Public Health Reporting Rethought By Pilot Project

Standardization effort aims to make patient health data in EHRs easier for public health agencies to access, so they can respond more quickly to infectious disease outbreaks.
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Preliminary results of a pilot project testing standardized reporting of public health information from electronic health records (EHRs) reveals that by using templates for clinical data, public health officials can improve the quality and coordination of care as they try to contain problems such as West Nile Virus, or outbreaks of whooping cough or flu.

"This was the first pilot implementation of clinical document architecture for the purposes of public health reporting from clinical care providers specifically in the area of communicable diseases," Dr. Nikolay Lipskiy, health IT standards and interoperability lead for the Centers for Disease Control and Prevention (CDC), said in an interview with InformationWeek Healthcare.

The pilot project is part of a three-year program in which IBM, the CDC, and the Public Health Data Standards Consortium (PHDSC) are collaborating on ways to make patient health data in EHRs quicker and easier for health officials to access. The initiative involves creating, validating, and exchanging test public health case reports originating from commercial EHRs or health information exchanges (HIEs).

According to CDC officials, many healthcare providers currently send clinical information to public health agencies via phone calls, fax, or mailed paper forms, as well as electronic fill-in-the-blank forms. The irregular and delayed public health reporting process often creates inconsistencies and duplication of efforts.

The research program aims to develop a new approach to defining and delivering public health reporting by drawing insights from structured and unstructured data that currently exists in disparate systems. Scientists are creating templates for public health case reports that work with EHRs.This allows stakeholders to collect critical information, such as the demographics of a patient, clinical symptoms, and immunization records, in a format that all parties can easily understand.

New template tools and automated reporting technology were pilot tested for a year with public health information systems in Delaware, New York State, and San Diego County. Healthcare providers sent information electronically to local, county, state, and federal public health agencies to help them speed up their response times and enhance their efforts to control the spread of communicable diseases.

[ Most of the largest healthcare data security and privacy breaches have involved lost or stolen mobile computing devices. For possible solutions, see 7 Tools To Tighten Healthcare Data Security. ]

The researchers hope to publish the full results of the pilot project at the end of the month, but preliminary results show that duplication of information was reduced, and the evidence suggests that improvements in the organization and management of clinical data from EHRs hold great promise.

According to Lipskiy, by computerizing clinical information, data doesn't have to be entered twice. For example, providers could avoid filling out a hard-copy form and faxing it to the public health department. Instead, a physician could fill out an electronic chart with patient demographics and clinical information and send it to a hospital's electronic system in the format of electronic templates. These templates can be easily repurposed and sent to a public health agency without additional data entry tasks.

Furthermore, program scientists aim to describe clinical symptoms using standard nomenclature, and ICD-10 codes, which help health providers know what information to include in their reporting document.

The results of the three-year program will inform the Standards and Interoperability Public Health Reporting Initiative, which is a project run by the Office of the National Coordinator for Health Information Technology in collaboration with the CDC that addresses the challenge of electronic data exchange between clinical care providers and public health agencies. The initiative creates a roadmap to harmonize health IT standards between clinical care and population health systems beyond the Meaningful Use Stage 1 objectives.

However, developing a standardized approach to electronic public health reporting from EHR systems is not always a straightforward proposition, observed Dr. Seth Foldy, senior advisor for health informatics and practice at CDC's Public Health Surveillance and Informatics Program Office.

"We need to stay abreast of the standards that the clinical healthcare world is using, such as the clinical document architecture approach of sending an electronic document," Foldy said in an interview with InformationWeek Healthcare. "We have to slowly migrate at a pace that can be tolerated. It is a gradual and complex process."

Sondra Renly, lead scientist of collaborative public health transformation for IBM Research, said in a statement that a huge investment has been made to implement standards for the exchange of electronic health records, which contain critical clinical data that public health agencies need in a time of crisis.

"This community effort will bring near real-time automated reporting to public health and give public health the information required to protect society," Renly said. InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital CIO Roundtable issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.)

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