Transcript Title
The Public Health Laboratory
Perspective: readiness to
support “meaningful use”
PHDSC Annual Meeting
November 12th 2009
Mary Shaffran, MPA
Senior Director, Public Health Programs
Association of Public Health Laboratories
APHL’s NEW Mission Statement
“To promote the role of public health
laboratories in shaping national and
global health objectives, and to promote
policies, programs, and technologies
which assure continuous improvement in
the quality of laboratory practice and
health outcomes.”
Analysis, Answer, Action
*Meaningful use general objectives
(2011, 2013, and 2015)
• Improve quality, safety, and efficiency
– Capture Data in coded format
• Incorporate lab test results into EHR
• Engage patients
• Improve care coordination
• Reduce health disparities through public &
population health data-sharing
• Ensure privacy and security
*Health Information Technology Policy Committee June 16th 2009
Analysis, Answer, Action
The PHL e-health domain
Test Order / Result (ETOR) and Lab Result to local EHR/EMR
RHIO etc..
Analysis, Answer, Action
Flavors of Electronic Messaging
• Electronic Lab Reporting (ELR):
• Reportable disease related result from labs
to state EPI & NND related results to CDC
• Electronic Case Reporting (ECR):
• Reportable disease related patient
information from physician to state EPI
(includes lab results) – NND related deidentified cases on to CDC (from state EPI)
• Electronic Laboratory Messaging (ELM):
• Lab electronic data exchange between
partners
• test requests and results to submitter (local)
• test requests and results to submitter intra state
for:
– COOP, Surge, Reference tests
• Reportable disease related results to state and
federal EPI
Analysis, Answer, Action
As we wait for a “definitive”
definition…..
“The concept of meaningful use is simple and
inspiring, but we recognize that it becomes
significantly more complex at a policy and
regulatory level. As a result, we expect that
any formal definition of “meaningful use”
must include specific activities health care
providers need to undertake to qualify for
incentives from the federal government.”
10.01.09 Quote from a Message from Dr. David Blumenthal, National Coordinator for Health Information Technology- Analysis, Answer, Action
http://healthit.hhs.decenturl.com/healthitmessage
And see the problems that are arising
“We’re not going to be able to make a lot of
progress on any higher level ambitions until
we can get our arms around some of the nittygritty details, like the exchange of lab results
and greater standardization”
– Micky Tripathi, co-chairman, Health IT Policy Committee
Experts call for widening scope of lab test exchange
http://govhealthit.com/newsitem.aspx?nid=72229
Analysis, Answer, Action
PHL: Putting their House in Order• Increasing data exchange capacity & expertise
• Taking control of their vocabularies• Reviewing and tracking pertinent federal
standards development
• Working with LIMS vendors– Defining the best solutions to meet data exchange
• Participating in the Public Health Laboratory
interoperability project (PHLIP)- 22 states, CDC-CCID &
CDC-NCPHI working collaboratively
Analysis, Answer, Action
PHLIP- advancing lab data exchange
PHLIP includes components related to:
• laboratory data vocabulary
• messaging
• security and architecture
• building community and collaboration around
the critical issue of laboratory data messaging
Analysis, Answer, Action
PHLIP Current Use Cases
Analysis, Answer, Action
PHLIP TECHNICAL ARCHTECTURE
Route not Read (RnR) Hubs
•
•
Direct Send: Currently in place
(will transition to RnR Hub
when Phase 3 is complete)
PHL
1
RnR Hub
FL
Phase 1: Implement RnR Hubs
in FL and NE
PHL
2
•
•
PHL
3
RnR Hub
NE
CDC
PHL
n
Phase 2: Develop Hub-to-Hub
Interoperability
Phase 3: CDC develop
capability to exchange
messages with RnR Hubs
Status:
• Direct Send: In Production (used for H1N1 and seasonal
surveillance)
• Phase1: In Production
• Phase 2: In Production
• Phase 3: Available- not yet in full production- CDC can poll the
hubs.
Looking
Forward to
Our Future..
THE FUTURE OF DATA EXCHANGE TO SUPPORT CLINICAL CARE
Future of PHLIP- ETOR with clinical
partners
• Release PHLIP harmonized lab order and
result terminology
• Forge stronger collaborations with private
sector
• Work with the ONC NHINConnect technical
staff and the CDC to establish the mechanism
for the RnR hubs to be used as a pilot for NHIN
architecture for the PHL to Clinical Lab use
case.
Analysis, Answer, Action
PHLIP in Action- H1N1 response
What’s in a Name?
A pig by any other name….
Influenza A unsubtypeable
Novel Influenza A H1N1
Swine Influenza Virus
Influenza A H1N1 swine-like
Novel Influenza A H1N1 swine-like
Influenza A H1, porcine
swine-origin influenza virus
Swine-origin Influenza A (H1N1)
SO-IV
Flu A/SW H1
………………………………………
The result..
• PHLIP Outbreak Response
• States utilizing PHLIP
• Impact on daily operations
• PHLIP Role
• Lead in determining LOINC and SNOMED codes for
new Influenza assays
• Collaborating with ELR, LIMSi, and other partners
to harmonize data elements..
Analysis, Answer, Action
Recommendations• Evidence that we NEED clear direction on test names
and procedures AS the test protocols are developed.
– a terminologist should participate at the outset in the
naming of new tests and determination of the results
• Assays should go to FDA with standardized codes
already submitted…messaging cannot be an
afterthought!
Analysis, Answer, Action
Obstacles for PH to address if they are
to remain relevant in HIT
• State/Local Relationships – not working well
together
• Public Health has to be perfect over practical
• Funding problems have decimated Public
Health Departments, especially
knowledgeable informatics workforce
– Siloed funding is a huge obstacle
Analysis, Answer, Action
THANK YOU
For More Information
Contact
[email protected]
Analysis, Answer, Action