Impact of HIE on Public Health Laboratories

1. Impact of HIE on Public Health Laboratories

2. What you may not know… JOINT PUBLIC HEALTH INFORMATICS TASK FORCE (JPHIT)

3. HRSA Health Outcome Policy Priority Improve quality, safety, efficiency and reduce health disparities

4. Health Information Exchange Traditional Model Grizzell’s 6-Tier Model Often Used in Public Health Frieden’s Conceptual 5-Tier Public Health Framework (Thomas R. Frieden, MD, MPH Aj of PH, April 2010)

5. HIT: Health Information Technology Broad terminology for adoption and use of IT in a health setting

6. EMR vs. EHR EMR Consensus Definition: Comprehensive electronic health record which includes laboratory, pharmacy, clinical and demographic data gathered from all applicable entities (public health laboratories, hospitals, private offices, etc) . EHR • HIMSS definition: Component of the electronic health record which is owned by an institution

7. HIE: Health Information Exchange The secure transfer of electronic health information such as a medical record from one entity to another place, using electronic messaging such as HL-7

8. Meaningful Use Evolving definition to electronically capture in coded format and to report health information and to use that information to track key clinical conditions

9. HITECH Vision To improve the health of Americans and the performance of the nation’s health system through health information technology (HIT). • An important component of health reform • Harness the full potential of digital technology to prevent and treat illnesses and to improve health.

10. HITECH Goals • Improve quality, safety, efficiency, and reduce health disparities • Engage patients and families • Improve care coordination • Ensure adequate privacy & security protections for personal health information • Improve population and public health

11. ONC Activities • Definition of ‘Meaningful Use’ and Setting Standards for Electronic Health Record Incentive Program • $60M Program to Fund Strategic Health IT Advanced Research Projects • Health IT "Beacon Communities" • $80 Million Available to Support Health IT Workforce • www.healthit.hhs.gov

12. Pathway to ARRA Incentives CCHIT-certified or new certifying bodies yet to be named Stage 1: 25 measures; 17 require only attestation In either Medicaid or Medicare program

15. Staged Implementation: Stage 1 • Electronic capture of health information in a coded format • Tracking key clinical conditions and communicating outcomes for care coordination • Implementing clinical decision support tools to facilitate medication and disease management • Reporting for public health purposes.

16. Staged Implementation • Stage 2: Builds on stage 1; computerized provider order entry; electronic transmission of diagnostic test results; research • Stage 3: Builds on stage 3; promotes improvements in quality and safety; patient access and involvement; improved population health data

18. Implications for public health • Assess and ensure readiness in several areas: • For 2011, ELR and syndromic surveillance • Both testing capability of systems to report and actual submissions • Increase capacity for data management and analysis • Coordination across programs, state HIT coordinator, state HIE plan, Medicaid, enterprise architecture plan, etc.

19. Survey of State Health Agencies on Meaningful Use Readiness and Public Health Informatics Resources

20. 24 respondents • 21 responded to funding questions • Survey in the field for three weeks (4/5-4/26) • Distributed to state public health agency Informatics Directors/CIOs or state health officials if no informatics director was designated.

22. Which of the following best describes your agencies Technical Assistance needs in preparing for data exchange with Health Information Exchanges and Electronic Health Records? Choose all that apply.

23. State/territorial Medicaid agencies are required to submit a Medicaid Health IT plan to develop their Medicaid Health IT Infrastructure. How would you describe the public health agency’s interactions with Medicaid planning activities?

25. Public Health IT Funding Needs • Of 21 states that described their resource needs: • States need an average of $1.55 million per year, with a median of $1.2 million • Range: $85,000-$3,200,000 • 25th percentile $505,000 • 75th percentile $2,350,000 • Category needs (yearly average): • Informatics staff, $325,000 • IT staff, $380,000 • Program staff, $290,000 • IT Systems, $555,000 • One-time needs: Hardware, $315,000

26. Grant Programs in HITECH HHS Secretary Shall Establish Programs of: Grants to states to promote health IT (emphasizing health information exchange) Implementation Assistance and Education of IT workforce

27. KY HIECC • Implement secure and interoperable statewide e-health network • Improve quality and efficiency of KY Health Care System

28. 6 KY-HIECC Committees • Privacy and Security • Interoperability and Standards • Business Development and Finance • Accountability and transparency • Provider Adoption and Meaningful Use • Population Health

29. Potential Value of KHIE to PH • More timely and complete delivery and receipt of disease reports (provider specific or federal partners) • Faster transmission of better information to case managers • Efficient Syndromic Surveillance • Enhance communication with selected provider and patient populations

30. Implications for Public Health • Unprecedented opportunity to partner on HIE and population health improvement • Funding, policy and regulations are aligned • Private and public sector buy-in • Expectations for public health capabilities around HIE will increase.

31. Implications for Public Health • Opportunity to work with CDC and other federal partners to align funding streams with HITECH priorities • Opportunity to explore certification of public health information systems • CCHIT-like modular certification around MU requirements, or around broader PHIN requirements?

32. Laboratory Medicine’s Role • Socioeconomic Factors • Narrowing poverty gap shows • Cleaner water • Cancer screening • Air quality screening • Vaccination screening • Choosing Good Health w/Public Health Assistance • Analyzing fluoridation in water • Environmental lead testing and asbestos • Food testing • Confirming Protective Interventions • Immunization monitors • Colonoscopy evaluations

33. Traditional Laboratory Applications • Cardiovascular Analysis • Lipids – Cholesterol • Hemoglobin A1C – Medication Compliance • Education • Benefits of screening • HIV • TB • Rubella • Hepatitis

35. HIT in Hospitals (Jha et al., NEJM 2009)

36. Lab Results • Hospitals only (2011) • Content: HL:7 2.5.1 • Vocabulary: LOINC v2.27, when such codes were received within an electronic transactions from a laboratory • MU Measure: Hospitals must perform at least one test of EHR capacity to send if the PH entity has the capacity (2011)

37. Laboratory Objective and Measure Incorporate lab test results into EHR as structured data At least 50% of clinical lab tests results are in a certified EHR technology as structured data

39. LIS requirements to enable medical data exchange • HL-7 ready? • Nationally accepted codes (LOINC codes)

40. LOINC Codes

41. LIS requirements to enable medical data exchange • Mappings local codes to LOINC codes • RELMA • SNOMED • National Library of Medicine

42. RELMA

43. LIS requirements to enable medical data exchange • Communication • Central hub concept (Health Information Exchange)

44. Communication Hospital Private Practice X Central Hub (HIE) X State Lab CDC