The Standards and Interoperability Framework Public Health-Reporting Initiative

Establishing collaboration on harmonization of standards for electronic public health reporting

Riki Merrick, APHLAnna Orlova, PhD, PHDSC

Lise Stevens, FDANikolay Lipskiy, 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.

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

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

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 EHRsHarmonization / alignment of data elements across

different Public Health Agencies (domain specific)

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

Provider EHR Local/State/Federal PH

Provider - Initiated Report

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)

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

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

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)

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

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

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

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 (4th Qtr)

Phase 1 Phase 2

User Story / Use Case Development

Phase 1 Phase 2

2/29 3/14 3/28 4/11 4/25 5/9 5/232/152/11/171/3

Standards Analysis and Selection; Data Dictionary; DAM

Pilot Readiness Assessment

6/6 6/20 7/4 7/18 8/1 8/15

Implementation Guide Development

Public Comment

Public Comment - CLOSED

Public Comment

Communication / Outreach

Functional Requirements / Data Element Requirements / IE Requirements

PHRI – Use Case /Standards Harmonization / Specification

You Are Here

Courtesy of John Stinn

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

Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct

Initiation

PHRI - Roadmap

2011

2012

User Story Validation Use

Case Documentation

FR / Modeling

Stds Harm

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

Spec Develop.

Reference Implementatio

n Pilot

Evaluation for

Certification

Courtesy of John Stinn

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