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Reusable Tools for Public Health Messaging and Vocabulary Standards

Reusable Tools for Public Health Messaging and Vocabulary Standards. CSTE Conference June 5 th , 2012. Riki Merrick, MPH Eric M. Haas, DVM, MS.

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Reusable Tools for Public Health Messaging and Vocabulary Standards

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  1. Reusable Tools for Public Health Messaging and Vocabulary Standards CSTE Conference June 5th, 2012 Riki Merrick, MPH Eric M. Haas, DVM, MS The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of CDC or the Agency for Toxic Substances and Disease Registry.

  2. Overview Public Health Lab Interoperability Project (PHLIP) Introduction Tools and Processes Electronic Laboratory Reporting (ELR) Program Approach Projects Laboratory Technical Implementation Assistance for Public Health (LTIAPH) Electronic Lab Reporting-Technical Assistance (ELR-TA) Tools and Processes re-used

  3. PHLIP – Who and What Actors and Use Cases • Electronic Lab Surveillance Message (ELSM) • Public Health Lab (PHL) to Centers for Disease Control and Prevention (CDC) WHO Global Influenza Surveillance Network • Electronic Test Order and Result (ETOR) • PHL to CDC Lab and back • PHL to PHL and back • Route-not-Read (RnR) hubs PHLIP is supported by cooperative agreement #CCU303019 from the Centers for Disease Control and Prevention (CDC).

  4. PHLIP – Who and What • Standards Used • Transport • PHIN-MS • Messaging • ELSM – HL7 v2.3.1ORU^R01 • ETOR – HL7 v2.6 OML^O33 and OUL^R22 • Vocabulary • LOINC for ordered and resulted tests • SNOMED for results • SNOMED and HL7 for specimen terms • UCUM for units • HL7 elsewhere in the message

  5. PHLIP – … and Why PHLIP

  6. PHLIP - ELSM PHL 1 sends ELSM to CDC using the RnRhubs PHL 1 PHL 2

  7. PHLIP - ETOR PHL 1 sends ELSM to CDC PHL 2 can do ETOR with CDC All are using the RnR hubs PHL 1 PHL 2

  8. PHLIP - Big Picture PHL 1 sends ELSM to CDC PHL 2 can do ETOR with CDC PHL 1 and PHL 2 can do ETOR with each other All are using the RnR hubs PHL 1 PHL 2

  9. PHLIP – ELSM: Current Activities Data exchange requirements developed and released PHLIP Workgroup (PHLs and CDC) collaboratively build knowledge and improve process Technical Assistance Team (TAT) supports implementation virtually and on site since March 2010

  10. PHLIP - ELSM Map June 2012 As of June 1, 2012: 36/57 PHLs sending production data

  11. PHLIP – ETOR Current Activities Pilot implementation for Salmonella orders from 3 SPHLs to CDC and result messages back to SPHLs Pilot testing of PHL to PHL ETOR for Influenza surge capacity in 2 PHL groups IA - NE – MN and FL - TX

  12. PHLIP– Tools and Processes Working Group Calls SharePoint for all documents/resources Data Collection Sheet Messaging template Encoding guideline Specimen Cross-Mapping Table NND harmonization Prioritization PHLIP Technical Assistance Team (TAT)

  13. PHLIP - Processes Different Calls for different Use cases and topics: Problem solving Core Group Vocabulary Implementation Issues Formalizing Decisions Change Control Board

  14. APHL Informatics SharePoint • APHL Informatics SharePoint: • Messaging guidelines • Vocab Resources • Definitions/conventions • Contact Information • Helpful Links • Project Management • Information about other APHL Informatics programs

  15. PHLIP - Data Collection Sheet

  16. PHLIP - Messaging Template

  17. PHLIP - Encoding Guideline Working Group Calls

  18. PHIN VADS Value Sets Current value sets for ELSM, ELR HL7 v.2.5.1, and many other message guides:https://phinmqf.cdc.gov/default.aspx

  19. PHIN Message Quality Framework PHIN MQF Validation Tool: https://phinmqf.cdc.gov

  20. Specimen Cross-Mapping Table

  21. PHLIP - Meet the TAT

  22. ELR initiative – What is it Vision Programs Data Flow Program Approach Vocabulary & Messaging Guidance Technical Implementation

  23. ELR initiative – Vision Provide assistance to Public Health Labs and Public Health Agencies Promote interoperability Promote adherence of messaging and data standards amongst data exchange partners including LOINC, SNOMED and HL7 messages Enable state public health labs (SPHLs) to exchange laboratory data with public health agencies (PHAs) building the data exchange infrastructure for other use cases One-on-one tailored technical assistance, while developing a common baseline/framework and reusable components. Collaborate with each other as well as other national efforts

  24. ELR initiative – Programs 2010-2012 LTIAPH: Laboratory Technical Implementation Assistance for Public Health ARRA HITECH grant for 10 ELC grantees plus 2 guests Data flow from PHL to PHA Consultative (not prescriptive/enforcer) role ELC grantee list: Arizona, Florida, Houston, Iowa, Massachusetts, Michigan, New York State, Philadelphia, Rhode Island, and Virginia LTIAPH is supported by Cooperative Agreement Number 1U50HK000105 from Centers for Disease Control and Prevention (CDC).

  25. ELR initiative – Programs 2011 - current ELRTA: Electronic Lab Reporting Technical Assistance CDC sponsored assistance to PHA to connect to PHLs AND Commercial labs – and provide help with v2.3.1 connections, if needed Application process managed through CDC Targeted Technical Assistance by APHL informatics team ELRTA is supported by cooperative agreement #CCU303019 from the Centers for Disease Control and Prevention (CDC).

  26. ELR initiative – Data flow Legend: Grey circles: Out-of-scope for LTIAPH/ELR-TA

  27. ELR 251 Implementation Assistance Approach

  28. ELR initiative - Program Approach Balance level-of-effort between providing and developing a common framework and re-useable components and one-on-one assistance by building Menu of Services Leverage “webinar” concept to plan milestones and share the knowledge with broader audience Conduct Current State Assessment Collaborate with other national efforts (ELR Taskforce, RCMT update, LabMCoP, S&I Framework lab related initiatives and PH reporting)

  29. Vocabulary & Messaging Guidance Formed Vocabulary Core Work Group Developed “ELR 251 Constrained Profile” Disease/agent prioritization (Tier-1, Tier-2, etc) Pilot group : Chlamydia, Gonorrhea, Salmonellosis, Hep C, Pertussis and HIV Map vocabulary for ‘Pilot Group’ Tests and Resulted Tests: LOINC Test Results : SNOMED-CT Specimen : SNOMED-CT Leverage RCMT for Tier-1 and Tier-2

  30. Vocabulary Collaboration Framework

  31. Vocabulary & Messaging Guidance (continued….) Position statement clarifying ELR specs around Results §170.207 (c) Laboratory test results. Standard. Logical Observation IdentifiersNames and Codes (LOINC®) version 2.27, when such codes were received within an electronic transaction from a laboratory (incorporated by reference in §170.299). Webinar on ELR Implementation guide (§170.205(c) Electronic submission of lab results to public health agencies. Standard)and comparison between 2.3.1 and 2.5.1 message Electronic Test Order and Results data flow: Preliminary comparison between ELINCS and PHLIP ETOR implementation specifications

  32. Technical Implementation Review existing data flows / architecture Create prototype tooling Conversion to ELR 251 Up convert to ELR 2 5 1 from 2. 3.1, 2.3.z and other variations Down convert from ELR 2.5.1 to 2.3.1 Testing framework

  33. ELR (Sender) side

  34. ELR (Receiver) side Focus on: Design / architecture Vocabulary and HL7 message transformations Tools: Orion Rhapsody (mostly) MQF Receiver profile And other testing / validation framework

  35. PHLIP Tools Reused in ELR initiative • Data Collection Sheet • Encoding guideline • Working Group Call • Vocabulary Harmonization for Nationally Notifiable Diseases (NNDs) • Mapping and Terminology Conventions • Specimen Cross-Mapping Table  Vocabulary  HL7 Messaging  Project Management  Technical Assistance Team • Messaging template • Mapping Conventions (EPI info and specimen) • ETOR guide v2.6 for interested labs • Message Validation Tools (MQF)

  36. ELR Tier Groupings In the tier groupings, diseases have been grouped into tiers for implementation based on complexity and volume.

  37. Constrained Profile Message Guide The Implementable Profile can be customized to meet the needs of the PHA.

  38. Constrained Profile Message Template

  39. PHIN VADS RCMT Current list of LOINCs and SNOMED codes for reportable conditions https://phinvads.cdc.gov/vads/ViewCodeSystemConcept.action?oid=2.16.840.1.114222.4.5.274&code=RCMT

  40. Intangibles • Knowledge • Experience  Relationships PHLIP Intangibles Reused in LTIAPH and ELRTA

  41. In Summary APHLinformatics Program Approach PHLIP LTIAPH ELRTA Vocabulary & Messaging Guidance across all programs Technical Implementation coordinated and for all programs Contact: Linda.Cohen@aphl.org Wes.Kennemore@aphl.org

  42. QUESTIONS? rmerrick@iconnectconsulting.com

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