collaboration of the health it policy and standards committees · 1/25/2017 · through these...

Public Health Task Force, January 25, 2017 1

Collaboration of the Health IT Policy and Standards Committees

Public Health Task Force Final Transcript

January 25, 2017

Presentation

Operator All lines are now bridged.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Thank you, good morning everyone this is Michelle Consolazio with the Office of the National Coordinator. This is a meeting of the Health IT Policy and Health IT Standards Committee’s Public Health Task Force. This is a public call and there will be time for public comment at the end of today’s call. As a reminder, please state your name before speaking as this meeting is being transcribed and recorded. I’ll now take roll. Anne Fine?

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Yes, I’m here, thank you.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Hi, Anne. Andy Wiesenthal? Anjum Khurshid?

Anjum Khurshid, PhD, MPAff, MBBS – Director of Data Integration, Dell Medical School – University of Texas at Austin Yes, I’m here.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Hi, Anjum.

Anjum Khurshid, PhD, MPAff, MBBS – Director of Data Integration, Dell Medical School – University of Texas at Austin Hello.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Brian Anderson? Chesley Richards? Floyd Eisenberg?


Floyd Eisenberg, MD, MPH, FACP – President – iParsimony, LLC I’m here.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Hi, Floyd. Marc Ovehage? Janet Hamilton? Julia Gunn?

Julia Gunn, RN, MPH – Director Communicable Disease Control Division – Boston Public Health Commission Here.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Hi, Julia.

Julia Gunn, RN, MPH – Director Communicable Disease Control Division – Boston Public Health Commission Hi.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Margaret Lampe?

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention I’m here.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Hi, Margaret.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention Hello.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Noam Arzt?

Noam Arzt, PhD – President – HLN Consulting, LLC I’m here, good morning.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Hi, Noam. Richard Loomis? Riki Merrick?

Riki Merrick, MPH – Lead Specialist, Informatics Terminology – Association of Public Health Laboratories I’m here.


Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Hi, Riki. Steve Hasley? Susan McBride?

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center I’m here.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Hi, Susan. And from ONC we have Rachel on the line. I don’t think Jim was able to join us.

Rachel Abbey, MPH – Public Health Analyst – Office of the National Coordinator for Health Information Technology Yes, I’m here.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Anyone else…hi, Rachel and I think Michael Baker is on the line as well?

Michael Baker, MS – Management Analyst – Office of the National Coordinator for Health Information Technology Yes, I am.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Is there anyone else from ONC? Hi, Michael and I’m sorry Sanjeev we have you as well from CDC?

Sanjeev Tandon, MD, MS – Health Scientist – Centers for Disease Control and Prevention Yes, I’m here.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology So, there’s a lot of people today. Hi, Sanjeev.

Sanjeev Tandon, MD, MS – Health Scientist – Centers for Disease Control and Prevention Hello.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Has anyone else joined since we did roll?

Brian Anderson, MD – Senior Manager of Clinical Effectiveness & Network Medicine – athenahealth This is Brian Anderson.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Hi, Brian.


Brian Anderson, MD – Senior Manager of Clinical Effectiveness & Network Medicine – athenahealth Hi.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Okay, with that I’m going to turn it over to Anne.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Okay, hi, thank you Michelle and hello everybody, good morning, thank you all again for joining the call. I just wanted to take a couple of minutes just to remind everybody about what our charge is so that you can bear that in mind as you’re listening to the presentations and also as we’re having discussion.

And so I’ll just say that our major charge is to make specific recommendations to better assist in the standardization of pregnancy status data, clinical decision support in health IT systems and case management in public health settings, and then specifically using Zika as the use case and looking at how to make recommendations on how we should capture pregnancy status, how we should send and share pregnancy status from electronic health records to public health or from commercial laboratories to public health, the use of any clinical decision support specifically for Zika but potentially for others, as this could be applied to other public health needs and then for case management and follow-up on how to move…especially regarding how to move electronic case reporting forward.

So, during the past few calls we’ve listened, we’ve heard presentations on a variety of topics including the public health authority for receiving this type of information and what we do with it, electronic laboratory reporting, we’ve had a really excellent presentation on what’s happening with electronic case reporting and also on what some best practices are for using clinical decision support to support clinical workflows.

And so today we are going to be learning more about the US Zika Pregnancy Registry and to understand how the information and data that is sent to public health regarding Zika and pregnancy is being used and for that we are going to welcome Emily Petersen who will be presenting on that and Emily is the Lead of the US Zika Pregnancy Registry, she is a Medical Officer at the Centers for Disease Control and she’s also a Practicing Obstetrician so I’m just going to turn it over to her and thank her for participating.

Emily E. Petersen, MD – Medical Officer – Department of Health & Human Services, Centers for Disease Control and Prevention Thank you so much. Good morning. Today I will be talking about the US Zika Pregnancy…what the US Zika Pregnancy Registry is, why it was established, how this surveillance system works and what you could do to support the registry. Next slide, please.

As part of CDC’s Zika response a number of public health surveillance systems were established to learn more about Zika virus infection and its effects on pregnant women and infants. These include the US Zika Pregnancy Registry which collects data on pregnancies with laboratory evidence of possible Zika virus infection in all states and territories except for Puerto Rico.

The Zika Active Pregnancy Surveillance System, which is similar to the registry in Puerto Rico, Proyecto Vig in Colombia, which is also similar to the registry and then also the Zika Birth Defect Surveillance, which is active birth defect surveillance of potentially Zika-related birth defects whether or not laboratory evidence of Zika virus is confirmed in pregnancy as well as ArboNET Surveillance of Children


with postnatal Zika. Through these projects we aim to get a complete picture of Zika virus infection and its impact on pregnant women and infants. Next slide.

The US Zika Pregnancy Registry was established to monitor pregnancy and infant outcomes following Zika virus infection during pregnancy including learning more about timing, the risk of infection during pregnancy and the spectrum of outcomes associated with Zika virus infection in pregnancy.

Data from the US Zika Pregnancy Registry is used to inform clinical guidance and public health response. The registry is a supplemental surveillance effort coordinated by CDC and is dependent on the voluntary collaboration of the state, tribal, local and territorial health departments and we’ve really enjoyed establishing wonderful working partnerships and collaborations. Next slide.

The US Zika Pregnancy Registry regularly analyzes and publishes findings from the registry in peer review journals and informs CDC’s clinical guidance. Additionally, data from the US Zika Pregnancy Registry and the Zika Active Pregnancy Surveillance System in Puerto Rico are publically reported biweekly on CDC’s Zika Virus Homepage shown above. These numbers reflect the number of pregnancies with laboratory evidence of possible Zika virus infection and have been reported to the pregnancy surveillance system. Next slide.

The registry includes pregnant women that have laboratory evidence of possible Zika virus infection and exposed infants born to these women. If infants with previously unrecognized congenital Zika virus infection are identified their mothers will be included in the registry retroactively.

Cases are identified by state and local health departments and reported to CDC. Early in the response it was relatively easy to identify cases that met the inclusion criteria as all Zika testing requests and results needed to go through the state health departments.

Health departments continue to identify cases through their state lab testing, however, the lab testing has expanded to commercial labs and as this has occurred it has become more difficult as the pregnancy status of the patients whose positive lab test results are unknown when the health department is receiving the results.

So, health departments are doing a great job and their best to identify pregnancy status but in hearing from all of our jurisdictional health department partners if pregnancy status was available on the lab results this could help improve efficiency and ensure completeness of case ascertainment.

Healthcare providers are also reporting eligible pregnant women and infants to health departments and we aim to get a complete ascertainment as much as possible for pregnancies with laboratory evidence of possible Zika virus infection. Next slide.

The US Zika Pregnancy Registry collects maternal health history data, neonatal assessment data, infant follow-up data and laboratory results as well as prenatal and postnatal imaging. For maternal health history the US Zika Pregnancy Registry collects information about the pregnant women and her Zika virus infection such as exposure, symptom status, suspected mode of infection and her pregnancy course including past medical history, obstetric history, prenatal testing.

For neonatal assessment the US Zika Pregnancy Registry collects information about the delivery and the newborn including the first physical exam, imaging and diagnostic testing that occurred during the birth hospitalization and this includes essential elements that assess the infant for signs of congenital Zika virus disease or reports on normal findings.


The US Zika Pregnancy Registry collects data on infants at 2, 6 and 12 months and their routine follow-up exams including physical exams, developmental assessments, imaging and diagnostic testing that occurs within the first year of life.

The US Zika Pregnancy Registry also collects data on Zika-related lab results and prenatal and postnatal imaging. Next slide.

There are several methods state, tribal, local and territorial health departments use to collect data for the US Zika Pregnancy Registry. The method chosen might depend on the number of Zika cases in the jurisdiction, previously established practices for data abstraction for surveillance, for already existing surveillance systems such as birth defect surveillance and the public health structure in the state.

Many jurisdictions with a high volume of cases have hired health department staff or worked with local health departments to abstract medical records. In other jurisdictions health department staff collect data from healthcare providers via phone calls or ask healthcare providers to complete data collection forms.

In hearing from experiences with our state and local health department partners, data collection has been facilitated when health department staff are able to obtain remote access to electronic health record systems at hospitals. Once the data is collected by the state health department it is then transferred to the CDC. Next slide.

The identity of people in the registry is kept confidential and CDC has obtained a federal assurance of confidentiality authorized under Section 308(d) of the Public Health Service Act which allows CDC Programs to ensure registry participants that CDC can use no identifiable information for any purpose other than the purpose for which it was supplied unless a participant has consented to that disclosure. Next slide.

In hearing from our jurisdictional health department partners it would be helpful if the health at the pregnancy status was clearly indicated in the electronic health record and especially if the pregnancy status was noted on the lab order requisition and results form. I think this is consistent with the detailed charge of this Task Force and I’m happy to hear about that. Next slide.

The locations of Zika testing is expanding including commercial labs and when jurisdictions receive reports of positive Zika results it would be most helpful to have the pregnancy status denoted in the results.

We are concerned that participation and complete ascertainment of cases for the US Zika Pregnancy Registry will decline without pregnancy status reporting given the expansion of the labs. To address this we are working with birth defect surveillance to identify infants with Zika-related birth defects but this will not capture infants with normal findings at birth who it is also vital to follow for infant outcomes leading to potentially less informed public health response.

We are also working on healthcare provider outreach to ensure complete reporting as much as possible but we definitely want to make sure that we address all potential inefficiencies in the system such as the pregnancy status not being readily available and I think that this would really help to improve the efficiencies and streamline function of the US Zika Pregnancy Registry. Next slide.


I want to thank you for the opportunity to speak with you today and would be happy to answer any questions and also appreciate any other comments from Margaret Lampe or Anne Fine if you have any other thoughts please feel free to contribute to the discussion. I appreciate your attention. Thank you.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Thank you so much Emily. I think all of the folks on the line can appreciate an incredible amount of work and how important this work is and I certainly…being from a jurisdiction myself that has contributed probably I think we’re getting near between 250 and 300 pregnant women and all their infants that are now currently almost…at least 2/3 of whom have been born. I know we’ve been working very closely with the pregnancy registry and really appreciate their support of our work and I know that they also are happy to have us as partners.

So, one additional comment that I wanted to make is that just so that everyone on the call understands that the testing for Zika virus is incredibly complicated, it’s one of the most complicated infectious diseases that I’ve work on from a surveillance point-of-view and the information about whether a women of reproductive age is in fact pregnant or not is really critical to not just counting and investigating that case and following the infant but also just for additional testing that needs to be done and so when an initial preliminary test is positive then additional testing may need to be done and we certainly appreciate having the information about whether somebody is pregnant or not in terms of making sure that additional testing is done for a pregnant woman as opposed to a non-pregnant person.

So, that’s just an additional comment about how this information could be so useful upfront if we were able to get it and I also wanted to mention that certainly the commercial sector has become a much, much bigger player, at least here in New York City, in terms of testing these women and I’m sure that is going to be the trend nationwide.

So, I’d like to open it up to others for questions or additional comments? Can you folks hear me?

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology We can hear you Anne.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Okay, good, I just want to make sure I wasn’t talking to nobody.

Emily E. Petersen, MD – Medical Officer – Department of Health & Human Services, Centers for Disease Control and Prevention Yes, Anne, I just wanted to say, you know, New York City has been such a wonderful partner and definitely has a, you know, large volume of cases and so much work and I think that, you know, it’s just been so impressive the, you know, huge amount of work that has gone on and I do think that you represent how having that pregnancy status would really, really help to improve the system for the US Zika Pregnancy Registry as well as clinical care and so I really appreciate your comments and, you know, New York City Department of Health has just done such wonderful work and we’ve been so happy to have you as a partner.


Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Thank you, so much.

Anjum Khurshid, PhD, MPAff, MBBS – Director of Data Integration, Dell Medical School – University of Texas at Austin This is Anjum, if I can ask a question? Can you hear me?

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Sure go ahead?

Anjum Khurshid, PhD, MPAff, MBBS – Director of Data Integration, Dell Medical School – University of Texas at Austin Yeah, okay, all right. So, thank you for the presentation and I’m curious how long is this registry going to continue? Is it going to be like an ongoing registry from now onwards or is there kind of a timeline when the number of cases that are reported falls below a certain level that it will be discontinued?

Emily E. Petersen, MD – Medical Officer – Department of Health & Human Services, Centers for Disease Control and Prevention Sure, so our goal is to at least continue so that we are able to perform infant follow-up for at least one year after the cases and after delivery in the United States. We have been able to secure funding and grant funding to our jurisdictional partners and I think, you know, we’ve been able to extend that for a fair amount of time but I think we ideally would like to capture more information after one year of age for the children as the Puerto Rico Zika Active Pregnancy Surveillance System is doing. They are planning to collect data for three years but I think that we are committed to making sure that we’re able to follow-up for one year after delivery.

Anjum Khurshid, PhD, MPAff, MBBS – Director of Data Integration, Dell Medical School – University of Texas at Austin Thank you.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) I have some…this is Anne, I’m going to pose a few questions to the group and to Emily and maybe this will help with stimulating some of the discussion.

So, one question is that if we are trying to capture pregnancy information at the time of either the test for Zika, the initial test or when a Zika diagnosis may be entered into the electronic health record, or when a case comes to the attention of public health somehow, what data elements, what information do you feel or do others feel would be necessary to capture that might help to inform not just whether a case is in a pregnant woman and therefore needs to be further investigated so that we can capture all…collect all the data that’s needed for the registry, but also there are clinical management issues and so I just wanted to mention that managing a pregnant woman with Zika requires additional testing to be done during the pregnancy, it requires that additional specimens be collected at the time of delivery to assist with either confirming the diagnosis of Zika or doing the tests in the infant to try to determine whether the infant has congenital infection and so in order for that to happen the caregivers need to


know that the woman had Zika virus infection potentially and then it also can impact the care and management of the infant.

And just so everybody knows the translation of data from the fact that a mother has been tested for Zika and maybe positive for Zika to the care of the infant is a really tricky thing in operations so that often times when an infant is born in a hospital unless the data are represented well in an electronic medical record or some other way the pediatricians caring for the infant may not even know that infant may have been exposed to Zika and then the outpatient pediatricians may not know that infant may have been exposed to Zika.

So, my question is, what data can we capture in public health in addition to pregnancy status or what data do we need to capture or do we not need to capture it at all in order to ensure that the case is managed properly, that the infant maybe linked to the mother’s Zika result and that the result of the investigation overall can be both investigated and communicated back to the caregivers for the pregnant woman and the infant.

These are complex questions and I don’t know that EHR data transmission can solve all of them but I’m curious what folks think.

So, for example, the estimated date of delivery is that something that public health should get so that they can intervene as needed or the outcome of the pregnancy was a live birth, did a live birth happen and if so what’s the medical record number of the infant? Are these things that we should try to capture or should we just restrict it to just getting pregnancy status?

So, that’s a lot of questions I threw out but I thought maybe we have some discussion on that.

J. Marc Overhage, MD, PhD – Chief Medical Informatics Officer – Cerner Corporation This is Marc Overhage, this is just a clarifying question, you threw out the question about live births for example but there is reporting of live births to public health routinely today and much of it online.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) I’m not aware of any real-time reporting of live births to public health. There is…

J. Marc Overhage, MD, PhD – Chief Medical Informatics Officer – Cerner Corporation A fair amount of its web-based, you know, pretty much within hours’ entry. I know certainly in Indiana that’s the model and I believe that’s true in many states.

James Daniel, MPH – Public Health Coordinator – Office of the National Coordinator for Health Information Technology Well…

J. Marc Overhage, MD, PhD – Chief Medical Informatics Officer – Cerner Corporation But even it’s not real-time, I mean, do you need real-time for public health intervention or is a day okay or a week okay?


Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Well, that’s a really interesting point actually because I guess my question is, at least here in New York City, we do have a Vital Registry and we do capture births. I don’t know if we have electronic births registry or birth data reporting but if we do the fact that I don’t know about that and the fact that it isn’t in the same…

J. Marc Overhage, MD, PhD – Chief Medical Informatics Officer – Cerner Corporation Sure.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Department means that we don’t have any linkage to those data for use in this purpose, for this purpose. So, I’m curious what’s happening…

James Daniel, MPH – Public Health Coordinator – Office of the National Coordinator for Health Information Technology So…

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Elsewhere.

J. Marc Overhage, MD, PhD – Chief Medical Informatics Officer – Cerner Corporation Maybe we should.

James Daniel, MPH – Public Health Coordinator – Office of the National Coordinator for Health Information Technology Yeah, Michelle…

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) So…

James Daniel, MPH – Public Health Coordinator – Office of the National Coordinator for Health Information Technology This is Jim, maybe we should get actually someone on that negotiation to come to the in-person hearing to talk about what overlap of data that might actually be and I can reach out to them.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Jim, you’re hard to hear, you’re trailing off but I think you mentioned something about at the hearing? Sorry.


James Daniel, MPH – Public Health Coordinator – Office of the National Coordinator for Health Information Technology Yeah, sorry, we could get someone to speak about birth registries at the hearing from their association.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Okay.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) That would be such an interesting thing to do because linking the mother with the baby from a public health point-of-view has been a major challenge and I don’t know if other folks on the line might want to comment on that as well.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention This is Margaret Lampe, I’d like to comment on the question about is one day or a week early enough and, you know, infant testing should occur generally within two days of birth for Zika and if you recall our purpose for this is not only for Zika but for a number of other things and for HIV if we’re going to initiate prophylaxis that would need to be within the first 12 hours of life and so, well, you know, public health intervening within 12 hours might be really ambitious. I would say that timeliness would be important.

Floyd Eisenberg, MD, MPH, FACP – President – iParsimony, LLC This is Floyd Eisenberg with a comment. I have to say a similar problem has shown up in the electronic clinical quality measures and trying to define them and defining what is gestational age at a specific point in time or at birth and/or estimated date of delivery and one of the thoughts that has occurred there is that for the child the information on the mother should be part of an assessment performed on the child with structured data, which doesn’t necessarily happen in structured form today, to be able to access it and send it onto other sites or use for measurement or decision support but connecting the charts isn’t always a straightforward issue. So, it almost needs to be captured, the information about the mother, on the child’s record. Just a thought that I’d like to hear a conversation on.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention So, Floyd are you suggesting like clinical decision support in the pediatric record to prompt the questions, the appropriate questions about whether there was a potential exposure?

Floyd Eisenberg, MD, MPH, FACP – President – iParsimony, LLC If decision support is more than just a popup alert, yes. So, if it includes a documentation template that would be helpful.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Honestly, even for public health purposes, even if in the infant’s chart we could simply capture the mother’s name, date of birth, demographics that by itself would be a major win because then we could link the infant to the mother’s lab results which we should have via ELR or some other way.


Floyd Eisenberg, MD, MPH, FACP – President – iParsimony, LLC Just to add a comment. The comment about HIV and assuring that there’s treatment within 12 hours is likely something that is easier to manage on the electronic health record side with clinical decision support rather than going back and forth with public health, but just my thought.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) The other thing, a thought I just had, is that this is somewhat analogous in some ways to the immunization records, a bidirectional immunization registry function, because pediatric practitioners and OB practitioners as well caring for mothers that may have had care elsewhere but pediatric practitioners caring for infants could certainly benefit from being able to understand the exposure information for the infant and to have that information available to them electronically might be very helpful. I don’t know if that’s something that’s feasible in the short-term but it’s information that public health has access to but that may not be in the same medical system as the pediatrician’s EHR is in, if that makes sense.

Floyd Eisenberg, MD, MPH, FACP – President – iParsimony, LLC This is Floyd again, not hearing other responses yet, the communication and bidirectional exchange with immunization registry is a good example of what can help. I guess the question is, does that…would that occur in real-time coming from a hospital specifically, for instance a first hepatitis B virus vaccine would that occur in real-time or end of day, or in batch, well not batch, but at some later time. The issue really would be is there something that you can include in a send for immunization registries or is that what you’re looking for?

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) You know I may be jumping ahead too much. I think maybe we should think about the idea of having information just as you do for I think hepatitis B or for syphilis, or other diseases that information about the mother is actually included in the infant’s record and I think that probably might be the better way to go but I’m not sure how…what I was suggesting is that if they’re in different health systems that public health could play a role to provide that information to a practicing pediatrician through a sort of registry which is what we have.

But maybe we could talk a little bit, go back a bit to what you were talking about Floyd which is the ability to get some information from the mother into the infant’s record such as the gestational age or Zika testing for the mother. Is that something that this committee would like to address, this workgroup or demographics for the mother into the infant’s record?

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center This is Susan McBride; I’ve been digesting everything that’s been discussed so far and just to react to the last question, that would really complicate things. Your better approach would be tying the mother and baby record together and then you always look for exclusion criteria when you would not want to do that and that would be in the case of adoption and if you’ve got some sensitivity and while it would be a rare case given the context and what we’re talking about it’s still something you have to consider. It’s not an automatic link between the mom and baby when you have those types of exclusions that you would have to deal with.


The other thing that has occurred to me in the discussion is that we really are calling for HIE capability that systems have the ability to transmit the data to a known pediatrician but many parts of the country do not. So, short of a functioning IHE some of what we’re talking about here would be pretty difficult.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) So, maybe something that we could actually ask during the hearing of how this is done for other congenital infection diseases such as syphilis and perinatal hepatitis if at all or HIV.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention Yeah, this is Margaret I’m skeptical that this is done for HIV but I think it’s a critically important question. As we are talking though and thinking about the scope of the objectives for this panel and our goal of having recommendations by early April it seems we need to really have some good time, you know, maybe take some time to really focus in on what are our priority items and certainly for Zika insuring that infant testing occur and that infant be followed is critically important. I am wondering if that is something that we could have as part of the clinical decision support discussion, but certainly asking about it at the hearing would be helpful.

James Daniel, MPH – Public Health Coordinator – Office of the National Coordinator for Health Information Technology Yeah, this is Jim, am I audible Michelle?

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Yes.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention I hear you.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Yes.

James Daniel, MPH – Public Health Coordinator – Office of the National Coordinator for Health Information Technology Okay. I think that’s a really good point about the priorities for this Task Force and thank you for keeping us on track and I think maybe some of that follow-up information are things that we document and say we need to come back and revisit this we don’t have enough time in our 90-day frame period but document that these are other things that are important, and again, not only important for Zika with things like HIV and hepatitis B, here are our recommendations around the pregnancy status so we can at least move forward with that, here are the things that we think we need to come back and address in another group. Does that seem fair Michelle?

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology I think that makes sense.


Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Yeah, and this is Anne, I’m sorry I got off on a tangent but I agree with that. I think we should start here. I mostly wanted to mention that this has been…it’s a very complex area but I agree that we should focus in on the pregnancy status as a place to start.

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center This is Susan McBride and one of the things that I think would be helpful is to go back to the algorithm from the CDC and we’ve looked at one way that our health science center actually approached it with CDS but there are likely others out there and to really back in to understanding what is our EHR capable of doing now and how are people addressing the CDC’s algorithm with it because they are using CDS and building different approaches to that right now and there is likely a lot of commonality around what folks are doing regardless of EHR, but for those that have done it I don’t think everybody has executed particularly in the ambulatory setting. But it would be helpful for us to hear how they’ve approached it and then back into what the gaps are of additional information that we might need to track the information and the current algorithm.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Are you…Susan, are you saying…and let me try to understand this, are you saying that there are EHRs that are currently using CDS to try to determine who to test…

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center Yes.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) And what additional tests need to be done?

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center That’s exactly what I’m saying and if you recall Floyd’s and our presentation, I think it’s two meetings back now, on workflow the workflow that I was pointing to that Steph Hoelscher out of our health science center had done, she had taken our infectious disease module that arose out of the Ebola issues and we have, using Cerner, created an ability with that ID module to track travel history and we modified that and triggered CDS off of that infectious disease and she has tried to build it flexibly enough to where depending on the next crisis or next event we have that you could build into it additional criteria. So, there are likely others who have done that out there.

And I know some of the hearings that we heard around Ebola and then subsequently, and hearing is not the correct word, but Jim Daniel some of the sessions that we had with the EHR vendors and then others came forward that were listening to how people were prepping their EHR around Ebola, we had the same thing around Zika a couple…a few calls on Zika. So, to go back to some of that and hear how folks are doing that right now I think that it would be informative to this group.


Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Well, it sounds like we should try to get some of those folks perhaps for the hearing who have done that and hear from them.

The other thing I will mention is that those…that type of information, what you just mentioned sort of the “did the patient travel if so to where” the questions you would incorporate into your clinical decision support that would inform the provider about what to do and what to order or what not to order those pieces of information would also be, I must say, extremely useful for public health to capture and have in probably a simplified form but the reason being that now that testing has moved to the commercial sector we don’t know other than women of reproductive age if somebody has traveled or not, why were they tested, maybe they were tested because they appeared at their provider’s office and said “hey, I’m scared I have Zika” and “you know I was on the subway with someone with Zika” just so they don’t really…they’re not necessarily really even at risk. So, if there’s information like that which could be captured and sent it would probably be helpful to public health and so I think that’s something that we might want to address in the hearing also.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention This is Margaret I would second that.

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center There are also other capabilities within some of our Meaningful Use certified products, and this is Susan McBride, that might be helpful to some of what we’ve discussed and so the automated ability to generate referral notifications to referral docs, so if you knew the pediatrician of record for the baby in the mom’s chart then you could trigger some of that alert with CDS to notify the physicians that this baby maybe potentially exposed or has been confirmed positive or whatever the status.

So, there are, you know, in addition to CDS our Meaningful Use capabilities have other features that we might be able to utilize as well and that maybe beyond scope but it is something we ought to consider on down the road.

Julia Gunn, RN, MPH – Director Communicable Disease Control Division – Boston Public Health Commission This is Julia Gunn and we’re seeing great success with our…we’ve become very much EPIC-driven across the city at our healthcare sites and through the Care Everywhere, so if the follow-up, the pediatric follow-up is going to be say in a community health center that’s an OCHIN client they can actually go in and look at the mother’s birth record or the child’s record and so it gives them far more greater detail to address some of the issues and that is continuing to evolve as it’s moving forward and that is not even within the HIE sort of domain yet.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) So, I will add, just since we’re talking about things that work in a kind of interesting way, we here in New York City use the Citywide Immunization Registry to locate where the infant is receiving care. So sometimes we can actually search in our Citywide Immunization Registry by the mother’s name and then we can find the, not always, but sometimes, find the infant and see where the infant has last received a vaccination and then we know which pediatrician where we might be able to get records or


find that infant. It’s really…I don’t want to leap into that other piece but we are using the CIR for that purpose.

So, maybe we should go back to talking a little bit about if we do get notifications of lab results certainly we’re getting positive lab results, I don’t know that we’re all getting negative lab results we’re getting some negative lab results on Zika but figuring…you know trying to get the pregnancy information with that what elements do we think are capturable that might help us in terms of managing…knowing whether to investigate a case and also helping to gather the information that we need for the registry and manage the case.

I’ll just maybe go back to Floyd and say you had mentioned attempts to get gestational age at a certain point in time and could you maybe elaborate a little bit on what has been tried and what has worked or not worked?

Floyd Eisenberg, MD, MPH, FACP – President – iParsimony, LLC Well, over a couple years trying to identify that in a measure and I don’t manage the measure it’s the Joint Commission that created it, but they’ve tried different ways to find gestational age and basically it’s documented as an observation at a point in time but trying to find it in a consistent way across electronic health records has been problematic and they’re still trying.

But I do know that at delivery most facilities in some template do capture gestational age at birth and the American College of Obstetrics and Gynecology recommend that but whether it’s in structured form or not, or retrievable has been one of the challenges.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) So, I guess that would lead to the question of whether we should make a recommendation for that to be collected in a more standardized fashion.

Floyd Eisenberg, MD, MPH, FACP – President – iParsimony, LLC That would be helpful. One of the other things that one of the measures is looking for is, has the mother agreed to exclusively breastfeed and that’s also hard to find in anything but narrative form. I’m not…I know you’re not looking for that but it’s information about…on the baby’s record about the mother’s decision that’s basically causing a similar problem. So, there are a number of issues.

It would be…from a clinical perspective I think it would be helpful if all the issues were looked at together as far as what should be captured and what should be present. The piecemeal approach seems problematic in some way.

Julia Gunn, RN, MPH – Director Communicable Disease Control Division – Boston Public Health Commission This is Julia Gunn again, and an ultrasound would be extremely helpful it would give you the status of the infant as seen on ultrasound but also the gestational age and other metrics about the development of the child and that has a standardization associated with it.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Julia, are you talking about prenatal ultrasound or a postnatal?


Julia Gunn, RN, MPH – Director Communicable Disease Control Division – Boston Public Health Commission Yes, prenatal.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Okay. I know the prenatal just…I mean our experience in New York City has been that the prenatal ultrasound data is extremely variable and difficult to interpret so I would see that as a pretty major challenge but you could get the report…

Julia Gunn, RN, MPH – Director Communicable Disease Control Division – Boston Public Health Commission But it’s all…

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) I guess.

Julia Gunn, RN, MPH – Director Communicable Disease Control Division – Boston Public Health Commission If we could get the report, I mean that would be a huge, it’s like a lab report and it would provide us with more detail because very often what providers do is they just pull it into their record and so what you’re seeing is in their observation section is actually just the ultrasound report. I’m also concerned if they’re transcribing a gestational age they’re going to take it from the ultrasound too and sometimes people make mistakes. It’s not perfect but I think it could really be helpful and it’s in one place.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Is it in one place across electronic health records?

Julia Gunn, RN, MPH – Director Communicable Disease Control Division – Boston Public Health Commission I don’t know that answer, that’s a really good question. But I think imaging sections may be different. That might be something to ask other groups or vendors. Where do they store that type of information. Susan where do you store that in your system that’s Cerner isn’t that correct?

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center Yes, we are Cerner and interestingly enough we’ve actually been challenged with this issue recently because we’re using our clinical data to actually inform some clinical scenario development and we’re having to scrub it of PHI and guess what the PHIs have been PDF documents that are in your reports and they’re everywhere and so they can get tucked and attached in many different places of the current system and a lot of it depends on procedure of where…and I don’t mean the procedure that’s being done I mean the procedure of the clinicians and how they’re using the system. Those PDF documents are throughout in reports like that.


Julia Gunn, RN, MPH – Director Communicable Disease Control Division – Boston Public Health Commission But isn’t there a place where like the imaging is stored like chest x-rays and CTs, and ultrasounds?


Julia Gunn, RN, MPH – Director Communicable Disease Control Division – Boston Public Health Commission That is…


Julia Gunn, RN, MPH – Director Communicable Disease Control Division – Boston Public Health Commission That’s separate, so…and they can be brought into a note but is there…very much like labs could there be imaging reporting.

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center Yeah, the imaging reporting is typically stored in one area but it is…they are PDF type documents. They’re not structured data.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Yeah and I will say, you know, we have tried to use health information exchange data in New York City to look at imaging, this was for hepatitis C, and we found that at least how it’s represented in the patient lookup portal in HIEs that imaging/procedure data was not well standardized at all and that the names of the different imaging that were done and the way results were captured was extremely not standard and made it difficult to use at least in current form, that’s our experience here in New York City.

So, let’s keep that on as a question, I’m just not sure if there’s an easy answer but it would be a really good question to ask at the hearing too.

So, we have like another 10 to 15 minutes for this conversation so we talked about gestational age, we talked about outcome data for live births. I’m wondering if anybody can speak to if it’s possible to get outcome data, like if a person has been pregnant would it be possible to get the date that the pregnancy outcome happened and any other information about the pregnancy outcome if it were not a live birth is that even a possibility or not possible? Has anybody ever tried?

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center Can you ask that question again? This is Susan McBride.


Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) So, for…at least for the use case of Zika if we get information that a woman was pregnant, and there’s an ancillary question, which is recently pregnant, is it possible…I mean, one of the questions is can we get anything like an estimated date of delivery or gestational age which would provide the same information, that was one question we asked, but let’s just suppose that this woman was pregnant, came in delivered a baby, frequently we don’t get the information that the woman was tested for Zika or the woman may not have been tested for Zika at the time she was pregnant it maybe that she’s tested at the time of delivery.

Is there any way for us to get any information about that person who was just tested and whether there was a live birth or a recent termination of any kind and is that something we should even ask about or hope to get, or should we only want to get, only be making recommendations about getting information on women who are currently pregnant? So, I guess that’s what I’m exploring is whether…because for some of these women of reproductive age they may have just given birth when they get tested.

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center Well, this has been one of the challenges in the discussion about capturing pregnancy status is the evolving nature and the fact that we don’t currently go in and if you have tracked pregnancy status we don’t go in and say “not pregnant anymore.”

So, in how we would structure…beginning to standardize how you capture pregnancy status we would have to trigger status updates with respect to live birth delivery or, you know, what occurred with that pregnancy and when so that the status of the woman regarding pregnancy could be updated because right now given…and Floyd you’ve address this before in some of the dialogue that that’s the challenge right now with the way it is currently tracked or not.

Floyd Eisenberg, MD, MPH, FACP – President – iParsimony, LLC So, this is Floyd, I agree, actually I was hoping some others on the call might chime in here as well, but it’s a problem with any condition that’s found on a problem list most…many clinicians don’t go in and take if off the list or indicate resolution so using that as a method of determining activity tends to be problematic.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Problematic problems.

Floyd Eisenberg, MD, MPH, FACP – President – iParsimony, LLC Right.

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center But this is the kind of thing I would expect that we would make recommendations to the Standards and Policy Committee about, what are…and that’s why I think it’s going to be important to understand what’s current, what is currently available with certified products and where are the gaps and this is clearly one of the gaps that we would have to make recommendations about that would need to be addressed regarding pregnancy status.


Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) One other question I had is, is there…it occurred to me when I was first asked to be involved with this committee that this type of information about whether a women is pregnant is actually relevant, very relevant, to the spectrum of healthcare providers it’s not just relevant for public health, in fact it’s probably more relevant for clinical providers and especially when prescribing medication, you know, certain medications are contraindicated in pregnancy, certain medications you have to use caution, different dosages, procedures that may or may not maybe should or should not be done on pregnant women. It seems like there is sort of a win/win in terms of trying to ascertain and present to both the provider as well as to public health whether a women is currently pregnant or perhaps postpartum even.

What do folks think about that? Is there any way to leverage that to promote improved standardization and capturing of this type of information?

Julia Gunn, RN, MPH – Director Communicable Disease Control Division – Boston Public Health Commission This is Julia Gunn again, and when I look at records there are many places where providers are documenting that as it aligns with their business processes and so it’s not just in one place many use point of care testing for pregnancy. There’s a whole spectrum of information and it’s…and I think the question about pregnancy status and having providers do one more thing it takes us also beyond standardization but also to sort of the behavioral practices of clinicians and will they do the box and as Floyd has pointed out they don’t update the problem list, they’re onto the next issue.

So, I think, you know, some of what we may propose from a technical perspective may not be aligning with the behavioral aspect and I think that’s an area that we should be mindful of. If there’s a way to leverage what’s being documented across the EHR and take humans out of it that would be a good thing.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) So, I guess that’s partly what I’m also asking is, if there were a way to use currently existing data to…and some kind of clinical decision support or algorithm to kind of calculate is a person, is a woman of reproductive age currently pregnant or possibly currently pregnant and any associated dates that might be available in the record already to aggregate that information in such a way that it could be either presented back to clinicians as they’re caring for a patient or captured and retrieved by public health.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention This is Margaret Lampe again, I think there have been a number of things done in various studies that, you know, have various sensitivities and specificities for pregnancy status but certainly, you know, if a woman is known to be pregnant to the provider if that’s what were…I’m sorry, if a woman is known to be pregnant by a healthcare provider in that same EHR system that’s probably not that difficult to detect there are a number of things that would be ordered early on in a pregnancy that wouldn’t be ordered for a non-pregnant person so that could, you know, signify that a woman is pregnant.

The gestational age on the other hand I don’t know about that except, you know, whether she’s seeing an obstetric provider and they document her gestational age of course. This group has discussed various ways of capturing pregnancy status among women who are pregnant and either don’t know it


themselves or their providers don’t know it and I…or a healthcare provider hasn’t diagnosed it if you will and I suspect that might be beyond the scope of our work but I want to put that out there.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Others on the call have thoughts on this question? Do others…

James Daniel, MPH – Public Health Coordinator – Office of the National Coordinator for Health Information Technology Hey, this is Jim, I just wanted to say that particular workflow that Julia was talking about does sound a lot like structured data capture and perhaps that is something that we need a briefing on either on one of our calls or at the hearing as well and Michelle that’s easy to find some folks to talk about at the hearing.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Okay, we’ll add it to the list.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) I mean, the other option is to, at the time, as we mentioned at the time of any Zika test order for the provider to be required to enter some information about pregnancy but that, I mean, could be extended to other conditions as well. But, you know, one thing that I would have a question about is how many…out of all the Zika tests that get ordered how many of them are currently electronically ordered versus ordered on some kind of paper and so how effective would it be to do something like that. Would that really solve this problem or would it not?

James Daniel, MPH – Public Health Coordinator – Office of the National Coordinator for Health Information Technology So, Anne, I think as we move towards commercial labs doing a lot of the testing those are probably going to be more electronic order. We do know that public health departments don’t really have that capacity. We are working with APHL on helping to build out that capacity for the public health labs and I know that we already have APHL who will be there at the hearing to help discuss that as well.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Okay that’s good.

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center This is Susan McBride and I do have an answer for us in terms of how Cerner handles the baby and mom record and there’s an ability to capture related records so after the baby is born a new record is created with its own MRN as a related record to mom.


Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Well that’s helpful.

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center It does break off a certain aspect of mom’s documentation into the baby’s new chart, how flexible that is I don’t know but again I think it would be helpful to hear from some of these folks that are deep in the weeds on the build because I did reach to Steph Hoelscher to ask her and she was the one that did the clinical workflow and the CDS so I do think that it will be helpful for us to be able to query various folks like Steph about these types of things.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) That sounds like a great idea to me. I think that would be really interesting to hear about. Thank you. Do we want to move onto the hearing update? I’m wondering if other folks who may or may not have spoken up yet have additional comments about this which has been a rather wide ranging but very interesting conversation about what kind of data we might be able to capture and what might be useful to capture regarding pregnancy. Do folks have additional comments or should we move onto the hearing, talking about the hearing? It sounds like can move…

James Daniel, MPH – Public Health Coordinator – Office of the National Coordinator for Health Information Technology It sounds like we can move on, yeah.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Yeah, yeah.

James Daniel, MPH – Public Health Coordinator – Office of the National Coordinator for Health Information Technology Michelle is that you?

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Yeah, we can go the next slide. Yeah, so I just wanted to give a brief update on the hearing. So, we have started to invite folks based upon our conversations that we had and a few folks have confirmed and we’re working through to identify if we need to find other folks in people’s places that aren’t able to attend.

We talked about a few additional invites during today’s call. We also talked about some additional questions we might aggregate those as questions that can be asked at the hearing of the panelists once they’ve provided their testimony.

So, just a reminder on the logistics of the hearing, each panel will have the panelist present, they’ll be given five minutes to each present. Once all the panelists have presented we’ll then open it up to all of


you to ask additional questions based upon the information that they have shared. It allows you all to have a good discussion with the panelists and dig a little bit deeper.

So, we just wanted to review the questions based upon our previous conversations and share them with you all. These are the questions that have been shared with panelists at this point and some of the questions relate to all the panels and then some of them are very specific to each panel. So, for the public health panelists these are the questions that we’ve come up with. I’m not sure I want to read the entire slide to you all but I will read a little of it.

So, relative to pregnancy status, what at a minimum, and optimally, does public health need to know?

How is pregnancy status captured across the continuum? Where is pregnancy information captured electronically and what elements in the EHR would be best for public health to leverage?

The third question we’ll be asking panelists to answer is, is there a need to automate the CDS for determining if someone should get a Zika test?

And then the final question, is there a need to automate clinical decision support for emerging health threats?

So there are a little bit deeper questions underneath some of those but these are the questions that we’ve given to the first panelists. If you go to the next slide. Sorry, those are the overall generic questions.

So, for each panel we have given them specific questions so for clinical workflow they have certain questions, lab and standards have questions. If you go to the next slide, clinical decision support has some specific questions and I believe…is that all of them? Yes.

So, those are the specific questions we’ve given to each panel it certainly, for our use, is not limited to asking just those questions. If there are more questions that we need to hear about we can certainly ask those. These were just given as guidance for their testimony.

Just so you all know we do have calls with the panelists that we invite to walk through what’s expected of them. Typically what we ask of them is that they send written testimony in advance so you all will have time to review those based upon when they send them to us though and then we ask that they provide, you know, a little bit higher level information in what they provide in their testimony within the five minutes.

So, apologize I was a little bit all over the place when I presented that but does anyone have any questions about the hearing and the questions that we’ll be asking?

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center Yes, this is Susan McBride, and back to our earlier discussion, do we have a question that explicitly asks some of these folks about their clinical workflow implementing the CDC algorithm around Zika? Because we want to hear how they’re doing it.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology No.


James Daniel, MPH – Public Health Coordinator – Office of the National Coordinator for Health Information Technology Yeah, Michelle, I think we could add that to the CDS section of questions.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Yeah.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Okay.

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center But you want to make sure the folks that are addressing clinical workflow talk about how their CDS…how they’ve built their CDS around clinical workflow as well.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology So, we can follow-up with the panelists on that panel and add that additional question.

Susan McBride, PhD, RN-BC, CPHIMS – Professor – Texas Technology University Health Sciences Center Thank you.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Are there any other concerns, any questions that we may have missed for other panels?

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) I think that we did not…I mean there is a question that we eluded to here which is whether…I mean, we could ask has anybody done this but found a way to capture and transmit additional data to public health. So, like for example if you’re ordering a Zika test, travel, did the patient travel. So, whatever you’re capturing in the clinical decision support is there a way to send some of that to public health or to anyone?

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology

Okay.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) So, if for example CDS helps to determine that a person might be pregnant and therefore should get a Zika test or whatever Zika test they should get it seems useful for that to also be transmitted or


potentially useful anyway. I think that could go under public health or under the clinical decision support.

James Daniel, MPH – Public Health Coordinator – Office of the National Coordinator for Health Information Technology Yeah, I mean, we could put it in both.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention There’s one, this is Margaret, there’s one issue that’s gnawing at me a bit and I’m not giving you a specific question for the panel but…and I’m not 100% sure this is applicable to Zika but it very well may be, so some folks may have…some women might have a chronic condition such as HIV or hepatitis C and then become pregnant so when they’re first diagnosed with their illness they’re not pregnant but then they subsequently become pregnant and then that is something public health would want to know about. So, there are some monitoring tests that would be done certainly for HIV.

So, are there, you know, outside of ask at order entry what is…how important really is the structured data capture and how can that pregnancy status be communicated outside of the instance of a specific test being ordered.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) That is a great question. I think we should add that question because I think that’s a really important question is like, if public health needs to know is a woman pregnant or what’s the pregnancy status if there’s an ability to query an electronic health record somehow to get it.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention Yeah.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Thank you for that question.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention Thank you.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Does anyone else feel that there might be more questions or some other worded question that would help us get to what we need?

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) I do want to…I think we should pose the question of whether it is…and maybe this might be…again these things overlap so much it’s hard to decide where to stick the question but the question I was thinking of, is it important to capture a recent pregnancy or a postpartum because that is so critical, at least for Zika, if you don’t capture it, if the person is not tested during pregnancy which actually we see a lot but then


delivers that’s when the exposure history is elicited and then that person is technically not pregnant anymore. So, I’m wondering if that’s a question we should explicitly ask.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention That’s really…yeah, I think that’s really important as well and that will be an issue for a number of the conditions or it might be identified in the infant alone.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Exactly and that sort of leads you into that whole linkages conversation which I think we don’t…

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention Right.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) We can try to be clear about where we do want to go and what the limit of that is because I think that’s so complicated that it is hard to wade into and then wade out without being clear that might be something that we can talk about before the hearing. Did Jim and Michelle, did you get that one or whoever’s taking notes?

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Yes and if we didn’t we can go back and listen to the recording to make sure we did.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Okay, I hope you don’t have to do that, my goodness.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology So, I guess just one final call for questions, if anyone thinks of anything as well please feel free to send them, this is Michelle, send them our way and we can certainly add them.

We also talked about a few additional folks that we might like to invite, if anyone has contact information or if there is anyone in particular that you think would be good, again, we would love for you to share the information and you all know the hearing is getting closer so the sooner that we can invite people and nail everything down the better.

Hopefully, all of you have made your travel arrangements and are planning to come in for the in-person hearing on the 8th and for this group on the 9th to talk about recommendations and I think that’s everything related to the hearing for now.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Okay, great…


W …

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) I have one question, this is Anne, are you…how are we in terms of finding people for each of the panels are there any panels where we actually…I have one person I want to recommend for you guys but I just don’t have…I haven’t made contact with that person yet but is there anything that we need that the group might want to reach out for where we actually have sort of a need for more people?

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology If Kim is on…Kim are there any holes anywhere? I know the last time we spoke there was one panel that had lesser people on it but I forget which one it was off the top of my head. If Kim isn’t on we’ll follow-up maybe via e-mail.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Okay.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology And…

Riki Merrick, MPH – Lead Specialist, Informatics Terminology – Association of Public Health Laboratories Well this is…

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Solicit some advice or additional help if we need it.

Riki Merrick, MPH – Lead Specialist, Informatics Terminology – Association of Public Health Laboratories Okay, this is Riki Merrick I’m still trying to find you a public health lab person, the ones I’ve contacted they all have issues with getting travel approved on their side. So, I’m still looking.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Thank you, Riki.

W And it is acceptable for them to provide their five minutes virtually and remain on for the discussion?

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Yes.


W Okay.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Obviously not as great…

W It’s not ideal.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology As having them in person but if they can’t make it in person on the phone works.

Riki Merrick, MPH – Lead Specialist, Informatics Terminology – Association of Public Health Laboratories Okay, I’ll keep that in mind, I might go back to the first person I talked to.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Thank you.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention And then we’re…in terms of asking folks, you know, they might be able to fly up and back in the same day, is it possible to know which panel is happening on which day?

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology So, all the panels…all the testimony is being done on February 8th.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention Oh, okay.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology February 9th is really just for the Task Force to come up with recommendations coming out of the hearing.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention Got you.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology So, the only problem with that could be if they’re on the first panel or the last panel depending upon their flight times but we can certainly share the draft agenda with them if that’s a factor.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention Okay, thank you.


Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) And I noticed that we don’t have a meeting in between now and then. Is there going to be any kind of a planning for the hearing or do you guys just take care of that?

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology I mean, most of the work will get done behind the scenes. I think the planning for the hearing for you all is once we start to receive testimony to do your best to read through it, it usually comes at once so it will be a lot of reading. So, you know, whatever you all can do to review the material that comes in will make you better prepared for the hearing and we may communicate a few items via e-mail so be on the lookout for that.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Okay, great, thank you.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Okay, let’s go ahead to the next slide. So, I think we’ve already mentioned this needs to be updated. So, the hearing is on February 8th and then on February 9th the Task Force will come up…will work to come up with recommendations coming out of the hearing and then we’ll have some more time to talk on the 13th.

So, again, be on the lookout for information regarding the hearing. We may send you an e-mail to help you all prepare in addition to all the batches of material that will come in before the hearing. So, Anne before I turn it back to you I’m going to go ahead an open it up for public comment and then we’ll do some final wrap-up.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Okay.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology So, Jaclyn can you please open up the lines?

Public Comment

Jaclyn Fontanella – Digital Project Manager – Altarum Institute Sure. If you are listening via your computer speakers you may dial 1-877-705-2976 and press *1 to be placed in the comment queue. If you are on the phone and would like to make a public comment, please press *1 at this time.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology So, Anne, let me turn it back to you to see if you have any final comments before we close today?


Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) I don’t really have any final comments except I really wanted to thank Emily, I don’t know if she’s on the line still and I also wanted to thank all the folks who did contribute. I personally, if you have additional thoughts about the conversation today or any of the experiences that you’ve had that you think could help to elucidate some of the topics we talked about I would really appreciate either you can send it directly to me or to the whole group but I really encourage others who may not have spoken up to contribute in whatever way they can and thank everybody for their participation and also to the folks who are doing all this organizing and work behind the scenes, especially setting up the hearing it sounds like a lot of work so thank you all.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Thank you, Anne, and thank you to everyone for all your contributions. We have no public comment so we look forward to seeing you all in person on February 8th.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Thank you.

Michelle Consolazio, MPA – Federal Advisory Committee Program Lead – Office of the National Coordinator for Health Information Technology Talk to you all soon.

Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) Bye-bye.

W Thank you.

Julia Gunn, RN, MPH – Director Communicable Disease Control Division – Boston Public Health Commission Thank you.

W Bye.

Floyd Eisenberg, MD, MPH, FACP – President – iParsimony, LLC Thank you.

Margaret Lampe, MPH, RN – Nurse Scientist – Centers for Disease Control and Prevention Thank you, Anne.

M Bye.


Anne Fine, MD – Medical Director, Reportable Disease Data Analysis and Informatics Unit, Bureaucracy of Communicable Disease (BCD) – New York City Department of Health and Mental Hygiene (DOHMH) You’re welcome.

Anjum Khurshid, PhD, MPAff, MBBS – Director of Data Integration, Dell Medical School – University of Texas at Austin Bye.

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