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Ways, not places: Death certification from an EHR
Jeff Duncan, MS Utah Department of Health
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Email in 1992…Places
http://www.windley.com/archives/2012/03/ways_not_places.shtml
America OnlineMCI
Compuserve
Phil Windley 2012
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Evolution of Health IT …PlacesBilling EHR Rx
Laboratory (LIS)
Radiology (RIS)
EDRS
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Integrated Delivery systems such as Intermountain Healthcare…Ways
EHR Laboratory (LIS)
Radiology (RIS)
DOH
Payers
Health Information Exchange (HIE)
RxBilling
Clinical Workstation
Others
Internal Communications
External Communications
HL7
HL7
HL7
*Reportable Diseases* Immunizations
*Syndromic Surveillance
HL7
*Death Certification
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What is HL7?
• HL7 is…– An ANSI standards organization
– A family of standards for exchanging health information
HL7 v2 Message:
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What is in the DSTU?
• Message Structures– ADT^04—Add– ADT^08--Update– ADT^23--Delete
• Message Contents– Demographic fields for matching– Cause of death fields from death certificate
• Constraints– Which fields are optional, which fields are required
• Value sets—what values are allowed
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Intermountain’s EHR screen:
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2011 20122009 2013
CDC Pan Flu GrantUDOH received funding to create a death reporting interface with Intermountain.
Pilot testingImplemented at one Intermountain Clinic
HL7 Version 2.3 Interface Planning and DevelopmentInterface development and testing
DSTU Implementation
Pilot test expanded to Salt Lake City Metro Area
Timeline of events—UDOH-Intermountain Death Interface
2010
Upgrade to DSTUProject begins
HITECH act and Meaningful Use
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Certification Process
Business Rules-matching and merging-update / delete messages
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Advantages of certification through EHR
For Physicians:• No need to remember login and password to EDRS• Access to relevant clinical data• Potential for clinical decision support
For Public Health:(hypothesis)Engaging physicians within their workflow in the
EHR will:• Improve timeliness, completeness and accuracy of death
data • Engage more physicians in electronic death registration
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Challenges
• Ensure data semantic standards meet the needs of public health
• Ensure standards are flexible to meet the unique needs of individual jurisdictions
• Ensure data quality standards are met or exceeded
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Next Steps
DSTU implementation (July, 2013)
Testing for one year
Provide feedback to HL7 (July, 2014)
HL7 ballots and approves normative standard
Industry implements standard.
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Acknowledgements
• NCHS– Michelle Williamson
• Intermountain Healthcare Team– Jacob Tripp, PhD
• Utah Department of Health– Leisa Finch, EDR Coordinator
• Multidimensional Software Creations (MDSC)– Stephen Clyde, PhD– Mike Jolley, Project Manager
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Questions?
Jeff Duncan, MSPublic Health Informatics Program Manager
Office of Public Health InformaticsUtah Department of Health