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Public Health – EHR Vendors Collaboration InitiativeWebinar
Leveraging Health IT to Support Public Health LabsJune 19, 2018
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https://www.cdc.gov/ehrmeaningfuluse/public-health-ehr-vendors-collaboration-initiative.html
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Question and Answer SessionHow to submit or ask questions in ReadyTalk for the panel members?
3
Submit or Ask QuestionsSubmit your text question and comments using the Question Panel
Please raise your hand to be unmuted for verbal questions.
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Leveraging Health IT to Support Public Health LabsMichael Baker, Policy Advisor, Department of Health and Human Services, Office of the Secretary,Office of Intergovernmental and External Affairs
June 19, 2018
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Where we are
5
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An example of current workflow
6*Documented by Dr. Leanne Field at the University of Texas at Austin
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Where We Want To Go
7
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Analysis. Answers. Action. www.aphl.org
Analysis. Answers. Action. www.aphl.org
Enhancing Clinical/Epi/Lab Coordination through the Use of a Electronic Test Order and Result Web Portal
Medicaid Public Health CoP & Public Health EHR Vendors call June 19, 2018
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Synopsis
• Project background• Critical success factors • Developing the solution• Outcomes and Next Steps
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MissionShape national and global health outcomes by promotingthe value and contribution of public health laboratoriesand continuously improving the public health laboratory system and practice.
VisionA healthier world throughquality laboratory systems
Policy
PracticeScience
APHL
APHL
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Public Health SystemsInstitutional Research Quality Systems
Global Health Informatics
Infectious DiseasesPreparedness & ResponseEnvironmental Health
NBS & GeneticsFood Safety
Public Health Programs
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Electronic Test Order and Result Work• Web Portal RFP distributed
– CDC TB program supported– National DST reference center– iConnect/Lab Web Portal (LWP) Selected
• Programmatic Efforts to assist ETOR– White paper / policy statement (CDC DLS)– Standards Development (LOI/LRI)
• LWP deployed on AIMS VPC – 5 Antibiotic Resistance Lab Network (ARLN) regional
labs– CDPH National TB DST reference center
• HHS ONC ETOR process improvement– Expand use of LWP to support emerging infectious
disease use case.– Expand to look at provider, lab and epi
communication channels-
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ETOR in the Clinical DomainCare & Treatment: Passive Surveillance
DETECT REPORT RESPONDREPORT
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ETOR in Public Health:Active Surveillance Needed
DETECT REPORT RESPOND
critical
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Public Health Data Needs Constantly Evolve
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Patient Identifier
Sample ID (Lab)
Date Collected
Test Method Ordered
Test Result
Patient Identifier
Dates of Travel
Exposure to Stagnant Water
Country Visited
Exposure to Mosquitos
Patient Identifier
Name of Clinic
Observations
Date of treatment
Preliminary Diagnosis
Integrated Disease Surveillance
Patient Identifier
Sample ID (Lab)
Date Collected
Test Method Ordered
Test Result
Lab Data
IntegrationBroker
Patient Identifier
Dates of Travel
Exposure to Stagnant Water
Country Visited
Exposure to Mosquitos
Population Data
Name of Clinic
Observations
Date of treatment
Preliminary Diagnosis
Clinical Data
Patient Identifier
Sample ID (Lab)
Date Collected
Test Method Ordered
Test Result
Patient Identifier
Dates of Travel
Exposure to Stagnant Water
Country Visited
Exposure to Mosquitos
Patient Identifier
Name of Clinic
Observations
Date of treatment
Preliminary Diagnosis
Patient Identifier
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Laboratory data
Modifying LIMS to support epidemiologically
significant data difficult
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• Clinical submitters lack an efficient way of ordering tests, retrieving status and receiving results for suspect Zika cases.
• Current methods to capture epidemiological significant questions when a specimen is submitted for Zika testing (known as Ask at Order Entry questions), are not efficient or cumbersome and “after the fact” to help with testing prioritization.
• Epidemiologists do not have an efficient way to assist in the testing process to authorize, sort and prioritize testing based on submitter provided information and national case definitions.
Problem Statement: Zika and Other “non-standard” tests
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HHS Challenge:
Build on current informatics tools to support clinical and public needs in the face of Zika and other emerging diseases
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National Tuberculosis Drug Susceptibility Testing Reference Lab
Provide ETOR tools that support TB-DST shared services
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Antibiotic Resistance Lab Network
Electronically report CRE colonization results to a network of cross-jurisdictional clinical and public health partners within 48 hours of specimen
receipt
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Critical Success Factors• Use existing resources and share best practices
• Design flexible, extensible ETOR system
• LIMS EMR agnostic
• Accommodate multiple workflow submission modes:• Paper, Web-based, EMR Submission, LIMS Synchronization
• Ensure solution standardization, while maintaining flexible approach
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Identified Barriers• Tough to meet all user expectations out of the gate
• Use of cloud computing tools
• Extensive support needed for long-term maintenance of different HL7 message specifications, transport configurations
• Ongoing maintenance requires time, personnel, and technical support expertise
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Proof of Concept Approach
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Discovery Phase Deliverables
• Document and validate existing and potential workflows
• Document functional requirements
• Perform Gap Analysis between LWP and Requirements
• Define user scenarios and prioritize enhancements
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Technical Approach
Centrally hostedSelected competitively LIMS agnostic
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A secure, cloud based environment that accelerates the implementation of health messaging by providing shared services to aid in the transport, validation, translation,transformation and routing of electronic data.
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AIMS in Action
160
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Project Results
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Enhancement 1:EPI prioritization functionality & admin tool expansion
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Enhancement 2: StarLIMS to LWP sync-up
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Enhancement 3:EMR to LWP Order Interface
EMR Interface LWP
Order HL7
Order JSON
ACK Processed
ACK Processed
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Enhancement 4: Patient Centric Functions
• Ability to track patients over time, across systems• Ability to manage patient demographics, insurance,
diagnosis, medications• Ability to define custom patient metrics • Ability to view trends and track patient results over time
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Analysis. Answers. Action. www.aphl.org
New Patients page - Demographics
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Analysis. Answers. Action. www.aphl.org
New Patients page – orders specific to patient
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Proof of Concept System Screens
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System Demonstration
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Analysis. Answers. Action. www.aphl.org
Specimens Grid
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Timeline displays key events in specimen life cycle
Commentary panel enables secure message exchange between clinics and laboratory
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Test Ordering
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AOE Questions based on program/test
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EPI Review screen
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Published Patient Reports
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User Support
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Analysis. Answers. Action. www.aphl.org
EMR to ETOR to LIMS integration
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What's Next?
Continued system evolution & deployment
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Implementation of Enhanced Epi Functionality:Use Case: ARLN: CRE ColonizationObjective: Interrupt AMR Transmission
DETECT REPORT
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Engage and Collaborate
• Complex initiative- needed to expand membership beyond PHLs
• Technical, business and operational components
• Meeting the needs of the project sponsors and PH stakeholders
• APHL technical efforts come into play– AIMS/member services– Cloud Computing options
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Identify operational/institutional topics for BC taskforce to consider
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Look at an all-hazards approach-How can we better leverage the community to:
Define and evolve common solutions to support both clinical and public health ETOR
Identify the ETOR business case/operational drivers
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Analysis. Answers. Action. www.aphl.org
Thank You!Questions?