Public Health Data Standards Consortium phdsc

1. Public Health Data Standards Consortiumhttp://www.phdsc.org “

2. PUBLIC HEALTH DATA STANDARDS CONSORTIUM~ PHDSC 2012 ANNUAL BUSINESS MEETING ~ November 8-9, 2012, Hyattsville, MD NEXT STEPS: Towards Public Health Sector Transformation and Sector Unity Report from Data Standards Committee Maiko Minami HLN Consulting, LLC Public Health Data Standards Consortium maiko@hln.com

3. Data Standards Committee Overview Co-Chairs: Robert Davis, Starla Ledbetter • Subcommittees • Health Care Services Data Reporting Guide (HCSDRG) - Chair: Robert Davis • Payer Typology - Chair: Roxanne Andrews • Oversees activities - Implementation of Business Use Case: HIT Standards Web-Resource Center

4. PHDSC & Strategic Plan Overview Disease-Based Model of Care Health-Based / LHS Model of Care Catalyst • PHDSC • Build “Coordinated Voice” from • Public Health for HIT Standards • Bring Voice to HIT Standardization Efforts • Achieve Interoperability of Public Health & Healthcare Systems Mission Partner with Stakeholders Align System Functionality with PH needs EnableSystem Interoperability via HIT Standards Objectives

5. Strategic Initiatives Tasked to Data Standards Committee Strategic Initiative 1 Unify PH to Support Health-Based Model (HBM) / Learning Health System (LHS) • Goal • Align data gathering practices across PH using standards-based Information Systems (IS) • Objectives • Advocate need for transformation and migration • Form PH Transformation Coalition

6. Strategic Initiatives Tasked to Data Standards Committee Strategic Initiative 2 Unify PH Information Systems • Goal • Transform and align PH-IS to support information exchange across PH & partners • Objective • Build a Coordinated Voice and bring the Voice to HIT Standardization efforts

7. Strategic Initiatives Tasked to Data Standards Committee Strategic Initiative 3 Align/Integrate PH with Other Healthcare Sectors, including Admin Data Systems • Goal • Enable integration with PH, clinical, and administrative information systems • Objective • Monitor and participate in national initiatives that align PH and healthcare • Influence direction of activities w/ PHDSC vision

8. Data Standards Committee • Purpose • Data Standards Committee coordinates data standards activities for PHDSC • Goals • Identify current and future public health data needs • Work with standards development organizations to support those needs • Educate PH stakeholders about these standards and to promote their usage

9. PHDSC Projects: 2012-2013 Assuring Health IT Standards for Public Health Project 1: Assure HIT Standards for Public Health (Business Case: Role of Public Health in National HIT Standardization) Project 2: PHDSC Participation in Health Data Standards Development for Administrative Data Exchanges Project 3: Public Health Functional Requirements Project Project 4: Standards for Early Hearing Detection and Intervention (EHDI) Program Project 5:Standards for Public Health Laboratory (PH-Lab) Data Exchange and Case Reporting Project 6:Standards for Occupational Health Data Exchanges Project 7: University-based Public Health Informatics Training

10. Data Standards (Project 2) Activities Participation in Health Data Standards Development for Administrative Data Exchanges • Participate in standards development activities: • Maintain the Health Care Service: Data Reporting Guide • Develop standards harmonization GAP ASSIST on-line tool • Collaborate with AHRQ and ANSI X12 to populate USHIK with All Payer Claims Database metadata • Develop IHE White Paper: Assuring Interoperability of EHR Systems and Administrative Data

11. Accredited Standards Committee (ASC) X12 Activities • ASC X12 Purpose • Develop messaging standards for over 275 business transactions, including standards for health care service data • PHDSC X12 Activities • Participate in X12 standards development activities • Health Care Service: Data Reporting Guide (HCSDRG) • Gap Assist Tool

12. Health Care Service: Data Reporting Guide (HCSDRG) • Purpose of HCSDRG • ACS X12 Implementation Guide to support Public Health reporting of health care service data • Based on HIPAA adopted standard compatible guide Health Care Claim: Institutional (837) • Same billing reporting requirements with addition of PH requirements (e.g. race/ethnicity, county) • X12 837 + PH requirements  837R • PHDSC Activity • Maintain and continue to sync the HCSDRG with current X12 standards

13. Gap Assist Tool • Purpose of Gap Assist Tool • Visual tool that provides a meta data perspective to see what data elements are supported in the HCSDRG across the different versions of the X12 standards • PHDSC’s way to let the public know of what the changes are across versions • PHDSC Activity • As the HCSDRG is updated, Gap Assist Tool is updated

14. Gap Assist Tool

15. Gap Assist Tool

16. National Uniform Billing Committee (NUBC) National Uniform Claim Committee (NUCC) • Purpose of NUBC and NUCC • NUBC develops a standardized data set for use nationwide by institutional providers and payers for handling health care claims • NUCC develops a standardized data set for use by the non-institutional health care community for handling health care claims • PHDSC Activity • Participate in standards development activities • Bring PH requirements to NUBC/NUCC

17. USHIK All Payer Claims Database (APCD) Portal: Background • Purpose of APCD • All Payer Claims Databases (APCDs) are databases, created by state mandate, that typically include data derived from medical, pharmacy, and dental claims with eligibility and provider files from private and public payers: • Insurance carriers (medical, dental, TPAs, PBMs) • Public payers (Medicaid, Medicare)

18. USHIK All Payer Claims Database (APCD): Typically Included Information • Patient demographics (DOB, gender, residence, relationship to subscriber) • Type of product (HMO, POS, Indemnity, etc.) • Type of contract (single person, family, etc.) • Diagnosis codes (including E-codes) • Procedure codes (ICD) • NDC codes for pharma Rx • Revenue codes • Service dates • Rendering provider (name, tax id, payer id, specialty code, city, state, zip code) • Prescribing physician • Plan charges & payments • Member liabilities (co-pay, coinsurance, deductible) • Date paid • Type of bill • Facility type

19. Current APCD States

20. USHIK All Payer Claims Database (APCD) Portal • Purpose of APCD Portal • APCD Portal in USHIK compares corresponding data elements of each state's APCD with the national standard for each data element. • APCD Portal was originally modeled after Gap Assist Tool

21. USHIK All Payer Claims Database (APCD) Portal • Partners in design and building of APCD Portal • Centers for Disease Control and Prevention/National Center for Health Statistics (CDC / NCHS) • Agency for Healthcare Research and Quality (AHRQ) • APCD Council (www.apcdcouncil.org) • Washington Publishing Company • PHDSC

22. USHIK All Payer Claims Database (APCD) Portal • Today, APCD Portal compares state APCD data and ASC X12 Data Standards • APCD Portal will include data elements from: • Each state's All-Payer Claims Database (APCD) • ASC X12 5010 standard • ASC X12 Post-Adjudicated Data Reporting Guides (published in August 2012) • National Council for Prescription Drug Programs (NCPDP) Uniform Healthcare Payer Standard Implementation Guide Version 1.0.

23. USHIK All Payer Claims Database (APCD) Portal • PHDSC Activity • Develop and maintain APCD Portal with partners • Plan to work with 6 APCD states to solicit feedback about the portal over the next 9 months

24. IHE White Paper: Assuring Interoperability of EHR Systems and Admin Data • Purpose • Describes areas where clinical health data from EHRs and administrative health data from Admin Systems must be better aligned to meet future reporting needs of public health programs. • Roadmap for developing interoperability standards for data exchanges of administrative health data between EHRs, admin data systems, and public health programs • PHDSC Activity • Developed IHE White Paper from Nov 2011 to Aug 2012 • For review by IHE QRPH Domain for eventual publication

25. Business Case (Project 1) Activities Assure HIT Standards for Public Health - Business Case: Role of Public Health in National HIT Standardization • Educate Public Health Community about Health Informatics and HIT Standards through HIT Standards Web-Resource Center(http://www.phdsc.org/standards/resource-center.asp) • Obtain Voice of the Customer feedback through JD Power and Associates survey to improve PHDSC website and HIT Standards Web-Resource Center • Improve design and information of PHDSC website • Improve Analytics on PHDSC Website to better understand usage

26. HIT Standards Web-Resource Center • Purpose • Educate the public health community on Health Informatics and HIT standards • 4 Different Modules • PHDSC Activity • Updated and maintained information in 3 Modules • Specifications for 4th Module completed. Launch in May 2013.

27. PHDSC Health Information Technology Standards Web-Resource Center(http://www.phdsc.org/standards/resource-center.asp)

28. Assuring Health IT Standards for Public Health

29. Assuring Health IT Standards for Public Health

30. Assuring Health IT Standards for Public Health

31. Assuring Health IT Standards for Public Health

32. Strategic Initiatives Tasked to Data Standards Committee Strategic Initiative 1 Unify PH to Support Health-Based Model (HBM) / Learning Health System (LHS) Strategic Initiative 2 Unify PH Information Systems Strategic Initiative 3 Align/Integrate PH with Other Healthcare Sectors, including Admin Data Systems

33. Data Standards Committee: Future Directions • Continue tostrategize activities to meet strategic initiatives • Continue to work with Standard Development Organizations to bring public health requirements to the table • Continue to educate the public health community about HIT standards and efforts • Specific issues to continue to think about • How to get clinical and admin data for public health needs; align existing standards • What is the “consensus” of public health?