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Dealing with Uncertainties: HIT Standardization
Public Health Data Standards ConsortiumHyattsville, MD
Dina Dickerson, [email protected]
Oregon Health AuthorityCenter for Prevention and Health Promotion
11.21.2013
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HIE pulse in Oregon
Meaningful Use:• Stage 1: HIE is live for Immunizations and ELR; syndromic
surveillance is piloting in 3 local sites• Stage 2: Phase 1 testing of HIE between partner EHR and state
newborn hearing screening registry is complete and Phase 2 planning is underway
• Stage 3: Work is underway to align with PHRI common data elements and to get experience with the HIT tools so that state programs are ready to receive the data from EHRs when available
Other:• Lots of nonstandard program-to-program data sharing, such as
Immunizations to WIC and ELR to CD reporting, but each dedicated interface adds another silo to maintain
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Other standards-based data sharing initiatives in Oregon
Maternal and Child Health and Related Services• Race to the Top: integrate and coordinate early childhood data
and services across agencies including health, public health, education and mental health
• Maternal, Infant, Early Childhood Home Visiting: integrate and coordinate home visiting data and services across agencies including health, public health, education and mental health
• HRSA MCHB Minimum Data Set: align performance measures across programs, identify supporting data elements, harmonize across data elements and value sets, and designate a standard for use by all HRSA MCHB-funded programs
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Oregon EHDI* CDA Phase 1 Pilot - Lessons Learned
Step-1 Setting: Birthing Facility IT Product: Epic 2012 EHR (Test Harness) Report Content: Patient demographic information, NHS resultsStandards: HL7 CCD, IHE RFDActor: Content Creator Form Filler
Step-2 Setting: HIE IT Product: OZ Form Manager
Report Content: NHS Outcome Report Standards: HL7 CDA, IHE EHCP, IHE RFD, IHE XDR Actor: Form ManagerForm ReceiverContent CreatorDocument Source
Step-3 Setting: Oregon EHDIIT Product: Orion Rhapsody, Filemaker DBReport Content: NHS Outcome ReportStandards: HL7 CDA, IHE EHCP, IHE XDR Actor: Content ConsumerDocument Recipient
Interoperability Standards**
* Early Hearing Detection and Intervention (EHDI) program. Newborn hearing screening (NHS) is a Stage 2 Meaningful Use objective.
** Public Health Data Standards Consortium EHDI CDA Final Report
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Oregon EHDI Manual NHS Report Form*
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EHDI CDA SDC RFD Template*
* Public Health Data Standards Consortium EHDI CDA Final Report
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EHDI CDA Phase 1 Pilot – Lessons Learned
Data Exchange Architecture*
* Public Health Data Standards Consortium EHDI CDA Final Report
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EHDI CDA Phase 2 Proposal: Real Data & Systems
EHDI User Story – Report Form for Data Capture (RFD)
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EHDI CDA Phase 2: SDC Template
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HIE: even more silos?• Hospital IT staff fear a proliferation of one-off requests for EHR data
• Each request requires resources to set up and maintain• Can they do this once and address all reporting needs for Public
Health?
• Need to acknowledge and address those fears• minimize impact on stakeholders and partners• let them know up front what data Public Health requires and in
what format
• Transition to a shared data and workflow model• harmonize and standardize data and processes• receive standards-based data into shared data model• populate silos with shared data until they can be retired• use metadata to simplify the structure and process
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Priority areas to move toward HIT standardization• Awareness
• Flea Pushing a Boulder, 2009• Standards overload can be overwhelming
• Coordination• CCO’s and other clinical providers• Local health departments• Statewide programs
• Infrastructure• Shared data model• Shared workflow tools• Funding
• Workforce• No Public Health-wide Informatics in Oregon• Need trained Chief Informatics Officer, not Technology Officer• Need training in harmonization and standardization
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Awareness
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Awareness: standards overload
Data standards• CPT• DSM• ICD9, ICD10• LOINC• NIC-NOC-
NANDA• SNOMED• NFP• and so on
Interoperability standards• HL7 CCD• HL7 CDA• IHE RFD• IHE EHCP• IHE XDR• and so on
Data models• FHIM• HL7 • European RIM• and so on
Forms• SDC Template• RFD• and so on
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Coordination: CCO’s, LHDs, Nonprofits, State• Periodically receive a file from partner EHRs that contains all instances
of data needed by Public Health for prescribed time frame
• Parse the data on Public Health side and use it to update shared standards-based data model
• Public Health silos draw on shared data model for updates and actions• Harmonize and standardize the actions occurring in silos• Build shared functionality to address needed actions and notifications• Provide one stop shopping for providers to access and act on
notifications about their patients
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Infrastructure: standards deployment via a shared data model
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Infrastructure: standards development using a knowledge builder
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Workforce
IT is still in control today • Lack domain knowledge• Focus is on project management to acquire/implement a system• Little awareness of data and workflow standards
Decision-makers are skeptical• Burned by repeated IT failures• No background in informatics • Inroads in MCH, ELR and CD reporting but not integrated
Train program side people in harmonization and standardization• Data• Functionality
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Standards development and deployment: methodology to move from siloed to shared data
Inventory Consolidate Harmonize Standardize Classify Use Monitor
Create knowledge base of all forms, data elements and value sets
Organize data elements around shared themes
Align definitions and value sets for a theme
Identify standard representation and permissions
Assign metadata tags and user permissions to share data
Capture, act on and report the data
Track access and evaluate quality
Data Level
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Standards development and deployment: methodology to move from siloed to shared workflow
Inventory Consolidate Modularize Standardize Pilot Implement Monitor
Collect and deconstruct user stories according to workflow requirements
Create master user story that includes all workflow requirements
Align, simplify and reconstruct workflow requirements
Adopt one methodology to address workflow requirements
Test and fine tune modular solution and training tools in limited settings
Roll out solution
Track access and evaluate quality
Functionality Level
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Harmonization of core common data elements*
* Public Health Reporting Initiative Data Harmonization Profile
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Acknowledgements• Claudia Bingham• John Eichwald• Jay Eisenberg• Ellen Larsen• Nikolai Lipskiy• Riki Merrick• Steve Modesitt• Heather Morrow-Almeida• Trong Nguyen• Sue Omel• Anna Orlova• Lari Peterson• Matt Pitney• Walter Suarez• Meuy Swafford• Cate Wilcox• Patricia Yao• Chia-Hua Yu• Laura Zukowski