# Presentation: 318922

## American Health 

**American Health **
**Information Community**
**PH/CCC Workgroup Meeting**
**10/11/2007**

## Goals for this meeting

**Propose strategy to comply with Secretary’s request for roadmap, budget and resources to achieve RM Recommendations**
**Review and reprioritize workgroup priorities for 2009 **
**Receive update on status of Adverse Events Draft Recommendations.**

## Roadmap for Recommendations

***John Lumpkin, RWJ***
***Les Lenert, CDC***

## Scope

- Outbreak Management
- Laboratory response
- Countermeasure Allocation, Distribution and Administration
- Integration with Registries

## Recommendation 1.0:  Overarching 

- CDC, in collaboration with AMIA and the PHDSC, and working with Schools of Public Health and other informatics fellowship programs should enhance and promote the public health domain of the AMIA 10X10 initiative, the Partnership for Workforce Public Health Informatics Training, and similar programs to advance public health informatics workforce development.  The public health informatics competencies developed by the University of Washington and CDC, and other applicable work, should be used as a basis for this initiative.

## Recommendation 1.1:  Overarching

- HHS should work with CDC, HRSA, CMS and other federal agencies to include language in contracts, grants and cooperative agreements that ensures:
- Funds from a variety of programs can contribute to an informatics capacity and technical architecture that invests in advancing information systems and IT infrastructure required to support their implementation and interoperability.  This language should explicitly include systems and infrastructure that support public health labs, registries, surveillance systems, outbreak management and response systems, as well as other systems that receive data used for population health purposes.

## Recommendation 1.1: Overarching (cont.) 

- In order to meet the requirements of the Executive Order: Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs, funds can be used for technical support, to cover the cost of on-going system maintenance, and for updates and enhancements to provide functionality and adhere with interoperability specifications.**  **

## Recommendation 1.1: Overarching (cont.)  

- Metrics should be collaboratively developed with state and local public health partners to assess the ability of public health information systems to interoperate and support public health investigation and response.   These metrics should measure and monitor interoperability, usability, flexibility, quality, completeness and timeliness of data, as well as system functionality to support:
- Outbreak and event management.
- Countermeasure allocation, tracking, distribution and administration.
- Integration of laboratory information.
- Bi-directional exchange of data across clinical care and public health.

## Recommendation 2.0: Outbreak and Event Management 

- By March 2008, CDC  with ASTHO, NACCHO, CSTE, APHL and other appropriate groups, should update and refine criteria for functionality, security and interoperability of systems that support outbreak management at local, tribal, state and federal levels.  The criteria should:
- Be minimal but sufficient to support the needs of managing complex outbreaks.
- Ensure interoperability with other systems (such as other outbreak systems, laboratory information systems (LIS), systems that manage countermeasures, fatality management tracking systems, monitoring tools for quarantine and isolation, electronic health records (EHRs), and surveillance databases).

## Recommendation 2.0:  Outbreak and Event Management  (cont’d)

- Provide a starting point for a freely distributable software implementation and ongoing development and maintenance.
- Use as a starting point the AHIC Use Cases, the HITSP Interoperability Specifications, and the PHIN Functional Requirements for Outbreak Management.

## Recommendation 2.1: Outbreak and Event Management

- CDC, with input and assistance from state and local public health should support the development and testing of software systems designed to manage public health investigations (e.g., CDC Outbreak Management System, state or commercially-developed systems), including identification of important exposures, laboratory diagnostics, contact tracing and indication for preventive countermeasures such as infection control, isolation, quarantine, prophylaxis or treatment.

## Recommendation 2.1: Outbreak and Event Management (cont.)

- Facilitate the development of standards, shared architectural components and implementation guidance for possible and confirmed case exchange and make available to public health partners by October 2008.
- Develop, or commission the development or acquisition of, and support the maintenance of a freely distributable software implementation to support local, tribal, state and national agencies to manage outbreaks.  The criteria for this software implementation would be based on the collaboratively defined criteria defined in recommendation 2.0 above. This software should be available no later that March 2009.
- Develop test sites to measure the level of interoperability between EMR, LIS, surveillance and software developed for outbreak management.

## Recommendation 3.0:  Laboratory Response

- By June 2008, CDC in collaboration with APHL, CSTE, ASTHO, NACCHO, and other appropriate organizations should identify any types of data, codes and relationships needed (beyond those specified in the HITSP EHR / Biosurveillance lab result message), necessary to support:
- Test orders to and result reporting from public health labs.
- The coding of public health conditions in the HITSP lab message.
- Result reporting of veterinary and environmental data.
- Unambiguous linkage of laboratory data to clinical and public health records.

## Recommendation 3.1: Laboratory Response

- HHS, in conjunction with state and regional health information exchanges, public health and clinical laboratories, should develop the infrastructure and architecture for unambiguous unique identification of medical service providers in association with the NHIN initiative.  This should include ensuring that registries of medical service providers exist and that registry lookup capability is developed and available to laboratories for routing laboratory data back to the originating requestor, and to other appropriate parties, to support national electronic laboratory data exchange.

## Recommendation 3.2: Laboratory Response

- By October 2008, HHS, in collaboration with APHL, private laboratories, and other federal laboratories, should establish regional or national capabilities to receive and route laboratory results to all appropriate recipients simultaneously.
- Define the processes and approaches for consolidated receipt and routing of laboratory results.
- Support a proof-of-concept demonstrating an efficient regional or national mechanism for the acquisition of laboratory test order information as well as dissemination of test results to appropriate public health and clinical care providers.

## Recommendation 4.0:Countermeasure Allocation, Distrib., Admin.

- By March 2008, CDC  with ASTHO, NACCHO, CSTE, APHL, FDA, and other appropriate groups, should update and refine criteria for functionality, security and interoperability of systems that support countermeasure apportionment, tracking, distribution and administration at local, tribal, state and federal levels.  The criteria should:
- Be minimal but sufficient to support the needs of managing countermeasures during a response.
- Ensure systems are interoperable with other systems (such as outbreak systems, vendor managed inventories, point of distribution software, fatality management tracking systems, monitoring tools for quarantine and isolation electronic medical record (EMR), and surveillance databases).

## Recommendation 4.0: Countermeasure (cont.)

- Provide a starting point for a freely distributable software implementation and ongoing development and maintenance.
- Use as a starting point the AHIC Use Cases, the HITSP Interoperability Specifications, and the PHIN Functional Requirements for Countermeasure Response and Administration.

## Recommendation 4.1: Countermeasure

- By April 2008, CDC should convene a meeting to include representation from clinical partners, manufacturers, and distributors to understand the resources that are available in the private sector and develop strategies to exchange information on the availability of and demand for resources at any given time.

## Recommendation 4.2: Countermeasure

- CDC with HHS, and through the national agenda, should support the harmonization of standards and development of implementation guidance and shared architectural approaches for the exchange of countermeasure information.  These products should be made available to public health partners by December 2008.  Following the implementation of countermeasure response solutions, support the establishment of test sites to measure the level of interoperability with electronic health records, outbreak management systems, registries, surveillance systems.

## Recommendation 4.3: Countermeasure

- By June, 2008, HHS should facilitate development of national administrative or legal approaches for routine and emergency inter-state data exchange of countermeasure and immunization information.
- Address business propriety data concerns of relevant commercial supply chain entities.
- Develop a blanket agreement to provide federal support for sharing of data and resources when it is necessary.
- Communicate with and educate hospital risk management staff and privacy and confidentiality officers in clinical care settings to alleviate concerns about public health access to clinical data.

## Recommendation 5.0: Automated Integration with Registries

- By March 2008, CDC should convene a group of public health registry experts such as immunization, cancer, trauma, donor, chronic disease, and others to determine how the established capabilities and unique attributes of existing registries could be used in public health response.

## Recommendation 5.1:  Automated Integration with Registries

- By October 2008, CDC should develop a communication plan based on discussion and recommendations from the March 2008 meeting referenced in 5.0 above.  The overall goal of this plan is to communicate to public health officials the available registry resources for use during an emergency response.

## Priorities for 2009

***John Lumpkin, RWJ***
***Les Lenert, CDC***
***Review remaining workgroup priorities and determine top 2 priorities for 2009 ***
***Consider additional priority areas that should be considered from population health constructs***
**Public Health Surveillance and Response**
**Health Status/Disease Monitoring**
**Population Based Clinical Care**
**Population Based Research**
**Health Communications /Health Education**

## Public Health Surveillance and Response 
On-going systematic collection, analysis and interpretation of public health data essential to the planning, implementation, and evaluation of public health practice closely integrated with the timely dissemination of these data to those responsible for prevention and control, and management of the appropriate response. 

Health Status/Disease Monitoring 
Accurate, periodic assessment of community and patient-level health status.

- On-going systematic collection, analysis and interpretation of public health data essential to the planning, implementation, and evaluation of public health practice closely integrated with the timely dissemination of these data to those responsible for prevention and control, and management of the appropriate response.
**Health Status/Disease Monitoring**
- Accurate, periodic assessment of community and patient-level health status.

**Population Health – Five Main Areas**

**Notes:**
Public Health Surveillance and Response – 
On-going systematic collection, analysis and interpretation of public health data essential to the planning, implementation and evaluation of public health practice closely integrated with the timely dissemination of these data to those responsible for prevention and control, and management of the appropriate response.  

Health Status/Disease Monitoring - Accurate, periodic assessment of community and patient level health status
Identification of health risks (determinants of health and functional status) and determination of health service needs 

## Population Based Clinical Care 
Health and functional status for populations of people (e.g., income-based, ethnicity-based, age-based, gender-based, others defined as needed).

Population Based Research
Research for new insights and innovative solutions to health problems on a population level.

Health Communications /Health Education 
	  Inform, educate and empower providers,   
      consumers, and others about health and wellness 
      issues.

- Health and functional status for populations of people (e.g., income-based, ethnicity-based, age-based, gender-based, others defined as needed).
**Population Based Research**
- Research for new insights and innovative solutions to health problems on a population level.
**Health Communications /Health Education **
- 	  Inform, educate and empower providers,
-       consumers, and others about health and wellness
-       issues.

**Population Health – Five Main Areas (Continued)**

**Notes:**

Population Based Clinical Care 
Health and functional status for populations of people (e.g., income based, ethnicity based, age based, gender based, others defined as needed)

Population Based Research – Research for New Insights and Innovative Solutions to Health Problems on a Population Level
Ensure that all people, especially those who experience health disparities, will achieve their optimal lifespan and experience the best possible health in every stage of life

Health Communications /Health Education - Inform, Educate and Empower Providers, Consumers and others about Health and Wellness Issues 
Health information, health education, and health promotion activities designed to reduce health risk, promote better health, and improve and/or maintain health and functional status using methods such as health alerts, websites, collaboration forums, risk communications.

## Update on Adverse Events

***Les Lenert, CDC***

## Next Steps

- Prioritize next pop health domain(s) for recommendations
- Review scope and timeline for 2008 Public Health Use Cases –
- Immunizations and Response Management
- Public Health Case Reporting