Webinar 4 July 10, 2008 | 2:00 – 3:30 pm (Eastern)

1. Biosurveillance • Webinar 4 July 10, 2008 | 2:00 – 3:30 pm (Eastern) • Presenters HITSP Population Perspective Technical Committee • Floyd Eisenberg, MD, MPH, Senior Key Expert, Siemens Healthcare and co-chair of the Population Perspective TC • Lori Fourquet, e-HealthSign, LLC

2. Learning Objectives a webinar series on U.S. healthcare interoperability • During this 90-minute webinar, participants will explore the population perspective of health information sharing for natural and human assisted events with local, regional and national import, gaining a basic knowledge of: • syndromic surveillance through repurposing existing clinical information to detection of new patterns of disease as a routine process and during emergency situations; • situational awareness using repurposed clinical information to determine the extent and location of disease presentation as well as resource availability; (continued)

3. Learning Objectives (continued) expectations for information transfer from EHRs to biosurveillance information systems; HITSP specifications for biosurveillance information sharing; the relationship of the biosurveillance use case and interoperability specification to other efforts for public health and for data repurposing. a webinar series on U.S. healthcare interoperability

4. Biosurveillance Syndromic Surveillance Situational Awareness Disease Burden Healthcare Resources Security and privacy requirements for Biosurveillance HITSP Interoperability Specifications for Biosurveillance (HITSP IS 02) Units of Exchange Health Information Summary Documents Health Information Messages Conformance Subsets Questions and Answers Agenda a webinar series on U.S. healthcare interoperability

5. Introduction: Steve’s Story . . . part four • Patient is a 26-year-old male coping with the long-term effects of a brain tumor that was removed during his childhood • While traveling to San Diego with his family, Steve and his sister become ill with fever, diarrhea and dehydration • Both present to different local Emergency Departments • Steve is discharged in 48 hours • His sister requires several weeks in the hospital for kidney failure complications • Public Health receives notification of Steve’s sister’s presenting symptoms and stool culture results indicating E coli 0157:H7. Steve’s culture is negative and no report of his illness is received by Public Health • The source of the E coli 0157:H7 is not identified until approximately 100 cases present over the next three months

6. Introduction: Steve’s story (continued) • The Future Healthcare in an interoperable world • Steve’s and his sister’s presenting complaints and initial orders (i.e., stool culture requests) are transmitted within 24 hours to a Public Health Biosurveillance Information System (BIS) • The Biosurveillance Information System flags a significant increase in febrile diarrheal illness in the region not correlated to a specific zip code and prompts a case investigation • Within 48 hours of Steve’s presentation, Public Health identified the common thread in 95% of 20 known cases of eating salad at a roadside café on a local highway. • 48 hours later a common source is identified in home grown lettuce used exclusively in that café. The item is removed from the menu and no further cases occur.

7. Overview • HITSP is a volunteer-driven, consensus-based organization that is funded through a contract from the Department of Health and Human Services. • The Panel brings together public and private-sector experts from across the healthcare community to harmonize and recommend the technical standards that are necessary to assure the interoperability of electronic health records.

8. Deliverables and Mode of Operation • The HITSP Standards Harmonization Framework • Identify a pool of standards for an AHIC (American Health Information Community) Use Case • Identify gaps and overlaps in the standards for this specific Use Case • Make recommendations for resolution of gaps and overlaps • Select standards using HITSP-approved Readiness Criteria • Develop Interoperability Specifications (IS) that use the selected standard(s) for the specific context • Test the IS

9. Current Interoperability Specifications (IS)

10. Current Interoperability Specifications (IS)

11. IS 02 Biosurveillance • This Interoperability Specification defines specific standards needed to enable the exchange of data between healthcare organizations and providers and public health via an electronic network • Version: 2.1 Recognized • Version: 3.0 HITSP Panel Approved Doctor Public Health Agency IS 02 VIA AN ELECTRONIC NETWORK

12. HITSP IS 02 BiosurveillanceOverall Objectives • Implementation of near real-time, nationwide public health event monitoring to support early detection, situational awareness and rapid response management across care delivery, public health and other authorized Government agencies. • Describe the process or interaction that each primary stakeholder will invoke to capture, discover, anonymize and transmit relevant data to public health agencies: • Relevant Data: Essential ambulatory care and emergency department visit, utilization, and lab result data from electronically enabled health care delivery and public health systems • Transmission Requirements: Standardized and anonymized format • Time frame: Within 24 hours

13. Patient Clinicians Healthcare Delivery Organizations Laboratory Organizations Public Health Agencies Resource Suppliers Public HITSP IS 02 BiosurveillanceStakeholders

14. Public Health – Biosurveillance Information System Syndromic Surveillance: Identifies new patterns of disease presentation – recognize known and unknown causes (chemical, radiological, biological) Situational Awareness: Determines patterns exceeding expected thresholds and location of impact Determines resource availability and constraints HITSP IS 02 BiosurveillancePurpose and Use • Data Requirements: • Patient Demographics • Diagnostic Data • Chief Complaints • Triage Data • Laboratory Orders and Results • Physician Orders – Procedures • Capacity Information • Admission, Discharge, Transfer Data • Hospitals / Emergency Departments • Ambulatory Care (Primary, Specialty Providers) • Ancillary Providers (Lab)

15. Individual Healthcare Delivery Organizations Stand-alone hospitals and clinics +/or emergency departments or laboratories HITSP IS 02 BiosurveillancePerspectives Integrated Health Care Data Suppliers Organizations that cross jurisdictional boundaries, e.g., interstate hospital organizations, nationwide laboratory organizations, payer systems, integrated delivery network claims clearinghouses, etc. Public Health Agencies Relevant local, state and other public health agencies authorized to receive and use data to perform biosurveillance

16. HITSP IS 02 BiosurveillancePerspectives (continued) • Individual and Integrated Organization Perspectives • Healthcare organization establishes an agreement to send data to a Public Health biosurveillance information system • Clinical • Resource Availability • Data are transmitted in near real-time (within 24 hours) for information required by Public Health Agencies for biosurveillance • Data are Anonymized and Pseudonymizedto ensure full privacy compliance, with randomized data linker to allow authorized re-identification for public health investigations • Format data using approved standards • Communicate relevant data to Public Health Agencies

17. HITSP IS 02 BiosurveillancePerspectives (continued) • Public Health Agency Perspective • Provide listing of required biosurveillance data • Receive biosurveillance data • Verify authenticity of content • Acknowledge receipt of data • Log receipt of data • Analyze, investigate and respond

18. Public Health Base Facility Data ElementsFacility Identifiers

19. Public Health Base Facility Data ElementsBed Availability

20. Public Health Base Facility Data ElementsPatient Data Elements 1

21. Public Health Base Facility Data ElementsPatient Data Elements 2

22. Public Health Base Facility Data ElementsClinical Data Elements

23. Public Health Base Facility Data ElementsLaboratory / Microbiology Results

24. Public Health Base Facility Data ElementsLaboratory / Microbiology Results (continued)

25. Public Health Base Facility Data ElementsRadiology Results

26. HITSP IS 02 BiosurveillanceMain Business Actors Document-Based Transmission Hospital Physician Health Plan Laboratory Radiology Service Public Health Reporting / Biosurveillance Information System Message-Based Transmission More Info Appendix A Other Communities

27. HITSP IS 02 BiosurveillanceSharing Clinical / Operational Information Encounter Message Encounter Document C 39 C 48 Lab Result Terminology C 35 Lab Result Message Lab Report Document C 36 C 37 Radiology Result Message Sharing Radiology Results TP 49 C 41 Resource Utilization C 47

28. HITSP IS 02 BiosurveillancePrivacy and Security Secured Communication Channel Entity Identity Assertion T 17 C 19 Manage Consent Directives Collect & Communicate Security Audit Trail TP 30 T 15 Consistent Time Nonrepudiation of Origin T 16 C 26 Access Control TP 20

29. HITSP IS 02 BiosurveillanceInfrastructure Manage Sharing of Documents Anonymize T 13 C 25 Pseudonymize Notification of Document Availability T 24 T 29 Patient ID Cross-Referencing Retrieve Form for Data Capture TP 22 TP 50 HL7 Messaging

30. Constructs (single purposeor reusable) Units of Information Exchange HITSP IS Constructs - Re-Use and Re-Purpose Type 1: Base or Composite Standards • Re-UseApplying an existing construct to more than one IS • Re-PurposeUpdating a construct to meet the needs of a new Use Case • Can extend or constrain when reusing or re-purposing • Specifications contain a common superset • Superset can be extended as new requirements are encountered • Superset can be constrained with use-specific constraints

31. List Units of Information Exchange • HITSP C 35 (Component)Laboratory Terminology • HITSP C 47 (Component)Resource Utilization • HITSP C 48 (Component)Encounter Document Using IHE Medical Summary (XDS-MS) • HITSP C 39 (Component)Encounter Message • HITSP TP 49 (Transaction Package)Sharing Radiology Results • HITSP C 41 (Component)Radiology Results Message • HITSP C 37 (Component)Laboratory Report Document • HITSP C 36 (Component)Laboratory Result Message More Info Appendix B

32. Example: Lab Report

33. HITSP IS 02 BiosurveillanceConstructs – Content (continued)

34. HITSP IS 02 BiosurveillanceConstructs – Security, Privacy and Infrastructure More Info Appendix C

35. www.HITSP.org

36. IS 02 – Biosurveillance on www.hitsp.org

37. A Successful Collaboration • Interweaving many different standards to address business needs • A successful collaboration between HITSP and several HITSP member organizations developing base standards and implementation guides/profiles

38. HITSP IS 02 BiosurveillanceStrengths • Effective interoperability • Independent conforming implementations will interoperate • all dimensions of interoperability covered, including sharing/selective access, transport, identity management, anonymization, pseudonymization • Semantic Interoperability with core clinical content • Basic core data set for biosurveillance syndromic surveillance and situational awareness • Designed to equally empower the providers and Public Health with the same level of robustness (continued)

39. HITSP IS 02 BiosurveillanceStrengths (continued) • Practical interoperability • Standards that already have “implementation feasibility” validated • IHE Connectathon, HIMSS Interoperability Demonstration • Testing in real-world environments - NHIN, CDC • Flexible interoperability • Designed to allow “receivers of information” to operate at various levels of richness (explicitly defined IS conformance subsets): • Document-based data transmission • Message-based data transmission • Secured and Private interoperability • Encryption, public health authorization, user authentication • Anonymization, Pseudonymization

40. A concrete achievement for Steve • Implementation of HITSP IS 02 will allow Public Healthto identify relatively quickly foodborne disease risks and manage product recalls, and to quickly identify the presence and/or the extent of impact of illness due to chemical or biological agents whether naturally occurring or human assisted. • Future expansion of the IS may be able to assist in determining available resources for providing needed care, e.g., hospital beds availability in a region. • Steve, his sister, and other patients across the U.S. will therefore be better protected as Public Health will be able to provide appropriate warnings in a more timely fashion and to redirect healthcare resources where they are most needed.

41. Use or specify HITSP Interoperability Specifications in your HIT efforts and in your Requests for Proposals (RFPs) Ask for CCHIT certification Leverage Health Information Exchanges to promote HITSP specifications to make connections easier in the future Ask . . . Is there a HITSP standard we could be using? Get involved in HITSP . . . Help shape the standards How YOU can become involved

42. How YOU can become involved Learn more about specific HITSP activities during these upcoming webinars:    

43. Join HITSP in developing a safe and secure health information network forthe United States. Visit www.hitsp.orgor contact . . . Michelle Deane, ANSI mmaasdeane@ansi.org Re: HITSP, its Board and Coordinating Committees Jessica Kant, HIMSS Theresa Wisdom, HIMSS jkant@himss.orgtwisdom@himss.org Re: HITSP Technical Committees

44. Sponsor Strategic Partners www.HITSP.org

45. Biosurveillance Questions and Answers

46. Biosurveillance • APPENDIX SLIDES • Appendix A – link from Slide 25 • Appendix B – link from Slide 31 • Appendix C – link from Slide 34