S&I Public Health

*We will start the meeting 3 min after the hour

February 10th, 2015

This meeting is being recorded and un-paused and will be available via the wiki

*Please mute your phone when not speaking to assist with background noise.

Agenda

• Updates – A Shared Nationwide Interoperability Roadmap– Interoperability Standards– HIT Policy Committee Meeting– PHTT Education Meetings– SMART Links 

A Shared Nationwide Interoperability Roadmap• Connecting Health and Care for the Nation: A

Shared Nationwide Interoperability Roadmap Draft Version 1.0

– http://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf– http://www.healthit.gov/policy-researchers-implementers/interoperability-roadmap-public-comments

• Public comment period ends at April 3, 2015 at 5PM.

• Discussed in detail at the Joint HIT Committee Meeting 2/10/2015 (ongoing during this meeting)

– http://www.healthit.gov/facas/calendar/2015/02/10/joint-hit-committee-meeting

Principles of Interoperability

2015 Interoperability Standards Advisory

• http://www.healthit.gov/standards-advisory• Of particular interest

– Section II: Best Available Content/Structure Standards and Implementation Specifications

– Section III: Best Available Transport Standards and Implementation Specifications

– Section IV: Best Available Standards and Implementation Specifications for Services

HIT Policy Committee Meeting (past)

• Past meeting• HIT Policy Committee Virtual• Meeting Date: Tuesday, January 13, 2015, 9:30

am to 3:00 pm• http://

www.healthit.gov/FACAS/calendar/2015/01/13/hit-policy-committee-virtual

• Public Health focused presentations• Outcome: Formation of a joint HITPC/HITSC public

health workgroup

Joint HITPC/HITSC Meeting

• Going on at this moment• Reviewing the Shared Nationwide

Interoperability Roadmap• Live link and recording/slides etc. at

– http://www.healthit.gov/facas/calendar/2015/02/10/joint-hit-committee-meeting

PHTT Education Committee

• February 4th

– “Lessons learned (and being learned) in the implementation of EHR in British Columbia”

– Elizabeth Kinney, Manager, Research Policy, Provincial Health Services Authority (PHSA), Vancouver BC

• Next education meeting - March 4th 2015th– “The AHIMA framework for Information Governance in

Healthcare”– America Health Information Management Association

(AHIMA)– Deborah K. Green, RHIA, MBA

SMART Links

• SMART– http://smartplatforms.org/

• SMART on FHIR– SMART "Classic" is being transitioned to support-only

mode as we continue new development on SMART on FHIR.

– http://docs.smartplatforms.org/

• SMART on FHIR Sandbox– http://docs.smartplatforms.org/sandbox/

Public Health and Patterns (working title)

• Goal: Elicit HIT Vendor thoughts• Drive discussion at the Public Health EHR

Vendor Meeting next week• Present public health use cases as patterns and

in examples • Use as a means for HIT developers to prepare a

gap analysis against technologies and standards• Always aligning towards standards and

interoperability

A common general pattern

• A “Case” centric pattern– Identify an individual– Gather additional data– Ongoing follow-up

• There are other patterns, including, but not limited to, those that monitor populations for disease, syndromes, care, utilization; patterns that support screening programs (hearing, cancer, heart disease).

Identify an individual

• Person has a clinical diagnosis of “x”• Person has a laboratory confirmed diagnosis of

“x”• Person has a laboratory order for suspect “x”• Person has new diagnosis code(s) that indicates

“x”• Person has a prescription (or prescription

pattern) that indicates “x”• Person is a contact of another person

Gather additional data (reporting)

• Specific points differ by disease/syndrome• Additional variance by jurisdiction • Some data points will be in common• Currently often passive• The provider may know and initiate• The provider may not know and require “a prompt”

– This is not to imply an immediate prompt or pop-up on a screen

• Slides after here were not covered

A Public Health Program

• Program Description

• Jurisdiction X has designed a community-based intervention to help those with chronic conditions. Community educators have been recruited and trained in culturally adapted interventions that will be based in the community in churches and social organizations as appropriate.  The primary focus will be education for individuals with Type II diabetes that are having difficulty controlling their labs.

• The program will be implemented in community health centers as well as participating group practices in the catchment area. The EHRs of the participating clinics and providers have been configured to utilized existing software tools based on the S&I framework. 

• The program’s primary use case are Identify and Recruit Participant, Enroll Participants and Notify Public Health Agency, and Track Participants.

Use Case 1: Identify and Recruit Participant

 • Actors: Provider, Patient, PHA (CDS system)

• Description: Prior to, or at the beginning of, a clinical encounter patient’s demographic information, problem list and recent lab results are passed to a Clinical Decision Support tool hosted by the PHA. Should the information indicate Patient is a candidate for inclusion in the program the EHR indicates that fact to provider as well as specific information about the candidate program. Provider counsels patient as needed.  

• S&I Connection: CDS used to identify and recommend program participants   

Use Case 2: Enroll Participants and Notify Public Health Agency

• Actors: Provider, Patient, PHA (system - forms repository,  receipt of data)

• Description: Provider indicates a patient’s willingness to participate (after UC1). EHR utilizes SDC functionality to get the participation form definition from the form repository, render the form prefilled with patient information and the suggested program location, provider fills in additional information, and information is transmitted to PHA. 

• S&I Connection: SDC model used to render forms with merged data and return to PHA   

Use Case 3: Track Participants

• Actors: System Use Case (primarily) EHR and PHA

• Description: As patient has additional clinical encounters at clinic or provider, clinical information are persisted in EHR. At desired intervals a DAF model is used to query for participants. This tracking continues post-program to gather longitudinal results.  Perhaps de-identified patient information from similar individuals in clinic or providers patient panel are used as control group.      

• S&I Connection: DAF model used to gather longitudinal data set  

• Other Use Cases: Program Participation - as individual attends program participation information is documented outside of this “system” at PHA.

S&I Public Health Contact Information

ONC Public Health Lead: Dan Chaput (daniel.chaput@hhs.gov)

CDC Public Health Lead: John M. Saindon (uzn0@cdc.gov)

PHTT Wiki Page: http://wiki.siframework.org/Public+Health+Tiger+Team

SDC Wiki Page: http://wiki.siframework.org/Structured+Data+Capture+Initiative

DAF Wiki Page: http://wiki.siframework.org/Data+Access+Framework+Homepage

CQF Wiki http://wiki.siframework.org/Clinical+Quality+Framework+Initiative

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

Weekly PHTT Meeting Info (Tuesdays):• Time: 2:00pm - 3:00pm Eastern• URL: https://siframework1.webex.com/• Dial-In Number: 1-650-479-3208• Access Code: 665 131 907