Information Exchange (HIE) • Meaningful Use and Public Health • The scenarios demonstrated in the Interoperability Showcase • Case Reporting and Decision Support • Biosurveillance • Immunization • Meaningful use as demonstrated in these scenarios HIMSS 2010

5. Public Health – 10 Essential Services 1.Monitor 2.Diagnose and investigate 3.Inform, educate 4.Mobilize 5.Develop policies and plans 6.Enforce 7.Link 8.Assure 9.Evaluate 10.Research HIMSS 2010

6. Meaningful Use • Through provisions of ARRA there will be incentives for “meaningful use” • Meaningful use of EHR technology will improve health care quality, efficiency and patient safety. HIMSS 2010

7. Public Health and Meaningful Use • How can public health leverage electronic information? • Many of the meaningful use criteria are related to public health functions • These demos show examples of how public health can leverage electronic information HIMSS 2010

8. The HIE Project and the Interoperability Showcase • HITSP identifies existing standards • Integrating the Healthcare Enterprise (IHE) • Incorporates HITSP standards into interoperability profiles • Interoperability Showcase • WA participating since 2006 HIMSS 2010

9. Population and Public Health Scenarios Demonstrated Case Reporting and Decision Support Biosurveillance Immunization HIMSS 2010

10. Case Reporting and Decision Support • The story - Patient with influenza-like-illness visits provider, case is reported to public health, decision support is offered • Standards used (RFD, CCD, Xforms) • Facilitates communication between PH and provider • Meaningful use • Record demographics, medications, vital signs • Capability to provide electronic submission of reportable lab to public health agencies • Implement clinical decision support rules HIMSS 2010

11. Case Reporting and Decision Support • For 2011 MU requirements limited to electronic submission of reportable labresults to public health agencies • By 2013 and 2015 will include more interactive public health alerts and ultimately more sophisticated epidemiological uses of the data including automated real-time adverse event reporting, disease outbreaks, and bioterrorism response. • Bi-directional communication (Brian Dixon from Regenstrief will present on this in detail - 12:30 Tuesday) HIMSS 2010

12. Population and Public Health Scenarios Demonstrated Case Reporting and Decision Support Biosurveillance Immunization HIMSS 2010

13. Biosurveillance • The story – patient with ILI symptoms visits PCP, lab is ordered and results recorded in the HIE’s registry and repository • The standards used (XDS document sharing) • PH query developed to identification of results of interest to public health • Meaningful use • Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice. • Electronically record, store, receive and manage laboratory orders HIMSS 2010

14. International Society for Disease Surveillance (ISDS)National Level – Distribute age-specific (TERS) Temporal Epidemic Response Surface plots HIMSS 2010

15. Biosurveillance Adding a regional level HIE doubled our surveillance area Original Surveillance Combined WA Biosurveillance Coverage Rate New INHS HIMSS 2010

16. Population and Public Health Scenarios Demonstrated Case Reporting and Decision Support Biosurveillance Immunization HIMSS 2010

17. Immunization • The Story • A parent accesses her child’s immunization record using a PHR, and sees the same data as the PCP • The Immunization Information System (IIS/Registry) is updated when messages from EHR systems are sent to the HIE registry repository, and are transformed to HL7 2.X messages • Public health accesses the IIS for individual and population views of the data • The standards and profiles used • Cross Enterprise Document Sharing (Immunization Content) • Patient Demographic Query HIMSS 2010

18. Immunization – Meaningful Use Meaningful Use • ImprovePopulation & Public Health • Capability to submit electronic data to immunization registries and actual submission where required and accepted • Demonstrates two types of immunization content submission to IIS ( HL7 2.5 and XDS-MS, IC ) • Engage patients and families in their health care • Provide patients with electronic copies of their health information • Improve Care Coordination • Capability to exchange key clinical information HIMSS 2010

19. Population and Public Health Scenarios Demonstrated Case Reporting and Decision Support Biosurveillance Immunization HIMSS 2010

20. Demonstrating Meaningful use of EHR • Often more than one way to satisfy these criteria depending on states • Important to examine the way work is done now and how workflow will change if these data are made available • Public Health systems designed to leverage EHR data will also need to comply with standards • We have learned much and continue to learn from our demonstration and pilot projects in Washington State HIMSS 2010

21. Thank You • CDC Funding • Thanks • Bill Lober, Debra Revere (University of Washington) • David Dobbs (Contractor) • Charley Magruder(CDC) • Contact Information • Bryant T. Karras MD - Bryant.Karras@DOH.WA.GOV • Rebecca Hills - hillsr@uw.edu HIMSS 2010

22. References • Hills RA, Lober WB, Painter IS. Biosurveillance, Case Reporting, and Decision Support: Public Health Interactions with a Health Information Exchange. Lect Notes Comput Sci. Biosecure. 5354, pp 10-21, 2008. • Close N, Lofy K, Sandifer T, Lowe P, Karras BT. Utilization of Washington State’s Public Health Emerging Event Detection System (PHEEDS) for 2009 H1N1 Surveillance. ISDS conference, 2009 *Participate the population health focused tours offered at the Showcase! HIMSS 2010

23. The participation of any company or organization in the NHIN and CONNECT area within the HIMSS Interoperability showcase does not represent an endorsement by the Office of the National Coordinator for Health Information Technology, the Federal Health Architecture or the Department of Health and Human Services. Thank You