Public Health IT Unit 4 Public health enabled

Public Health IT Unit 4: Public health enabled Electronic Health Records, Decision Support, and Their Role in the Meaningful Use of Health Care Technology Lecture c This material (Comp 13_Unit 4 c) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1 U 24 OC 000003. This material was updated by Columbia University under Award Number 90 WT 0004. This work is licensed under the Creative Commons Attribution-Non. Commercial-Share. Alike 4. 0 International License. To view a copy of this license, visit http: //creativecommons. org/licenses/by-nc-sa/4. 0/.

EHRs, Decision Support, and Meaningful Use of HIT Learning Objectives • Objective 1: Discuss the New York City Department of Health and Mental Hygiene partnership with a commercial EHR vendor and how it created a public health – enabled EHR • Objective 2: Describe the EHR "meaningful use" movement and how it could transform existing clinical / public health practices 2

EHRs, Decision Support, and Meaningful Use of HIT Learning Objectives (Cont’d – 1) • Objective 3: Demonstrate knowledge of public health – oriented clinical decision support including an integrated strategy using multiple tools such as alerts, order sets, smart forms, and quality reporting • Objective 4: Describe the strategies, features, and systems needed for public health agencies to define and build the necessary connections to EHRs as identified by the “meaningful use” legislation • Objective 5: Identify the essential features of four primary public health IT functions including syndromic surveillance, bi – directional immunization registries, public health alerts, ad – hoc reporting, etc. 3

Motivation • Immunization registries are a public health meaningful use function • Immunization is effective but many children do not receive it • 1990’s NYC measles epidemic • Without a centralized record – keeping system, providers cannot obtain up – to – date records • Many providers do not immunize without seeing a child’s record 4

New York Citywide Immunization Registry (CIR) • Provides a central record – keeping system to track immunization statuses • Enables health care providers to readily determine the immunization status of a child during a visit • Provides an official printout of an immunization record • Identifies children who are overdue for scheduled vaccinations 5

Law requirements • Reporting of all immunizations administered to all NYC patients under age 19 required within 14 days of administration • Must report all historical immunizations in order to report a complete history for a patient • Need patient consent to report immunizations administered to patients age 19 and over 6

Methods of Reporting • Online Registry • Electronic reporting – Web File Repository – EHR CIR bidirectional web – services o Real time query and upload 7

Web File Repository (WFR) 4. 14 Figure (NYC Department of Health, 2008). 8

EHR immunization data 4. 15 Figure (Buck, 2010). 9

EHR CIR bidirectional web-services 4. 16 Figure (Buck, 2010). 10

Future Functions • Receive and view CIR immunization history within the EHR itself • Reconcile CIR and EHR immunization histories • Report immunization history to CIR in real – time and receive confirmation message • Review errors for submitted messages to identify records needing correction • Improved matching service to CIR through the use of CIR patient immunization registry IDs 11

EHRs using the service 4. 17 Figure (Buck, 2010). 12

Public health needs • Public health communication – Public health officials needs a mechanism to communicate directly with clinical personnel for a variety of reasons including: o o Tracking disease outbreaks Research surveys Public health detailing visits Medication or vaccine recalls • Public health data gathering – Public health officials regularly need to assess the health of their communities – Surveys conducted at the local, state, and federal levels 13

EHR public health solutions • Public health alerts – If public health officials could distribute relevant messages directly to providers at the point – of – care, they could target their interventions / monitoring more effectively • Public health ad – hoc reporting – If public health officials had a means to get aggregate count information from provider clinics throughout a region, they could track health care in virtually real – time 14

Query builder 4. 18 Figure (Buck, 2010). 15

Reporting policy 4. 19 Figure (Buck, 2010). 16

Messages inbox 4. 20 Figure (Buck, 2010). 17

Registry reports 4. 21 Figure (Buck, 2010). 18

Alerts 4. 22 Figure (Buck, 2010). 19

Reporting 4. 23 Figure (Buck, 2010). 20

Conclusion • Public health enabled EHR can be use to meet both public health and clinical goals • Meaningful applications of healthcare technology 21

Unit 4: EHRs, Decision Support, and Meaningful Use of HIT Summary – Lecture c • The New York City Department of Health has built an ad – hoc query and alert system that helps them identify emerging acute threats and monitor chronic disease issues throughout the community • Bidirectional immunization histories are providing information back to providers about their patients 22

EHRs, Decision Support, and Meaningful Use of HIT References – Lecture c References: Buck MD, Anane S, Taverna J, Amirfar S, Singer J. The Hub Population Health System: Distributed Ad-Hoc Queries and Alerts. J Am Med Inform Assoc. Diamond CC, Mostashari F, Shirky C. Collecting and sharing data for population health: a new paradigm. Health Aff (Millwood). 2009 Mar-Apr; 28(2): 454 -66. Hripcsak G, Soulakis ND, Li L, Morrison FP, Lai AM, Friedman C, Calman NS, Mostashari F. Syndromic Surveillance Using Ambulatory Electronic Health Records. J Am Med Inform Assoc. 2009 Mar 4. [Epub ahead of print] Lurio J, Morrison FP, Pichardo M, Berg R, Buck MD, Wu W, Kitson K, Mostashari F, Calman N. Using electronic health record alerts to provide public health situational awareness to providers. J Am Med Inform Assoc. 2010 Mar 1; 17(2): 217 -9. Standards & Interoperability (S&I) Framework – Query Health. Retrieved on October 3 rd, 2010 from http: //wiki. siframework. org/Query+Health Stockwell M, et al. Using an Electronic Immunization Information System to Improve Immunization Rates. 23

EHRs, Decision Support, and Meaningful Use of HIT References – Lecture c (Cont’d – 1) Charts, Tables, Figures: 4. 14 Figure: NYC Department of Health, 2008. 4. 15 Figure: Buck, M. (2010). EHR immunization data- screen shot. New York Department of Health and Mental Hygiene, Primary Care Information Center. 4. 16 Figure: Buck, M. (2010). EHR-CIR bi-directional web-services. New York Department of Health and Mental Hygiene, Primary Care Information Center. 4. 17 Figure: Buck, M. (2010). EHRs using the service. 4. 18 – 4. 19 Figures: Buck, M. (2010). Images of desktop- systems and query building. New York Department of Health and Mental Hygiene, Primary Care Information Center. 4. 20 – 4. 23 Figures: Buck, M. (2010). Images of desktop- systems of eclinicalworks system. New York Department of Health and Mental Hygiene, Primary Care Information Center. 24

Unit 4: EHRs, Decision Support, and Meaningful Use of HIT, Lecture c This material (Comp 13 Unit 4 c) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU 24 OC 000013. This material was updated in 2016 by Columbia University under Award Number 90 WT 0005. 25