BEACH UpdatePopulation and Public HealthPublic Health Tiger Team
Dr. James Killeen
UC San Diego Dept. of Emergency Medicine
Beacon Education, Analytic and Coordination Hub
SD Beacon Objectives
Build Regional HIE Infrastructure• Integrate Health IT into Care Delivery
– Improve care coordination among providers– Engage patients and families
• Quality: Cardiovascular disease– Acute care: EKG transmission from EMS to Hospitals for acute
Myocardial Infarctions• Reduce Time to Catheterization and False Positive Rates
– Chronic care: Reduce 30 day re-admissions • Public Health Enhancements & Meaningful Use
– Immunizations– Syndrome Surveillance– Electronic Lab Reporting
• Cost Efficiency– Reduce repeat ED visits, hospital admissions & Redundant Tests
2
Beacon Innovations
• Regional and inter-state EMS Hub Services• Situation Awareness• Population health data and analytics• Public health data, visualization and analytics• Meaningful Use public health reporting certification and
compliance support• Embedded Medical Devices• Tele-medicine and Tele Lab• Environmental Data
San Diego
Beacon
CDC
Community A
VA/DOD
State/Local Government
Community B
ClinicsEMS
County PH
SD VA/DOD
SSA
Evolving from the BEACON to the BEACH
BeaconLeveraging information and best practices across all Beacon Communities while also
EducationIncluding and informing communities that were not participants in the grant program by
Analytic Using analytical tools to create situational awareness
CoordinationCreating a forum in an aligned manner for the exchange of data and information using
HubThe UCSD Emergency Medicine Department as the common center of activity
Public Health Data Starts Locally
• Raw Data is reported to PH – PHI, De-identified and Aggregate• PH Applications and Informatics Analyze• Information is Generated and Shared
Info
Data
RawData
Public Health
Population Health utilizes PH Analysis
• PH Shared Info is Source data – De-Identified and Aggregated• New data sources – EMS, Behavioral Health• Includes Healthcare, Research and Businesses• Generated new Information that is Shared
Info
Data
RawData
Public Health
Population HealthInfo
Data
NewData
Community Health
• Pop Shared Info is Source data –Aggregated• New data can be added• Includes Entire Community, State and Federal • Generated new Information that is Shared
Info
Data
RawData
Public Health
Population Health
Community Health
Info
Data
Info
Data
NewData
Current Focus
• Population and Public Health• Maximizing data to public health• Support existing applications and systems• Enable rich analytics, visualization and reporting• Consistent interfaces for interoperability
Info
Data
RawData
Public Health
Population HealthInfo
Data
NewData
Population and Public Health Hub
HIEInterface(optional)
Hospital
ProviderNetwork
FQHC, DOD & VA
Individual Practice
ClinicalLaboratory
Cancer Case
Electronic LabReporting
ChildhoodLead
SDIR Imperial
CAIR
RIDE
Other States
SD webvCMR
CDPH CalREDIE
CDC BioSense
HMS EpiCenter
Collaborate.org
JH ESSENCE
Others
Others
Immunization
Syndrome Surveillance
Regional Reg
RASSCLE
ACKs, Feedback & Data Provenance
Health System
Public Health
Route to existing applications
Health Partner
IZ PHCR ELR POU Dx SS
Support Existing Systems
Immunization Registry
PH Cases SurveillancePH Case Management and Investigation
EMR/EHR LIS
Health
IndicatorsD
emog
raph
ics
Health Partners
IZ
PHCR
ELR
POU Dx
SS
Hub Simplifies the Process
Immunization Registry
PH Cases Surveillance
EMR/EHR LIS
Now Applying the Data
1. Upcoming back-to-school and fall vaccination campaigns
2. Asthma
3. Diabetes
Immunizations
Seasons
POU Dx
Economic
Case Reporting
Pharmacies
Care Facilities
Transportation
Syndromes
Schools
Populations
BMI
Lab Results
Elderly Care
Regions
Air Quality
• Thousands die every year• Vaccination campaigns are a tool
– Both influenza and pneumonia
• Challenges– How effective are we?– Can we be more effective?
• If we can collect and analyze data faster…– Campaigns can be targeted and adjusted– Surveillance can be a by-product of routine care
Seasonal Influenza
Surveillance – Influenza-Like Illness
Encounter•Assessment
School Nurse•Screening Test
Urgent Care•Rapid Diagnostic
Emergency Department•Diagnostic & Typing
Public Health Laboratory•Typing & Subtyping
Vaccinations Encounters Test Results
Real-Time Situation Awareness
GoalCompress time to
knowledge to mitigate overall impact and cost
Population and Public Health Hub
Population and Public Health Hub
Syndrome Surv
ELR
Rapid Diagnostics
Case Reporting
Exposure Monitoring
Public Health(Protected Health
Information)
Community(Aggregate)
Regional &Healthcare
(De- & Un-Identified)
ACKs, Feedback & Data Provenance
Immunizations
Environmental DataC
lou
d &
Des
kto
p
Too
lkit
s
Policy / Governance
Business Rules
Platform Deployment
• Priorities– Support existing application-
specific data flows– Establish new flows to support
analytics and other needs– Provide information back to
stakeholders in a timely manner
• Rules– Interoperability by design– Reduce dependence on HL7– Open standards– Open interfaces
• Agile in the Extreme• 2-6 cycles• Discovery
– 2-6 hours concept– 2-6 days proto
• Dynamic– 2-6 days concept– 2-6 weeks proto
• Map to existing design patterns and enhance services
Service Bus
High Level Architecture
SecurityProvenanceGovernance
New ApplicationsAnalysis, Visualization, Reporting
Data InRouter
Data Out
Router
PreProcessEngine
DataAccessLayers
PostProcessEngine
LegacyApps
Coding,Look up
ExtData
StagingData
AppData
Data Marts
Data Whse
Syndrome Surveillance Example
Validation Router
BioSensePP
CollaboratePP
Sequence
Filter
Enrich
Enrich
AppData
Data Whse
Case Reporting – Pertussis
Patient
Router
Watchdog:LabOrder
Enrich: Care Detail
Enrich:Pat Detail
Enrich:IZ Lookup
Notify:PH Case
ExposureMonitor
HEAT Data
EHR ICD-933.X Trigger
EHR orSDC
Validation
IZ Data
Create:Pot Case