nikolay lipskiy, md, drph, mba

Nikolay Lipskiy, MD, DrPH, MBAModerator - CDC

E10: Working towards Health It Standards for Public Health Reporting:

Report From the Public Health Laboratory Results Workgroup of the

ONC S&I Framework

Riki Merrick, MPHAssociation of Public Health Laboratories/ iConnect

Consulting Anna Orlova, PhD

PHDSCBill Brand, MPH

Public Health Informatics Institute

Panel Outline

1. ONC Standards & Interoperability (S&I) Framework, Laboratory Results Interface (LRI) Initiative : Public Health Laboratory Result Workgroup

2. S&I Community Led Public Health Reporting Initiative: Charter

3. Q&A and Discussion on Selecting Use Cases for the S&I Public Health Reporting Initiative

American Recovery and Reinvestment Act (ARRA)

Feb 17, 2009 – signed ARRA includes Health Information Technology

for Economic and Clinical Health Act (the HITECH Act) for advancing the meaningful use (MU) of health information technology (HIT) to improve quality of care and establish a foundation for health care reform

ARRA created 2 Federal Advisory Committees:• Health IT Policy Committee• Health IT Standards Committee

http://www.recovery.gov/About/Pages/The_Act.aspx

American Recovery and Reinvestment Act (ARRA)

Meaningful Use (MU) of HIT and Public HealthIn 2010 HIT Policy and HIT Standards Committees

identified three types of public health reporting that were adopted for Stage 1 of the HITECH-funded CMS Incentive Program:

Capability to submit electronic data to public health agencies for

syndromic surveillance immunization registries reportable (as required by state or local law) lab

resultshttp://www.recovery.gov/About/Pages/The_Act.aspx

About ONC S&I Framework

Office of the Chief Scientist

National Coordinator for Health IT

Office of Economic Analysis & Modeling

Office of the Chief Privacy Officer

Deputy National Coordinator for

Operations

Deputy National Coordinator for

Programs & Policy

Office of Policy & Planning

Office of Standards & Interoperability

Office of Provider Adoption Support

Office of State & Community Programs

• 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.

ONC S&I Framework

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

ONC S&I Framework An S&I Initiative focuses on a single challenge

with a set of value-creating goals and outcomes that will enhance efficiency, quality and effectiveness of the delivery of healthcare, through the development of content, technical specifications and reusable tools and services.

Current Initiatives include:• Transition of Care (TOC)• Lab Results Interface (LRI)• Provider Directory• Query Health

http://wiki.siframework.org

http://wiki.siframework.org/

ONC S&I Lab Results Interface (LRI) Initiative

Mission:

To enable ambulatory primary care physicians to receive and meaningfully use standardized structured electronic lab results

Focus: Establish the nationwide Implementation Guide for electronic

submission of Lab Results to Ambulatory EHRs Build on existing HL7 2.5.1-based lab reporting guides Incremental approach: ambulatory use case today, others later

Initiative Objectives: EHR and LIS vendors agree that they can implement and use the

IG while minimizing intermediaries, customization and translation

Providers adopt EHRs that conform to the LRI IG, facilitated by Meaningful Use, State HIEs, RECs, and broad product availability 1Office of National Coordinator for Health IT (ONC). Standards and Interoperability (S&I) Framework..The Lab Results

Interface (LRI) Workgroup’s Public Health Laboratory Reporting Sub-Workgroup. http://wiki.siframework.org/Lab+Results+Interfacte+(LRI)+Initiative

http://wiki.siframework.org/

ONC S&I Lab Results Interface (LRI) Initiative

LRI Initiative Working Groups Use Case and Requirements Architecture and Implementation Requirements Vocabulary Implementation Guide (IG) Analysis Public Health Laboratory Results Pilots Validation Suite

ONC S&I LRI Public Health Laboratory Results Workgroup

Purpose Outline the path forward that will harmonize the laboratory data

exchange between public health and clinical care with the Lab Reporting Interface specification.

Develop roadmap to incorporate the Public Health HL7 implementation guide and define a path forward for harmonization.

Deliverables Public Health Abbreviated use case2

Required elements in ELR guide table3

Guide variance analysis including ELR guide4

• 1Office of National Coordinator for Health IT (ONC). Standards and Interoperability (S&I) Framework..The Lab Results Interface (LRI) Workgroup’s Public Health Laboratory Reporting Sub-Workgroup. URL: http://wiki.siframework.org/LRI+Public+Health+Lab+Results+WG

• 2http://wiki.siframework.org/file/view/HHS_ONC_Public%20Health%20Reportable%20Lab%20Results%20_Abbreviated%20Use%20Case_FINAL_v%201%200_061511.docx

• 3http://wiki.siframework.org/file/view/ONC_PH_RequiredFieldsinELR251_DRAFT_v0.3.xls• 4http://wiki.siframework.org/file/view/LRI%20Matrix%20Including%20Public%20Health

http://wiki.siframework.org/LRI+Public+Health+Lab+Results+WG

S&I Framework Lab Results Interfaces (LRI) Initiative: Outcomes and Next

StepsOutcomes:

Consensus on new HL7 2.5.1-based IG, with some elements of HL7 2.6/2.7 pre-adopted (balloting expected in September)

IG approach enables flexibility for future harmonization with ELR Guide, while using “profiles” to enable constrained guidance today

Consensus on use of SNOMED CT & LOINC as vocabularies Use of UCUM vocabulary for Units of Measure and SNOMED for

specimen information is subject to pilots Presented findings to HIT Standards Committee for consideration

as a recommended standard for Meaningful Use Stage 2Next Steps:

Limited Production Implementations (“pilots”) planning underway

Community-driven PH effort has formed, and is focused on creating a charter that will be presented to ONC in September.

S&I LRI Initiative Wiki Screenshot

http://wiki.siframework.org/Lab+Results+Interface+%28LRI%29+Initiative

ONC S&I LRI Public Health Laboratory Results Workgroup Identifies the Need

for an New Initiative During the June S&I Face-to-Face meeting the LRI

Public Health Laboratory Results Workgroup recognized the need for harmonization of Health IT standards for data exchanges for public health programs beyond three public health domains in MU Stage 1 warranting the creation of a new community led initiative on Public Health Reporting

Office of National Coordinator for Health IT (ONC). Standards and Interoperability (S&I) Framework..The Lab Results Interface (LRI) Workgroup’s Public Health Laboratory Reporting Sub-Workgroup. URL: http://wiki.siframework.org/LRI+Public+Health+Lab+Results+WG

http://wiki.siframework.org/LRI+Public+Health+Lab+Results+WG

S&I Community Led Public Health Reporting Initiative

Purpose:The purpose of the community led initiative is to gather Public Health Reporting experts to determine the scope for a potential Public Health Initiative, based on the needs of the Public Health Community. Once the scope and charter have been determined, it will be presented as a potential S&I initiative to stakeholder agencies (e.g., ONC, CDC, and possibly others) in an effort to obtain agency support for addressing initiative objectives.

Charge:The S&I community led Public Health Reporting Initiative will develop and implement a standardized approach to electronic public health reporting from electronic health record (EHR) systems to local, state and federal public health programs that addresses the needs of several different reporting use cases, with the long-term goal of reducing the difficulty (to both providers and public health agencies) of implementing electronic versions of the broad spectrum of public health reporting. http://wiki.siframework.org/Public+Health+Reporting+Initiative

Proposed S&I Public Health Reporting Initiative

Addressing Interoperability Challenges: Lack of harmonized activities to enable electronic data

exchange between clinical and population care and across public health agencies

No consistent unified practice on reporting public health cases/events and patient safety, product safety/ effectiveness events

http://wiki.siframework.org/Public+Health+Reporting+Initiative


Addressing Interoperability Challenges (Continued): Actions are needed for:

• A Unified Approach for harmonization of public health business processes and functional requirements for public health information systems; and

• Inclusion of Public Health in the full array of activities under the S&I Framework (standards harmonization and testing; standards-based product certification and deployment )



Goal:

The goal of the community led S&I Public Health Reporting Initiative is to harmonize HIT standards and implementation guides for bi-directional communication between clinical care and public health entities for selected use cases. http://wiki.siframework.org/Public+Health+Reporting+Initiative


Public Health Domains (Programs)The public health domains that will be

considered may include but are not limited to: Maternal and child health (e.g., early hearing detection and

intervention (EHDI); vital records) Communicable diseases Chronic disease (e.g., cancer, diabetes) Immunization Injury Occupational safety and health Adverse event reporting (drugs, biologics, devices, tobacco,

foods) Medical countermeasures and emergencies Surveillance (e.g., syndromic surveillance, biosurveillance,

surveillance administered by FDA)


Timeframe:

The S&I Public Health Reporting Initiative will operate starting October 2011 through December 2013 and will strive to deliver deliverables for timely consideration of the HIT Standards Committee during FY 2013 for MU Stage 3



Scope:At first, the Initiative will focus on individual-patient reporting from EHR systems and patients/consumers to public health agencies (local, state and federal) for the Initial Case reports.


Provider EHR Local/State/Federal PH

Initial Case Report


Milestones:

The S&I Public Health Reporting Initiative will examine several reporting use cases that share similar business

processes, information exchange requirements and data requirements

Select and harmonize standards, develop harmonized implementation guide(s), reference implementation(s) (testing) and certification criteria and processes for these use cases to be considered for MU Stage 3

identify a few sites to pilot test artifacts from this Initiative including the deployment of certified HIT products to enable interoperability of EHRs and public health information systems

develop a Roadmap for HIT Standardization for public health reportinghttp://wiki.siframework.org/Public+Health+Reporting+Initiative


Milestones (Continued):In the first three months (Fall 2011) the Initiative will focus on: Building a Consensus on Public Health Reporting Definitions Building a Consensus on Public Health Reporting HIT

Standardization Framework Assessing Various S&I Initiatives in which public health has to

be involved and designate representatives to these initiatives Selecting Priorities & Establishing Timeline for short-term

(ready by December 2013) and longer-term harmonization and testing of standards and specifications for public health reporting, and

Developing a Detailed Workplan for the Initiative activities in 2012-2013.



Examples of Standards: Data Standards (Vocabularies & Terminologies, e.g. LOINC,

HL7, SNOMED, UCUM, X12) Information Content Standards (HL7 Reference Information

Model (RIM)/Federal Health Information Model (FHIM)) Information Exchange Standards (e.g. HL7 V2.x; HL7 CDA,

ICSR V3.0) Privacy & Security Standards Identifier Standards (e.g. NPI) Functional Standards (IHE, HL7) Business Process Standards (e.g. BPMN, BPEL, UML) Interoperability Specifications (ONC S&I guides, HITSP, IHE

Profiles)http://wiki.siframework.org/file/view/Charter%20Template_PH_Reporting_080911.pptx – templatehttp://wiki.siframework.org/file/view/PH_Reporting_Initiative_Charter_Draft_072711.docx - word document

http://wiki.siframework.org/file/view/Charter%20Template_PH_Reporting_080911.pptx

http://wiki.siframework.org/file/view/PH_Reporting_Initiative_Charter_Draft_072711.docx


Proposed Stakeholders Centers for Disease Control

and Prevention (CDC), DHHS US Food and Drug

Administration (US-FDA), DHHS

Agency for Healthcare Quality and Research (AHRQ), DHHS

Health Resources and Services Administration (HRSA), DHHS

ONC Initiatives including Federal Health Interoperability Modeling and Standards Initiative /FHA/FHIMS, S&I Framework Initiatives (TOC, LRI and others)

State Public Health Departments and Laboratories

Public Health Data Standards Consortium (PHDSC)

Public Health Informatics Institute (PHII)

Joint Public Health Informatics Task Force (JPHIT)

Association of Public Health Laboratories (APHL)

Association of State and Territorial Health Officials (ASTHO)

Council of State and Territorial Epidemiologists (CSTE)

International Society for Disease Surveillance (ISDS)

National Association of City and County Health Officials (NACCHO)


Proposed Stakeholders (Continued) American Immunization

Registry Association (AIRA) American Clinical Laboratory

Association (ACLA) North-American Association of

Central Cancer Registries (NAACCR)

American Health Information Management Association (AHIMA)

National Association of Health Data Organizations (NAHDO)

Health Information and Management Systems Society (HIMSS)

Standards Development Organizations and Standardization Entities, e.g., Health Level Seven (HL7), Integrating the Healthcare Enterprise (IHE), Clinical Data Interchange Standards Consortium (CDISC) and other

EHR Vendors Association Laboratory Information

Systems Vendors Association Others

http://wiki.siframework.org/file/view/Charter%20Template_PH_Reporting_080911.pptx – templatehttp://wiki.siframework.org/file/view/PH_Reporting_Initiative_Charter_Draft_072711.docx - word document

http://wiki.siframework.org/file/view/Charter%20Template_PH_Reporting_080911.pptx

http://wiki.siframework.org/file/view/PH_Reporting_Initiative_Charter_Draft_072711.docx


Charter Developed by the S&I Initiative Group (Sprint Team) during July-August, the Charter describes the Initiative


Proposal for the ONC S&I

Public Health Reporting Initiative

Charter


PARTICIPATE in the Public ReviewAugust 19 – September 5


Proposal for the ONC S&I

Public Health Reporting Initiative

Charter


PARTICIPATE in the Public Review

Meetings with Public Health Stakeholders

General Public Health AudienceCDC Public Health Informatics Conference, August 21-24, 2011

Session E10, Tuesday 1:30-3:00pm

Public Health Professional Associations Joint Public Health Informatics Task Force (JPHIT) Meeting, September 20-21, 2011


Timeline to Launch the InitiativeActivity Date Deliverable

1st Call of the Initiative Group 07-27-11 1st Draft Charter2nd Call of the Initiative Group 08-10-11 2nd Draft Charter3rd Call of the Initiative Group 08-16-11 Charter for Public

CommentsRelease Charter for Public Comments

08-19-11 Public Comments

Public Comments Period Ends 09-05-11 List of Public Comments4th Call of the Initiative Group 09-07-11 Comment Reconciliation5th Call of the Initiative Group 09-14-11 Comment ReconciliationFinalize the Charter based on Public Comments

09-26-11 Final Charter

Submit the Charter to ONC 09-28-11 Final Charter

Potential Use /Business Cases

Proposed S&I Public Health Reporting Initiative Wiki

http://wiki.siframework.org/Lab+Results+Interface+%28LRI%29+Initiative


Participate in Public Review and

Join the S&I Initiative Group to Finalize the Charter

E-mail to Wendy Scharber at [email protected] http://wiki.siframework.org/Public+Health+Reporting+Initiative

mailto:[email protected]

nikolay lipskiy, md, drph, mba

Documents