Links to the Healthcare System for Surveillance

1. Links to the Healthcare System for Surveillance 2006 NAPHSIS Annual Meeting Lois M. Haggard, PhD Utah Department of Health Lois M. Haggard, PhD, Utah Department of Health

2. “From nearly anywhere in the world, we can withdraw money from our bank accounts, pay bills, apply for a mortgage, book airline tickets and even order groceries online. But more often than not, we can’t share an X-ray digitally from one hospital to another, even if they are on opposing street corners.” Michael Leavitt, Secretary for the U.S. Department of Health and Human Services (Former Utah Governor) National Context Lois M. Haggard, PhD, Utah Department of Health

3. 2001 NCVHS Report • The 2001 report from the National Committee on Vital and Health Statistics, NHII—Information for Health1 • National information infrastructure (NHII) is a “standards-based architectural framework to enable more seamless sharing of person-specific health information.”2 Lois M. Haggard, PhD, Utah Department of Health

4. 2004 Executive Order • Presidential Executive order in April 20043 • The Office of the National Coordinator for Health Information Technology (ONC) was created • Mandate to assure universal interoperable personal electronic health records by 2014. Lois M. Haggard, PhD, Utah Department of Health

5. 2004 Strategic Framework • July 2004, ONC published the “Framework for Strategic Action,” proposed the NHIN4 • accelerate the use of EHRs • interconnect clinicians • better information for consumers • improve public health surveillance Lois M. Haggard, PhD, Utah Department of Health

6. Other National Initiatives • Public Health Information Network (PHIN), CDC’s initiative • Markle Foundation’s Connecting for Health5 • Public Health Informatics Institute, Opportunities for Public Health2 • Agency for Healthcare Research and Quality (AHRQ) contracts to facilitate health information exchanges Lois M. Haggard, PhD, Utah Department of Health

7. Local and State Initiatives • Indiana Health Information Exchange (IHIE) • Massachusetts e-Health Collaborative (MAeHC) • Mendocino County, Calif. • Inland Northwest Health Services (INHS) Spokane, WA. • Utah Health Information Network (UHIN) Lois M. Haggard, PhD, Utah Department of Health

8. Who? • Current exchange partners • Could begin by exchanging • the same information we do now, • with the same partners, • but ELECTRONICALLY, using standard messages, interoperable systems. • New exchange partners • E.g., pharmacies sharing medication history with physicians Lois M. Haggard, PhD, Utah Department of Health

9. Who? • Personal Health Record • Some propose that the patient should maintain it, such as on a smart card or a USB memory device. Lois M. Haggard, PhD, Utah Department of Health

10. Payer B Payer A Payer … Communicable Disease NVSS CDC Hosp A Hosp B Hosp … Immunization Funeral Home B Funeral Home A Funeral Home … Births Deaths State Health Department LHD A LHD B LHD … Lab A Doc … Doc B Doc A Pharmacy A Pharmacy B Soc. Security Admin. Pharmacy … Lab … Lab B Who? Lois M. Haggard, PhD, Utah Department of Health

11. What? • Clinical information. • Information we store and use about individuals to serve them, to enhance their wellness. • Electronic messages Lois M. Haggard, PhD, Utah Department of Health

12. Electronic Messages • Text message: • e.g., Email • XML message: • structured text • can be machine readable Hi, Andrea! Jimmy H. received his OPV at our clinic yesterday. <patient> Jimmy H. </patient> <vaccine> OPV </vaccine> <date> 01/15/2006 </date> <provider> clinicA </provider> Lois M. Haggard, PhD, Utah Department of Health

13. HL-7 message: Electronic Messages MSH|^~\&||MA0000||GA0000|199705221610||VXR^V03|19970522MA53|T|2.3.1|||AL MSA|AA|19970522GA40| QRD|199705221605|R|I|19970522GA05|||25^RD|^KENNEDY^JOHN^FITZGERALD^JR|VXI|^SIIS QRF|MA0000||||256946789~19900607~MA~MA99999999~88888888~KENNEDY^JACQUELINE^LEE~BOUVIER~898666725~KENNEDY^JOHN^FITZGERALD~822546618 PID|||1234^^^^SR^~1234-12^^^^LR^~3872^^^^MR~221345671^^^^SS^~430078856^^^^MA^ ||KENNEDY^JOHN^FITZGERALD^JR^^^L|BOUVIER^^^^^^M|19900607|M|KENNEDY^BABY BOY^^^^^^ B|W^WHITE^NY8 RACE CODES^W^WHITE^HL70005|123 MAIN ST^APT 3B^LEXINGTON^MA^00210^ ^M^MSA CODE^MA034~345 ELM ST^^BOSTON^MA^00314^^BLD~^^^^^^BR^^MA002| |(617) 555-1212 ^PRN^PH^^^617^5551212^^||EN^ENGLISH^HL70296^^^|||||||WN^NOT HISPANIC^LOCAL CODE SET^NH^NOT OF HISPANIC ORIGIN^HL70189|CHILDREN=S HOSPITAL PD1|||CHILDREN=S HOSPITAL^L^1234^^^^XX~LEXINGTON CLINIC^^1234A^^^^FI |12345^CARE^ PRIMARY^^^DR^MD^^^L^^^DN|||||||03^REMINDER/RECALL - NO CALLS^HL70215|Y|A|19900607 NK1|1|KENNEDY^JACQUELINE^LEE|32^MOTHER^HL70063||||||||||||||||||||||||||||||898666725^^^^SS NK1|2|KENNEDY^JOHN^FITZGERALD|33^FATHER^HL70063||||||||||||||||||||||||||||||822546618^^^^SS PV1||R||||||||||||||||||V02^19900607~H02^19900607. . . Lois M. Haggard, PhD, Utah Department of Health

14. What? • Patient-Centered Exchanges • (pssst… this is the linkage part…) • Master patient index is key. • Ensure correct ID of patient (make sure you’ve got the medication history for the CORRECT John Smith) • Unduplicated records will be important to realize gains efficiency Lois M. Haggard, PhD, Utah Department of Health

15. What? • Utah Goals: • Electronic medical records for all patients • Inter-connected information systems • Timely public health surveillance • Robust Regional Health Information Organization (RHIO) Lois M. Haggard, PhD, Utah Department of Health

16. Where? • Remove geographic barriers to care. • (i.e., anywhere) Lois M. Haggard, PhD, Utah Department of Health

17. When? • First, we need: • Electronic medical records • Clinical data stored in STRUCTURED, UNIFORM, CODED, electronic formats • Appropriate, completed HL-7 standards • Data storage structures in public health • Compatible privacy and security practices • Governance structures (what body will set policy, make decisions?) Lois M. Haggard, PhD, Utah Department of Health

18. Lois M. Haggard, PhD, Utah Department of Health

19. Payer … Payer A Payer B Communicable Disease CDC NVSS Hosp A Hosp B Hosp … Immunization Funeral Home A Funeral Home B Funeral Home … Births Deaths State Health Department Information Broker (RHIO) LHD A LHD B LHD … Lab A Doc … Doc A Doc B Pharmacy A Pharmacy B Soc. Security Admin. Pharmacy … Lab B Lab … How? Lois M. Haggard, PhD, Utah Department of Health

20. From Southern Utah To Salt Lake City UHIN: Linking Communities And all points between. . . Lois M. Haggard, PhD, Utah Department of Health

21. Where We Are: • UHIN eCoverage • 3rd Party payers’ claims (450+ payers) • Medicaid and Medicare • Hospitals (100%) • Physicians/clinics (85-90%) • Laboratories (100%) • Local health departments (100%) • Mental health centers (100%) • Chiropractics (90%) Lois M. Haggard, PhD, Utah Department of Health

22. Why? Lois M. Haggard, PhD, Utah Department of Health

23. Why? • Access, Quality, Cost • “To increase the efficiency of existing paper-based and non-standardized electronic patient information exchanges among health care organizations. • “To make complete, timely, and accurate informatin available to providers in order to improve the quality and reduce the unnecessary utilization of health care services.”6 Lois M. Haggard, PhD, Utah Department of Health

24. Why? • Facilitate reporting to public health. “The most obvious immediate benefit … to public health lies in improving mandated public health reporting.”2 (p. 8) • Notifiable disease • Birth and death certificate data • Immunizations • Newborn screening • Public health registries (e.g., birth defects, cancer, injury, etc.) Lois M. Haggard, PhD, Utah Department of Health

25. Value to Public Health2 • “More timely and complete receipt of disease reports • “Analysis and display of geographic distribution of illness or injury to focus public health interventions or services • “Improved ability to communicate with selected provider and patient populations” • “Easier identification and analysis of gaps in preventive health services …” (p. 7) Lois M. Haggard, PhD, Utah Department of Health

26. 10 Essential Health Services • Monitor health status • Diagnose and investigate • Inform and educate • Mobilize partnerships • Develop policies and plans • Enforce laws and regulations • Link people to services • Assure competent workforce • Evaluate health programs • Research Lois M. Haggard, PhD, Utah Department of Health

27. 10 Essential Health Services • Monitor health status • Diagnose and investigate • Inform and educate • Mobilize partnerships • Develop policies and plans • Enforce laws and regulations • Link people to services • Assure competent workforce • Evaluate health programs • Research 1. Monitor health status 2. Diagnose and investigate 10. Research Lois M. Haggard, PhD, Utah Department of Health

28. Birth Hospitalized Death Filling in the Gaps • Major Life Events • Health Surveys • Self-reported lifestyle, health insurance, chronic conditions, etc. • Notifiable Diseases • Selected disease events, variable reporting completeness Lois M. Haggard, PhD, Utah Department of Health

29. Person-Centric Data Views • New opportunities: • What happens to people after they go off Medicaid? • How many patients “shop” for doctors who will prescribe desired medications? • How many suicide victims saw a medical provider in the months prior to their death? What kind of a provider was it? What medications were they on? Lois M. Haggard, PhD, Utah Department of Health

30. Person-Centric Data Views • New opportunities: • Utilization patterns (medical home, ED use, prenatal care) of uninsured • Recommended preventive care at appropriate intervals (immunizations, cancer, BP, cholesterol screening, etc.) • Genetics research on chronic conditions, (e.g., depression, asthma, atherosclerosis, etc.) Lois M. Haggard, PhD, Utah Department of Health

31. Person-Centric Data Views • New opportunities: • How many children seen in the ED for asthma had been prescribed an asthma medication? • How many people visit their doctor with a chief complaint of “fatigue?” What tests are performed? What is the eventual diagnosis? • Do women have more doctor visits than men after accounting for reproductive-related visits? Lois M. Haggard, PhD, Utah Department of Health

32. Current Utah Projects • AHRQ Pilot Projects • Discharge summaries • Hospitals to physicians • History and physical • Physicians to hospitals; hospitals to physicians, referrals • Laboratory results • Labs to physicians/hospitals, • Medication histories • Payers to physicians, hospitals, & pharmacies Lois M. Haggard, PhD, Utah Department of Health

33. Utah’s RWJF Project • Business plan for public health participation in exchange of clinical health information. • Identify opportunities that provide value to both the private and public sector partners. • Immunization registry • Notifiable disease, lab reporting • Newborn screening • Vital events registration (e.g., prenatal care visits from mom’s medical record to birth certificate) Lois M. Haggard, PhD, Utah Department of Health

34. HISPC • Health Information Security and Privacy Collaboration • 34 states funded • Funding from AHRQ, RTI contractual agreements • Stakeholder review of laws and business policies that support or inhibit information exchange. Lois M. Haggard, PhD, Utah Department of Health

35. Thank You Lois M. Haggard, PhD Office of Public Health Assessment Utah Department of Health 801-538-9455 loishaggard@utah.gov Lois M. Haggard, PhD, Utah Department of Health

36. References Lois M. Haggard, PhD, Utah Department of Health