Public Health Information Network (PHIN) and accelerating an interoperable Electronic Health Record Claire Broome, M.D. Centers for Disease Control and Prevention (CDC) May 19, 2004 WEDI Annual Meeting
Public Health Lab Law Enforcement and First Responders
Hospital or Health Plan
Public Health Information Network (PHIN)
Health Department
Investigation Team
Ambulatory Care
CDC and Other Federal Organizations
Vaccination Center Non-Clinical Sources OTC, 911, etc.
RX Pharmaceutical Stockpile
Public
PHIN Coordinated Functions
Detection and monitoring – support of disease and threat surveillance, national health status indicators Analysis – facilitating real-time evaluation of live data feeds, turning data into information for people at all levels of public health and clinical care Information resources and knowledge management reference information, distance learning, decision support Alerting and communications – transmission of emergency alerts, routine professional discussions, collaborative activities Response – management support of recommendations, prophylaxis, vaccination, etc.
What is PHIN? Gartner Group project on PHIN implementation – PHIN is a multi-organizational business and technical architecture Technical standards Data standards Specifications to do work Is also a process Commitment to the use of standards Commitment to participating in development and implementation of specifications
Public Health Information Network Early Event Detection BioSense Outbreak Management Outbreak Management System Surveillance NEDSS Secure Communications Epi-X Analysis & Interpretation BioIntelligence analytic technology Information Dissemination & KM CDC Website Health alerting PH Response Lab, vaccine administration, etc.
Federal Health Architecture, NHII & Consolidated Health Informatics
PHIN Components Services/Tools Health
Alert Network (HAN) – Internet connectivity, alerting and distance learning
Vocabulary
– standardized vocabulary maintenance, versioning, and provisioning
CDC
Web Redesign – public health information architecture--better access
PHIN
MS – secure data transport
PHIN Components
Applications National
Electronic Disease Surveillance System (NEDSS) – disease surveillance, electronic laboratory reporting
BioSense
– early event detection
Laboratory
Response Network (LRN) – diagnostic capacity and information delivery
PHIN and interoperable clinical care systems
Biosense PHIN surveillance (NEDSS) PHIN Messaging System
BioSense - Principles
Early event detection is critical for Bioterrorism management and response The most useful tools will be dual use; Bioterrorism capable and regularly exercised for “routine” public health activities Multiple data sources should be co-ordinated to facilitate signal evaluation and reduce user burden Both diagnostic and pre-diagnostic (syndromic) data exist in electronic form in many yet untapped healthrelated data stores
What is Biosense?
Near real-time data access Analysis capabilities at local, state and national levels Shareable outbreak detection algorithms and analytic capabilities National coverage
National and Regional Data Sources
BioSense System I City / State Recipients
National labs test requests & results DoD and VA sentinel clinical data Clinical lab orders Nurse Call Line Data Lab Response Network (including BioWatch) Over-the-counter drug sales
Analysis and Visualization
BioSense System II National and City / State
Regional Data Sources
(proposed)
Recipients
National labs test requests & results DoD and VA sentinel clinical data
Analysis and Alerts
Regional clinical networks Nurse Call Line Data
Electronic Investigation
Lab Response Network (including BioWatch) Over-the-counter drug sales (others)
State and Metropolitan Surveillance and Response Systems
Next Steps
BioSense system infrastructure is in use at CDC System I released for state and city use April 2004 For public health users, AND as a platform for evaluation of early detection analytics Actively seeking additional: Outbreak analytic approaches Display approaches for multiple data sources Interested groups->
[email protected]
National Electronic Disease Surveillance System (NEDSS)-PHIN surveillance component
Browser-based data entry over Internet Person-centric Case investigation capabilities Electronic Laboratory Results HL 7 messages (2.x) can be received Security that meets HIPAA standards HL7 Version 3 case notification message from state to CDC
NEDSS Base System
NEDSS compatible system for state and local use developed by an experienced web software developer (Computer Sciences Corporation)
Also useful as a specific implementation of NEDSS e.g. standard messages, database model Version 1 includes 93 notifiable diseases, and modules for vaccine preventable diseases, hepatitis, bacterial meningitis and pneumonia Now at Version 1.1.3; includes expanded data entry capacity, reporting capacity, locally defined fields
NEDSS Site Status as of 6/1/2004 Chicago
New York City Philadelphia Washington D.C.
Los Angeles
31 Total NBS Sites
Houston
NBS In Use – 3
NBS Deployment Underway - 9 NBS = NEDSS Base System (CDC-developed)
NBS Deployment Planned - 19 NBS Collaborative Development - 1 NEDSS – Compatible State/Jurisdiction Development - 26
NEDSS funding 50 states, 6 cities, and 1 territory funded for NEDSS: 43 started with Assessment & Planning phase in September 2000 FY2003 NEDSS grants: 31 propose NEDSS Base System; 26 NEDSS compatible approach September 2002: Public Health and Social Services Emergency Fund provides >$1 billion for state and local public health preparedness capacity guidance from CDC and HRSA to use PHIN standards for IT investments Guidance explicitly includes NEDSS as part of surveillance September 2003 : second year Preparedness funding
HRSA grants $498 million ; CDC $870 million
Public Health Information Network Messaging System (PHIN-MS) Software for industry standards based interinstitutional message transport available from CDC
ebXML “handshake”, PKI encryption and security
Payload agnostic (HL-7, text file, etc)
Bi-directional data exchange
PHIN-MS in use by state and local partners for point to point messaging (ED and lab to state; state to CDC) Several commercial systems planning to incorporate Technical assistance available for public health partners
How can PHIN accelerate an interoperable Electronic Health Record?
Public health intrinsically must exchange information with all clinical partners in a population Concrete solutions for probable EHR needs – e.g. bidirectional secure messages (ebXML); HL7 V 3 messages; implementation guides Evident public value—outbreak detection, preparedness ROI for decreased reporting burden Development of data use agreements
Next steps for advancing partnerships
Second PHIN conference Atlanta, May 24-27, 2004 Consortia--Connecting for Health, eHealth Initiative, ?WEDI Specific collaborations with current PHIN tools & systems CDC policy that all IT investments with CDC cooperative agreement funds use PHIN standards PHIN Alerting and Secure Communications PHIN Vocabulary Provisioning services
Background Information
Conclusions from Gartner Group review of PHIN implementation An independent review of the PHIN Version 1 has been completed PH partners interviewed agree to the vision and overall direction of the PHIN The PHIN standards and specifications are a strong start and are appropriate for use in PH, as annotated in this report
What does PHIN have to do with HIPAA?
HIPAA mandates national health care data standards and policies in four areas: Transaction content; unique identifiers for providers, health plans; security; privacy PHIN architecture standards are HIPAA compliant: supports “dual use” for security, messaging elements Approach to PHIN data standards is HIPAA compliant: Adopting HIPAA standards where relevant Advocating inclusion of data elements relevant to public health with SDO’s
What does PHIN have to do with HIPAA Privacy Rule?
Privacy Rule allows current practice of sharing data with public health Rule permits health care providers to share individually identifiable information with legally authorized public health entities for public health activities Public health activities include surveillance (NEDSS), investigation, intervention
