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LHDs and HIE Opportunities and Challenges in the New HIT Landscape to Transform Public Health Practice and Protect and Improve the Health of the Community Presentation to the Kansas Association of Local Health Departments June 19, 2012,

  1. Public Health Informatics Federal Initiatives (con’t.) • Federal HIT Infrastructure- Office of the National Coordinator (ONC)  Policy and Standards  EHR adoption- Meaningful Use  Regional Extension Centers (RECs)  Certification and testing of EHRs • ARRA HITECH Funding streams- • Demonstrations  State Health Information Exchange (HIE) grants  Beacon and Sharp Grants • CDC policy changes, grants and technical assistance • CMS Incentives for EHR adoption- Meaningful Use, • CMS New care delivery and payment models PCMH, ACOs • CMMI Innovation Grants- 20 KALHD 6-19-12

  2. ARRA, HITECH and Opportunities for Public Health Uses of health IT have the potential to bring many benefits to public health agencies, including: • Earlier detection of infectious disease outbreaks • Improved tracking of chronic disease management • Improved coordination of care across public and private providers • More accurate assessments of disease burden in the community, or of the impact of community-wide prevention initiatives • Trusted stewards of personal information Source: The Value of Health IT in Improving Population Health and Transforming Public Health Prac tice- A Brief for Local and State Health Officials A joint Publication of the Public Health Informatics Institute and the InfoLinks and Connections Communities of Practice November 2009 21 KALHD 6-19-12

  3. Public Health Informatics Drivers Centers for Medicare & Medicaid Services • NPRM for Meaningful Use ( an incentive for EHR adoption) was published in the Federal Register for public comments • Numerous PH organizations made MU comments in an organized fashion: NAPHIT ASTHO, NACCHO, CSTDE, APHL, PHDSC, Public Health Informatics Institute, AIRA • Webinars convened members, organizations and health departments to collect and vet comments sent individually and collectively including a coordinated response by JAPHIT. • PH reporting as menu option in Stage 1 MU. • State-mandated lab reporting • Reporting immunizations to state immunization system • Syndromic surveillance • identification of patients for outreach and disparities reduction. 22 KALHD 6-19-12

  4. Public Health Informatics Drivers Centers for Medicare & Medicaid Services • New care delivery and payment models • Patient Centered Medical Home- Medicare projects • Health home: Medicaid projects • Health Homes for Medicaid Enrollees with Chronic Conditions • ACO- Accountable Care Organization • Medical Neighborhood • The Kansas Patient Centered Medical Home Initiative (Ks PCMHI is a project of the Kansas Academy of Family Physicians in conjunction with the Kansas Association of Osteopathic Medicine, the Kansas Chapter of American Academy of Pediatrics, the Kansas Chapter of the American College of Physicians, and the Kansas Medical Society. 23 KALHD 6-19-12

  5. Center for Medicare & Medicaid Innovation CMMI- http://www.innovations.cms.gov/ • Initiatives to achieve the IHI Triple-AIM  Improving the patient experience of care (including quality and satisfaction)  Improving the health of the populations  Reducing the per capita cost of health care • June 12, 2012-Two awards which include KS  Project Title: “Multi -community partnership between TransforMED, hospitals in the VHA system and a technology/data analytics company to support transformation to PCMH of practices connected with the hospitals and development of “ Medical Neighborhood ”  The University of North Texas Health Science Center (UNTHSC), in partnership with Brookdale Senior Living (BSL), is receiving an award to expand and test the BSL Transitions of Care Program which is based on an evidenced-based assessment tool called Interventions to Reduce Acute Care Transfers (INTERACT 24 KALHD 6-19-12

  6. Meaningful Use (MU) 25 KALHD 6-19-12

  7. Health Outcomes Policy Priority: Improve population and public health Care Stage 1 Objectives Stage 1 Measures Goal(s) Eligible Providers Hospitals Communicate Capability to submit Capability to submit Perform at least one test of certified with public electronic data to electronic data to EHR technologies capacity to submit immunization registries and immunization registries and electronic data to immunizations health agencies actual submission where actual submission where registries required and accepted required and accepted Capability to provide Capability to provide Performed at least one test of electronic syndromic electronic syndromic certified EHR technology's surveillance data to surveillance data to capacity to provide electronic public health agencies public health agencies syndromic surveillance data to and actual and actual transmission public health agencies (unless transmission according to applicable none of the public health agencies according to law and practice to applicable law and which an EP or eligible hospital practice submits such information have the capacity to receive the information electronically) Capability to provide Performed at least one test of the EHR electronic submission of system's capacity to reportable lab results (as provide electronic submission of required by state or local reportable lab results to public health law) to public health agencies (unless none of the public agencies and actual health agencies to which eligible submission where it can hospital submits such information have be received the capacity to receive 26 the information electronically) KALHD 6-19-12

  8. Meaningful Use and PH Informatics • Participate in national standards organizations such as HL7, LOINC, develop use cases, ballot standards, produce implementation guides, ONC S&I initiative • Develop use cases for Integrated Health Enterprise (IHE), emergency preparedness and response, immunizations, newborn screening, early hearing detection scheduled for HIMSS Connectethon 2011. • Develop Testing criteria for public health components of meaningful use for Certification • Develop education and other tools for Regional Extension Centers to advise and encourage providers to choose and implement public health meaningful use components 27 KALHD 6-19-12

  9. Regional Extension Centers (RECs) • RECs were created last year under the HITECH Act, part of the ARRA Act of 2009.  HITECH provided approximately $2 billion in new programs to provide training and technical assistance and to demonstrate the effectiveness of health information technology in supporting improvement in care.  Under the HITECH Act, $677 million is allocated for the next two years to support a nationwide system of RECs. • KS REC- KS Foundation for Medical Care, Inc -(KFMC) is the federally designated HITREC for the state of Kansas. http://www.kfmc.org/rec/  Accelerate Health Information Technology (a-HIT) in Kansas! 
 KFMC’s services are designed to take your organization from its current state – whether you are starting with a paper-based system or just need to optimize your current EHR – to MU in order to qualify for the Medicare or Medicaid Incentives.  target their assistance to eligible primary care providers in smaller practices as well as small and rural hospitals and public health clinics.  will also serve as a resource for all providers in an area, giving assistance, as feasible, to any doctor, hospital or clinic making the request. 28 KALHD 6-19-12

  10. Health Information Exchange (HIE) • Health information exchange (HIE) -transmission of healthcare- related data among facilities, health information organizations (HIO) and government agencies according to national standards. • The State Alliance for e-Health, 2006 NGA ONC-approved models:  Government-Led Electronic HIE : Direct government provision of the electronic HIE infrastructure and oversight of its use. (ME, VT)  Public Utility with Strong Government Oversight : Public sector serves an oversight role and regulates private-sector provision of electronic HIE. (TN, UT)  Private-Sector-Led Electronic HIE with Government Collaboration : Government collaborates and advises as a stakeholder in the private-sector provision of electronic HIE. ( DE, NE) 29 KALHD 6-19-12

  11. Office of the National Coordinator- HIE Support • State Health Information (State HIE) Exchange Cooperative Agreement Program.  In total, 56 states, eligible territories, and qualified State Designated Entities (SDE) received awards. • The Beacon Community Cooperative Agreement Program  provides funding to 17 selected communities throughout the United States that have already made inroads in the development of secure, private, and accurate systems of electronic health record (EHR) adoption and health information exchange. Many include public health. 30 KALHD 6-19-12

  12. Role of Public Health in Health Information Exchange (HIE) • Source of clinical and other health information on clients seen by public health, or on specimens tested by public health. • Source of information on emergent issues in a community that could assist a clinician in diagnostic and treatment decisions. • Source of population based analysis of individual disease data to provide improved trends to providers. • Recipient of reportable disease information. • Recipient of biosurveillance data reporting streams • Provider of expert knowledge in population health improvement, and in clinical and treatment guidelines. Source: The Value of Health IT in Improving Population Health and Transforming Public Health Prac tice- A Brief for Local and State Health Officials A joint Publication of the Public Health Informatics Institute and the InfoLinks and Connections Communities of Practice November 2009 31 KALHD 6-19-12

  13. Public Health Contribution to Population Health 1 KALHD 6-19-12

  14. Population-wide Quality Measures 2 KALHD 6-19-12

  15. Healthcare data benefit to Public Health DavidsonGibson MUbriefing.pdf 3 KALHD 6-19-12

  16. LHDs in Health Data Exchange DavidsonGibson MUbriefing.pdf 4 KALHD 6-19-12

  17. Role of Public Health in National Quality Strategy DavidsonGibson MUbriefing.pdf 5 KALHD 6-19-12

  18. NACCHO LHD Operational Jurisdiction DavidsonGibson MUbriefing.pdf 6 KALHD 6-19-12

  19. Context of LHDs DavidsonGibson MUbriefing.pdf 7 KALHD 6-19-12

  20. Creation of Public Health Use Cases DavidsonGibson MUbriefing.pdf 8 KALHD 6-19-12

  21. Overview of KHIN 9 KALHD 6-19-12

  22. Public Health in KHIN 10 KALHD 6-19-12

  23. LHDs and KHIN 11 KALHD 6-19-12

  24. Example from HITE-CT Connecticut’s HIE 12 KALHD 6-19-12

  25. Example from HITE-CT Connecticut’s HIE 13 KALHD 6-19-12

  26. Example from HITE-CT Connecticut’s HIE 14 KALHD 6-19-12

  27. Example from HITE-CT Connecticut’s HIE 1 KALHD 6-19-12

  28. Example from HITE-CT Connecticut’s HIE 2 KALHD 6-19-12

  29. Crescent Beacon in LA Zachery M. Ziwa, Chief Technology Officer, Louisiana Department of 3 Health & Hospitals KALHD 6-19-12

  30. Crescent Beacon in LA Zachery M. Ziwa, Chief Technology Officer, Louisiana Department of 4 Health & Hospitals KALHD 6-19-12

  31. Crescent Beacon in LA 5 KALHD 6-19-12

  32. Crescent Beacon in LA LHD Opportunity 6 KALHD 6-19-12

  33. VT Blueprint for Chronic Care 1 KALHD 6-19-12

  34. Integration of public health from VT Hospitals  A foundation of medical homes and community health teams that can Medical Specialty Care & Disease support coordinated care and linkages Home Management Programs with a broad range of services Community Health Team Medical  Multi Insurer Payment Reform that Social, Economic, & Nurse Coordinator Home Community Services Social Workers supports a foundation of medical Nutrition Specialists homes and community health teams Community Health Workers Medical MCAID Care Coordinators Mental Health & Home  A health information infrastructure Public Health Specialist Substance Abuse Programs that includes EMRs, hospital data Medical sources, a health information Home exchange network, and a centralized Healthier Living Workshops registry Public Health Programs & Services  An evaluation infrastructure that uses routinely collected data to support services, guide quality improvement, Health IT Framework and determine program impact Evaluation Framework KALHD 6-19-12 2

  35. Public Health in the Medical Neighborhood LHD Opportunity LHD Opportunity 3 KALHD 6-19-12

  36. Role of HIE in population health • Source of improved population health data collection • Ability to promptly route and deliver to community clinicians emergent information from public health • Assist public health in cross-jurisdictional collaboration on data collection and sharing • Improved continuity of care Source: The Value of Health IT in Improving Population Health and Transforming Public Health Prac tice- A Brief for Local and State Health Officials A joint Publication of the Public Health Informatics Institute and the InfoLinks and Connections Communities of Practice November 2009 4 KALHD 6-19-12

  37. Health Data Initiative • The IOM and HHS has hosted The Health Data Initiative Forum for 3 years, most recent 6/5-6/12 • to accelerate momentum for the public use of data and innovation to improve health. It includes  fast-paced demonstrations  range of tools and applications developed using health data,  discussion sessions,  data and apps exposition where participants can interact with featured innovators  Several public health departments attended and many apps have been developed for public health • http://www.hdiforum.org/ 5 KALHD 6-19-12

  38. How the Health Data Initiative Works LHD Opportunity 6 KALHD 6-19-12

  39. About Healthy People HP2020 • Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. • For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to:  Encourage collaborations across communities and sectors.  Empower individuals toward making informed health decisions.  Measure the impact of prevention activities. 7 KALHD 6-19-12

  40. What’s New for HP 2020? Focus on the Determinants of Health- • Identifying, measuring, tracking, and reducing health disparities through a determinants of Health approach • New Topic areas for 2020 • Adolescent Health • Blood Disorders and Blood Safety • Dementias, including Alzheimer’s Disease • Early and Middle Childhood • Genomics • Global Health • Healthcare Associated Infections • Health Related Quality of Life and Well-Being • Lesbian, Gay, Bisexual, and Transgender Health • Older Adults • Preparedness • Sleep Health • Social Determinants 8 KALHD 6-19-12

  41. Healthy People 2020 in the Digital Age • Stay connected with Healthy People 2020 and the Office of Disease Prevention and Health Promotion (ODPHP). • Connect Online • Subscribe to “Who’s Leading the Leading Health Indicators?” • Join the Healthy People Consortium • Follow us on Twitter@GoHealthyPeople on Twitter.. • Connect With Healthy People on LinkedIn • Join the Healthy People 2020 LinkedIn group and invite your colleagues to do the same. • View the Latest Healthy People Videos on YouTube Healthy People 2020 Announces the Leading Health Indicators App Challenge 9 KALHD 6-19-12

  42. Accountable Care Act : Changes in Relationship between PH and HC • Health Information Technology • Opportunity to rethink how surveillance is done • Opportunity to expedite analysis of large sets of outcome data • Opportunity for public health to use its surveillance and epidemiology • expertise to hold the reformed system accountable • What does surveillance mean in an era where policy and community prevention are central? Source: Trust for America’s Health, Richard Hamburg www.healthyamericans.org/health-reform 10 KALHD 6-19-12

  43. Accountable Care Act : Changes in Relationship between PH and HC (continued) • Coverage of key preventive services  Mandated coverage of all USPSTF A and B recommendations  Mandated coverage of all ACIP immunizations • What does this mean for direct delivery of care by public health agencies? • Where is the best place to deliver this care? • Role of health departments in holding the health care system accountable Source: Trust for America’s Health, Richard Hamburg www.healthyamericans.org/health-reform 11 KALHD 6-19-12

  44. Re-organizing Public Health and its Business National, state and local HIT initiatives and new CDC direction provide an opportunity for Public Health to….. • Engage directly in health reform and HIT efforts • Use new tools for collaboration and outreach • Collect and exchange data • Share its expertise in convening community stakeholders • Protect confidentiality • Analyze and disseminate information for health professionals and the public. 12 KALHD 6-19-12

  45. Kansas Health Matters website 13 KALHD 6-19-12

  46. Re-organizing Public Health and its Business Re-align and reorganize Public Health business processes • Technological advancements are changing the way public health must “do business”  Change operational model from “information consumer” to “information broker”  Make organizational changes to meet the needs of community partners  Meet the growing demands to electronically exchange information with physicians, hospitals and other public health agencies  Ensure that they are maximizing the collection and use of data to provide the best community service (Reference: Informatics on the Organization Chart, Public Health Informatics Institute, Connections 2007 Newsletter) 14 KALHD 6-19-12

  47. Role of Public Health Critical Success Factors Public Health Imperatives to get into and stay in the HIE game • Establish a high level informatics position/function in the health department  Disseminate an informatics strategy • Embrace standards  Participate as public health subject matter experts in the development and evaluation of use cases • Collaborate with university informatics programs • Join and participate in organizations that support public health informatics • Be aware of funding for informatics initiatives • Organize to apply for grants and partner or collaborate with other stakeholders. 15 KALHD 6-19-12

  48. LHDs and HIE Opportunities and Challenges in the New HIT Landscape to Transform Public Health Practice and Protect and Improve the Health of the Community Presentation to the Kansas Association of Local Health Departments June 19, 2012, Wichita Kansas Susan M. Salkowitz Salkowitz Associates, LLC salkowit@hln.com

  49. Afternoon Agenda • KHIN Presentation- Laura McCrary • KDHE/LHD approaches to Meaningful Use, timetable and options for reporting • LHD Opportunities and Challenges for Participating in the emerging HIT/HIE Environment  Options for connectivity and exchange  Data Management- quality, appropriate use  Privacy, Security, Consent Issues  Collaboration, participation with stakeholders 2 KALHD 6-19-12

  50. Healthcare Information Technology – Convergence With PH- CDC Changes CDC- Positioning to address health reform • Health care system, local, state and national  Clinical preventive services-area of largest impact  Care coordination  Case management  Workflow • Greater coordination with ONC and Federal and state HIE initiative (PHIN-NwHIN)  Sponsorship of attendees and sessions at HIMSS in Atlanta, March 2010; Davies Public Health Awards  Active participation in standards and policy particularly with public health use cases  Use of social media: Twitter and Facebook collaboration and social networking 3 KALHD 6-19-12

  51. CDC PHI Conference 8/11 4 KALHD 6-19-12

  52. CDC & Meaningful Use- Strengthening the Link between Healthcare Providers and Public Health Seth Foldy, MD MPH FAAFP 5 Senior Advisor Public Health Surveillance and Informatics Program Office KALHD 6-19-12

  53. CDC & Meaningful Use- Strengthening the Link between Healthcare Providers and Public Health Seth Foldy, MD MPH FAAFP 6 Senior Advisor Public Health Surveillance and Informatics Program Office KALHD 6-19-12

  54. CDC & Meaningful Use- Strengthening the Link between Healthcare Providers and Public Health Seth Foldy, MD MPH FAAFP Senior Advisor Public Health Surveillance and Informatics Program Offic e 7 KALHD 6-19-12

  55. Standards for Meaningful Use Area HIT Standards Cmte Stage 1/2011 Current IFR recommendations Stage 2/2013 Content Exchange or Package Patient summary data package CCD, CDA template, or CCD or CCR Alternatives expected to be HL7 2.5.1 narrowed based on HIT Stds Committee recommendations E-prescribing data package NCPDP SCRIPT 8.1/10.6 NCPDP SCRIPT 8.1/10.6 NCPDP SCRIPT 10.6 Lab data reporting to public HL7 2.5.1 HL7 2.5.1 Potentially newer versions, health agencies package based on HIT Stds Cmte Recommendations Administrative data package X12 4010A1 and NCPDP 5.1 and X12 4010A1 and NCPDP 5.1 and X12 5010 and NCPDP D.0 and CAQH CORE CAQH CORE CAQH CORE Public Health Surveillance and HL7 2.3.1., HL7 2.5.1 HL7 2.3.1., HL7 2.5.1 Potentially newer versions, Reporting based on HIT Stds Cmte recommendations Immunization Reporting to HL7 2.3.1, HL7 2.5.1 HL7 2.3.1, HL7 2.5.1 Potentially newer versions, registries based on HIT Stds Cmte recommendations Quality Reporting CMS CDA and respective CMS PQRI CMS CDA and respective template lib. specifications template library specifications 8 KALHD 6-19-12

  56. Standards for Meaningful Use Area HIT Standards Cmte Stage 1/2011 Current IFR recommendations Stage 2/2013 Vocabulary – 2 (codify content) Lab Orders and Results Local or proprietary Ability to accept LOINC LOINC codes or candidate Stage codes 2 standard Electronic Prescribing Local or proprietary Any code set by an RxNorm codes or candidate Stage RxNorm drug data 2 standard source provider that is identified by NLM as being a complete data set integrated within RxNorm Public Health According to applicable According to applicable GISPE or according to Surveillance or Reporting public health agency public health agency applicable public health requirements requirements agency requirements Immunizations CVX CVX CVX 9 KALHD 6-19-12

  57. CDC & Meaningful Use- Strengthening the Link between Healthcare Providers and Public Health 10 Seth Foldy, MD MPH FAAFP KALHD 6-19-12 Senior Advisor Public Health Surveillance and Informatics Program Office

  58. CDC & Meaningful Use- Strengthening the Link between Healthcare Providers and Public Health Seth Foldy, MD MPH FAAFP 11 Senior Advisor Public Health Surveillance and Informatics Program Office KALHD 6-19-12

  59. Standards & Interoperability Framework for PH Reporting 12 Seth Foldy, MD MPH FAAFP KALHD 6-19-12 Senior Advisor Public Health Surveillance and Informatics Program Office

  60. Public Health Needs HIEs Seth Foldy, MD MPH FAAFP Senior Advisor Public Health Surveillance and Informatics Program Office 13 KALHD 6-19-12

  61. KDHE Support of Meaningful Use • Website information for • Disease reporting for Health Professionals • Laboratory reporting requirements  http://www.kdheks.gov/epi/disease_reporting.html • Reporting to KS Web-IZ-  http://www.kdheks.gov/immunize/webiz.html • Meaningful Use information for eligible providers  http://www.kdheks.gov/epi/meaningful_use.htm • State IT infrastructure for electronic systems for reporting of MU measures 14 KALHD 6-19-12

  62. KS Meaningful Use Information on KDHE website 15 KALHD 6-19-12

  63. KDHE Support of Meaningful Use • Development, support and operation of applicable systems:  KSWebIZ- Immunization Information System (Registry)  Epi-Trax for notifiable disease reporting  BioSense for Syndromic Surveillance  Vital Records for demographic information  Proposed Medicaid eligibility and enrollment system • Development of electronic interfaces for uni and bi- directional reporting from LHD electronic records and EHRs 16 KALHD 6-19-12

  64. KDHE Support of Population Health • Public Health Informatics Office • Vital Statistics data analysis • Kansas Information for Communities (KIC) • Healthcare Associated Infections • Kansas Health Matters 17 KALHD 6-19-12

  65. IIS, Interoperability and Meaningful Use CDC releases (ARRA) Funding Enhancing the Interoperability of Electronic Health Records (EHR) and Immunization Information Systems (IIS) 35 Grantees receive funding to develop interfaces between their IIS and provider EHR systems. 18 KALHD 6-19-12

  66. KS WebIz Immunization Information System-IIS • KSWebIZ-the statewide immunization registry, is a web-based centralized birth to death database that maintains complete, accurate, and secure immunization records for all Kansas residents. • Various methods of connection are enabled:  Data entry via web interface into native application-ability to access all functionality on a record by record basis  Bi-directional access via KIPHS, Insight for LHDs  Uni-directional or bi-directional interface to selected provider EHRs- Office Practicum, for example.  Bi-directional interface to 14 FQHCs through KHIN (enabled by grant)  Developing one-off interfaces is time consuming, expensive  Providers now being encouraged to report via HIE- moratorium on further individual interface development 19 KALHD 6-19-12

  67. KS WebIz Immunization Information System-IIS • Meaningful Use-Stage 1 • Some already connected providers have attested • Exclusion letter to postpone attestation without penalty is posted for use by all providers • Providers will benefit by reporting MU via HIE as standardized formats and use of appropriate standards will be supported • Reporting by MU eligible providers will be helpful but not sufficient by itself to greatly increase number of immunization records in KSWebIZ • Use of DIRECT not recommended for reporting to KSWebIZ  Not bidirectional  Will not support other KSWebIZ functions 20 KALHD 6-19-12

  68. KS WebIz Immunization Information System-IIS • Provider Participation in KSWebIZ  No legislative requirement for providers to report  Provider participation is voluntary  Participation of an individual may be opted out even if provider is reporting • Potential impact of reporting via HIE  Reduce need for individual interfaces- HIE will parse and translate messages to send to KSWebIZ  Will support provider Meaningful Use reporting (if applicable)  Will increase the volume and accuracy of the immunization information  Will populate reports by county and zip code level for greater local immunization program support and community assessment • Future Issues  HIE is opt in or opt out- not selective opt out. May reduce IZ records which the patient does not otherwise object to  HIE may wish to support other IIS functions such as decision support, reminder recall instead of KDHE or  Providers might decide the MU reporting is enough and not use other functions  Incremental roll out of HIE may extend period of provider non-participation 21 KALHD 6-19-12

  69. Lab Interface Improvement There is a lack of harmonized specifications standards and code sets to enable the exchange of lab results. The cost and time to initiate new electronic laboratory results interfaces hampers broad adoption of such interfaces. The field by field details of HL7 v2 implementation Challenge guides used by clinical labs and EHRs vary, creating a need for mapping or configuration per interface, and the prevalence of core subsets of LOINC codes for common tests and analyses also varies, causing downstream issues in decision support and quality reporting. Limited to address this challenge for the subset of lab reporting to primary care (internal medicine, Scope Statement family practice, pediatrics) • Achieve cost savings of up to 90% due to lab interface development improvements by 2015 Target Outcomes • Reduce total lab interface implementation time by up to 20% by 2013 Meaningful Use Incorporate lab results into EHR as structured data Alignment • EHR Lab Scenarios (ONC/AHIC) • Electronic Health Record (Laboratory Related Use • Laboratory sends lab results to ordering provider Cases/Stories Result Reporting) (ONC/AHIC) (NHIN Direct) 22 KALHD 6-19-12

  70. Surveillance at KDHE • Moving to Epi-Trax from EDRS  Will be able to accept laboratory reports electronically- previous system required manual data entry • Currently testing Electronic Laboratory Reporting (ELR)  Exploring hospital labs, then reference labs  Providers do not perform ELR, only Hospitals 23 KALHD 6-19-12

  71. Electronic Laboratory Records • More problems with lab standards, vocabulary, coding in KS and nationally  ONC working to get ELRs on board  No incentives to exchange  Some states piloting using Surescripts  Utility of DIRECT for lab results not known- KDHE looking at other states 24 KALHD 6-19-12

  72. Electronic Laboratory Records • KHIN and LACIE certified to do business in KS • Currently in 30 day patient notification for July 1 start date. • HIEs are engaging partners themselves. • Some labs do not have the ability to exchange • LHDs want to get the results sooner but need to support the state infrastructure 25 KALHD 6-19-12

  73. Syndromic Surveillance The overall adoption rate for syndromic surveillance is extremely low, yet meaningful use requirements demand an increased level of surveillance reporting. There is a direct need for a simplified way of reporting standardized data to appropriate public health authorities that will Challenge enable meaningful use requirements associated with surveillance to be fulfilled. It is debatable as to whether providers can meet existing and future surveillance requirements with the current implementation guidance available. Develop a syndromic surveillance service specification to be used by vendors to deploy a standardized syndromic surveillance service within their infrastructure Scope NOTE: This initiative would complement the work conducted by ISDS and CDC to develop Stage 1 Statement meaningful use recommendations for syndromic surveillance. The ISDS recommendations are available for public comment and review at : http://www.syndromic.org/uploads/files/ISDSRecommendation-PROVISIONAL_vFINAL.pdf • Increase syndromic surveillance reporting by 10% by 2013 Target • Increase syndromic surveillance data collection response times for at least 2 conditions by 20% Outcomes Meaningful Use Provide electronic syndromic surveillance data to public health agencies Alignment • Public Health Case Reporting (ONC/AHIC) • Laboratory reports test results for some Related Use • Hospital or provider send chief complaint data to specific conditions to public health (NHIN Cases/Stories public health (NHIN Direct) Direct) 26 KALHD 6-19-12

  74. Syndromic Surveillance at KDHE • BioSense now in Open Source • KDHE participating at CDC • Working on decision support • Syndromic data reporting by providers • Information is available to LHDs, but seems to be of low value • Priority on Syndromic surveillance- an effect of Bioterrorism 27 KALHD 6-19-12

  75. Role of HIE in Surveillance/ELR • Meaningful use reporting does not change the legal reporting requirements of notifiable diseases/events, etc. • KDHE will provide the infrastructure for MU reporting whether directly from LHDs, providers and hospitals or via the HIE. • KDHE is working with KHIN to establish the portals, security to interact with the HIE • The HIE will act to simplify provider reporting and make it more efficient which will increase the frequency and volume of reports and provide a more robust data base for state and local use. 28 KALHD 6-19-12

  76. Other KDHE Data Assets • Population Health Data  KIC web tool based on MO system- updating to 2 nd generation  KS Health Matters- vendor supported  Vital Records • Analytical team • PH assessment- tied to county health assessment • Diabetes program track  Tracks eye exams using CDEMS based in provider offices • BRFS surveys  Health promotion  Awareness  Prenatal 29 KALHD 6-19-12

  77. Other KDHE Data Assets • Medicaid now located in KDHE • Managed care being updated • KEES- New eligibility and enforcement system  Will provide EMPI capability • Challenges:  Managing core system roll out, testing and implementation  Working with timetable of KHIN deployment  Staff and budgetary issues  Competing priorities 30 KALHD 6-19-12

  78. Public Health Role in HIE • KHIN- extensive information on website • KDHE Public Health Role in HIE  KDHE = public health infrastructure of HIE  Portals for bi-directional reporting for surveillance, immunizations  Support for meaningful use public health measures • LHD options for connecting  Point to point bidirectional to KDHE Portal(s)  Via interface to LHD system- KIPHS or Insight (FQHCs via interface with Success EDS)  Via Emdeon EHR Lite to HIE 31 KALHD 6-19-12

  79. LHDs and KHIN 32 KALHD 6-19-12

  80. LHD Challenges • KIPHS, Insight, Emdeon- choices to make- • Upgrade, replace, supplement • Which applications to move and with what priority • Resource constraints • Budgetary • Staff- skills, training, capacity • Leadership- commitment • Community partners • Priorities/ Strategic planning 33 KALHD 6-19-12

  81. LHD Challenges • What is value proposition for your department to connect to KHIN? • Can you identify “Use cases”?  What is the “low hanging fruit” -  (note:- a critical success factor for the learning health system is “a galvanizing health concern”)  Smoking is still a problem in KS- (17% , 22 ND rank) • Who would be your community partners?  Are there any health coalitions- Izs, Diabetes, etc?  Do you have a Medical Home or Medical Neighborhood project in your jurisdiction? 34 KALHD 6-19-12

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