iex for clinical communication and coordination: health department to clinical care
DESCRIPTION
AMIA 2012 Chicago Presymposium - WG-03: Current Issues for Population Health Informatics in Healthcare and Public Health - presentation by Joseph Gibson, MPH, PhD and Catherine Schenck-Yglesias, MHSTRANSCRIPT
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Population Health Informatics in Health Care and Public Health
Topic Areas:• Long Term Objectives for Working Population Issues• Best Practices for Health Registries• Information Exchange (IEx) for Detection and Monitoring:
Clinical Care to Health Departments• IEx for Clinical Communication and Coordination:
Health Department to Clinical Care• Health Departments and HITECH / ACA• Balancing Personal and Population Privacy Needs• Social and Mobile Media and Prevention• Open Source and Cloud for Public and Population Health:
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IEx for Clinical Communication and Coordination: Health Department to Clinical Care
Joe Gibson, MPH, PhDDirector of Epidemiology, Indianapolis (Marion County)
Catherine Schenck-Yglesias, MHSProject Director, Johns Hopkins International
Development Program
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PERSONALLY IDENTIFIABLE AND NON-IDENTIFIABLE PUBLIC HEALTH DATA FOR CLINICAL BENEFIT
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Identified PH Data for Clinicians
• What vaccines does this patient need now?– Pt’s immunization history, compared to recommended
schedule• Newborn genetic disorder testing results
– Routing heel-stick blood test results to pediatricians & parents
• Results of special lab tests– Some tests are usually done at public health laboratories
• Home visit information from public health nurses• Rx monitoring program (identify excessive narcotic
use)
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Unidentified PH Data for Clinicians
• Setting the Index of suspicion– What unusual diseases are around today?– What is prevalent today, and with whom?– Examples: TB, syphilis (diseases familiar to MDs)
• Unusual Outbreaks– What symptoms?– Where the treatment & follow-up recommendations?– What are the prevention recommendations?– Examples: Monkey pox, pH1N1, contaminated
injectable steroids
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HEALTH AND HUMAN SERVICES DATA FOR CLINICAL BENEFIT
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Health and Human Services Information of Use to Clinicians
• Risk– Data on social service issues of the community
and specific individuals that represent risk factors, comorbidities or challenges to preventive health and treatment plans
• Resolution– Programs at local health and human/social
services departments that may be able to assist patients in addressing current and preventing future clinical issues
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Preventive Health Examples
• Environmental Hazards– Agency for Toxic Substances and Disease Registry (ATSDR) Pu
blic Health Assessments• when people have been or are likely to be exposed to a toxic substance
and, usually, how and when they were exposed• whether the exposures are likely to lead to illness• recommends ways to protect public health
• Obese patients– What is his most convenient opportunity for exercise? What
programs are near his home?– Are fresh fruits and vegetables available at a nearby store?– Are walking or biking trails near his home?– What parks are nearest his home? Do they have free or low-cost
physical activity programs?– Does his neighborhood have sidewalks?
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Potential HHS / Social Service Data Sharing
Source: Shank, Nancy C., "Understanding Human Services Utilization: Opportunities for Data Sharing between Federally Funded Programs” (2009). Nancy Shank Publications. University of Nebraska Public Policy Center. Paper 6.
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Appropriate Referral to Local Health and Social Services
• Adult Mental Health Services• Adult Protective Services• Aging Services• Catholic Charities• Child Care Services• Child Welfare Services• Domestic Violence Service via Abused Persons
Program• Early Learning and Child Care• Education through Public School System• Emergency Assistance• Environmental Hazard Elimination• Federally Qualified Health Centers• Fitness/Wellness Programs• Foster Care• Goodwill Services• Head Start Providers• Homeless Program• Housing Stabilization Services• In-home Aide Services• Income Support Services
• Jewish Community Center• Limited English Proficiency (LEP) Services• Maternity Services• Medical and Primary Care Services• Medicaid Enrollment• Protective Adoption• Public Health TB Clinic• Public or Medicaid Provider Mental Health
Treatment• Senior Centers• Smoking Cessation Programs• Supplemental Nutrition Assistance Program
(SNAP), formerly known as Food Stamps• Special Needs Housing Services• Substance Abuse Treatment• Temporary Assistance for Needy Families (TANF)• Vocational Rehabilitation• Workforce Investment Act (WIA) Services (training
and employment)• Women, Infants and Children (WIC) Services• Workforce Services
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INFORMATICS INTERVENTIONS
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PH data to clinicians:Current Usual Practice
• Push to providers: via letters, email, faxes– For both identified & broadcast information
• Pull by providers: web sites, media• Providers log-in to immunization
databases• Lab results often delivered by mail
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Nascent Electronic Exchange
• Secure email• Electronic alerts delivered via HIE
– same route as lab. results• Conditional alerts in EHRs
– During a TB outbreak among homeless, system prompts for TB tests when homeless appear at ED
– During syphilis outbreak, patients meeting the outbreak profile were flagged for testing
• Immunization histories pushed to EHR
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The Future: Knowing a pt’s context
Regarding an obese patient:• What programs are near his home?• Are fresh vegetables available nearby?• Has sidewalks in his neighborhood?• What support networks are available?
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• What data gets pushed from PH?• What data gets pulled by EHR?• Are other modes more effective?• What data requires provider
authentication?
The Future
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ABC Residential
& Group Care
Health & Disability
Caseworker Team
Planning & Resource Allocation
Financial Management
Program Management
Information Technology
Child Welfare
Aging Voc. Rehab
Mental Retardation
Seniors Centers
Medicaid Contractor
No Child Left
Behind
GoodwillServices
DevelopmentalDisabilities
Community Health
CommunityMental Health
Workforce Develop
Medicaid
Income(TANF, Emerg.
AidMedicaid
Jewish Community
CenterCatholic
Chairities
Child Care
CourtsCriminalCivilJuvenile JusticeFamily CourtDivorce
Head Start
Team-basedIntegrated
Intake
Head Start Providers
Federal Dept.of HHS
Federal Dept. of Education
Criminal Justice Ecosystem
Health & Human Services Ecosystem
State Health & Human Services
Local Social Service Agencies
Information Technology
State DepartmentOf Education
Multi-Discipline
Client Plan & Review
WIA
PortalClient dataProvider dataReferral dataPerformance
Workflow &Scheduling
TANF
EBT
Data Warehouse
BI ToolsEAI Tools
State Tax
Suppliers
One Stop CentersMultiple LocationsInterdisciplinaryPre-eligibility AssessmentEmergency AssistanceChild careService Delivery (e.g. Empl.)Facilitate Self-service
Secured Internet
Police
Banks ClientsUnited WayHospitals
Network of Community Service
Providers
SACWIS
Child Support
Integrated Case Management
Food Stamps
Child Welfare Caseworker
Team
Child SupportCollections
Income Sec.Caseworker
Team
K-12 Education Ecosystem
Workforce Inv.Child Welfare
Foster CareProtectiveAdoption
Public HealthMental Health
SubstanceAbuse
Treatment
ERP
Schools
RevMax
MedicaidTANF
Regional State & Local Client Plan & Assessment Teams
Productivity &Collaboration
IntegrationTechnologies
Provider Management
Compliance Management
Human Resource Management
IT Management
DepartmentManagement
Microsoft A
rchitectural Vision
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Public Health
Addictions & Mental Health
Medical Assistance Programs
Children, Adults & Families
SAMHSA
ACF
IHS
RSA
State View: Silo’d Architectures, Funding, Services
Rich Howard – CIO Oregon DHS
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Informatics Linking Health with Human/Social Services
• Build a common client index or master client index to track overlapping and unduplicated client load – better anticipate need and improve service delivery
• Integrate eligibility for all health and social programs federal, state and local with eligibility requirements
• Ensure compliance with all federal, state and local confidentiality and privacy protocols
• Digitize all records and move to a paperless environment• Integrated case management system that allows for public and private
sector users access and use of the system• Routine data sharing/integration options:
– Real time, two-way integration– Periodic, two-way integration– Periodic, one-way integration and – Periodic, one-way analysis integration
Source: Stewards of Change; Montgomery County Dept of Health and Human Services; Homeless Management Information System (HMIS) Integration Strategies and Solutions
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POLICY ENVIRONMENT NEEDED TO SUPPORT THESE INFORMATICS INTERVENTIONS
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Data Sharing Plans
• Intent and scope• Risks & benefits of sharing, of not sharing, and monitoring
plan• Data sharing methods• Staff roles and responsibilities• Minimum data elements needed• Method to ensure confidentiality and security• How data will be used, published, and retained/destroyed• Confidentiality agreements• Knowledge and training requirements
– Annual training for staff accessing identifiable dataSource: Centers for Disease Control and Prevention. Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs: Standards to Facilitate Sharing and Use of Surveillance Data for Public Health Action. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2011
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Supportive Policy and Practice Environment
• Information sharing is clearly defined, meets confidentiality and privacy requirements, and is integrated in training and practice.
• Integrated case management is clearly articulated by leadership and embedded in operations, procedures, training and practice.
Sources: Stewards of Change Human Services 2.0™: A Framework for Interoperability
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Supportive Policy and Practice Environment
Goal: • A nationally recognized confidentiality policy that enables data
sharing
Current status:• Different laws and rules apply to different data sources and
diseases– Communicable diseasas– Birth & death data– HIV– Mental health– HIPAA, FERPA
Sources: Stewards of Change Human Services 2.0™: A Framework for Interoperability and Alliance of States with Prescription Monitoring Programs
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TOWARD A CONSENSUS STATEMENT ON THE POTENTIAL CLINICAL BENEFITS OF PUBLIC HEALTH INFORMATICS
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Data Sharing Summary
Health Department Non-identifiable Data
Social Services Non-identifiable Data
Health and Social Services Identifiable Data
Data Shared Local community and relevant subpopulation statistics (e.g., by race and ethnicity, SES, risk factors) in the community (health statistics)
Available local, state, and federal programs for health and human services to respond to health problemsfor populations of varying means
Information on the individual from health information exchanges, health department registries and social service records
Via E-mail, website? E-mail, website? InfoAlert – e.g., same system that lab results come through. Letter/fax.
Clinician Action
More effectively target screening of patients for specific health problems
Refer patients to the relevant services
Continuity of care
Informatics Intervention
Extract/send relevant population data
Extract/send relevant population data
Extract/send relevant individual data or integrate systems
Policies and Plans
Data Sharing Plans, Confidentiality and Security Policies
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Discussion Questions
• How do we ensure that the right patients get the right benefits from public health and human services data sources at the right time?
• Prioritizing the data and information to communicate– What content is available?– What is valued by clinicians and patients?– When is it needed?
• How do we effectively deliver the information?– Push by PH to EHR (or other interface)?– Pull by EHR from PH?– MD authentication & pt matching for identified data
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Session Title
• Discussion Synopsis: