southern nevada health district division of community healthapr 23, 2015 · huitz new york state:...
TRANSCRIPT
Southern Nevada Health District
Division of Community Health
Office of Public Health Informatics Cassius Lockett PhD, Director of Community Health
What is Health Informatics?
• Let us start by defining “informatics”
– Discipline focused on the acquirement, storage and use of information in a specific setting or domain
– More about managing information and people than technology
– Sometimes defined as an activity at the crossroads of people, information and technology
What informatics “is and isn’t”
Isn’t • Cross-training where basic
informational sciences meet a biomedical application domain (Nursing, Dental, Public Health, Medical, Translational, etc)
• Relentless pursuit of assisting people
• Tower of achievement – Business process
– System development
– System implementation
Is
• Scientist or clinicians tinkering with computers
• Analysis of large data sets
• Circumscribed roles related to deployment of EHR
• Profession of health information management
• Anything done using a computer
Meaningful Use Activities
Meaningful Use (MU) refers to provisions in the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act:
• Authorized incentive payments through Medicare and Medicaid to clinicians and hospitals that use electronic health records (EHRs) in a meaningful way to improve clinical care through EPs, EHs.
– Eligible Providers (Medicaid): 1) Physicians 2) Nurse Practitioner 3) Certified Nurse-midwife 4) Dentist 5) Physician Assistant in FQHC
– Eligible Providers (Medicare): 1)Doctor of Medicine or Osteopathy 2) Doctor of Optometry 3) Chiropractor 4) DDS or DDM 5) Doctor of Podiatry
• Stage 1-intended to capture data and share; Stage 2-focuses on advanced clinical processes (CDS, CPOE, etc); Stage 3-focuses on trying to improve outcomes
• MU did not incentivize Public Health to receive, process and make the data meaningful.
5
Meaningful Use Public Health Objectives
To improve public and population health (Data capturing and sharing):
All EPs and EHs must choose at least one of the public health measures to demonstrate Meaningful Use from a Menu Set (10 objectives). Stage 2 MU all three if possible.
• EPs– must choose reporting to immunization information systems or reporting syndromic surveillance to public health
• EHs– must choose reporting to immunization information systems, electronic reporting lab results to public health or reporting syndromic surveillance to public health
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7
Meaningful Use 3 (proposed rule)
Public Health and Clinical Data Registry Reporting
Standard EPs must report on at least 3 of the first 5, while EHs
report on 4 of the 6
EP, EH, CAH select from:
Measure 1
Immunization registry HL7 2.5.1
Measure 2
Syndromic Surveillance Reporting
2) BioSense 2.0 NDPBH/SNHD
Measure 3
Case Reporting FHIR, SDC, CDA SNHD RCKMS
Measure 4
Public Health Registry CDA release 2 EPs and EHs allowed to submit only measure 5, 4
Measure 5
Clinical Data Registry EPs and EHs allowed to submit only measure 5, 4
EH, CAH only select from:
Measure 6
Electronic Reportable Laboratory Reporting
HL7-2.5.1 SNHD ELR
Office of Informatics
Mission is to manage resources, health information and technology to create actionable data to improve the health of Southern Nevada
Office of Informatics
• 4 Corner Stones (aligned with MU) 1. Reportable Disease-EpiTrax(TriSano), RCKMS
2. Electronic Laboratory Reporting- TriSano and the SNPHL LIMS increased STD volume during FYE 2014
3. Healthcare integration-Electronic Health Records, Big Data, CCD, CDA, etc
4. Situational Awareness-BioSense 2.0 (National Syndromic Surveillance Program) and Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)
Office of Informatics
• EpiTrax (TriSano) 1. Reportable Disease-
RCKMS potential
2. ELC Grant focus on Electronic Laboratory Reporting
3. Result of significant increase in ELR volume during 2014 due to SNPHL LIMS connection 3488
8837
30032
83842
Total Non EHR 2013 Total Non EHR 2014 Total EHR 2013 Total EHR 2014
SNHD, Electronic Laboratory Reporting Volume from Electronic
Health Records (EHR), 2013 vs. 2014
Office of Public Health Informatics
• EpiTrax (TriSano)
1. Electronic Laboratory Reporting by Disease Category
61
136
160
798
1378
1666
14075
24894
40674
0 10000 20000 30000 40000 50000
TB
Zoonotic
VPD
Enteric
Other CD
Influenza
HIV
Hepatitis
STD
SNHD, Electronic Laboratory Reports by Disease Group, 2014
Office of Informatics
• Electronic Case Reporting: Reportable Condition Knowledge Management System (RCKMS) partnership with CSTE and CDC
1. Healthcare integration-RCKMS
• From the CSTE FOA:
– This CSTE Pilot is intended to support participation of public health agencies in a collaborative effort to represent Laboratory and Case reporting criteria in rules that can be consumed by an open source CDS and used to determine if a electronic laboratory report should be sent from the provider to public health.
RCKMS CDS FEASIBILITY MEETING On-Site Participants: February 24, 2015
Introductions
Jurisdictions Houston: Ryan Arnold, Biru Yang Illinois: Judy Kauerauf, Jennifer Vahora SNHD: Sony Varghese, C Lockett Virginia: Jeff Stover, Jane Moore, Marylyn Huitz New York State: Hwa-Gan Chang Florida: Janet Hamilton Oklahoma: Lauri Smithee PHII: Jim Jellison APHL: Eddie Gonzalez, Michelle Meigs ASTHO: Paula Soper, Marcus Rennick
Intermountain: Shan He, Darren Mann HLN: Noam Arzt, Daryl Chertcoff, Amy Moniz RCKMS Steering Committee Co-chairs: Rita Altamore (CSTE/WA DOH), Laura Conn (CDC), Catherine Staes (University of Utah) Members: Shu McGarvey (Northrop Grumman), Julie Lipstein (L3-Stratis), Denisha Abrams (Northrop Grumman) CSTE: Janet Hui, Meredith Lichtenstein
Facilitator: Jeff Benning, LIC
RCKMS Pilot Jurisdictions (Houston, SNV VA, IL, NY, NYC UT, CO, WA, DE)
PH Reporters
CDS Feasibility Demonstration Scope
Repository
Who, What, When, Where, How - Reporting Criteria
- Reporting Actions - Links
Structured Rules Logic
Hospital Labs (Intermountain)
LIMS
EHR
PH Reports
Value Sets Data Load
National, Clinical & Public Health Laboratories
LIMS
Ambulatory Care
EHR
OpenCDS - Reporting Criteria
* Green shows in-scope for Pilot
Subscription Management & Notifications
Reporting
Web Services
Syndromic Surveillance
• Syndromic surveillance is the use of pre-diagnostic information in a near real time fashion for further investigation for public health action.
• Pre-diagnostic information precedes the diagnosis for a disease.
• Pre-diagnostic conditions may include – Influenza like illness, rash, specific infection,
gastrointestinal, localized cutaneous lesion, neurological, hemorrhagic illness, severe illness/death, botulism like (sub-syndromes: descending paralysis, blurred vision, etc)
Office of Informatics
• Syndromic Surveillance 1. Situational Awareness-BioSense 2.0 (National Syndromic
Surveillance Program) and the Electronic Surveillance for the Early Notification of Community-Based Epidemics (ESSENCE)
2. Working with State to host John Hopkins University recent version of ESSENCE at SNHD
3. ESSENCE will provide granularity for producing illness related reports for example ILI (place, person, time)
Summary
• 4 Corner Stones (aligned with MU) 1. Reportable Disease-RCKMS
2. Electronic Laboratory Reporting- EpiTrax
3. Healthcare integration-Electronic Health Records, Big Data, CCD, CDA, etc
4. Situational Awareness- BioSense 2.0 and the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)
Issued that Remain to be Resolved?
• Interoperability
– Semantical
– Syntactical
• Case reporting
– RCKMS
• Health Care Integration
– CDA, FHIR, etc
• CDA, FHIR, SDC other standard?
Questions?