Wayne Enanoria, PhD, MPH

Health Commission Meeting

March 20, 2018

Applied Research, Community Health

Epidemiology, and Surveillance (ARCHES)

Update

Overview

1

A3 Overview

2

Maven Electronic

Health Record

(EHR)

3

Current State, 2016

Population Health Division A3

• Title:

• Data to support decision-making to improve population health.

• Target:

• Actionable, integrated, person-centered, population-based data pertaining to the social determinants of health and public health conditions that can be readily accessed to support decision-making.

• PHD A3 is aligned with two initiatives of the SFDPH:

• Actionable knowledge anytime, anywhere

• Developing our people

• Initial Phase:• Person-Centered Data Integration Steering Committee meeting in

September, 2016

• Multi-disciplinary Committee Membership from PHD programs

• Purpose: to prioritize the PHNIX build given program needs and use.

Establishing Priorities, August 2016

Tuberculosis

Module

Electronic Lab

Report Module

Key Decision to build:

• Core functions for tuberculosis control and prevention

• Improved tuberculosis case detection and management

• Active case finding and targeted testing

• Evaluation of immigrants and refugees with TB or TB infections

• Public Health surveillance of tuberculosis cases and case reporting

• Clinical management and follow-up of active cases

• Outbreak management and contact investigations

• Analytics and reporting

• Program evaluation

Core Functionality

• Maven will contain information on all TB cases in SF and their identified contacts and all patients seen in the clinic (Latent Tuberculosis Infection).

• Information includes demographic information, epidemiology, genotype, TB testing (serology, skin tests, microbiology, molecular data).

• Maven will be enhanced to handle outbreak data.

• Data on infected individuals, their close contacts, treatments/interventions, and health outcomes.

• Until the new EHR is built, Maven will contain clinical data for clinical decision support.

Key Contents

Understanding Current Work Flows

Current State: What Processes Did We Map?

Clinical Services

» Active TB case

» TB case with Class B

immigrant designation

» TB patient receiving

ongoing clinical care

Research

TBESC study participant

(LTBI cases)

Prevention

& Control

TB disease control

investigation

Surveillance

& Reporting

» Pulling sputum results

» RVCT

» Annual Progress Report

» EDN B notification

Current vs. Future State: Contact Investigation

• Administrative

• Demographic

• Immigration and B-Notification

• Clinical/Medical Evaluation

• Treatment/Management History

• Risk Factors

• Contact Investigation

• Exposure Site Assessment

Maven Question Packages

• TB Medication Orders

• DOT/DOPT Treatment Log

• Care Coordination and Communication

• Appointments

• Insurance & Billing

• The Maven TB module includes the following question packages:

• Electronic Lab Reporting for Public Health is the automatic transmission of all laboratory reports from laboratories to state and local public health departments.

• Electronic lab reports contain information for Title 17 reportable conditions.

• Sources of Data

• Public Health Laboratory, Population Health Division

• California Reportable Disease Information Exchange (CalREDIE)

• Clinical Laboratory, ZSFGH

Electronic Lab Reporting Module

• Two rounds of User Acceptance Testing

• Validate that Maven can store the ELR data properly;

• Identify errors that need to be corrected;

• Verify that the system is functioning as expected;

• Obtain user feedback and “acceptance” of the system.

Electronic Lab Reporting Module

PDSA Cycles for Improvement

Image Source: http://sisep.fpg.unc.edu/book/export/html/178

Electronic Health Record Implementation

Information Systems

• Michelle Tom

• Angela Liu

• Tina Lee

• Mark Bridge

• Steve Solnit

• Tru Vu

• Ruby (Madhumita) Das

• Trevor D’Sa

• Tiffany Tsukuda

Acknowledgments

Population Health Division• Chris Keh

• Laura Romo

• Rocio Agraz-Lara

• Samira Causevic

• Felix Crespin

• Janice Louie

• Indiana Galarza

• Taliba Miller

• Billy Luong

• TB Clinic Staff

• Bob Kohn• Christiana Toomey • Sharon Pipkin• Thomas Knoble• Amy Nishimura• Melissa Ongpin• Annie Vu• Jennie Chin• Dale Gluth• Jennifer Grinsdale• Priscilla Chu• Israel Nieves-Rivera• ARCHES Staff

Questions/Comments?

Thank You