welcome! health and the internet ◦ continued innovation ◦ learn from others and by doing ...
TRANSCRIPT
Welcome!
Health and the Internet◦ Continued innovation ◦ Learn from others and by doing
Future Based Agile Thinking◦ Envision a desirable future◦ Try it out
People-Centered Internet: Workshop
Your workshop Interrupt-Driven Format
◦ Short introduction◦ Presentation and Demos (15-20 minutes)◦ Discussion◦ Short break
Learning Health System ◦ It is a journey
Interactive
Community Health Data◦ Getting and understanding data
Use Case: Seasonal Influenza◦ What can the data tell us?
Use Case: Asthma◦ Using ICT to engage clinician and patient
Use Case: H.E.A.T. Application◦ Engaging citizens in their public health
Agenda
Solano County, California◦ Health Officer and Deputy Director of Health &
Social Services◦ 425,000 people
Population and Public Health Data
A Community of Health Innovation◦ Working with the UC San Diego BEACH◦ A “wind tunnel” for trying new ideas and concepts
Dr. Bela Matyas
Accessing Critical Data in Public Health
Bela T. Matyas, MD, MPHHealth Officer, Solano County
Electronic submission of community health and other public health data◦ From EMRs, labs, point-of-use devices and other
relevant sources◦ To inform community health and public health
programs Access to these data (de-identified and/or
aggregate, as appropriate) for healthcare providers, academics and the general public
Personal data submission, as appropriate Avatars to inform personal health
Vision for Public Health Data
Statutory Reportable Conditions, Title 17 Syndrome Surveillance data Reportable data under Meaningful Use Vital Statistics Community Health Indicator data Needs Assessment data Public Health Nursing and case
management data Jurisdiction-specific data Clinical data for jurisdiction clients
Critical Data for Public Health
Reportable Conditions
Reportable communicable diseases and selected
other conditions (e.g. certain toxins, syndromes)
Occurrence of any unusual disease
Outbreaks of any disease
Lapses of consciousness
Childhood lead poisoning
Reporters: providers, laboratories, schools, facilities
Other Data
Vital Statistics
◦ Birth records, Death records, Fetal & Infant Mortality
Community Health Indicator Data
◦ BRFSS and other surveys, OSHPD data, County Health
Rankings, smoking rates, obesity rates, poverty rates
Needs Assessment data
◦ MAPP, CHNA, other generalized assessments
◦ MCAH, Mental Health, other specific assessments
Other Data, cont. Public Health Nursing and case management
◦ At-risk families, foster care, Ryan White, TB, STDs
Jurisdiction-Specific Data
◦ Emergency Medical Services, animal bites, chronic
diseases (e.g. asthma, cholesterol level, HbA1c),
injuries, ‘public health importance’
Clinical data
◦ CCS clients, CHDP
◦ Primary care, mental health, dental, substance abuse
Data Partners
Sources/senders
◦ Healthcare providers, healthcare facilities, EMS
◦ Laboratories, including out-of-state
◦ Other LHDs, CDPH
◦ Clinics, managed care plans, CBOs, schools, etc.
Receivers
◦ CDPH, other State Agencies (DHCS, EMSA, etc.), CDC
◦ Community partners, clients, other LHDs
Uses of Data
Case reports, case investigation
Outbreak detection
Outbreak investigation and control
Disease surveillance and trend analysis
Community health status & improvement
Program implementation and evaluation
System assessment (e.g. EMS)
Client care
Current Data Pathways
Fax, mail, telephone
Electronic lab reports
Health information exchanges
Source -> LHD -> State
Source -> State -> LHD (hopefully)
Source -> HIE -> State and/or LHD
Mostly point-to-point
Labs/hospitals: up to dozens of data receivers
Meaningful Use & ACA: Opportunities
HITECH Meaningful Use
◦ Financial incentives & penalties for EHRs
◦ Public Health Objectives: Immunization, ELR, SS
◦ Cancer and “Special” Registries
◦ Promotes health information exchanges
Affordable Care Act (healthcare reform)
◦ Promotes prevention & primary care partnerships
Local public health works with its healthcare providers in alignment and support of Federal and State efforts
Local public health is the “Public Health Authority” in California◦ Can delegate to provide services on its behalf
HITECH represents a great opportunity◦ Public health staff can shift resources from data
collection to data use and application◦ Transition from faxes and manual entry to electronic
If public health is ready and able!
Solution Approach
Current point-to-point approach for transmission to State and LHDs too inefficient, variable quality
Substantial burden on data sources, esp. hospitals, providers and labs
Substantial burden on LHDs for data acquisition and quality assurance
Scalability limited Preferred model: a single data feed to local
public health◦ Electronic data transmission to a router/hub
The Preferred Solution
All public health data flow to “hub”, which both translates data (QA) and routes to destinations including CDPH HIE Gateway
Subscription Software as a Service model Data available “in the cloud” or a local copy
under the governance of local public health and its partners, or both
Allows jurisdictions to focus on internal needs with a single feed from healthcare
The “Hub”
Maximum ease for data sources; single pipeline Router vs. database (transmission, not storage) Accept data from all source EHRs Data QA and universal data mapping at Hub Route data to any destination Maximum flexibility Maximum scalability Standard, not custom; software-as-a-service Long-term value (indefinite timeframe) Able to share data with partners
The “Hub” Design Specifications
The Hub
Hospital A
Hospital B
Provider I
Provider II
Regional HIO
PrivateHIO
LocalPHA
Router
Regional/Statewide• CDC/ASTHO BioSense 2.0• CDPH HIE Gateway
• CA – CAIR• CA – CalREDIE
• CA – Cancer Registry• CA – Lead / RASSCLE
SolanoCloud Copy
Solano Hub
(Internal)
DOD, VA
Other Jurisdictions
Routing Model
Population and Public
Health Hub
Enterprise HIE
Vendor-Based HIE
Payer-Based HIE
Regional HIE
Quest / Clinical Labs
ACKs, Feedback & Data Provenance
Provider Network
DOD, VA, Tribal
SolanoInternal
Hub
Orders
All Categories of Partners
Results
State and Regional Systems
Single Provider Practice
Population and Public
Health Hub
HIEInterface(optional)
Hospital
ProviderNetwork
FQHC, DOD & VA
Individual Practice
ClinicalLaboratory
Cancer Case
Electronic LabReporting
ChildhoodLead
SDIR Imperial
CAIR
RIDE
Other States
SD webvCMR
CDPH CalREDIE
CDC BioSense
HMS EpiCenter
Collaborate.org
JH ESSENCE
Others
Others
Immunization
Syndrome Surveillance
Regional Reg
RASSCLE
ACKs, Feedback & Data Provenance
Health System
Public Health
Route to existing applications
Population and Public
Health Hub
HIEInterface(optional)
Hospital
ProviderNetwork
FQHC, DOD & VA
Individual Practice
ClinicalLaboratory
BehavioralEMR
LIMS
EnvironmentalHealth
ClincalEMR
POU Diagnostics
ACKs, Feedback & Data Provenance
Health System
Public Health
SolanoInternal
Hub
Master Patient
Master Provider
Route to internal systems
Population and Public Health Hub
Syndrome Surv
ELR
POU Dx
911 Dispatch
Amb Run Data
Local Public Health
(PHI, De- & Un-Identified)
Community(Aggregate)
Regional &Healthcare
(De- & Un-Identified)
ACKs, Feedback & Data Provenance
Immunizations
Environ DataC
lou
d &
Deskto
p
Toolk
its
Policy / Governance
Access / Rights
New “data driven” analysis
PPHH: Benefits to Public Health• Realize the potential of Meaningful Use reporting
• Improve Community Health by enhancing Partner relationships
• Quality electronic data and information
• More effective use of resources and error reduction
• Give back to Partners
• Technical scalability and sustainability
• Shared governance and management oversight by BEACH under UCSD
Where to Next?
• Seasonal Influenza
• Blending disparate data sources
• Real-time surveillance
• Permit pro-active management
• Implement HEAT and asthma applications
• Engage DOD, VA and surrounding communities as partners
• Community Health Hub – engaging healthcare partners
• Catchment area awareness
• People-centered internet – public engagement
Population and Public Health People
People Population and Public Health
Mutual Benefit
General Observations
Discussion