Reflections. Building the Bridge: The Digital Intersection of Healthcare and Public Health Lab Executive Summary

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4 Building the Bridge: The Digital Intersection of Healthcare and Public Health Lab Executive Summary 4 Our vision: we will work together to improve the health of our nation by creating a bi-directional exchange of health information between public health and healthcare While the group identified many challenges, there was overall optimism that the vision can be accomplished This is not a technical challenge, it is a matter of governance, will, and resources The process will move forward with active, timely and broad stakeholder engagement Our governance body will include representatives from public health, providers, and vendors. It will be enhanced and refined as we move forward Reflections The first phase, testing implementation, will be complete by July 1, 2017 with a range of jurisdictions, vendors and delivery systems Both the governance and technical solution will be built to evolve Definitive commitments were made by participants that will move the ball forward We will start with notifiable disease data Our work will build on work already done by others We have a high level work plan to guide our efforts This is an historic convening of all three stakeholder groups that will result in a sustained effort over time

5 Building the Bridge: The Digital Intersection of Healthcare and Public Health Lab Executive Summary 5 Statement of Purpose Key stakeholders in the digital health care and public health community came together for a 2-day immersive experience to collaborate on a vision for digital health data exchange and a proofof-concept for Electronic Case Reporting to improve the health, well-being and security of the nation. AGENDA LAB PARTICIPANTS Participant Organization Participant Organization Chris Alban Epic John Lumpkin RWJF Scott Becker APHL Bill Mac Kenzie CDC Jason Bonander CDC Tushar Malhotra eclinicals Works Geoff Caplea AllScripts Lori Melichar RWJF ACT I ACT II ACT III Envisioning the Bridge Welcome and set the stage Build a shared understanding around the facts and constraints Shape an understanding through 3 user stories Laying a Foundation for Success ecr Proof of Concept Affirm for the need and purpose of an ecr proof of concept by further defining the proof of concept Further define the proof of concept approach Charting the Path Forward Create the notional timeline Reflections Select a tool and closing thoughts Brian Carter Cerner Sharon Moffatt ASTHO Benson Chang Deloitte Patrick O'Carroll OASH Jim Daniel ONC Richard Paskach HealthPartners Art Davidson NACCHO Dan Pollock CDC Jim Doyle Epic Indu Ramachandran Kaiser Brian Edlin CDC Dave Ross PHII Jeff Engel CSTE Mark Rupp Nebraska Medical Center David Friedman Deloitte Vivian Singletary PHII Kirsten Hagemann Cerner John Stinn Deloitte Hilary Heishman RWJF Ben Stratton Deloitte Steve Hinrichs APHL Kathy Turner CSTE Michael Iademarco CDC Jagan Vaithilingam eclinical Works Kevin Isbell Kaiser Joe Wall Meditech Jim Jellison PHII Andy Wiesenthal Deloitte Andrew Karson Partners Larry Wolk ASTHO

6 Building the Bridge: The Digital Intersection of Healthcare and Public Health Lab Executive Summary 6 ACT I Act I Envisioning the Bridge John Lumpkin from the Robert Wood Johnson Foundation kicked off the Lab by introducing the ecr vision. All participants were then asked to demonstrate their alignment to the vision and execution thereof by positioning themselves on the spectrum between storm clouds and sunny skies. While the majority of participants landed on sunny skies for both, several shared realistic skepticism and concerns with the group. That we work together to improve the health of our nation for creating bi-directional exchange of health information between public health and healthcare. An interview with John Lumpkin

7 Building the Bridge: The Digital Intersection of Healthcare and Public Health Lab Executive Summary 7 ACT I Act I Envisioning the Bridge To continue building a shared understanding, participants were asked to explore constraints and considerations through the eyes of each stakeholder group. They then used three different case studies as a means to understand current pain points and articulate future aspirations. Articulate the fiscal opportunities in changing care systems CDC does not have direct control over state/local jurisdictions and does not get the data directly. Variation drives up cost, drives up risk and compromises quality for all parties. Data can be a liability; requires security and adds risk of litigation Multiple competing priorities. Hitch our wagon to Zika! Emerging Systemized Flexible Sensitive to workflow If/Then/Else Architecture Existing pipeline Triggers & standards exist for pulling data out of EAR Public Health can consume & act on data electronically Acute Trust, education, collaboration, and partnership Does not end with report, i.e. after providers report event, they receive real time information that is useful to them, for example: a picture of what is going on in the jurisdiction or information telling them if this is part of something bigger Chronic Establish a purpose indicators data sources triggers Passive data collection Understand intervention options and tailor stakeholders, data, flows, trigger Automation lowers risk and failures * For complete exercise outputs, see Appendix.

8 Building the Bridge: The Digital Intersection of Healthcare and Public Health Lab Executive Summary 8 ACT II Act II Laying a Foundation for Success ecr Proof of Concept In the afternoon of Day 1, participants began to define critical success factors for the ecr proof of concept (POC). Participants agreed that, in order to be successful.. An ecr proof-of-concept will: Allow as many groups as possible to see themselves in it; i.e. it will include meaningful diversity, such as geography, technological capabilities, urban vs rural, resourcing levels and jurisdictional model (city/county/state) Include multiple vendors Include multiple types of care systems Prove that we can send and receive data Test automatic trigger codes (not updates) Prove that we can partner Include content and formatting of case reports that is standardized, automated, passive, accurate, useful and timely, and evaluate conformance in measurable ways to each of those parameters Demonstrate that we won t lose the ability to share information beyond notifiable requirements Be sustainable

9 Building the Bridge: The Digital Intersection of Healthcare and Public Health Lab Executive Summary 9 ACT II Act II Laying a Foundation for Success ecr Proof of Concept To close out Day 1, and kick off Day 2, participants discussed and defined the fundamental requirements for the POC governance structure, roles and responsibilities/operating model and core technical approach. * For complete exercise outputs, see Appendix.

10 Building the Bridge: The Digital Intersection of Healthcare and Public Health Lab Executive Summary 10 ACT III Act III Charting the Path Forward In the final module, participants identified critical milestones and dependencies that will guide the ecr POC implementation effort between today and January 1, IMMEDIATELY Q Q Q1 & Q Q3 & Q Broad stakeholder engagement for all of the above Funding Plan identified for POC First trigger codes CDC, APHL, CSTE PH Informatics Conference 8/24/16 Define messaging Develop ecr readiness toolkit for PH agencies CSTE External Communications happening PHII Sustainability plan and scalability plan ASTHO HL7 ecr Implementation guide published CDC, CSTE Secretariat and neutral convener formed PHII, RWJF 8/1 Governance body defined and recruited RWJF, CDC, PHII, EHRA, ASTHO RCKMS on AIMS CSTE, CDC, APHL Data use agreement POC defined ASTHO What have we learned that may refine standards PH Agencies report readiness Challenges and Opportunities Current pilot lessons learned gathered and analyzed to inform POC Funding proposal (RFP, response, implementation) Review and analysis of current pilot. Get in part from vendors, providers, PH CSTE Review & analysis of current PH Governance Group ASHTO Launch recruitment of participants for the POC CDC Council votes on ecr policy statement CSTE Draft press release Document ecr business requests CERN, PHII, CSTE Establish tech WG CDC, APHL, Epic Establish tech working group & requirements group CSTE, CDC, ECW, APHL, EHRA, Epic, Cern, meditect, AllScripts, HPartners Define measurable metrics for success CPC, CSTE, ASTHO, HPartners, Epic POC sites & participants selected CSTE, Epic, AllScripts, Partners, Health Partners, NPAL/UNMC, Define communications plan CDC, PHII, ASTHO POC started CSTE, ASTHO Privacy & Security Policy POC tech solutions defined POC eval complete CTSE & ASTHO Report on measurable success metrics PH expansion plan beyond POC identified ASTHO Recruit next implementation sites CSTE Governance Entity launched CDC, EHRA,, ASTHO January 2018 It could be even more urgent

11 Building the Bridge: The Digital Intersection of Healthcare and Public Health Lab Executive Summary 11 ACT III Act III Charting the Path Forward To close the Lab, participants were asked to work within their stakeholder group to select a tool from the tool box that represented the role they will play in ongoing planning, implementation and maintenance efforts for the initial ecr POC. Further, many participants offered specific commitments* to support and contribute to the effort. Providers We are on the front lines, measuring the impact, efficiency, etc. *In many cases, these commitments were pending approval from their organization s leadership. Public Health We will measure what we do Vendors Test connections, technical how do we make things work?

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13 Appendix

14 City Hall Gallery Walk Not-for-profit systems have community benefit requirement How will we leverage Community Board Assessment Regulations (?) Not-for-profit systems have community benefit requirement Data can be a liability: Requires security Chance of litigation, e.g. Apple v FBI How to quantify the Return on Investment for public health reporting There is a lot of information gathered by software Stewards of the patient/doctor relationship

15 City Hall Gallery Walk Golden Rule Centers - plural National healthcare surveys Most conditions are vastly underreported Epidemiologists want to inform the public they are the bosses Multiple, competing priorities. Hitch our wagon to Zika!

16 City Hall Gallery Walk Example of cooperation? Do exist (sic) Does the vendor community speak with one voice? Vendors have a lot of specific regulations to comply with AND providers have implementation cycles Managing a product means vendors cannot afford to satisfy all requests Public health doesn t know how to engage vendors Spend time on low value activities

17 City Hall Gallery Walk Articulate the fiscal opportunities in changing care system How does the next generation of MDs, RNs and public health want to do business? Workforce developments and evolution

18 Public Comments What does success look like? * Synthesized on Slide 17

19 Public Comments What does success look like? * Synthesized on Slide 17

20 User Stories Emerging Conditions User Story #1: Public Health Surveillance of Currently Non-Reportable Conditions, like Elizabethkingia Today: Outbreaks of emerging diseases occur and cases of novel manifestations of common diseases occur. Some public health jurisdictions are mandated to monitor the new disease as a reportable condition, and want the disease to be electronically reportable. Public Health Agencies are unable to monitor and provide accurate guidance on outbreaks and physicians do not have a sufficiently broad view of the events to identify anomalous events until they are full blown epidemics.

21 User Stories Emerging Conditions

22 User Stories Emerging Conditions

23 User Stories Emerging Conditions

24 User Stories Emerging Conditions

25 User Stories Acute Illness User Story #2: Electronic Case Reporting of Standard Reportable Events, like influenza Today: A patient comes into the physician s office in <Local Jurisdiction> with certain symptoms. The physician decides on a diagnosis. According to applicable regulations, the event is reportable. The physician is aware that the case is reportable, but lacks the form and the time. The physician instructs his staff to report it, but they also lack the form and the time. The case is not reported.

26 User Stories Acute Illness

27 User Stories Acute Illness

28 User Stories Acute Illness

29 User Stories Acute Illness

30 User Stories Chronic Diseases User Story #3: Public Health Surveillance of Chronic Diseases, like diabetes Today: A public health diabetes control officer is monitoring all of the diabetics in their jurisdiction. They would like to know when the patients become insulin dependent. Currently there is no straightforward way to do this in the current environment. They make an arrangement with the office nurse of a busy practice to periodically report how many patients have had new insulin prescriptions.

31 User Stories Chronic Diseases

32 User Stories Chronic Diseases

33 User Stories Chronic Diseases

34 User Stories Chronic Diseases

35 Core Technical Approach

36 Core Technical Approach

37 Core Technical Approach

38 Governance

39 Governance

40 Roles & Responsibilities

41 Roles & Responsibilities

42 Roles & Responsibilities

43 ecr POC Definition

44 Your Greenhouse Facilitation Team 44 Sarah Minor-Massy Christine Nelson Leigh Otey Jeanne Strepacki Saagar Thakkar

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