jim greene, md, ms
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Jim Greene, MD, MSDeputy Director
Center for Health Statistics and InformaticsCalifornia Department of Public Health
Neal RosenblattChief
Informatics BranchCenter for Health Statistics and Informatics
California Department of Public Health
Jeremy PineChief
Information Technology SectionChronic Disease Surveillance and Research
Branch Center for Health CommunitiesCalifornia Department of Public Health
James P. Watt, MD, MPHChief
Division of Communicable Disease Control Center for Infectious Disease
California Department of Public Health
What’s in interoperability for CDPH ?
Progressive capability maturity to integrate population health management data with healthcare delivery systems data, making
data and information more easily accessible as a means to improve
community health throughout California.
The How of Interoperability: CDPH
Interoperability Primer & Roadmap Planning Toolkit
– A Strategy for Interoperability, Assessment, Implementation, and Data
Sharing
Objectives • Strategic Approach • Governance • Implementation • Output
Neal Rosenblatt
Chief, Informatics Branch
Center for Health Statistics and Informatics
California Department of Public Health
2017 – 2022
Presentation Topic & Contents
The How of Interoperability: The Interoperability Primer & Roadmap Planning Toolkit− A CDPH Strategy for Interoperability Assessment, Implementation, and Data Sharing
• Objectives & Strategic Approach– Registries/Surveillance Systems Forum, June
2016– Business, Data, and Technology
• Governance– Organizational Structure
• CHSI Informatics Branch– Information Management Services
• EODS Steering Committee– Workflow
• RME Toolkit & Implementation• Output
– As-Is/To-Be Requirements Documentation– Interoperability Strategic Plan
Topic Presentation Contents
Objectives
From the CDPH Planning for the Future of Registries & Surveillance Systems Forum, June 22, 2016:• Identify needs and opportunities for registries and surveillance
systems as we plan the future of data sharing and interoperability• Understand CDPH’s individual registries and data system priorities
for business, data, and technology needs including:1. Linking common identifiers for sharing information; 2. Collaboration with hospitals and providers; 3. Leveraging data lessons learned from other states; 4. Agreement of a common data dictionary; 5. Using data to educate the public – “tell our story”; 6. Data agreements with outside sources; 7. Identifying Centers and Offices with similar goals to work together.
Objectives upon which the RME
Toolkit development process was
founded
Identify needs and opportunities
Understand CDPH’s individual registries and data system priorities
Linking common identifiers Collaboration with hospitals and providers
common data dictionary
Data agreements
CDPH Registries, Surveillance Systems, and Business Support Systems
• 2.1 ADOLESCENT FAMILY LIFE PROGRAM (LODESTAR)
THE CENTER FOR FAMILY HEALTH (CFH)
• 2.2 BLACK INFANT HEALTH PROGRAM (ETO)
THE CENTER FOR INFECTIOUS DISEASES (CID)
• 2.3 CALIFORNIA BIRTH DEFECTS MONITORING PROGRAM (CBDMP)
• 2.4 CALIFORNIA IMMUNIZATION REGISTRY(CAIR)
• 2.5 CALIFORNIA OFFICE OF REFUGEE HEALTH
• 2.6 CALIFORNIA REPORTABLE DISEASE INFORMATION EXCHANGE (CALREDIE)
THE CENTER FOR HEALTHY COMMUNITIES (CHC)• 2.7 CALIFORNIA CANCER REGISTRY (CCR)
• 2.8 CHILDHOOD LEAD POISONING PREVENTION BRANCH (RASSCLE II)
• 2.9 DCDC CALIFORNIA LABORATORY INFORMATION MANAGEMENT SYSTEM (CAL-LIMS)
• 2.11A ELEVATED LEAD VISUAL INFORMATION SYSTEM (ELVIS)
• 2.11B WORK-RELATED ASTHMA PREVENTION PROGRAM (WRAPP)
• 2.11C OCCUPATIONAL PESTICIDE ILLNESS PREVENTION PROGRAM (OPIPP)
• 2.11D FATALITY ASSESSMENT AND CONTROL EVALUATION PROGRAM (FACE)
• 2.10A NEWBORN SCREENING DISORDER REGISTRY
• 2.10B CHROMOSOME REGISTRY
• 2.10C NEURAL TUBE DEFECTS REGISTRY
• 2.12A CALIFORNIA HIV SURVEILLANCE SYSTEM
• 2.12B HIV CARE DATABASE (ARIES)
• 2.12C HIV PREVENTION DATABASE (LEO)
• 2.13 FLUORIDATION & ORAL HEALTH SURVEILLANCE SYSTEM (FLOHSS)
• 2.14 PARKINSON’S DISEASE REGISTRY
• 2.15 CALIFORNIA STROKE REGISTRY
• 2.16 CALIFORNIA SMOKER’S HELPLINE
THE CENTER FOR HEALTH STATISTICS AND INFORMATICS• 3.1 CALIFORNIA INTEGRATED VITAL RECORDS SYSTEM (CAL-IVRS)
• 2.17 CALIFORNIA BIOBANK PROGRAM
• 3.2 WIC MANAGEMENT INFORMATION SYSTEM (WIC-MIS)
1.1 Working Definition of a Public Health RegistryThe California Department of Public Health (CDPH) does not have a unified definition of a public health registry. For purposes of this report, a registry is defined “as a database of identifiable entities containing a clearly defined set of health and demographic data collected for a specific public health purpose.”
1.2 BackgroundThe California Department of Public Health (CDPH) currently supports 27 identified public health registries and surveillance systems at varying phases of development. These registries vary by purpose, scope, function, funding source, technical capabilities, implementation, case definition and case-finding (ascertainment) procedures, determination of data elements, data collection and processing procedures, data access policy, and a framework for dissemination of registry data and findings.
LEGEND:• Grouped by CDPH Centers• Indexed to California Department of Public Health Registries: A Report for the Directorate (2015)
THE CENTER FOR HEALTH CARE QUALITY (CHCQ)• X.X LICENSING AND CERTIFICATION PROGRAM (HFCIS)
Governance Structure
Directorate
DO-ITCommittee
PolicyCommittee
EODS Steering
Committee
B/F WGJim Greene / Alex
Haq, Co-Chairs
O & CEllen Badley, Chair
DS/DQ WGNeal Rosenblatt,
Chair
LPS WGJim Greene, Chair
Tech WGYasser Lahham / Neal Rosenblatt,
Co-Chairs
Oversight is provided by DS/DQ and Technical Workgroup Leads EODS Info Mgt Services & Analytics
Services Unit
Research Data Supervisor II
VACANT581-223-5734-909
(916) XXX-XXXX
Eyobe AkoRDS II
581-223-5758-909
(916) XXX-XXXX
Chelsea ScheiberRDS II
581-223-5758-909
(916) XXX-XXXX
Marisa ReyITS II
580-151-1414-909
(916) XXX-XXXX
Vonda LongITS II
580-151-1414-909
(916) XXX-XXXX
Predictive Analytics Services Team
(P.A.S.T.)
Analytics Services Unit
E O D S
Rebecca FeinCID ContractorXXX-XXX-XXXX-
XXX(916) XXX-XXXX Program
SpecialistCHCQ
Latonia Richardson
CHCQ SupportXXX-XXX-XXXX-
XXX(916) XXX-XXXXProgram
SpecialistCAIR/CalREDIE
Giselle LauITS II
580-151-1367-909
(916) XXX-XXXX
Information Management Services
Team (I.M.S.T)
Info. Mgt Lead/
EODS 3.0
Colin ChewRDA II
581-223-5731-909
(916) XXX-XXXX
IT Dev/Ops/SDLC
Scott Fujimoto, MD, MPHPHMO II
580-223-7722-001(916) 324-6376
Ryan BealRS III
580-223-5594-909
(916) 552-8041
Laura LundRS III/Branch Lead580-223-5605-001
(916) 552-8113
David DauphineRS II
580-223-5582-003
(916) 552-8224
Michael RodrianRDM III (RDA)580-223-5740-
901(916) 872-5866
Mayra CanoHPS I
580-223-8338-002
(916) 650-6895
Research Scientist Supervisor I
VACANTTony Agurto, CEA (Acting)
580-223-5651-904(916) 552-8100
Science AdvisorEODS
Neal RosenblattRS III
580-222-5594-909
(916) 621-1540
Victoria DaherRDS II
580-223-5758-001
(916) 552-9873
Cal-IVRS
Let’s Get Healthy California / Open Data
Angel ValdezAGPA
580-223-XXXX-XXX
(916) 552-9978
DS/DQ WGNeal Rosenblatt,
Chair
Technical WGYasser Lahham
Neal Rosenblatt, Co-Chair
Oversight is provided by DS/DQ and Technical Workgroup Leads
EODS Steering Committee
EODS Steering CommitteeEODS Information
Management Service/ Analytics Services Unit(Within CHSI Informatics Branch)
Information Management Service Function Between CDPH Data Coordinators and EODS Information Management Services
Team
Data CoordinatorsCDPH
Centers/Offices
CID CHSI
CHC
CFH CEH
CHCQ
OHE EPO
Inclusion Criteria = Data Collecting, Sharing, Exchanging Entities
Depicts requirements information flow
ToolkitImplementatio
n/ Requirements
Gathering Process
• Interoperability “Readiness” Assessment
• Requirements Gathering
• Strategic Planning
• Interoperability Solutions• Predictive Analytics Service• Data Standards/Data Quality• Data Privacy/Security• Governance• Data Curation• Information & Data Management/ EODS 3.0
Minor Reorganization2018
Data Coordinators& Workflow
EODS INFORMATION MANAGEMENT SERVICES TOOLKIT
3 Components• Manual• Workbook• Training Guide
AssessmentRequirements
Gathering Process
Information Management Services Toolkit
Interoperability Readiness Assessment
• Interoperability Primer• Worksheet Series
– Business Case for Interoperability
– Goals + Objectives
– Strategic Planning
• Section 1.0– Business Case for
Interoperability– Worksheets 1.5 – 1.6
• Section 2.0– Goals + Objectives– Worksheets 2.1 – 2.2
• Section 3.0– As-Is/To-Be Strategic
Planning– Worksheets 3.1 – 3.8
User Manual Workbook Training Guide
EODS Planning History
Roadmap Exercise + Objectives
Business + Data + Technology Strategic Approach
Toolkit Development + Alignment
Interoperability Primer
Toolkit Contents + Exercises
Roadmap Toolkit Content Areas: 1.
2.
3.
Three (3) key steps to defining how to get from a current As-Is state to a desired future To-Be state
TABLE 3. ROADMAP PLANNING TOOLKIT LIST OF WORKSHEETS
Roadmap Toolkit Implementation:
1 Day StrategicPlanning Workshop
Strategic PlanningPrep Work
TABLE 3. ROADMAP PLANNING TOOLKIT LIST OF WORKSHEETS
Toolkit Workflow
As-Is / To-Be Specifications Output to Roadmap Vendor
6 – 8 week implementation process
RME Toolkit Alignment with State and National Initiatives, and Federal Policy
Aligns with:21st Century Cures Act (2016)ARRA HITECH Act (2009) MACRA (2015) U.S. DHHS ONCAHIMA Data Standards CAHIE/CTENCHHSA 2016 Information Strategic Plan CHHSA 2012-2014 HIE Plan CHHS Master Data Management StrategyPublic Health 2035 Vision
Federal
National
Statewide
California Association of Health Information Exchanges (CAHIE)
CAHIE Founding:• $38.8M State HIE Cooperative
Agreement Grant (2011)o Provisioned by HITECH (2009) through
ONCo CHHS Initial Administrator
• CAHIE formed as 501(c)3 (2013)CTEN: California’s inter-organizational health information exchange CIC: A committee of CTEN participants. Upholds set of policies and procedures for trusted exchange CalDURSA: California's multi-party data sharing agreement for trusted statewide health information sharing; compatible with DURSA in partnership with ONC’s eHealth Exchange
CALIFORNIA ASSOCIATION OF HEALTH INFORMATION EXCHANGES OBJECTIVES:
1. PROMOTE A REGULATORY ENVIRONMENT IN CALIFORNIA THAT ENABLES PROVIDERS, CONSUMERS, AND
OTHER STAKEHOLDERS TO EXCHANGE AND APPROPRIATELY ACCESS HEALTH INFORMATION.
2. CREATE A COLLABORATIVE ENVIRONMENT THAT FOSTERS AND SUPPORTS COOPERATION AMONG OUR
MEMBERS AND OTHER STAKEHOLDERS TO SOLVE DIFFICULT PROBLEMS AND SHARE LESSONS LEARNED IN
HEALTH INFORMATION EXCHANGE.
3. FOSTER THE ADVANCEMENT AND GROWTH OF ELECTRONIC INFORMATION EXCHANGE THROUGH
CREATING AND SUPPORTING INFORMATION EXCHANGE INITIATIVES.
4. ENABLE AND SUPPORT HIGH-VALUE INFORMATION EXCHANGE AMONG UNAFFILIATED COMMUNITIES.
5. PROVIDE SERVICES IN SUPPORT OF STATEWIDE HEALTH INFORMATION EXCHANGE ACTIVITIES AND
INITIATIVES.
Founding, Structure, Policies & Procedures
California HIE LandscapeCAHIE CTEN Membership:
• 11 Community HIOs• 6 Enterprise HIOs• Other Point-to-Point Exchange• 38 of 58 Counties have Community HIO
presence
To-Be Interoperability Solution for the Roadmap Planning ExerciseIn Alignment with CAHIE CTEN and ONC TEFCA
CalDURSA
When completed, Roadmap Toolkit output will provide the following information by CDPH Center/Office and by Program data collection system:
• A brief overview of the registry, surveillance system, or business support system
• Its current and envisioned future state • Mission and Value statements • SMART goals and objectives statements • SWOT Analysis
o Identifies proposed pathways to get from a current “As-Is” state to a desired future “To-Be” state
o Informs RME vendor of business, data, and technology requirements• Opportunities to engage State and National interoperability
initiatives and directly address federal policy
Thank You!
Neal Rosenblatt
Chief, Informatics Branch
Center for Health Statistics and Informatics
California Department of Public Health
3701 N. Freeway Blvd, Sacramento, CA 95834
Email: Neal.Rosenblatt@cdph.ca.gov
Contact Information
Interoperability Use Case
Electronic Pathology ReportingJeremy PineInformation Technology Section ChiefChronic Disease Surveillance and Research BranchCenter for Healthy CommunitiesCalifornia Department of Public HealthJanuary 7, 2019
California Caner Registry
The Path Forward
• What – Recent Legislative Change• How – Program Execution• The Future – Where we are headed• Why – Define the purpose
California Cancer Registry
• 1987 - First statewide data collection year – Hospital generated cases– Manually abstracted by Certified Tumor Registrar
(CTR) staff
• 180,000 New Patients per year– 200,000 new tumors, 240,000 hospital cases
• 2001 – First implementation of electronic Pathology Reporting
Introduction
• CA State Assembly Bill 2325 – Introduced in February of 2016 by
Assemblywoman Susan Bonilla, 14th District - Contra Costa, Solano Counties
– Approved and signed by Governor Jerry Brown on September 14, 2016
Assembly Bill Text
This bill, on or after January 1, 2019, would, among other things, require a pathologist diagnosing cancerto report cancer diagnoses to the department by electronic means, including, but not limited to, either directly from an electronic medical record or using a designated Internet Web portal provided by the department.
CA Health and Safety Code 103885
Assembly Bill Text (Cont.)
3 (C) A pathologist shall not be responsible for acquiring missing or inaccessible patient demographic information not provided to him or her beyond the content of the required cancer-specific data elements
CA Health and Safety Code 103885
Many Large Parts to the Plan
• Communications • Data Standards• Technical Support• Software/Hardware/Network Development• Testing/Implementation Support• Operational Process Changes
Milestones
January 15, 2017
July 1, 2017
January 1, 2018 January 1,
2019June 8, 2018
September 14, 2016
Registration Process
• Registration with the California Cancer Registry is required for electronic pathology reporting
• A Laboratory or institution may register a single time on behalf of all of its pathologists
• https://pathreporting.ccr.ca.gov/registration/
Data Elements• Required
– Patient Information (First, Last)– Ordering Physician Information (First, Last, Provider NPI, CA License
Number, Address)– Ordering Facility (Facility Name, NPI, Address)– Principal Result Interpreter (Last, First, CA License Number)– Cancer Diagnosis (Order Filler Number, Date Specimen collected, Date
results reported, Report Text)• Required if available
– Patient Information (14 fields)
Data Format
• HL7 v2.5.1 ORU_R01 - CDC National Standard NAACCR Volume V:– Simple Narrative– Synoptically Structured – Synoptically Structured using College of American
Pathologists (CAP) Electronic Cancer Checklist (eCC)
• SDC XML – CAP eCC Structured Data Captured(SDC)– IHE QRPH SDC Rev. 2.1 Trial Implementation
Required Data ElementsElectronic HL7
• California HL7 v2.5.1 Constraints Document• Fields are designated as required or required if accessible• Specific constraints including:
– Identifier Type – CCR wants Medical Record Number (MR) or Social Security Number (SSN)
– Producer’s reference – CCR wants the CLIA number of the Lab
Transmission Methods
• CCR will accept electronic pathology reports through four methods of transmission:
1. Web Services (SOAP, REST)2. Minimal Lower Layer Protocol (MLLP)3. Secure File Transfer Protocol (SFTP)4. Direct Data Entry Web Portal
Current State of Implementation
• 537 Reporting entities have registered• 198 Reporting entities have completed onboarding• 239 Reporting entities are actively within the process
of onboarding– 210 via a new interface– 28 to report via the Direct Entry Portal
• 100 Registered entities have yet to initiate onboarding
What does the future look like?
• Support transition of interfaces off of HL7 v2.5.1– Move away from customized interfaces and data
constraints
• Towards HL7 v3– Consolidated Clinical Document Architecture (C-CDA)– Clinical Document Architecture (CDA) based reporting
What is in HL7 v3 C-CDA?
CDA Document Types (9 Common Types)
Continuity of Care Document
Consultation Notes
Discharge Summary
Diagnostic Imaging Reports
Clinical History and Physical
Operative Note
Progress Note
Procedure Note
What is in a CDA Document Type?
Continuity of Care Document (CCD) Templates
Header Medications
Allergies Immunizations
Problems Medical Equipment
Procedures Vital Signs
Family History Functional Stats
Social History Results
Payers Encounters
Advance Directives Plan of Care
What is CDA on FHIR?
• FHIR – Fast Healthcare Interoperability Resources – Structured and Standardized constraints – Blueprint for a shared message structure– Enables direct query and response
Why are new standards important to CCR?
• Timeliness of Data• Data Curation Cycle of 24 months to 6 months
or less• Near-time access to data for researchers and
clinicians
Cancer based CDA Implementation
HL7 CDA ® Release 2 Implementation Guide: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1, DSTU Release 1.1 – US Realm
What’s next for CDA and Cancer Reporting?
• Reporting to Public Health Cancer Registries from the Pubic Health Case Report (eICR)
• Reporting to Public Health Cancer Registries from Clinical Oncology Treatment Plan and Summary
What can CCR do with CDA based data?
• Genetic Data guides cancer treatment decisions in today’s world– Central Cancer Registries should start to stratify
surveillance data on genetic profiles and associated treatment decisions in near-time
– Focus towards use of CCR data in clinical environments
Future of a Central Cancer Registry
• 21st Century Central Cancer Registry– Near-time Surveillance– Clinical Decision Support– Clinical Research Evaluation
• Leverage technology and emerging health information data exchange standards
Improving Public Health through Electronic Case Reporting
James Watt, MD MPHChief
Division of Communicable Disease Control
January 7, 2019
Presentation flow
• Overview of Electronic Case Reporting (eCR)• Overview of the Digital Bridge• Update on eCR implementation in California
Electronic case reporting (eCR)
• Automated generation and transmission of case reports from electronic health records to public health agencies
• Automated communications from public health agencies to health care providers
eCR flow
Provider EHR Decision Support
IntermediaryPublic Health
Provider
enters information into the EHR
as part of regular
workflow
sends an electronic
report based on a set of standard triggers
reviews report,
determines reportability
and forwards to appropriate
public health agency
receives report and
acts to protect
public health
receives confirmation
of report and
information from public
health agency
Benefits of eCR
• Public health– Improved timeliness and quality of disease reports– Improved data for public health action– Increased efficiency of communications to health care
providers• Providers
– Increased efficiency of reporting to public health– Reduced uncertainty of reporting requirements– Improved communication flow from public health– Compliance with meaningful use requirements
The Digital Bridge: A partnership of health care, health IT and public health organizations
• Goal: improve our nation’s health through bidirectional information flow between health care and public health
• A forum for sharing ideas• An incubator for innovative projects • Initial focus: eCR, leveraging investments by
CDC, CSTE and APHL
Digital Bridge organization
• Governance body– Health care networks– Health IT vendors– Public health agencies
• Program management office• Workgroups
– eCR implementation– Evaluation– Legal and regulatory– Strategy
Digital Bridge approach
• Leverage the APHL Informatics Messaging Services (AIMS) platform built for electronic laboratory reporting (ELR)– Hosted on Amazon Web Services– Uses standardized, EHR system agnostic transmission
• Utilize a decision support intermediary (Reportable Conditions Knowledge Management System—RCKMS)– Provide a library of reporting triggers for use by EHRs– Review, validate and route case reports
• Provide national coordination, tools, training and technical assistance for eCR
Digital Bridge progress
• Houston Methodist/Epic• Production date: Nov. 14, 2018• Able to trigger on problem list –SNOMED• SNOMED translated to ICD-10 when diagnosis is not triggered• As of December 7, 2309 eICRswere received and processed by RCKMS with 69 determined as reportable and sent along to the Houston Health Department.
• Utah Intermountain Health/Cerner
• Successful end-to-end workflow testing• IMH pushed eICR/ triggering functionality to production without sending messages through the firewall to AIMS– Within one week –3,000 eICRs generated for 1,800 unique patients for five pilot conditions
Jan 2019 Feb 2019 Mar 2019 Apr 2019 May 2019 June 2019 July 2019 Aug 2019 Sept 2019 Oct 2019 Nov 2019 Dec 2019
Digital Bridge eCR Implementation Timeline - 2019 DRAFT
New York State SiteProduction
New York State Site Connectivity/Onboarding/Testing
Anticipate discussion of how eCR onboarding will be opened up as part of eCR transition
New York City SiteProduction
Kansas SiteProduction
New York City Site Connectivity/Onboarding/Testing
Kansas Site Connectivity/Onboarding/Testing
California SiteProduction
Michigan SiteProduction
California Site Connectivity/Onboarding/Testing
Michigan Site Connectivity/Onboarding/Testing
California eCR status:• Pilot testing initiated• Production transmission planned for early 2019• Evaluation of pilot planned for mid 2019
eCR next steps
• Legal arrangements for HIPAA compliant data transmission to AIMS
• Evaluation of pilot activities– System impacts– Data quality, completeness, timeliness
• Ongoing communications with stakeholders
Questions?
• www.digitalbridge.us• www.cdph.ca.gov/Programs/CID/DCDC/Pages
/Electronic-Case-Reporting-eCR.aspx
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