webinar 4 july 10, 2008 | 2:00 – 3:30 pm (eastern)

1enabling healthcare interoperability

Webinar Series

Sponsored by the HITSP Education, Communications and Outreach Committee

Webinar 4 July 10, 2008 | 2:00 – 3:30 pm (Eastern)

Presenters HITSP Population Perspective Technical Committee

Floyd Eisenberg, MD, MPH, Senior Key Expert, Siemens Healthcare

and co-chair of the Population Perspective TC

Lori Fourquet, e-HealthSign, LLC

Biosurveillance

HITSP – enabling healthcare interoperability

Learning Objectives

During this 90-minute webinar, participants will explore the population

perspective of health information sharing for natural and human

assisted events with local, regional and national import, gaining

a basic knowledge of:

— syndromic surveillance through repurposing existing clinical

information to detection of new patterns of disease as a routine

process and during emergency situations;

— situational awareness using repurposed clinical information to

determine the extent and location of disease presentation

as well as resource availability;

a webinar series on U.S. healthcare interoperability

(continued)


Learning Objectives (continued)

— expectations for information transfer from EHRs to biosurveillance

information systems;

— HITSP specifications for biosurveillance information sharing;

— the relationship of the biosurveillance use case and interoperability

specification to other efforts for public health and for data repurposing.

a webinar series on U.S. healthcare interoperability


Biosurveillance

— Syndromic Surveillance

— Situational Awareness

Disease Burden

Healthcare Resources

— Security and privacy requirements for Biosurveillance

HITSP Interoperability Specifications for Biosurveillance (HITSP IS 02)

Units of Exchange

— Health Information Summary Documents

— Health Information Messages

Conformance Subsets

Questions and Answers

Agendaa webinar series on U.S. healthcare interoperability


Introduction: Steve’s Story . . . part four

Patient is a 26-year-old male coping with the long-term effects of a brain tumor that was removed during his childhood

While traveling to San Diego with his family, Steve and his sister become ill with fever, diarrhea and dehydration

Both present to different local Emergency Departments

— Steve is discharged in 48 hours

— His sister requires several weeks in the hospital for kidney failure complications

Public Health receives notification of Steve’s sister’s presenting symptoms and stool culture results indicating E coli 0157:H7. Steve’s culture is negative and no report of his illness is received by Public Health

The source of the E coli 0157:H7 is not identified until approximately 100 cases present over the next three months


Introduction: Steve’s story (continued)

The Future Healthcare in an interoperable world

— Steve’s and his sister’s presenting complaints and initial orders (i.e., stool culture requests) are transmitted within 24 hours to a Public Health Biosurveillance Information System (BIS)

— The Biosurveillance Information System flags a significant increase in febrile diarrheal illness in the region not correlated to a specific zip code and prompts a case investigation

— Within 48 hours of Steve’s presentation, Public Health identified the common thread in 95% of 20 known cases of eating salad at a roadside café on a local highway.

— 48 hours later a common source is identified in home grown lettuce used exclusively in that café. The item is removed from the menu and no further cases occur.


HITSP is a volunteer-driven, consensus-based organization that is funded

through a contract from the Department of Health and Human Services.

The Panel brings together public and private-sector experts from across

the healthcare community to harmonize and recommend the technical

standards that are necessary to assure the interoperability of electronic

health records.

Overview


The HITSP Standards Harmonization Framework

— Identify a pool of standards for an AHIC (American Health Information

Community) Use Case

— Identify gaps and overlaps in the standards for this specific Use Case

— Make recommendations for resolution of gaps and overlaps

— Select standards using HITSP-approved Readiness Criteria

— Develop Interoperability Specifications (IS) that use the selected

standard(s) for the specific context

— Test the IS

Deliverables and Mode of Operation


IS 01 Electronic Health Record (EHR) Laboratory Results Reporting

IS 02 Biosurveillance

IS 03 Consumer Empowerment and Access to Clinical Information via Networks

IS 04 Emergency Responder Electronic Health Record (ER-EHR)

IS 05 Consumer Empowerment and Access to Clinical Information via Media

IS 06 Quality

IS 07 Medication Management

Current Interoperability Specifications (IS)


IS 02 Biosurveillance

This Interoperability Specification defines specific standards needed

to enable the exchange of data between healthcare organizations and

providers and public health via an electronic network

— Version: 2.1 Recognized

— Version: 3.0 HITSP Panel Approved

IS 02VIA AN

ELECTRONIC NETWORK

IS 02VIA AN

ELECTRONIC NETWORK

Doctor Public Health Agency


HITSP IS 02 BiosurveillanceOverall Objectives

Implementation of near real-time, nationwide public health event monitoring to

support early detection, situational awareness and rapid response management

across care delivery, public health and other authorized Government agencies.

Describe the process or interaction that each primary stakeholder will

invoke to capture, discover, anonymize and transmit relevant data to public

health agencies:

— Relevant Data: Essential ambulatory care and emergency department

visit, utilization, and lab result data from electronically enabled health care

delivery and public health systems

— Transmission Requirements: Standardized and anonymized format

— Time frame: Within 24 hours


Patient

Clinicians

Healthcare Delivery Organizations

Laboratory Organizations

Public Health Agencies

Resource Suppliers

Public

HITSP IS 02 BiosurveillanceStakeholders


Public Health – Biosurveillance Information System

— Syndromic Surveillance: Identifies new patterns of disease presentation –

recognize known and unknown causes (chemical, radiological, biological)

— Situational Awareness:

Determines patterns exceeding expected thresholds and location of impact

Determines resource availability and constraints

Ambulatory Care (Primary, Specialty Providers)

Data Requirements:— Patient Demographics

— Diagnostic Data

— Chief Complaints

— Triage Data

— Laboratory Orders and Results

— Physician Orders – Procedures

— Capacity Information

— Admission, Discharge, Transfer Data

Ancillary Providers (Lab)

Hospitals / Emergency Departments

HITSP IS 02 BiosurveillancePurpose and Use


Individual Healthcare Delivery Organizations

Stand-alone hospitals and clinics +/or emergency departments or laboratories

Integrated Health Care Data Suppliers

Organizations that cross jurisdictional boundaries, e.g., interstate hospital

organizations, nationwide laboratory organizations, payer systems, integrated

delivery network claims clearinghouses, etc.

Public Health Agencies

Relevant local, state and other public health agencies authorized to receive and use

data to perform biosurveillance

HITSP IS 02 BiosurveillancePerspectives


Individual and Integrated Organization Perspectives

— Healthcare organization establishes an agreement to send data to a Public Health biosurveillance information system

Clinical

Resource Availability

— Data are transmitted in near real-time (within 24 hours) for information required by Public Health Agencies for biosurveillance

— Data are Anonymized and Pseudonymized to ensure full privacy compliance, with randomized data linker to allow authorized re-identification for public health investigations

— Format data using approved standards

— Communicate relevant data to Public Health Agencies

HITSP IS 02 BiosurveillancePerspectives (continued)


Public Health Agency Perspective

— Provide listing of required biosurveillance data

— Receive biosurveillance data

— Verify authenticity of content

— Acknowledge receipt of data

— Log receipt of data

— Analyze, investigate and respond

HITSP IS 02 BiosurveillancePerspectives (continued)


Public Health Base Facility Data ElementsFacility Identifiers

AHIC Data Element HITSP- Selected Standards

Facility Identifier HIPAA National Provider Identifier

Facility Name Text String

Facility Location FIPS 55-3 [NIST] GNIS [USGS]

Number of Facility Beds HL7-defined

Number of Licensed Beds HL7-defined



Admissions last 24 hours HL7-defined

Discharges last 24 hours HL7-defined

Deaths last 24 hours HL7-defined

Clinical Status HAVE values as in AHIC definition [OASIS]

Facility Status HAVE values as in AHIC definition [OASIS]

Facility Operations HAVE values as in AHIC definition [OASIS]

Staffing HAVE values as in AHIC definition [OASIS]

Decontamination Capacity HAVE values as in AHIC definition [OASIS]

EMS Traffic Status HAVE values as in AHIC definition [OASIS]

EMS Capacity HL7 Defined

Public Health Base Facility Data ElementsBed Availability



Diagnosis/Injury Code ICD9-CM, SNOMED-CT

Diagnosis Type HL7 V2.5

Diagnosis Date/Time HL7 V2.5

Discharge Disposition Universal Billing Codes (UB-92/NUBC CURRENT UB DATA SPECIFICATIONS MANUAL)

Patient Class HL7 V2.5

Date and Time Illness Onset LOINC code: ‘11368-8^Illness/Injury Onset Date/time^LN’

Chief Complaint This HITSP IS will use the CHI recommended SNOMED CT as a reference terminology to communicate interoperable information among and between systems, with the HITSP IS Pre-condition that the sending and using systems must use formal coded nursing terminologies such as the Clinical Care Classification (CCC) System and the Omaha System that are integrated in SNOMED CT

Public Health Base Facility Data ElementsPatient Data Elements 1



Pseudonymized Data Linker None Available

Encounter Date/Time HL7 V2.5

Year of birth HL7 V2.5

Age UCUM

Gender HL7 V2.5

Zip U.S. Postal Service Zip Code

State Federal Information Processing Standards (FIPS 55-3) [NIST]

Date/time last update HL7 V2.5

Public Health Base Facility Data ElementsPatient Data Elements 2



Temperature LOINC code ‘8310-5^BODY TEMPERATURE^LN’; UCUM

Pulse Oximetry LOINC code: ‘19960-4^PULSE OXIMETRY^LN’ ; UCUM

Nursing/Triage Notes This Interoperability Specification will use the CHI recommended SNOMED CT as a reference terminology to communicate interoperable information among and between systems, with the HITSP Interoperability Specification Pre-condition that the sending and using systems must use formal coded nursing terminologies such as the Clinical Care Classification (CCC) System and the Omaha System that are integrated in SNOMED CT

Provider Identifier None Available

Public Health Base Facility Data ElementsClinical Data Elements



Result SNOMED-CT

Method type SNOMED-CT

Result unit UCUM

Test interpretation HL7 V2.5

Public Health Base Facility Data ElementsLaboratory / Microbiology Results



Reporting Laboratory Identifier

CLIA Unique Laboratory ID [FDA]

Performing laboratory CLIA Unique Laboratory ID [FDA]

Report date/time Hl7 defined

Report status HL7 V2.5

Collection date None specified

Collection method HL7 V2.5 SNOMED-CT

Specimen Source SNOMED-CT

Specimen HL7 V2.5 Specimen Type Codes OR SNOMED-CT Specimen Codes

Ordered test code LOINC code associated with test/procedure

Resulted test LOINC Laboratory Test Identifiers

Public Health Base Facility Data ElementsLaboratory / Microbiology Results (continued)



Study ID/Radiology Number None Available

Study date and time None Available

Report date/time None Available

Report Status HL7 V2.5

Test Performed AMA CPT+ Textual Description which can include modification

Impressions LOINC tag: ‘19005-8^X-RAY IMPRESSION^LN’

Date / Time Revised HL7

Public Health Base Facility Data ElementsRadiology Results


Other Communities

Hospital

Physician

Health Plan

Laboratory

Radiology Service

Document-Based

Transmission

Message-Based

Transmission

Public Health

Reporting /

Biosurveillance

Information System

More Info Appendix A

HITSP IS 02 BiosurveillanceMain Business Actors


Lab Result Terminology

C 35

Lab Report Document

C 37

Lab Result Message

C 36

Encounter Message

C 39

Encounter Document

C 48

Sharing Radiology Results

TP 49

Radiology Result Message

C 41

Resource Utilization

C 47

HITSP IS 02 BiosurveillanceSharing Clinical / Operational Information


Manage Consent Directives

TP 30Collect & Communicate Security Audit Trail

T 15

Entity Identity Assertion

C 19

Secured Communication Channel

T 17

Access Control

TP 20

Nonrepudiation of Origin

C 26

Consistent Time

T 16

HITSP IS 02 BiosurveillancePrivacy and Security


Pseudonymize

T 24Notification of Document Availability

T 29

Anonymize

C 25

Manage Sharing of Documents

T 13

HL7 Messaging

Retrieve Form for Data Capture

TP 50

Patient ID Cross-Referencing

TP 22

HITSP IS 02 BiosurveillanceInfrastructure


Constructs(single purpose

or reusable)

Type 1: Base or Composite Standards

Re-Use

Applying an existing

construct to more than one IS

Re-Purpose

Updating a construct to

meet the needs of a

new Use Case

Can extend or constrain when reusing or re-purposing

— Specifications contain a common superset

— Superset can be extended as new requirements are encountered

— Superset can be constrained with use-specific constraints

Units of Information Exchange HITSP IS Constructs - Re-Use and Re-Purpose


List Units of Information Exchange

HITSP C 35 (Component) Laboratory Terminology

HITSP C 47 (Component) Resource Utilization

HITSP C 48 (Component) Encounter Document Using

IHE Medical Summary (XDS-MS)

HITSP C 39 (Component) Encounter Message

HITSP TP 49 (Transaction Package) Sharing Radiology Results

HITSP C 41 (Component) Radiology Results Message

HITSP C 37 (Component) Laboratory Report Document

HITSP C 36 (Component) Laboratory Result Message

More Info Appendix B


Example: Lab Report


Document Document Description

HITSP/C35 HITSP Lab Terminology Component

HITSP/C37 HITSP Laboratory Report Document Structure Component

HITSP/C48 HITSP Encounter Document Component Using IHE Medical Summary XDS-MS

HITSP/TP49 HITSP Sharing Radiology Results Transaction Package

HITSP/C36 HITSP Laboratory Result Message Component

HITSP/C39 HITSP Encounter Message Component

HITSP/C41 HITSP Radiology Results Message Component

HITSP/C47 HITSP Resource Utilization Message Component

HITSP IS 02 BiosurveillanceConstructs – Content

(continued)


Document Document Description

HITSP/C25 HITSP Anonymize Component

HITSP/T24 HITSP Pseudonymize Transaction

HITSP/TP22 HITSP Patient ID Cross-Referencing Transaction Package

HITSP/TP13 HITSP Manage Sharing of Documents Transaction Package

HITSP/T29 HITSP Notification of Document Availability Transaction

HITSP/TP50 HITSP Retrieve Form for Data Capture Transaction Package

HITSP/T16 HITSP Consistent Time Transaction

HITSP/T17 HITSP Secured Communication Channel Transaction

HITSP/C26 HITSP Non-Repudiation Component

HITSP/C19 HITSP Entity Identity Assertion Component

HITSP/TP20 HITSP Access Control Transaction Package

More Info Appendix C

HITSP IS 02 BiosurveillanceConstructs – Security, Privacy and Infrastructure


www.HITSP.org


IS 02 – Biosurveillance on www.hitsp.org


A Successful Collaboration

Interweaving many different standards to address business needs

A successful collaboration between HITSP and several HITSP

member organizations developing base standards and

implementation guides/profiles


HITSP IS 02 BiosurveillanceStrengths

Effective interoperability

— Independent conforming implementations will interoperate

all dimensions of interoperability covered, including sharing/selective access, transport, identity management, anonymization, pseudonymization

— Semantic Interoperability with core clinical content

Basic core data set for biosurveillance syndromic surveillance and situational awareness

— Designed to equally empower the providers and Public Health with the same level of robustness

(continued)


Practical interoperability

— Standards that already have “implementation feasibility” validated

IHE Connectathon, HIMSS Interoperability Demonstration

— Testing in real-world environments - NHIN, CDC Flexible interoperability

— Designed to allow “receivers of information” to operate at various levels of richness (explicitly defined IS conformance subsets):

Document-based data transmission

Message-based data transmission Secured and Private interoperability

— Encryption, public health authorization, user authentication

— Anonymization, Pseudonymization

HITSP IS 02 BiosurveillanceStrengths (continued)


A concrete achievement for Steve

Implementation of HITSP IS 02 will allow Public Health

to identify relatively quickly foodborne disease risks and

manage product recalls, and to quickly identify the presence

and/or the extent of impact of illness due to chemical or

biological agents whether naturally occurring or human

assisted.

Future expansion of the IS may be able to assist in

determining available resources for providing needed care,

e.g., hospital beds availability in a region.

Steve, his sister, and other patients across the U.S. will

therefore be better protected as Public Health will be able to

provide appropriate warnings in a more timely fashion and to

redirect healthcare resources where they are most needed.


Use or specify HITSP Interoperability Specifications in your HIT efforts

and in your Requests for Proposals (RFPs)

Ask for CCHIT certification

Leverage Health Information Exchanges to promote HITSP specifications

to make connections easier in the future

Ask . . . Is there a HITSP standard we could be using?

Get involved in HITSP . . . Help shape the standards

How YOU can become involved


Webinar 1 Standardizing How We Share Information in Healthcare: An Introduction to HITSP

Thursday, June 5, 2008 — 2:00-3:30 pm EDT

Webinar 6 Quality

Thursday, August 7, 2008 — 2:00-3:30 pm EDT

Webinar 2 HITSP Foundational Components


Webinar 7 Security, Privacy and Infrastructure

Thursday, August 21, 2008 — 2:00-3:30 pm EDT

Webinar 3 Consumer Access to Clinical Information


Webinar 8 EHR and Emergency Response

Thursday, September 4, 2008 — 2:00-3:30 pm EDT

Webinar 4 Biosurveillance

Thursday, July 10, 2008 — 2:00-3:30 pm EDT

Webinar 9 Medication Management

Thursday, September 18, 2008 — 2:00-3:30 pm EDT

Webinar 5 Electronic Health Record (EHR) and Lab Reporting

Thursday, July 24, 2008 — 2:00-3:30 pm EDTwww.HITSP.org/webinars

How YOU can become involved

Learn more about specific HITSP activities during these upcoming webinars:


Jessica Kant, HIMSS Theresa Wisdom, [email protected] [email protected]

Re: HITSP Technical Committees

Michelle Deane, ANSI [email protected]

Re: HITSP, its Board and Coordinating Committees

Join HITSP in developing a safe and

secure health information network for

the United States.

Visit www.hitsp.org or contact . . .


Sponsor Strategic Partners

www.HITSP.org


Webinar Series


Biosurveillance

Questions and Answers


Webinar Series


Biosurveillance

APPENDIX SLIDES

Appendix A – link from Slide 25

Appendix B – link from Slide 31

Appendix C – link from Slide 34