Brief Profile Proposal for 2011/12 presented to the Quality, Research & Public Health (QRPH)

1. Incorporating Administrative information into Public Health Systems from Electronic Health Record Systems and Administrative Data Sets – A Landscape Analysis and Guidance Document Brief Profile Proposal for 2011/12 presented to the Quality, Research & Public Health (QRPH) Planning Committee Wendy Scharber Bob Davis Starla Ledbetter Anna Orlova September 30, 2011

2. The Problem • Today, for administrative data exchanges related to public health information systems (registries) there is no integration across EHR systems, public health registries, quality measurements registries, etc, • Admin data includes hospital discharge data, claims data, billing records sent to the state – Needs definition • Administrative data are used to • Evaluate patient safety, including the tracking of injury rates, inpatient costs, patient characteristics, and outcomes for specific types of injuries, and informing the development of injury prevention programs; • Monitor the occurrence of disease; • Assess health resources and plan for better future allocation of resources; • Identify services that are lacking in a community; • Monitor environmental conditions.

3. The Problem • Many public health programs are working independently on this topic • Diabetes • Cancer Registries • AHRQ (Agency for Healthcare Research and Quality) • NAHDO (National Association of Health Data Organizations) • RISK - if this proposal is not undertaken this cycle • Continued development of discrepant standards • Duplication of work effort with duplication of resources • Fragmented implementation based on patient population

4. Use Case • We propose developing a White Paper Guidance Document describing the landscape of public health’s interaction with administrative data. • The White Paper will serve as a roadmap for developing Health IT interoperability standards for data exchanges between clinical electronic health record systems, administrative data systems and public health programs. • We propose to focus on diabetes care management, surveillance and quality measures as our example disease domain for this profile, validating the results with a second domain - the public health cancer registry program.

5. Use Case • A White Paper will: • Leverage community experience and needs to produce a generic solution that is scalable and that meets the needs of diverse programs. • Produce a cost-savings as many programs are currently working on this problem independently. A joint effort with a global solution will reduce the need for resources from multiple sources being targeted for the same activity.

6. Use Case • Process and Deliverables • Develop a common definition for the term “administrative data” • Explore the relationship between electronic health record systems, State Data Collection Systems (e.g., hospital association, NAHDO) (data senders) and public health agency systems (data receivers). • DELIVERABLE #1: Who sends data to whom using diabetes as the main use case, cancer registries and other domains as supporting cases for comparison. • Inventory of data elements currently collected in the Hospital Discharge Data Set (e.g. as specified in the Health Services Data Reporting Guide, and the NCVHS recommended core data elements for a hospital discharge system)   • Inventory of state-specific data elements/program specific data elements and what is needed by public health (e.g. clinical data to support quality measures) • DELIVERABLE #2 and #3: spreadsheet – Core Data Elements and program-specific/state-specific elements

7. Use Case • Process and Deliverables (continued) 4. Analysis and Recommendations on a Strategic Plan to help public health programs identify and collect administrative data including Data Sources • Recommendations on whether administrative data should be collected from the EHR or from other administrative data set systems. Data Content • Evaluation of existing solutions to resolve problems identified in the data gap analysis • Recommendations on the need for a generic content module for specifying administrative data content relevant for public health activities • Recommendations for adding certain administrative data to the Uniform Billing standards (ASC X12) • Recommendations on the need for consistency in collection of patient demographic fields (names, addresses, DOB, SSN) - and how a statewide MPI can bring the pieces of information together in a market/service area.  • DELIVERABLE #4: Strategic Plan with Recommendations

8. Why Publish within IHE • The Profile builds on the work already published in IHE-QRPH: • IHE White Paper on Knowledge Representation in Diabetes Care Management and Disease Surveillance, 2009; PHDSC authored. • Multiple public health programs that participate in IHE will be able to collaborate • EHR vendors within IHE will be able to provide their experience relating to collection and maintenance of administrative data within their software systems and can offer expert review and recommendations. • In the next IHE cycle (2012-13) the White Paper may be used to develop IHE Content Module Supplement

9. Proposed Standards & Systems • White paper process will identify options and solutions Current possibilities include: • ASC X12 Messaging Standards • National Uniform Billing Committee (NUBC) Standards • HL7 (vocabulary, CDA, 2.x) • PHIN -Vads • IHE Sharing Values Sets • IHE PIX and PDQ profiles for demographic information • HL7 PH Reporting Requirement Standard

10. Discussion - Work Effort