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CDA State Pilot Project: Timeframe• Nov-Dec 2011 – Recruitment and Pilot Design
– DE (DHIN, DHIE, DPH)• HAI reporting via NHSN (national health & safety network)?
– CA? (Atlas Public Health)– Greenway Technology– Oz Systems
• Jan 2012- IHE Connectathon Testing• Feb 2012 – HIMSS Showcase (Lab/case reports for
TB, HAI)• January-April 2012 – Development• May 2012- Pilot
Clinical Document Architecture (CDA) Standard for Public Health (CDA for PH): Proposed Public Health Programs for CDA for PH Pilot Project:
•Biosurveillance (with focus on laboratory data for influenza; and reporting decisions)•Cancer •Early Hearing Detection and Intervention (EHDI) •Electronic Laboratory Reporting
oTBoHepBoFluoAntraxoTularemia
•Electronic Case Reporting (provider to local/state PH; and local/state PH to CDC)oTBoHepB oFluoAntraxoTularemiaoPlus 10 other conditions
o See CDA for Public Health Wiki Page:URL: https://wiki.phdsc.org/index.php/PH-Lab#PH-CDA_Templates_Work_List
•Public Health Case Reporting (from EMR - HIV or TB or Morbidity Report)
Action Items• Statement of Work for Participating State(s) – 12/15
– (Mark, Anna, Marshall, Terese, Nitin, Lisa)– DE Interoperability Model
• Pilot Scenario(s) (Lisa, Jib)– Criteria for selecting conditions (standards are ready to go, morbidity/mortality prevalence, other)– Conditions – to be decided by CSTE and States - 12/15
• HIMSS Demo Scenarios – 11/28• CDA Templates – Initial 02/2012
– (Sondra, Mark, Marshall, Anna, Nitin)– TB, HAI (Atlas!)
• Technical Advisory Group (TAG) for State Implementations– Define challenges to address– APHL TAG for PHLIP as examples– Advisors: Nitin (Oz Systems), Atlas, DE, Sondra’s team,
• Calls schedule: Dec 2 1-2pm ET. Every Other Friday 2-4 starting 12/9• Outreach/Communication Plan for the Project – Ongoing – Maiko/CSTE/APHL
For TAG Leader1. Pilot Overview Document explaining the pilot to be replicable in other states
and domains – May 20121. Outline= IHE Volume 1 Write-Up or IHE PCC Workflow Profile 2011-2012
(ereferal and telemonitoring) – Draft 1/161. State Specific Description - Draft 2/28
2. Design the Pilot Architecture diagram1. State Specific Diagrams - Draft 2/28
2. Recruit/Form state pilot workgroups1. Identify/recruit senders-receivers vendors, PH programs, IT support for actual
site (DE, CA, TX, WI, CT; HISPC 10state project model)2. Define roles of the TAG members in the pilot and unintended consequences
3. Work with state pilot workgroups to execute the pilot test – invite APHL PHLIP TAGs and others – Flu Labs
4. Align with other pilots in PH and with S&I PH Reporting Pilots
PH Reporting Technical Framework
ProviderEHR
laboratoryLIMS
Local or State PH Program
IS
HIE
Or
PH Communication
Server
For HL7 2.x messages:
Rhapsody to translate 2.x
messages and CDA
For CDA:RFD
NHIN ConnectXDS
DSUBNAV
Pseudonymize
Test Result
Test Result
Test Result
Case Report Case
Report
CDC PH Program
IS
Test Result
Case Report
Clinical Document Architecture (CDA) Standard for Public Health (CDA for PH):
Proposed State-based Pilot Project Schema : Scope: 1,2,3
Test Order
Test Order
1
23
ProviderEHR
laboratoryLIMS
Local or State PH Program
IS
HIEOr PH
Communication Server
For HL7 2.x messages:
Rhapsody to translate 2.x
messages and CDA
For CDA:RFD
NHIN ConnectXDS
DSUBNAV
PseudonymizeTest
Result
Test Result
Test Result
Case Report Case
Report
CDC PH Program
IS
Test Result
Case Report
Test Order
Test Order
1
23
4
Clinical Document Architecture Standard for Public Health (CDA for PH):Proposed Pilot Schema: DELAWARE
ProviderEHR
(Core CX360)
CCDContent to
Pre-populate TB Case Report
Delaware PH Communication Server/Router
(Orion Rhapsody)
LaboratoryLIMS
(Labware)CDA
TB Lab Report
Form Manager
(OZ)
CDA TB Case Report
CDA TB Lab Report
CDA for Public Health Pilot ProjectPublic Health Reporting Schema: DELAWARE - FINAL
ProviderEHR
(Core CX360)
CDA TB Case Report
Delaware PH Communication Server/Router
(Orion Rhapsody)
CDA TB Case Report
Delaware Electronic Reporting
Surveillance System(DERSS)
Clinical Document Architecture Standard for Public Health (CDA for PH): Proposed Pilot Schema: SAN DIEGO
ProviderEHR
(GMT?, McKesson?Allscript?,Cerner?)
San Diego PH System
(Atlas)
PH Infrastructure
/ Form Manager
(Atlas)
CDAPertussis
Case Report
CCDContent to
Pre-populate Pertussis
Case Report
Clinical Document Architecture Standard for Public Health (CDA for PH): Proposed Pilot Project Schema: SAN DIEGO - FINAL
Public Health Infrastructure
or HIE
Form Manager
(Oz Systems)
CDAPertussis
Case Report
ProviderEHR
(Allscripts, Test Harness)
CCDContent to
Pre-populate Pertussis
Case Report
SDCPH-IS
(Atlas Public Health)
Clinical Document Architecture Standard for Public Health (CDA for PH): Proposed Pilot Project Schema: NEW YORK STATE
Form Manager
(?)
PertussisCDA Case
ReportProvider
EHR•Connexin •Medent
CCDContent to
Pre-populate Pertussis
Case Report
NYS PH System•UPHN,•Rochester RHIO (Axolotl)•THINC (GSI)
Clinical Document Architecture Standard for Public Health (CDA for PH): Proposed Pilot Project Schema: NEW YORK STATE - FINAL
Public Health Infrastructure
or HIE
Form Manager
(Oz Systems)
CDAPertussis
Case Report
ProviderEHR
(Connexin)
CCDContent to
Pre-populate Pertussis
Case Report
NYS PH-IS
(UPHN)
User Story: State-Specific Story, Condition-Specific, User Story: State-Specific Story, Condition-Specific, Setting SpecificSetting Specific
Communicable Diseases, Outpatient FlowPatient, Provider/Physician, Laboratory, PH agency
1. Patient comes to Physician with symptoms of a disease.2. Physician provides clinical examination and assesses medical history. If
patient’s symptoms require PH reporting w/o waiting for lab results, sends a report to PH agency.
3. Physician orders lab and any diagnostic tests. Office staff takes samples and sends them to Laboratory. Any diagnostic tests are performed.
4. Laboratory performs ordered tests on received specimens. 5. Laboratory send results to Physician and PH agency (if needed)6. Physician re-examines clinical findings/diagnostic results and lab results;
sends report to a PH agency.7. Electronic message validated by PH agency/information system8. Electronic confirmation was sent from PH agency to Provider9. PH agency links lab report and case report to single individual.
User Story Names:Actors:
Flow of Events:
Pre-conditionPost-condition
Preferred Timing for Each Event Type
EHR SystemPublic Health Agency’s Information System
3-3 Setting: Provider (PCP) LWF Order Placer XD*Lab (option) Content Creator
AND XPHR or EDR or XDS-MS (Referral Option) Content Creator
AND RFD Form Filler AND SVS (option) Value Set Consumer
3-6 Setting: Public Health State Disease Surveillnce
XD*Lab Content Consumer
C32/CCD (XDS, Direct) Content Consumer
RFD Form Receiver
3-5 Setting: Public Health Infrastructure
SVS Value Set Repository ----- RFD Form Manager
3-2 Setting: Lab LW F Order Filler
OR XD*Lab Content Creator
(XDS.b) 3-4 HIE
Infectious Disease Surveillnce XD*Lab Content Creator
C32/CCD (XDS, Direct) Content Creator
(XDR)
3-1 Setting: Provider (PCP) LWF (or talking point) Order Placer
HIMSS Interoperability Showcase: Public Health Reporting Use Case
1
2
3
Scope: 1,2,3
ProviderEHR
laboratoryLIMS
Local or State PH Program
IS
HIE
Or
PH Communication
Server
For HL7 2.x messages:
Rhapsody to translate 2.x
messages and CDA
For CDA:RFD
NHIN ConnectXDS
DSUBNAV
Pseudonymize
Test Result
Test Result
Test Result
Case Report Case
Report
CDC PH Program
IS
Test Result
Case Report
Clinical Document Architecture (CDA) Standard for Public Health (CDA for PH): Proposed State-based Pilot Project Schema
Test Order
Test Order