Transcript Stimulus Bill Update

Day 2: Registries
• Discussion Synopsis
– Blurring lines EHR – clinical care – PH
– Likely role of ACOs in public health functions
– Still challenges with data silos
– Think of registries as a function not a thing
– PH needs to bridge to clinical care
• Particular point of intersection – clinical decision
support
– Standardization of interaction
www.amia.org
Day 2: Registries
• Possible Consensus Statements / Areas for Work
– Move towards common national standards to
communicate with registries wherever they
reside
– Work to define new PH – clinical care
relationship
– Examine PH functions
www.amia.org
Day 2: Registries
• Possible Consensus Statements / Areas for Work
– Advance and broaden standardized 2D barcode
tech
– Use vaccines for kids and other positive
messages to sell PH needs
– Work on issue of additional data entry by
clinicians for particular purposes like PH – costs
and benefits
www.amia.org
Day 2: Information Exchange for Detection and
Monitoring – Clinical Care to Public Health
• Discussion Synopsis (1)
– Data needs by public health from clinical care comes
from different programs and in different forms
• Vital Statistics, Reportable Diseases/Conditions, Outbreak
Management, Registries (many and varied), Environmental
Health, Syndromic Surveillance, Emergencies, Healthcare
Associated Infections, etc
– There are some data flows/processes that are more
predictable than others (i.e., vital statistics vs outbreaks)
– Outbreaks - when you’ve seen one you’ve seen one
• Each outbreak requires different data elements at different times
(for example, Anthrax, H1N1, Fungal Meningitis, etc)
www.amia.org
Day 2: Information Exchange for Detection and
Monitoring – Clinical Care to Public Health
• Discussion Synopsis (2)
– Public health roles are changing; providers do not understand these
evolving roles
– Data needs from public health are growing and will continue to grow
– Need a flexible means to access clinical data during outbreaks
which doesn’t necessarily mean sending data
– Not all data needed by public health is in an EHR; not all data in an
EHR is reported to PH
– Limited data from PH is sent back to clinicians
– Differences in requirements of data create needs for customized
workflows in provider systems, increases burden for all and becomes
non-interoperable
– Capability limitations in some public health infrastructures to support
clinical information exchanges
www.amia.org
Day 2: Information Exchange for Detection and
Monitoring – Clinical Care to Public Health
• Possible Consensus Statements
– Move towards common national standards to communicate between
clinical care and public health
– Define/refine public health data needs and collection requirements in
the context of the changing role of public health
– Identify and expand on demonstrated opportunities of returning
information from public health to clinical care
– Ongoing lack of sustained funding support will hinder ability for
public health to be ready to fully exchange data with clinical care
using common standards
– Support for work to establish a common framework/model for
harmonizing data exchange requirements from public health (S&I
Framework) – but NOT attempt to define a SINGLE message to fulfill
ALL public health data needs
www.amia.org
Day 2: Information Exchange for Detection and
Monitoring – Clinical Care to Public Health
• Areas for further work / policy focus
– Reach out/educate providers, unions? Medical students? Public
health schools, about the changing role of public health, and the
changes needs for data and public health informatics
• Include a public health module in future informatics certification?
– Need to identify/develop/disseminate tools to assist public health
summarize data
• Use of video? Academic? Vendors? Providers? Open data?
– Need better mechanisms to identify/feature/disseminate best public
health practices that are occurring at the local/state level with respect
to collection/use/exchange of data with clinical care
– Need for a true ‘Manifesto’, a ‘Call to Action’ to secure funding for
public health information system improvements and resources
training/capacity building to avoid the ‘new digital divide’ between
clinical care and public health
• Workforce? Training issues? Expand fellowship programs
www.amia.org
• Create job descriptions for PH informatics positions
AMIA 2012 Current Issues Population Health
Informatics in Health Care and Public Health
Information Exchange for Clinical
Communication and Coordination:
Health Department to Clinical Care
Joseph Gibson
www.amia.org
Public Health Data
Public health provides two types of data to clinical care
Identified – examples: person's immunization history, newborn
genetic disorder test results, results from public health laboratory tests,
or information from home visits by public health nurses after a patient is
referred to them by a clinician.
Unidentified - the presence of unusual disease, the local prevalence
of various diseases, and characteristics of people at highest risk for
those diseases. unidentified data during unusual outbreaks
recommendations regarding an unusual condition, such as monkeypox,
SARS, or contaminated injectable steroids.
This type of information helps clinicians set their index of suspicion
appropriately
www.amia.org
Informing Clinicians of Contextual Information
• Treatment plan for an obese patient might be improved
if the clinician knows context of the patient's residence
– Green space
– Affordable physical activity programs
– Locations of fast food restaurants.
• Many electronic data sources from which such
information to refer a patient.
• Contextual information could be gathered and
organized by public health, for delivery to the
clinician.
• Current practice examples – paper, fax, HIE
www.amia.org
Sharing Data and Protecting Patient
Confidentiality
• There is no nationally recognized confidentiality
policy to enable appropriate data sharing.
• Confidentiality is regulated by a patchwork of laws
that vary from condition to condition and from region
to region.
• Examples: HIV, other communicable diseases,
mental health, birth certificates, and death certificates
each often have specific laws around confidentiality
that have distinct requirements.
www.amia.org
Day 2: Consensus Statement: Design of knowledge
management systems (Areas needing work)
How will knowledge management systems be
designed, through which public health can provide
clinical care with information?
• Defining the content to be included in case reports to
public health for different conditions:
– Minimal acceptable data capture in an EHR.
• Getting physicians attention:
– Partner with ACOs
– Create a feedback loop from providers, to refine message
content and improve the delivery modes
– Use of subscription systems
– Targeting appropriate care team members
www.amia.org
Balancing Personal & Pop’n Privacy
Needs
• Main Issues/Discussion Synopsis
– Genuine uncertainty about application of
law/conflicts in law (HIPAA in particular)
impede access
– Over-focus on pure compliance vs. ethical,
responsible uses of data
– Law allows for information “free riders”
– More use of technical models that facilitate
timely, easy access
www.amia.org
Balancing Personal & Pop’n Privacy
Needs
• Possible consensus statements:
– Policy frameworks should treat public
health uses of health data as primary, not
secondary
– Public health should have ready access to
clinical/claims data to meet lawful public
health needs (subject to clear rules &
accountability)
www.amia.org
Balancing Personal & Pop’n Privacy
Needs
• Areas for further work / policy focus
– Prioritize most critical legal/governance issues to
resolve
– Develop (with compliance officials & public health
officials together) best practices; get regulators to
bless if possible but at least make them widely
available
– Pilot & study alternative policy frameworks for
public health issues (emphasize all FIPPs)
– Study & disseminate promising technical access
models
www.amia.org
Open Source for Public & Population Health
“Getting people to adopt common
standards is impeded by patents.”
Sir Tim Berners-Lee
BCS, March 2006
http://www.bcs.org/content/ConWebDoc/3337
www.amia.org
Open Source for Public & Population Health
Terms
• Intellectual Property, Copyright, License, Patent
www.amia.org
Open Source for Public & Population Health
Terms
• Free Software, Copyleft, Viral License
“Free as in free speech, not as in free pizza.”
“GNU’s Not UNIX”
www.amia.org
Open Source for Public & Population Health
Terms
• Open Source, Open-source Software
1997
www.amia.org
Open Source for Public & Population Health
Terms
• Wiki, Creative Commons, Crowdsourcing
www.amia.org
Open Source for Public & Population Health
Terms
• Agile, Scrum, Sprint, Virtualization
www.amia.org
Open Source for Public & Population Health
Terms
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Intellectual Property, Copyright, License, Patent
Free Software, Copyleft, Viral License
Open Source, Open-source Software
Wiki, Creative Commons, Crowdsourcing
Agile, Scrum, Sprint, Virtualization
www.amia.org
Open Source for Public & Population Health
Examples
www.amia.org
Open Source for Public & Population Health
Examples
www.amia.org
Open Source for Public & Population Health
Issues
•Can open source methodologies help reduce
development costs and advance capabilities
for financially challenged organizations?
Yes, but it’s complicated.
Open source methodologies tolerate a high failure rate
in exchange for the competitive advantage of
crowdsourcing.
www.amia.org
Open Source for Public & Population Health
Issues
• What kinds of open source approaches are
most useful for population health and how
should limited funds be targeted?
Good question.
www.amia.org
Open Source for Public & Population Health
Issues
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Ownership
Participation
Sponsorship
Sustainability
www.amia.org
Day 2: Mobile / Social Media
Fringe, Fad, Fetish, Future
Jason Bonander
Office of Informatics/Information Resources Mgmt
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
www.amia.org
www.amia.or
Day 2: Mobile / Social Media
• Fringe, Fad, Fetish, Future
• It's sooo interesting because it's sooo open
• Signal to noise
• Speed vs accuracy
• Context
www.amia.org
www.amia.or
Day 2: Mobile / Social Media
• Fringe, Fad, Fetish, Future
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It's sooo interesting because it's sooo open
Quality aligned with evidence-base
Public to population health
Frustrating pace
Social media as data source for BRFSS!!
www.amia.org
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Day 2: Mobile / Social Media
Challenge.gov:
Health (80)
Science / Tech (105)
CDC (6)
ONC (26)
www.amia.org
www.amia.or
Day 2: Mobile / Social Media
Making more complex evidence/best
practice information usable for
app dev / social network use
data.gov
1200+ government apps
263 citizen apps
103 mobile apps
www.amia.org
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Day 2: Mobile / Social Media
'Tis better to have loved and lost
Than never to have loved at all
Tennyson
Mitigate risk
aversion
www.amia.org
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Day 2: Mobile / Social Media
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Cloud Essential Characteristics
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Self-service- service consumers directly provision
computing resources
Broad access- computing resources available over
the network on a variety of devices (PC, mobile,
other services)
Resource pooling- multi-tenancy and location
independence
Elasticity- computing resources can be elastically
provisioned (and returned)
Measured service- usage can be monitored,
controlled and reported.
Source: NIST SP 800-145 The NIST Definition of Cloud Computing
www.amia.org
Cloud Service Models
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Infrastructure as a Service (IaaS)- Raw access to
resources (e.g., data storage, virtualization)
 “Ops without hardware”
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Platform as a Service (PaaS)- Access to
preconfigured applications and systems.
 “Dev without ops”
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Software as a Service (SaaS)- Access to a complete
service or program (e.g., customer relationship
management)
 “Business without devs”
Source: NIST SP 800-145 The NIST Definition of Cloud Computing; “Cloud Architecture at Netflix” / @CodingFabian
www.amia.org
Cloud Deployment Models
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Private
 E.g., Healthcare System
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Community
 E.g., Laboratory Orders and Results using the APHL Cloud
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Public
 E.g., BioSense 2.0 on the Internet GovCloud
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Hybrid
 Mix of the above
 Surge capacity
 Load balancing
Source on the different models: NIST SP 800-145 The NIST Definition of Cloud Computing
www.amia.org
Benefits and Mandates
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Reduce costs
Increase agility
Better auditing, monitoring through virtualization
For government agencies, it’s an executive mandate
 Federal Cloud Computing Strategy, 2/8/2011
 “Cloud First”
 “Shared Services First”
Source: Federal Cloud Computing Strategy
www.amia.org
System Security and Information Privacy
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Integrity – Data is not improperly modified
Confidentiality – Data is not improperly disclosed
Availability – Data access is not disrupted
System rating – high water mark
 Low
 Moderate
 High
www.amia.org
BioSense 2.0
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Deployment Model: Public Cloud
Service Model: PaaS
Hosted by Amazon AWS GovCloud
Collaboration, Analysis, Surveillance Platform
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CDC
Other jurisdictions
Other Federal Agencies
Private (e.g., healthcare providers, pharmacies, national labs,
etc.)
 Public Access via Data.gov and Google Public Data Explorer
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“Moderate” C&A
Developed by Division of Informatics Solutions &
www.amia.org
Operations (DISO)
Public Health Surveillance Platform (PHSP)
and Shared Services
• PHSP is a multi-tiered architecture for the public health
surveillance
– Supports data submissions in multiple formats through many
channels
– Language-neutral data services
– Data analysis and human curation
– Analytical tools and services
– Integration with other programs and software platforms, including:
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National notifiable diseases,
Syndromic surveillance,
Electronic laboratory reporting,
Immunization,
Social media and unstructured news reports.
• Collaborative and iterative approach that involves
incremental improvements over time
www.amia.org
Public Health Surveillance Platform (PHSP) and
Shared Services
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Initial release on March 22nd, 2012
Platform Bazaar :: an open and free online directory
of technologies for posting, browsing and evaluating
existing or new options
 Allow Free (Open Source or Open Access) and Commercial
offerings to describe themselves
 Recommend funders to use this to evaluate the landscape
 Recommend jurisdictions to use and evaluate technology
investments
www.amia.org
Example of Use:
Sporting Events
Feature: Ad-hoc sharing
among multiple jurisdictions
during a sporting event
(e.g., Super Bowl 2012).
Utility: Prepare and
maintain situation
awareness by monitoring
specific events of concern
using informal sources in
addition to healthcare
utilization.
www.amia.org