2012 Annual Meeting “Towards Public Health Sector Transformation and Section Unity”

1. 2012 Annual Meeting“Towards Public Health Sector Transformation and Section Unity” ACHIEVING PUBLIC HEALTH GOALS THROUGH INFORMATION TECHNOLOGY STANDARDIZATION – INFRASTRUCTURE Walter Suarez, MD, MPH Executive Director, Health IT Strategy and Policy Kaiser Permanente Hyattsville, MD - November 14-15, 2012

2. Topics • Need for PH Data Standardization Infrastructure – Proposal for Action • Need for Certification of Public Health Information Systems – Proposal for Actions • Need for Resources for Public Health IT Infrastructure

3. Today’s Realities • Not all the data about a person/patient that is needed by public health is in an EHR system • Not all the data in an EHR system is needed by public health • There is data in public health systems that is needed in clinical care, and not currently available to clinicians • There is population-based data needed in clinical care that is not currently captured by public health • There are existing and new sources of data that are used by public health outside of EHR systems

4. Public Health Standardization Efforts • CDC (PHIN, BioSense, other) • ONC (MU, HIEs, Beacon Communities, other) • S&I Framework – Public Health Reporting Initiative • PHDSC • JPHIT • CSTE, NACCHO, ASHTO, NAPHSIS, APHL • SDOs • HL7 – PHER • IHE – Quality and Public Health • ISO – Public Health • WHO; work done in other countries

5. Most Active Areas • Immunization Systems (MU 1) • Syndromic Surveillance (MU 1) • Public Health Laboratory Reporting (MU 1) • Chronic Disease Registries (MU 2 - Cancer) • Interfacing with Clinical Decision Support tools (MU 2) • Healthcare Associated Infections (MU 3) • Adverse Event Reports (MU 3) • Acute Disease Reporting/Surveillance (MU 3) • Additional disease registries (MU 3) • Vital Statistics (MU 3?) • Other Registries (i.e., Hospital Discharges, APCDs)

6. Policy Issues • Scope and role of public health changing; lack of understanding of public health needs by clinical care • Increased data demands from clinical care by public health • Capability limitations in some public health infrastructures to support advanced health data standards/vocabularies • Privacy and confidentiality issues affecting the way providers and public health exchange data • Validity and reliability of data sources (data provenance)

7. Business and Technical Issues • Business and Operational Issues: • Need for special workflows, operational processes to fulfill public health requests for information • Need to support non-standard 'standards' to submit data to public health • Continued reliance on non-systematized systems and communications to exchange information with public health

8. Business and Technical Issues • Technical Issues: • Standards - Limited support for clinical messaging standards • Code sets: Reliance on ICD code sets, with a lack of support for more granular vocabularies/terminologies • Transport and Security: Limited infrastructure capabilities to support public health migration and participating in health information exchanges that allow for real-time, structured exchanges of public health data between clinical care and public health

9. Need for Data Standardization Infrastructure:Towards a Common Standard and Interoperability Approach for Public Health Reporting • ONC S&I Framework - Public Health Reporting Initiative • Developing a common set of core data elements that apply to all (or most) public health-related messages • Applying the same overall approach being used in clinical care message exchanges under MU (Consolidated CDA) • Core set of data elements (defined in an HL7 CDA) • A series of 'templates' that define specific, discrete sets of elements applicable to specific clinical domains/message needs • Defining a 'Public Health CCDA'

10. Need for Certification of Public Health Information Systems:Need for Voluntary System for Independent Certification of Public Health Information Systems • Meaningful Use Program established a model for certification of electronic information systems • In addition to EHRs, there are many other systems that are used in health care • Examples include Hospital Information Systems; Practice Management Systems; Pharmacy Systems; Laboratory Information Systems; Public Health Information Systems • Pursuing a voluntary mechanism to certify products is generally a minimum first-level step • Creates a market-driven opportunity; Allows purchasers of systems to exercise selection; allows vendors to distinguish themselves • Explore opportunity to work with certification organizations

11. Need for Certification of Public Health Information Systems:Need for Resources for Public Health IT Infrastructure • For every $1,000 invested in EHRs, there is $1 invested in public health • Very limited direct money being put into improving public health information systems – and they don’t really come from MU…. • The risk for a ‘new digital divide’ between clinical care and public health is growing • Need to develop a formal ‘Call to Action’ to raise awareness of the need to provide sustainable funding for public health to improve systems, adopt and implement standards, resource training, capacity building, support information exchanges, etc • Call to Action can come from JPHIT, but needs to be supported widely by providers, payers, others