Impact of HIE on Public Health Laboratories

What you may not know…

JOINT PUBLIC HEALTH INFORMATICS TASK FORCE

(JPHIT)

HRSA Health Outcome Policy Priority

Improve quality, safety, efficiency and reduce health disparities

Frieden’s Conceptual 5-Tier Public Health Framework

Grizzell’s 6-Tier Model Often Used in Public Health

Traditional Model

(Thomas R. Frieden, MD, MPHAj of PH, April 2010)

Health Information Exchange

HIT: Health Information Technology

Broad terminology for adoption and use of IT in a health setting

EMR vs. EHR

EMR

• HIMSS definition: Component of the electronic health record which is owned by an institution

• Consensus Definition: Comprehensive electronic health record which includes laboratory, pharmacy, clinical and demographic data gathered from all applicable entities (public health laboratories, hospitals, private offices, etc) .

EHR

HIE: Health Information Exchange

The secure transfer of electronic health information such as a medical record from one entity to another place, using electronic messaging such as HL-7

Meaningful Use

Evolving definition to electronically capture in coded format and to report health information and to use that information to track key clinical conditions

HITECH Vision

To improve the health of Americans and the performance of the nation’s health system through health information technology (HIT).

•An important component of health reform

•Harness the full potential of digital technology to prevent and treat illnesses and to improve health.

HITECH Goals

• Improve quality, safety, efficiency, and reduce health disparities

• Engage patients and families

• Improve care coordination

• Ensure adequate privacy & security protections for personal health information

• Improve population and public health

ONC Activities

• Definition of ‘Meaningful Use’ and Setting Standards for Electronic Health Record Incentive Program

• $60M Program to Fund Strategic Health IT Advanced Research Projects

• Health IT "Beacon Communities"

• $80 Million Available to Support Health IT Workforce

• www.healthit.hhs.gov

Pathway to ARRA Incentives

CCHIT-certified or new certifying bodies yet to be named

Stage 1: 25 measures; 17 require only attestation

In either Medicaid or Medicare program

Staged Implementation: Stage 1

• Electronic capture of health information in a coded format

• Tracking key clinical conditions and communicating outcomes for care coordination

• Implementing clinical decision support tools to facilitate medication and disease management

• Reporting for public health purposes.

Staged Implementation

• Stage 2: Builds on stage 1; computerized provider order entry; electronic transmission of diagnostic test results; research

• Stage 3: Builds on stage 3; promotes improvements in quality and safety; patient access and involvement; improved population health data

Implications for public health

• Assess and ensure readiness in several areas:– For 2011, ELR and syndromic surveillance

• Both testing capability of systems to report and actual submissions

• Increase capacity for data management and analysis

• Coordination across programs, state HIT coordinator, state HIE plan, Medicaid, enterprise architecture plan, etc.

Survey of State Health Agencies on Meaningful Use Readiness and

Public Health Informatics Resources

24 respondents 21 responded to funding questions

Survey in the field for three weeks (4/5-4/26)

Distributed to state public health agency Informatics Directors/CIOs or state health officials if no informatics director was designated.

Other-Please Specify

already accept HL7 messages for ELR and syndromic surveillance; ready for Immunization HL7 by Jan 2011

We have implemented an enterprise messaging hub for the exchange of data to/from our agency. We are in the process of implementing additional data exchanges within this infrastructure but have had limited resources to apply.

Responses-Other

Governance, legislation, private sector interests, resources in general

Assistance implementing an EMPI.

More data standards

Which of the following best describes your agencies Technical Assistance needs in preparing for data exchange with Health Information Exchanges and Electronic Health Records? Choose all that apply.

Other-Please specify

Medicaid is part of the state HIT committee

Sharing information, serve on HITE Advisory Comm

Medicaid rep also sits on interagency workgroup, so we are generally aware.

Medicaid not handeled by Dept of Health. Dept of Human Svcs is Medicaid agency.

Medicaid involvement is mostly from the Health Care Facilities surveys end

We are involved as appropriate.

State/territorial Medicaid agencies are required to submit a Medicaid Health IT plan to develop their Medicaid Health IT Infrastructure. How would you describe the public health agency’s interactions with Medicaid planning activities?

Other-Please specify

wide array of systems will make for a challenging implementation

Lack of CDC/HHS /ASTHO & CSTE guidance to states

Public Health IT Funding Needs

Of 21 states that described their resource needs:o States need an average of $1.55 million per year,

with a median of $1.2 million• Range: $85,000-$3,200,000• 25th percentile $505,000• 75th percentile $2,350,000

Category needs (yearly average):• Informatics staff, $325,000• IT staff, $380,000• Program staff, $290,000• IT Systems, $555,000

– One-time needs: Hardware, $315,000

Grant Programs in HITECH

HHS Secretary Shall Establish Programs of:

oGrants to states to promote health IT (emphasizing health information exchange)

o Implementation Assistance and Education of IT workforce

KY HIECC

Implement secure and interoperable statewide e-health network

Improve quality and efficiency of KY Health Care System

6 KY-HIECC Committees

Privacy and SecurityInteroperability and StandardsBusiness Development and FinanceAccountability and transparencyProvider Adoption and Meaningful UsePopulation Health

Potential Value of KHIE to PH

More timely and complete delivery and receipt of disease reports (provider specific or federal partners)

Faster transmission of better information to case managers

Efficient Syndromic SurveillanceEnhance communication with selected

provider and patient populations

Implications for Public Health

• Unprecedented opportunity to partner on HIE and population health improvement– Funding, policy and regulations are aligned– Private and public sector buy-in

• Expectations for public health capabilities around HIE will increase.

Implications for Public Health

• Opportunity to work with CDC and other federal partners to align funding streams with HITECH priorities

• Opportunity to explore certification of public health information systems– CCHIT-like modular certification around MU

requirements, or around broader PHIN requirements?

Laboratory Medicine’s Role

Socioeconomic Factorso Narrowing poverty gap shows

• Cleaner water

• Cancer screening

• Air quality screening

• Vaccination screening

Choosing Good Health w/Public Health Assistance• Analyzing fluoridation in water

• Environmental lead testing and asbestos

• Food testing

Confirming Protective Interventions• Immunization monitors

• Colonoscopy evaluations

Traditional Laboratory Applicationso Cardiovascular Analysis

• Lipids – Cholesterol

• Hemoglobin A1C – Medication Compliance

Education o Benefits of screening

• HIV

• TB

• Rubella

• Hepatitis

HIT in Hospitals

(Jha et al., NEJM 2009)

Lab Results

• Hospitals only (2011)

• Content: HL:7 2.5.1

• Vocabulary: LOINC v2.27, when such codes were received within an electronic transactions from a laboratory

• MU Measure: Hospitals must perform at least one test of EHR capacity to send if the PH entity has the capacity (2011)

Laboratory Objective and Measure

Incorporate lab test results into EHR as structured data

At least 50% of clinical lab tests results are in a certified EHR technology as structured data

LIS requirements to enable medical data exchange

• HL-7 ready?

• Nationally accepted codes (LOINC codes)

LOINC Codes

LIS requirements to enable medical data exchange

• Mappings local codes to LOINC codes

• RELMA

• SNOMED

• National Library of Medicine

RELMA

LIS requirements to enable medical data exchange

• Communication

• Central hub concept (Health Information Exchange)

Communication