STI ecr Learning Community: Webinar 2. April 27, 2017 Noon 1 p.m. EDT

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Agnes Price
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1 STI ecr Learning Community: Webinar 2 April 27, 2017 Noon 1 p.m. EDT

2 STI ecr Learning Community Webinar 2 Please use the link below to register for the webinar: Call Information: ; Access Code Objectives for webinar Provide updates from the AllianceChicago pilot ecr implementation Introduce the evaluation plan Discuss use of local codes vs standard health IT vocabularies

3 Recap from the Kickoff Webinar Overview of the STI ecr project Overview of PHII Technical Guidance Introductions of Pilot Partners Scope of Pilot Implementation Go to Learning resources section for kickoff slides

4 Vision for this Learning Community Today (Webinar 2) provides an update on AllianceChicago s pilot implementation progress Upcoming Webinars Webinar 3: Presentation of final findings, community feedback and next steps for ecr evolution (Mid-June, TBA) Bonus Webinar 4: Presentation on clinical decision support knowledge artifact for gonorrhea treatment (June 28) Outputs Revised PHII Technical Guidance Resource to disseminate pilot s lessons learned Feedback to HL7

5 Glossary C-CDA Consolidated Clinical Document Architecture; widely implemented HL7 specification used to standardized the content and structure of clinical care summaries Centricity FHIR GE EHR product implemented at AllianceChicago facilities Fast Healthcare Interoperability Resources; an emerging standard for the electronic exchange of healthcare information developed by HL7 GE Healthcare, a division of General Electric; the vendor that develops and supports the Centricity EHR product

6 Webinar 2 Agenda Time: Topic: 12:00-12:10 Welcome (Natalie Viator, PHII) Role Call by Organization (Natalie Viator, PHII) 12:10-12:20 Pilot Implementation Updates (Elizabeth McKnight, Jeremy Carr, AllianceChicago) 12:20-12:35 Introduction of Evaluation Plan (Roxane Padilla, AllianceChicago) 12:35-12:45 Local vs Standard Code Use in EHRs (Jim Jellison, PHII) 12:45-12:55 Questions and Discussion (All) 12:55-1:00 Wrap up (Natalie Viator, PHII)

7 Pilot Implementation Updates

8 EHR Build Progress Spring 2017 HIMSS Interoperability Showcase Initial concept was developed with GE to create ecr files to be delivered based on triggers Concept utilized a beta version of the FHIR technology being developed by GE for Centricity Alliance demonstrated delivery of a C-CDA via FHIR to a local health department.

9 EHR Build Progress Spring 2017 Integrating FHIR ecr into current day AllianceChicago continues to work closely with GE around development of the new FHIR integration AllianceChicago is participating in limited availability testing AllianceChicago is working closely with GE interface engineers in the testing and deployment of FHIR functionality Including ecr triggering

10 Scope of Pilot Implementation Alliance of Chicago Community Health Services (GE Centricity) Patient s encounter data entered into EHR EHR applies case detection logic to patient encounter data in EHR Match to trigger codes Patient s data meet reporting criteria EHR* builds case report Pull case report elements EHR* sends case report *may involve middleware (e.g., 3rd party interface engine) Illinois Department of Public Health Receive case report Deduplicate from ELR Categorize for case classification Add case to surveillance system Conduct case investigation Case notification to CDC...

11 Introduction of Evaluation Plan

12 Evaluation Plan Goal Provide data (both quantitative and qualitative) to analyze the performance of the technical guidance (PHII, HL7) Main input for pilot implementation summary report Will help inform necessary changes for future technical guidance revisions to meet the needs of the STI surveillance community

Evaluation Plan Resources Activities Outputs Outcomes Existing PHII Technical Guidance HL7 eicr IG Previous Pilot Findings HIMSS Findings PHII Team CDC Sponsor CDC Funding AllianceChicago Team

13 Evaluation Plan Resources Activities Outputs Outcomes Existing PHII Technical Guidance HL7 eicr IG Previous Pilot Findings HIMSS Findings PHII Team CDC Sponsor CDC Funding AllianceChicago Team Vendor/Middleware Teams IDPH Team Pilot STI ecr - conduct site visit - provide technical assistance - recommend changes to value sets and formats for case detection - design and document implementation - design and document evaluation - assess ecr practices, challenges, and opportunities - collect input for new learning resource - create summary report Learning Community - follow pilot activities using Plan-Do-Study-Act cycle (i.e. Webinar 2 and 3) - recommend changes to value sets and formats for case detection - collect input for new learning resource A revised version of the PHII Technical Guidance ( that aligns with the HL7 eicr IG. Provide feedback to HL7 Public Health Emergency and Emergency Response (PHER) workgroup on suggested revisions to the HL7 eicr IG. The Learning Community is socialized and informed on the progress made in the area of STI ecr. A new learning resource is available to support further STI ecr pilot activities according to a standards-based approach. Public health agencies are aware of the availability of the revised technical guidance and new learning resource. Public health agencies seeking to implement an EHR-based STI ecr process have access to summary report to avoid mistakes by referencing the experiences of others. Revised PHII Technical Guidance, pilot summary report, and new learning resource support greater uptake among state and local health departments of STI ecr. Increased interoperability between health care and public health. Emergence of a national, standardized ECR for STIs approach.

14 Background and Measures Pilot site Burden of disease Pilot Site City State 14

15 Diagnosis PHII Case Detection Logic Lab Test Order Positive Lab Result (Named Organism) Positive Lab Result (Presence vs. Absence) Treatment Prescribed Send ecr? YES YES YES NO NO

16 Evaluation Topics Evaluate the performance of trigger codes Evaluate the ecr and the effect on Community Health Centers and public health department workflows Evaluate areas of success and challenges for implementing EHR-based ecrs 16

17 Evaluation Data Source Domains Multiple sources of data Surveillance EHRs Observations Developers User

18 Evaluation Elements Triggers - Performance - Frequency - Feedback Completeness Feedback 18

19 Local vs Standard Code Use in EHRs

20 ONC 2015 Edition Draft Test Procedure for ecr PHII.org Health IT Module must 1. Consume and maintain a table of trigger codes to determine which patient encounters may be reportable 2. Match a patient encounter to the trigger code based on the parameters of the trigger code table 3. Create a case report for electronic transmission Subset of data elements and associated standards Encounter diagnosis; using either ICD-10-CM or SNOMED-CT Problem list; SNOMED-CT subset Laboratory test(s); LOINC Laboratory value(s)/result(s); No standard specified Medications; RxNorm where they exist, otherwise local codes Full draft available at:

21 PHII Case Detection Logic Anticipated Code Systems PHII.org Diagnosis (ICD-10 or SNOMED) Lab Test Order (LOINC) Positive Lab Result (Named Organism) (SNOMED) Positive Lab Result (Presence vs. Absence) (SNOMED) Meds Prescribed Send ecr? YES YES YES NO NO

22 Guidance vs Reality HIMSS commends the use of LOINC and SNOMED-CT code systems... but recognizes that challenges may arise when trying to implement [LOINC and SNOMED-CT]... as many EHR systems do not consistently use [LOINC and SNOMED-CT]... within their data elements and fields. - HIMSS, on submitted comments on 2017 Draft Interoperability Standards Advisory Full comment available at:

23 Discussion Based on your experience in collaborating with clinical partners on EHR-based ecr, where have you found a mismatch of local vs standard codes? ICD-10 SNOMED LOINC Other (e.g., RxNorm, CPT) What is known about the level of effort and cost of mapping between local and standard codes to support ecr?

24 General Questions and Discussion

25 Wrap-Up Learning Community Webinar 3 TBA Look for more details in early June Slides will be posted to phii.org/ecr-sti.

26 Supplemental Information

27 Evaluation Plan Evaluation Questions 1. Do the trigger code value sets perform as intended in the EHR system? 2. How can the trigger code value sets be improved? 3. How are patient data in the EHR evaluated against the trigger code value sets? Measures 1. Frequency that each code triggers the creation of an ecr (e.g., ICD-10 code A56.3, A71.0) 2. Sensitivity (comparing to paper case report creation) 3. Specificity ( ) 4. Positive Predictive Value ( ) 5. Negative Predictive Value ( ) 1. Feedback from implementers on suggested trigger code values to add or remove for case detection 1. Description of workflow setup, including: a.) any time delay between documenting the patient encounter data and evaluating it against the trigger code value sets b.)any time delay between evaluating data against trigger code value sets and sending to public health

28 Evaluation Plan Evaluation Questions 4. Does the trigger code decision logic perform as intended in the EHR system? Measures 1. Frequency of each rule type (e.g., diagnosis, lab test result of named organism) that triggers the creation of an ecr 5. How can the trigger code decision logic be improved? 6. Does the new ecr process reduce the burden of reporting on healthcare providers? 7. How complete is the ecr at the time of creation? 8. Does the ecr contain the data needed for public health case classification? 1. Feedback from implementers on suggested addition or removal of rule types 1. Change in person-hours per case report 1. Percent completeness of CSTE Identified Data Requirements (55 data elements) 1. Percent of ecrs that meet public health agency s case definition 2. Feedback on the ecr

29 Evaluation Plan Evaluation Questions 9. How effective were the implementation resources? Measures 1. Feedback from implementers on available resources: PHII Technical Guidance, HL7 eicr Implementation Guide v What additional resources are needed for implementing EHR-based ecr? 1. Feedback from implementers on future resources

Transforming Health through a Digital Bridge. Date

Transforming Health through a Digital Bridge Date What is Digital Bridge? A partnership of health care, health IT and public health organizations Goal is to ensure our nation s health through a bidirectional