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Nikolay Lipskiy, MD, DrPH, MBA1, Anna Orlova, PhD2 and Roniqua Watkins, BS1
1OSELS/PHITPO/DIPPC, CDC, Atlanta, GA, 2OD, Public Health Data Standards Consortium (PHDSC), Baltimore, MD
Public Health Laboratory (PH-Lab) Electronic Data Exchange :
Business Processes and Interoperability Solutions
ACKNOWLEDGMENTS CDC Office of Surveillance, Epidemiology and
Laboratory Services ONC Standards and Interoperability (S&I)
Framework, Laboratory Reporting Interface (LRI) Public Health Laboratory reporting Sub-group
PHIN Vocabulary and Messaging Community of Practice (VM CoP) and PHIN Technical Assistance Team
Public Health Data Standards Consortium (PHDSC) Association of Public Health Laboratories (APHL) American Health Information Management
Association (AHIMA) Scientific technology Corporation Atlas Public Health IBM Research
Background
The electronic submission of reportable lab results to public health is one of the Electronic Health Record (EHR) Meaningful Use (MU) objectives
Harmonization of health IT (HIT) standards for Public Health Laboratory (PH-Lab) results reporting between clinical care and population health aims to improve emergency response and case reporting
CDC’s Office of Surveillance, Epidemiology and Laboratory Services (OSELS) and PHIN facilitate harmonization of the PH-Lab Reporting across public health
The Public Health Laboratory Report Sub-group of the ONC S&I LRI activity and PHDSC engage partners on assessing existing gaps in the PH-Lab standardization and aligning MU objectives with broader public health needs
Presentation Outline
Preliminary results of the CDC OSELS/PHDSC/APHL/AHIMA project for operationalizing HIT standards PH-Lab data exchangesWhite Paper/Roadmap for PH-Lab Interoperability Building PH-Lab Interoperability
HL7 Public Health Reporting Requirements Standard IHE Integration Profile: Public Health Reporting- PH-LabHL7 Public Health Functional Profile - PH-Lab
PH-Lab and National Health IT Standardization Initiatives
Presentation Outline
Preliminary results of the CDC OSELS/PHDSC/APHL/AHIMA project for operationalizing HIT standards PH-Lab data exchangesWhite Paper/Roadmap for PH-Lab Interoperability Building PH-Lab Interoperability
HL7 Public Health Reporting Requirements Standard IHE Integration Profile: Public Health Reporting- PH-LabHL7 Public Health Functional Profile - PH-Lab
PH-Lab and National Health IT Standardization Initiatives
White Paper on PH-Lab Interoperability Efforts to Date:
PH-Lab Collaborative Business Requirements Project (APHL and Public Health Informatics Institute (PHII))
APHL PH-Lab Interoperability Project (PHLIP) CDC PH-Lab Interoperability Solutions and Solution Architecture
(PHLISSA) CDC Meaningful Use Electronic Laboratory Reporting Initiative Reportable Conditions Mapping Tables (RMCT) Initiative HL7 2.5.1 PH-Lab Reporting Implementation Guide ONC S&I Electronic Laboratory Interchange Implementation Guide IHE Laboratory Reporting Integration Profiles for Document-based
(CDA) Laboratory Reports Laboratory Interoperability Collaborative (Surescripts, College of
American Pathologists (CAP)) Ontoreason OPHPR/Lab Ontology Model Project
White Paper on PH-Lab Interoperability Assessment of Content Data Sources
(Examples)
White Paper on PH-Lab Interoperability Assessment of Process Flows for Lab
Preparedness
White Paper on PH-Lab Interoperability Harmonization of Data Standards – RCMT –
Mapping reportable Conditions to LOINC and SNOMED Standards
White Paper on PH-Lab Interoperability Actors:A Public Health Laboratory can have up to 10 different
recipients of similar or identical information such as 1. Other public health laboratories 2. Commercial laboratories3. Primary care providers4. Hospital infectious control practitioners5. Health program directors 6. State public health departments 7. State chief medical/health officer 8. City or county chief medical/health officers 9. State epidemiologists, and 10. Federal agencies
Source: APHL PHLIP Project
White Paper on PH-Lab Interoperability Review of Use Cases:
Source: APHL PHLIP Project
White Paper on PH-Lab Interoperability Interoperability is required for two PH Lab
business processes Receive Test Order Send Test Result
Selected PH-Lab Data Exchange Scenarios:AntraxTularemiaHepatitus B (hep B)Tuberculosis (TB)Influenza
White Paper on PH-Lab Interoperability Methodology to Operationalize PH-Lab
Standards:
PHDSC PH-Lab Project by HIT Standardization Phases, Products and Entities
HIT Standardizati
on Phases
Needs &
Priorities
Development &
Maintenanc
e
Selection &
Harmonization
Testing/Trial Implementati
on
Certification
Deployment
Goals
What should be
accomplished?
What are the standards?
What standards
to use?
Show what can be
accomplished
Certify standards-
based products
Deploy standards-
based products
HIT Standards and
Interoperability Framework Development
Entities
HIT Policy Committee
HIT Standards Committee
S&I Harmonizati
on Framework Initiatives
SDOs(e.g., HL7,
SNOMED (IHTSDO), LOINC,
ASC X12,NUBC,
ISO TC215)
IHE
(FormerlyHITSP, to be superseded
pending ONC decisions)
IHE
Certification Entities(CCHIT,
Drummond Group, Inc)
PHIN
IHE & PHDSC
Deployment Workshops
Standards Documents
Use Cases, CDC ELR Projects
PHII-APHLPHLIP
PHLISSA, RCMT, PHIN
Preparedness Report, etc.
Standards
HL7 2.x Implementa-tion Guides
Interoperability Specifications
Technical Frameworks
Integration Profiles
Test Reports
Functional Profiles
Certification Criteria
Deployment Reports
PHIN Adaption of the ONC Standards and Interoperability Framework
HIT Standardization and PHDSC ProjectsHIT
Standardiza-tion Phases
Needs &
Priorities
Development &
Maintenance
Selection &
Harmonization
Testing /Trial Implemen-
tationCertification Deploy-
ment
Goals What should be accomplished?
What are the standards?
What standards
to use?
Show what can be
accomplished
Certify standards-
based products
Deploy standards-based products
Public Health
Domains Undergoing
HIT Standardiza
-tion
BiosurveillanceImmunization
ELR
Public Health Reporting
Newborn Screening
Vital Records
BiosurveillanceImmunization
ELR
Public Health Reporting
Newborn Screening
Vital Records
Biosurveillance
ImmunizationELR
Public Health Reporting
Newborn Screening
Vital Records
PH-Lab
Public Health Reporting
Hearing
Vital Records
PH-Lab
Public Health Reporting
Hearing
Vital Records
PH-Lab
Hearing
ONCStandards
and Interopera-bility
Framework
Admin Data
PHDSC ProjectsHITSP ProjectsAHIC/MU
HIT Standardization and PHDSC ProjectsHIT
Standardiza-tion Phases
Needs &
Priorities
Development &
Maintenance
Selection &
Harmonization
Testing /Trial Implemen-
tationCertification Deploy-
ment
Goals What should be accomplished?
What are the standards?
What standards
to use?
Show what can be
accomplished
Certify standards-
based products
Deploy standards-based products
Public Health
Domains Undergoing
HIT Standardiza
-tion
BiosurveillanceImmunization
ELR
Public Health Reporting
Newborn Screening
Vital Records
BiosurveillanceImmunizationELR/PH-Lab
Public Health Reporting
Newborn Screening
Vital Records
Biosurveillance
ImmunizationELR/PH-Lab
Public Health Reporting
Newborn Screening
Vital Records
PH-Lab
Public Health Reporting
Hearing
Vital Records
PH-Lab
Public Health Reporting
Hearing
Vital Records
PH-Lab
Hearing
ONCStandards
and Interopera-bility
Framework
Admin Data
PHDSC ProjectsHITSP ProjectsAHIC/MU
Presentation Outline
Preliminary results of the CDC OSELS/PHDSC/APHL/AHIMA project for operationalizing HIT standards PH-Lab data exchangesWhite Paper/Roadmap for PH-Lab Interoperability Building PH-Lab Interoperability
HL7 Public Health Reporting Requirements Standard IHE Integration Profile: Public Health Reporting- PH-LabHL7 Public Health Functional Profile - PH-Lab
PH-Lab and National Health IT Standardization Initiatives
Building PH-Lab Interoperability
Standards Development HL7 Public Health Reporting Requirements Standard
(structured templates for representing jurisdiction-specific requirements)
Standards Harmonization and Testing IHE Integration Profile: Public Health Reporting- PH-
Lab Testing IHE Laboratory Profiles for Test Result Reports
using CDA documents for selected conditionsCertification of Standards-based HIT Products HL7 Public Health Functional Profile - PH-Lab
(functional requirements and conformance criteria for PH-Lab data exchange with clinical EHR)
Building PH-Lab Interoperability
Standards Development HL7 Public Health Reporting Requirements
Standard (structured templates for representing jurisdiction-specific reporting requirements)
Approved in May 2011 as an extension to the HL7 Healthcare Quality Measure Framework (HQMF) Standard -- joint work of the HL7 Structured Documents Workgroup and the HL7 Public Health & Emergency Response Workgroup
Will be balloted at HL7 in Nov-Dec 2011
Building PH-Lab Interoperability
Standards Harmonization and Testing IHE Integration Profile: Public Health Reporting- PH-
Lab Describes PH-Lab data exchanges in the context of public
health business processes for case/outbreak identification, investigation, and management.
Defines Clinical Data Architecture (CDA) documents for selected 5 conditions (antrax, tularemia, hep-B, TB, influenza) using RCMT
Defines interoperability standards for data exchanges
Published for Public Comments in June 2011 by the IHE Quality, Research and Pubic Health Committee
Currently under the Committee Review
Building PH-Lab Interoperability
Standards Harmonization and Testing (Continued) Testing IHE Laboratory Profiles for Test Result Reports
using using Clinical Data Architecture (CDA) documents for selected conditions
We will specify PH-Lab Report content for testing IHE-Lab Integration Profiles in CDA documents for selected 5 conditions (antrax, tularemia, hep-B TB, influenza)
Testing will be conducted at the IHE Connectathon, January 2012
Building PH-Lab Interoperability
Certification of Standards-based HIT Products HL7 Public Health Functional Profile – PH-Lab will
define functional requirements and conformance criteria of the HL7 EHR Functional Model for generating laboratory orders and receiving results reportsThe Profile will be developed by the PHDSC EHR-Public Health Task Force during August-November 2011Will be Balloted at HL7 in Nov-Dec 2011 and finalized by May 2012
Certification Criteria for PH-Lab data exchanges will be defined
We will work towards establishing the PH-Lab Certification Process with PHIN and the national certification entities
PHDSC PH-Lab Project by HIT Standardization Phases, Products and Entities
HIT Standardizati
on Phases
Needs &
Priorities
Development &
Maintenanc
e
Selection &
Harmonization
Testing/Trial Implementati
on
Certification
Deployment
Goals
What should be
accomplished?
What are the standards?
What standards
to use?
Show what can be
accomplished
Certify standards-
based products
Deploy standards-
based products
HIT Standards and
Interoperability Framework Development
Entities
HIT Policy Committee
HIT Standards Committee
S&I Harmonizati
on Framework Initiatives
SDOs(e.g., HL7,
SNOMED (IHTSDO), LOINC,
ASC X12,NUBC,
ISO TC215)
IHE
(FormerlyHITSP, to be superseded
pending ONC decisions)
IHE
Certification Entities(CCHIT,
Drummond Group, Inc)
PHIN
IHE & PHDSC
Deployment Workshops
Standards Documents
Use Cases, CDC ELR Projects
PHII-APHLPHLIP
PHLISSA, RCMT, PHIN
Preparedness Report, etc.
Standards
HL7 2.x Implementa-tion Guides
Interoperability Specifications
Technical Frameworks
Integration Profiles
Test Reports
Functional Profiles
Certification Criteria
Deployment Reports
On-going Activities ( 2008-now)
Developed methodology for public health participation in HIT standards development & harmonization.
New Activities (2010-11) Develop methodology for public health participation in HIT product testing and certification
Future Activities Develop methodology for evaluation of standard-based HIT products (standards-based HIT products deployment)
White Paper on PH-Lab Interoperability
Year 1 Year 2 Year 3
Harmonize Needs & Standards Test Certify & Deploy
Presentation Outline
Preliminary results of the CDC OSELS/PHDSC/APHL/AHIMA project for operationalizing HIT standards PH-Lab data exchangesWhite Paper/Roadmap for PH-Lab Interoperability Building PH-Lab Interoperability
HL7 Public Health Reporting Requirements Standard IHE Integration Profile: Public Health Reporting- PH-LabHL7 Public Health Functional Profile - PH-Lab
PH-Lab and National Health IT Standardization Initiatives
PH-Lab and National Health IT Standardization Initiatives
ONC S&I Public Health Reporting Initiative ONC S&I Laboratory Reporting Interchange (LRI)
Initiative and Public Health Laboratory Report Subgroup
ONC S&I Transition of Care Initiative ONC S&I Population Query Initiative Federal Health Architecture Initiative
Building PH-Lab Interoperability
Join us at the PHI Conference Interoperability Showcase
for demonstrations of interoperability solutions for
PH-Lab data exchanges
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.atsdr.cdc.gov