Agenda

1. Public Health Reporting InitiativeStage 3 Sprint: Implementation Guide DevelopmentPhone: 800-857-9362 x93830 1

2. Agenda • New Member Introductions • Begin review of sections of Implementation Guide • This week will focus on CDA • Next Steps • Additional Questions?

3. Suggested Ground Rules • Everyone may speak • ID your name & user story (report type) • Listen carefully • Read assigned work and minutes before each meeting • Limit “back-pedalling” to critical issues • Yield when it is “good enough”- do not let perfection threaten good • Seek consensus quickly; let moderator test consensus • If consensus fails, Tier 2 steps back to see if consensus can procede for this first version of the specification • Concerns about process? Immediately bring to Foldy’s attention • 678-733-4289 • skf6@cdc.gov

4. Implementation Guide Schedule

5. Approach

6. Reference Documents • Current reference documents being utilized to develop the implementation guide include: • Implementation Guide for CDA Release 2.0 - Consolidated CDA Templates - (US Realm) • IHE Quality, Research and Public Health (QRPH) - Technical Framework Supplement - Maternal Child Health - Birth and Fetal Death Reporting (MCH-BFDrpt) Trial Implementation • IHE Patient Care Coordination (PCC) - Technical Framework Supplement - Labor and Delivery Profiles - (Includes LDHP, LDS and MDS) • IHE Patient Care Coordination (PCC) - Technical Framework Supplement - CDA Content Modules - Trial Implementation • HOMEWORK – sprint team to provide additional references for inclusion in the implementation guide on a weekly basis

7. Report Document Template Homework – list out types of public health reports to think about as we craft the guidance

8. Patient Information – Data Elements

9. Patient Information – CDA • Patient information within a CDA-based public health report is represented in the CDA header through the recordTarget element. The recordTarget element identifies the patient or patients whose health history is/are described within this payload. A recordTarget is represented as a relationship between a person and an organization, where the person is in a patient role (PatientRole class). The entity playing the role is a patient (Patient class). The entity scoping the role is an organization (Organization class). A patient is uniquely identified via the PatientRole.id attributes.

10. Patient Contact Information – Data Elements

11. Patient Contact Information – CDA • Patient Contact Information is included within the CDA Header and can use multiple elements depending on the type of relationship being established. It is expected that for a public health report, the following general rules may apply when defining different patient contacts: continued

12. Patient Contact Information – CDA

13. Patient Contact Information – CDA The following table summarizes data elements used to define a <participant>relationship. Note that optionality is not defined. continued

14. Homework • Questions for sprint team review • What report types would use patient contact information? • What patient contact information data elements would be required in all report types? • Overall optionality to be proposed?

15. Payer Information – Data Elements

16. Payer Information – CDA • Questions for sprint team review • In what reports would payer information data elements (insurance type) be included? • As of now, is anything besides insurance type needed?

17. Provider Information – Data Elements

18. Provider Information – CDA • Information for providers within the public health report is primarily reported in two ways: • Tied to the <participant> element • Tied to a specific service event

19. Provider Information – CDA continued

20. Provider Information – CDA

21. Homework • Questions for sprint team review • Expectation is all report types will include provider information. Any concerns? • Implementation will focus on documenting provider information at the top level (as PCP) and also at the encounter level. Any concerns?

22. Social History – Data Elements

23. Social History – CDA

24. Social History Type Value Set

25. Social History within CDA • <text> • <content ID="socialhistory-1">Recently retired as a day care worker. Immigrated • from China 30 years ago. Husband passed away in 2003. 3 supportive children. Denies • current or history of tobacoo, EtOH, illicits. Exposed to second-hand smoke by • husband.</content> • </text> • <entry typeCode="DRIV"> • <observation classCode="OBS" moodCode="EVN"> • <templateId root="2.16.840.1.113883.10.20.1.33" /> • <id root="a13c6991-5c8b-11db-b0de-0800200c9a66" /> • <code code="14679004" displayName="Occupation" • codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"> • <originalText> • <reference value="#socialhistory-1" /> • </originalText> • </code> • <statusCode code="completed" /> • <effectiveTime> • <low value="19971203" /> • <high value="20001203" /> • </effectiveTime>

26. Homework • Questions for sprint team review • What report types will use the social history section? • Any additional social history types to be covered in the Social History Type value set? • Are there any concerns in using Social History to capture the following core common objects: • Employment Information • Toxic Exposure

27. Family History – Data Elements

28. Family History – CDA The Family History section contains data defining the patient’s genetic relatives in terms of possible or relevant health risk factors that have a potential impact on the patient’s healthcare risk profile. Public health reports (for example, reports on the relationship between a mother and their child) would report similar data elements for each family member, linked as a set of observations tied to the patient. continued

29. Family History – CDA As noted in Figure 2, the Family History section of a CDA Public Health Report is populated by creating a Family History Organizer for each family member, with observations then being associated with that Organizer. continued Figure 2 - Family History Conceptual Overview – CDA

30. Homework • Questions for Sprint Team Review • What report types will use the Family History section? • Any needed extensions for Family history needed?

31. Procedure – Data Elements

32. Procedure – CDA continued

33. Procedure – CDA continued

34. Procedure – CDA The following table contains an example of how the different parts of a procedure would be documented using CDA for a public health report: continued

35. Procedure – CDA

36. Homework • Questions for sprint team review • What report types would use procedures? • What procedure types are anticipated for public health reports?

37. Final Homework for next week • Review of reference documents • Review slides (paying attention to additional homework items) • Review next set of core common objects to discuss CDA and HL7 2.x implementation next week • Spreadsheet available on wiki here: http://wiki.siframework.org/PHRI+Implementation+Guide • Review ‘week 2’ tab

38. Questions / Discussion? • Wiki Page • http://wiki.siframework.org/PHRI+Implementation+Guide • Or click “Implementation Guide” button from any PHRI wiki page • Will post presentations, meeting minutes, “homework”, and documents for review • Additional Questions? Contact Lindsay Brown (lrbrown@cdc.gov) 38