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Linking EHRs Between PH, Social Service Agencies, and Other Relevant Organizations. How to Create Information Systems With Data that Flow Both Ways. Arthur Davidson, MD, MSPH Denver Public Health adavidson@dhha.org
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Linking EHRs Between PH, Social Service Agencies, and Other Relevant Organizations How to Create Information Systems With Data that Flow Both Ways Arthur Davidson, MD, MSPH Denver Public Health adavidson@dhha.org Committee on Recommended Social and Behavioral Domains and Measures for Electronic Health Records National Academies of Sciences Building 2101 Constitution Avenue NW Washington, DC 20418 April 8, 2014
Agenda • Conceptual Model • Linkage for Public Health Surveillance • Linkage for Public Health Intervention • Next Steps
Linkage Conceptual Model Quitline Social Service Clinical Care (EHR) Public Health Schools/Childcare
Linkage for Public Health Surveillance(Colorado) • Transparent, distributed data network • Modeled on the Mini-Sentinel (FDA) project and local experience with HMO Research Network (AHRQ) project • Governance • Voluntary participation; unlike mandated reporting, data use agreements established/required • Privacy • Minimal data necessary to achieve stated goal (de-identified to start) • Technical • Infrastructure: 1) common data model, 2) emphasize data quality assessment, and 3) federated query tool
Linkage for Public Health Surveillance(Colorado) • Colorado Health Observation Regional Data Service (CHORDS) • Provide a "laboratory" to develop and evaluate scientific methods to support public health surveillance • Afford Denver Metro and Colorado communities an opportunity to use existing EHR data systems for public health surveillance • Learn about barriers and challenges, both internal and external, to building a viable and accurate system of surveillance for public health events (e.g., conditions, behaviors and outcomes) • Build an event agnostic infrastructure for public health surveillance, quality assessment, and research
CHORDS RegistriesColorado Health Observation Regional Data Service e.g., Kaiser Permanente Standard (Virtual) Data Warehouse • Current registry efforts: • BMI • CVD risk • Tobacco use and SHS exposure • Mental health • Colorectal cancer • Adult obesity PMN Client Secure federated query CHORDS Query Service (PopMedNet ) PMN Authorize Authenticate e.g., Denver Health Standard (Virtual) Data Warehouse Secure federated query PMN Client
Link Clinical, Social and Environmental Data Across Multiple Delivery Systems Pre-CHORDS (e.g., weight status surveillance): • BRFSS self-reported demographic, weight data • Survey ~12,000 Colorado/year = 700 Denver/year • Allows county-level estimates only CHORDS state: • Combine measuredBMI data from multiple institutions • Include demographic data, residence location (geo-code) • Link geographically aggregated BMI data (e.g. census tract) with social and environmental data • Identify “place-based” interventions (e.g., social marketing, community resource development, and policy initiatives) • Pilot features of local data sharing network
Types and Sources of Geo-coded Social and Environmental Data for Mapping
Combined Measured BMI Data • Denver County (valid BMI) : • all ages: 184,644 (31%) • adults: 119,075 (26%) • children: 64,606 (51%) • Coverage varies widely: • > 50% for some communities • few with aberrant results
Linkage Conceptual Model Quitline Social Service Clinical Care (EHR) Public Health Schools/Childcare
e-Referral between EHR and Quitline Goal: Efficient EHR-mediated e-Referral (including patient preferences) to Quitline and timely acknowledgement/status messages returned to and posted within the EHR. • North American Quitline Consortium • Consensus process with ~15 Quitlinevendors/service providers • Message requirements: • Content: define common data elements • Structure: HL7 2.x and c-CDA formats • Transport: sFTP, Direct, web-service (WSDL-SOAP)
What next? CHORDS • Build out standard data model (i.e., add tables, required content/variables [IZ], extend time range) • Conduct comprehensive data quality assessment • Compare member-vs. visit-based denominator estimates • Expand stakeholders (PH and clinical) • Address duplicates Quitline • Set e-Referral standards, assure meets PH needs • Vet with EHRA and standards development organization • Consider as model for PH related HIE and e-referral for other community-based services
Sustainability strategy • Enhance “event agnostic” distributed surveillance/research network (e.g., breadth of use cases and stakeholders, depth of content) • Study utility of system to multiple stakeholders (i.e., communities, elected officials, and individuals) • Facilitate incorporation of new social/environmental data (e.g., barriers and assets) • Standardize approach to geocoding and de-duplication • Target outreach and community-based interventions (i.e., policy, systems and environmental changes) to those who need them • Assess impact on health disparities reduction • Develop cadre of applied researchers and methods