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Death Certification from an EHR in Utah: How’s this for meaningful?

Death Certification from an EHR in Utah: How’s this for meaningful?. Jeff Duncan Health Informatics Program Manager Utah Department of Health. The Idea. “ Why can’t I just login to my EHR and sign a death certificate?”. -Anonymous physician, University of Utah Medical Center, 2007.

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Death Certification from an EHR in Utah: How’s this for meaningful?

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  1. Death Certification from an EHR in Utah: How’s this for meaningful? Jeff Duncan Health Informatics Program Manager Utah Department of Health

  2. The Idea “Why can’t I just login to my EHR and sign a death certificate?” -Anonymous physician, University of Utah Medical Center, 2007

  3. Questions we asked then… • Who uses an EHR in 2007? • Intermountain Healthcare • What infrastructure would we use to get data from an EHR into our death database? • Existing HL7 interface for immunization data • How do we ensure NCHS and UDOH data standards? • Very detailed contract specifications and lots of coordination

  4. Timeline of events—UDOH-Intermountain Death Interface Meaningful Use Stage I CDC Pan Flu Grant UDOH received funding to create a death reporting interface with Intermountain. Pilot testing Implemented at one Intermountain Clinic Pilot test expanded to Salt Lake City Metro Area HL7 Version 2.3 Interface Planning and Development Interface development and testing Upgrade to DSTU Project begins Implement DSTU HITECH HITECH

  5. Original Project Goals • Improve timeliness • Surveillance depends on timeliness • < 72 hours for physician to certify • Improve data quality • Reduce ill-defined causes of death • Increase amount of information on death certificate • Increase physician participation • 70 to 80% use EDEN

  6. Overview of EHR Certification Process

  7. Death certificates per month over HL7 interface

  8. Timeliness

  9. Change in workflow EDEN Workflow (94% of deaths) Intermountain Workflow (51% of deaths)

  10. Number of Unique ICD10 codes

  11. Other conditions listed?

  12. Interval listed for underlying cause?

  13. Challenges 1. Change in Workflow

  14. Challenges • Matching and merging • Link on name, DOB, sex, SSN • Must be exact match or manual resolution • Data precedence • Name • Date of death • Time of death • Date last seen • ME Case

  15. Questions we ask now… • Who uses an EHR in 20072014? • Intermountain Healthcare 85% of hospitals • What infrastructure would we use to get data from an EHR into our death database? • Existing HL7 interface for immunization data Need infrastructure to support reporting from health care to public health • How do we ensure NCHS and UDOH data standards? • Very detailed contract specifications and lots of coordination • Standards Development and Implementation

  16. Standards Development and Implementation • HL7 Death Reporting • IHE Vital Records Death Reporting (VRDR) Profile • EHR presents YOUR form to the physician • Provides guidance to EHR vendors and Vital Records vendors • Reciprocate data exchange through standards • Patient discovery can be used to report fact and cause of death back to healthcare

  17. Acknowledgements • NCHS • Michelle Williamson • Delton Atkinson • Intermountain Healthcare Team • Jacob Tripp, PhD • Utah Department of Health • Leisa Finch, EDR Coordinator • Multidimensional Software Creations (MDSC) • Stephen Clyde, PhD • Mike Jolley, Project Manager

  18. Jeff Duncan jduncan@utah.gov

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