Bringing public health surveillance, monitoring, and response into the electronic age

1. Bringing public health surveillance, monitoring, and response into the electronic age This briefing has been developed under the auspices of Health Systems Research, Inc. under a contract with the Office of the National Coordinator, HHS Materials Developed in Consultation With: Thomas R. Frieden, M.D., M.P.H., & Farzad Mostashari, M.D., M.S.P.H., New York City Department of Health and Mental Hygiene John Loonsk, M.D., Office of the National Coordinator for Health Information Technology, HHS Leah Devlin, D.D.S., M.P.H., & Steve Cline, D.D.S., North Carolina Department of Health Edward Sondik, Ph.D., National Center for Health Statistics, HHS George Hardy, M.D., M.P.H. & Mary Shaffran, M.P.A., Association of State and Territorial Health Officials Laura Conn, M.PH., Centers for Disease Control and Prevention, HHS November 29, 2005

2. Scope and Boundaries of the Issue • Transformative potential of health IT for Public Health • Prevention-focused personal health records • Prevention-focused clinical decision support tools • Population-wide chronic disease management • Population-level quality monitoring • Public health surveillance

3. Possible Breakthroughs Potential IT breakthroughs for Public Health: • Strengthen existing public health IT systems • Promote the delivery of standardized health care data to public health for biosurveillance purposes • Build a nation-wide system that collects information from different jurisdictions and/or clinical facilities and enables both local and central analysis, alerts, and actions

4. Specific Biosurveillance Use-Case Transmit essential ambulatory care and emergency department visit, utilization, and lab result data from electronically enabled health care delivery and public health systems in standardized and anonymized format to authorized Public Health Agencies with less than one day lag time

5. Harmonized Use-Case • January 18, 2006 NHIN Contractors submit use-cases • March 19, 2006 AHIC releases harmonized use-case • June 29, 2006 HITSP releases draft standards for use-case • Oct 31, 2006 Data Sub Group releases minimum data set

6. AHIC Priority Issues (10/31/06) • Lack of central dissemination process for public health HIT standards • Privacy/ Security Concerns • Storage, retrieval, and management concerns of large amounts of data • Lack of EHR case reporting, adverse events, and electronic lab reporting (ELR) integration • Lack of interoperable bi-directional communication • Lack of EHR decision support to prompt • Immunization reminder • Prevention guidelines

7. Scope • “actions that are required to identify specific clinical care information used in the context of care and share these data with public health organizations to support Biosurveillance needs including initial event detection, situational awareness, outbreak management and response support” • Does not include how data are used by PH agencies (including alerts back to providers)

8. Scenario Flow

9. Ambulatory EHRs • NAMCS 2005 Survey: • 24% physicians reported using EHRs • Uncertainty in definition, includes full or partial • 3% annual increase • Higher rates with larger practices, HMOs • Lower rates in Northeast • Features: • Demographics reporting- 21% • Physician notes- 18% • Lab results- 17% • Public health reporting- 5%

10. PHDSC Use-Case • Focus on Ambulatory EHR- PH linkage • Includes public health investigation and response • Requirements Analysis Methodology • Generated by end-users, used by information system developers • Goals • Actors • Benefits to stakeholders • Use-case description (scenario) • Functions • Data Sources • Description of data flow and workflow • List of data elements • Standards needed • Process Issues encountered