BEACH UpdatePopulation and Public HealthPublic Health Tiger Team

Dr. James Killeen

UC San Diego Dept. of Emergency Medicine

Beacon Education, Analytic and Coordination Hub

SD Beacon Objectives

Build Regional HIE Infrastructure• Integrate Health IT into Care Delivery

– Improve care coordination among providers– Engage patients and families

• Quality: Cardiovascular disease– Acute care: EKG transmission from EMS to Hospitals for acute

Myocardial Infarctions• Reduce Time to Catheterization and False Positive Rates

– Chronic care: Reduce 30 day re-admissions • Public Health Enhancements & Meaningful Use

– Immunizations– Syndrome Surveillance– Electronic Lab Reporting

• Cost Efficiency– Reduce repeat ED visits, hospital admissions & Redundant Tests

2

Beacon Innovations

• Regional and inter-state EMS Hub Services• Situation Awareness• Population health data and analytics• Public health data, visualization and analytics• Meaningful Use public health reporting certification and

compliance support• Embedded Medical Devices• Tele-medicine and Tele Lab• Environmental Data

San Diego

Beacon

CDC

Community A

VA/DOD

State/Local Government

Community B

ClinicsEMS

County PH

SD VA/DOD

SSA

Evolving from the BEACON to the BEACH

BeaconLeveraging information and best practices across all Beacon Communities while also

EducationIncluding and informing communities that were not participants in the grant program by

Analytic Using analytical tools to create situational awareness

CoordinationCreating a forum in an aligned manner for the exchange of data and information using

HubThe UCSD Emergency Medicine Department as the common center of activity

Public Health Data Starts Locally

• Raw Data is reported to PH – PHI, De-identified and Aggregate• PH Applications and Informatics Analyze• Information is Generated and Shared

Info

Data

RawData

Public Health

Population Health utilizes PH Analysis

• PH Shared Info is Source data – De-Identified and Aggregated• New data sources – EMS, Behavioral Health• Includes Healthcare, Research and Businesses• Generated new Information that is Shared

Info

Data

RawData

Public Health

Population HealthInfo

Data

NewData

Community Health

• Pop Shared Info is Source data –Aggregated• New data can be added• Includes Entire Community, State and Federal • Generated new Information that is Shared

Info

Data

RawData

Public Health

Population Health

Community Health

Info

Data

Info

Data

NewData

Current Focus

• Population and Public Health• Maximizing data to public health• Support existing applications and systems• Enable rich analytics, visualization and reporting• Consistent interfaces for interoperability

Info

Data

RawData

Public Health

Population HealthInfo

Data

NewData

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

Health Partner

IZ PHCR ELR POU Dx SS

Support Existing Systems

Immunization Registry

PH Cases SurveillancePH Case Management and Investigation

EMR/EHR LIS

Health

IndicatorsD

emog

raph

ics

Health Partners

IZ

PHCR

ELR

POU Dx

SS

Hub Simplifies the Process

Immunization Registry

PH Cases Surveillance

EMR/EHR LIS

Now Applying the Data

1. Upcoming back-to-school and fall vaccination campaigns

2. Asthma

3. Diabetes

Immunizations

Seasons

POU Dx

Economic

Case Reporting

Pharmacies

Care Facilities

Transportation

Syndromes

Schools

Populations

BMI

Lab Results

Elderly Care

Regions

Air Quality

• Thousands die every year• Vaccination campaigns are a tool

– Both influenza and pneumonia

• Challenges– How effective are we?– Can we be more effective?

• If we can collect and analyze data faster…– Campaigns can be targeted and adjusted– Surveillance can be a by-product of routine care

Seasonal Influenza

Surveillance – Influenza-Like Illness

Encounter•Assessment

School Nurse•Screening Test

Urgent Care•Rapid Diagnostic

Emergency Department•Diagnostic & Typing

Public Health Laboratory•Typing & Subtyping

Vaccinations Encounters Test Results

Real-Time Situation Awareness

GoalCompress time to

knowledge to mitigate overall impact and cost

Population and Public Health Hub

Population and Public Health Hub

Syndrome Surv

ELR

Rapid Diagnostics

Case Reporting

Exposure Monitoring

Public Health(Protected Health

Information)

Community(Aggregate)

Regional &Healthcare

(De- & Un-Identified)

ACKs, Feedback & Data Provenance

Immunizations

Environmental DataC

lou

d &

Des

kto

p

Too

lkit

s

Policy / Governance

Business Rules

Platform Deployment

• Priorities– Support existing application-

specific data flows– Establish new flows to support

analytics and other needs– Provide information back to

stakeholders in a timely manner

• Rules– Interoperability by design– Reduce dependence on HL7– Open standards– Open interfaces

• Agile in the Extreme• 2-6 cycles• Discovery

– 2-6 hours concept– 2-6 days proto

• Dynamic– 2-6 days concept– 2-6 weeks proto

• Map to existing design patterns and enhance services

Service Bus

High Level Architecture

SecurityProvenanceGovernance

New ApplicationsAnalysis, Visualization, Reporting

Data InRouter

Data Out

Router

PreProcessEngine

DataAccessLayers

PostProcessEngine

LegacyApps

Coding,Look up

ExtData

StagingData

AppData

Data Marts

Data Whse

Syndrome Surveillance Example

Validation Router

BioSensePP

CollaboratePP

Sequence

Filter

Enrich

Enrich

AppData

Data Whse

Case Reporting – Pertussis

Patient

Router

Watchdog:LabOrder

Enrich: Care Detail

Enrich:Pat Detail

Enrich:IZ Lookup

Notify:PH Case

ExposureMonitor

HEAT Data

EHR ICD-933.X Trigger

EHR orSDC

Validation

IZ Data

Create:Pot Case

QUESTIONS?

Dr. James Killeen

jkilleen@ucsd.edu