Technology to Advance Public Health

Technology to Advance Public Health
Technology to Advance Public Health

Introduction

Good afternoon or good morning everyone. My name is Fran Phillips. I’m a former senior deputy with the Maryland Department of Health and Mental Hygiene. I’m currently consulting with the Health Systems Transformation Team here at AS-THO, the Association of State and Territorial Health Officials. I’d like to welcome you to today’s delivery and payment reform technical assistance call entitled-leveraging Innovations in Health Information Technology to Advance Public Health. AS THO with funding from the CDC launched this technical assistance call series in January 2015.

Identified for additional assistance (advance public health)

The purpose of the call was to focus on some of the key areas that states have identified for additional assistance as they move forward with payment and delivery reforms. The four-part technical call series consists of 90-minute calls with substantial time set aside for open discussion with the audience- that’s you – so that you get your questions addressed and have an interactive discussion with the presenters. Participants also have the opportunity to submit questions prior to each call. Today’s call is the fourth in the call series and, as I said, we’ll be highlighting opportunities for public health in leveraging health information technology innovation. So let’s turn to our first slide which as you can see presents the three objectives for today’s webinar. Briefly, first, the discussion will highlight examples of how advancements in health information technology – that is-hit – whether those advancements result from SIM grants or otherwise may be leveraged for public health purposes. Secondly, we will discuss the challenges which public health agencies face in accessing and interpreting new data sets. Thirdly, the discussion will identify population health gains to be derived from applying new health information technology to advance public health.

So before proceeding with the webinar we’d like to quickly pose two basic questions to you, our audience. As you know the subject of HIT is a vast one with many, many different levels of familiarity and experience. In order to orient our speakers in presenting their materials, it would be helpful if you could respond right now to the two questions. You’ll see two sets of slides appearing on your screen. The aggregate results of each question will be collated immediately and posted. So let’s take a moment and respond. Here you can see the first polling question which asks youth to identify your organization. So if you check the appropriate box there and go ahead and submit it then we’ll wait a minute and we’ll get a sense of our audience participants today. So the returns are still coming in from precincts-but as you can see we’ve got a good cross-section of folks on the slide, largely state public-health but also local public health agencies. I can see that you’ve now advanced to the next question which is whether or not you work directly in informatics. It looks like about two-thirds of you do have direct informatics experience in your work and one-third do not. So I think that’ll be very helpful. So thank you for taking that quick survey. Before our speakers begin then I’d like tosh are a bit of background as a basic level set prior to the presentations. As the first slide indicates a couple of key definitions to the terms that we’ll be using repeatedly during the discussion, that’s both health information technology as well as health informatics.

National Conference of State Legislators and the health informatics-definition

These are just two selected definitions of many that are out there. The definition for Hit comes from the National Conference of State Legislators and the health informatics-definition comes from the Great State of Louisiana, the Louisiana Center for Health Informatics. Next slide, please. So here’s a bit of history that probably is worth recalling for those of us like me who did not live and breathe with the legislative-or the federal level of the legislative beginning of HIT derived from the High Tech Act of 2009. Back at that time and clearly continues today HIT was seen as a powerful engine for economic growth. The ARRAS Act as you will recall intended to stimulate the nation’s economy and included-the high tech provisions which we are familiar with today. So health information technology is absolutely essential to health reform, which is to transforming healthcare delivery and financing to improving-quality, efficiency, and community health. The High Tech Act set forth a national technology-and information foundation that has indeed proven essential to implementing the provisional the subsequent Affordable Care Act. Next slide. This slide shows three steps, kind of the-building blocks in the progression of HIT infrastructure as it has been evolving.

Bilateral Communication

Moving-from digitizing data at the individual clinical site to more purposeful bilateral communication-of that data to population-wide data exchange for clinical and other purposes. The meaningful use as you see on this slide for those of us in public health and in the entire-health sector of course meaningful use has become a household term. It refers to the incentive program operated by Sachs’s Office of the National Coordinator for Health Information Technology that’s known as ON. ON links an estimated $30 billion in incentive payments-for demonstrations of meaningful use of various applications of HIT.

Next slide. So meaningful use as you probably know has three progressive steps moving from initial digitization of information to disease management, clinical decision support, medication management, support for patients’ access to their health information, transitions in care, quality measurement, and research, and lastly, and very importantly, communication with public health agencies. This slide shows examples of public health communications that are captured in meaningful use stages one and two. I’ll leave-meaningful use stage three to our presenters. Next slide. So I’ll conclude this really brief introduction to the development and importance of emerging health IT with this slide which represents-five – no, I guess more – a half dozen examples that are drawn from my own recent experience-with population health initiatives which have been greatly boosted by access to big data to health information technology.

So by that, I mean working with aggregated electronic clinical records via health information exchanges there are tremendous opportunities to advance specific public health challenges. So this list is just meant to illustrate a few examples, a few possibilities, and no doubt each of you has encountered equally meaningful examples. What I’ve got here as far as the six that I personally have experience with include mapping, surveillance information for preparedness purposes, communication of post-discharge hospital information, or clinical information to support warm hand offs or transitions to community providers. Certainly the clinical support for prescribes with prescription drug monitoring programs, prescribe rs of scheduled medications, and tapping into health information exchanges for that purpose. Interestingly we’ve used health information exchange data to evaluate certificate of need proposals and other regulatory activities around providers’ utilization.

Advancing population health

Then lastly looking at outcomes and effectiveness research for specific health conditions. So those are just some of my experiences. I know that as I said many of you have many other examples. While there really do remain major unresolved issues and barriers – we know that – to accessing health information technology from public health agencies it’s really clear that the enormous power of HIT is one that every sign in advancing population health. So with that let’s turn to our two expert speakers. First, we will hear from Jim Daniel for the national perspective followed by Wholefood for his presentation at the state level. What I’m going to give you here are very, very abbreviated backgrounds for two people whose experience in HIT and public health is both very deep and wide-ranging. Jim Daniel, MPH, has been the public health coordinator for CON since 2011.

Previously Jim was the chief information officer for the Massachusetts Department of Public Health where he also worked as an infectious disease epidemiologist and director of informatics. Joe Foxhound has more than 25 years of experience in data and technology strategy infrastructure and design in the private sector as well as in public health agencies. Within the Louisiana Department of Health and Hospitals, Joe heads the Center for Population Health Informatics. He has served on the steering committee for the AS THO Public Health Community Platform and represents the Office of Public Health on the State HIT Advisory Board. So here’s how we’ll organize the presentations. After Jim presents there will be time for a few questions before we move on to Joe’s presentations. The operator at that time will provide instructions for asking a question via the audio line or alternatively you may submit your written questions anytime in the chat-box.

Following Joe’s talk, they’ll be ample time for more questions for Joe or both-speakers. We will also pick up some of the questions that have been submitted prior to this call. So with that, I will turn the call over to Jim Daniel. Jim? Great. Thanks. Can you hear me okay? Absolutely. Okay. Can you just remind me about what time I should aim for our question – the initial question period to be aware of? We’re thinking about 25 minutes. Okay, super. That’s the math if that’ll work for you. Okay, thank you. All right. So we’re going to talk about a couple of different things today, both what’s in the current and proposed role for stage three. I know we just heard a little bit about what was in stage one and stage two for meaningful use but then I think I want to spend some time talking about somethings that are a little bit more exciting, what I like to call beyond meaningful use in public health. So we can go onto our first slide. So just to start us all off and level set there is actually a notice of proposed rulemaking out right now the comment period closed last month and that is for the stage three meaningful use program.

Stage three is a little different from the previous stages in that it really seeks to align all of the stages of meaningful use into one single stage. So moving forward starting in 2018 as required and 2017 as optional of the providers are really going to be in the same stage of meaningful use. They’re going to meet the new requirements set forth in stage three. Between now and then, the rest of 2015, 2016and 2017 there’s another notice of proposed rulemaking out from CMS called the modification rule that seeks to make the remaining years of meaningful use align with stage three as well. But again, it’s really trying to get all of the providers on the same timeline, same timeframe and in a way, it makes things easier for public health. There were a lot of differences between stage one, stage two, and the proposed stage three measures. Soit actually helps public health as well because there won’t be different processes that public health will have to support. Next slide. So on the CMS rule side, there are only eight objectives. One of the main goals of the new CMS rule with simplification.

Next Slide

So it’s much simpler, much fewer requirements. So there are currently only eight objectives. You’ll see objective number eight is public health and clinical data registry reporting. Next slide. So within the public health objective, I think a lot of people get concerned because there is only one objective but within that objective, there are actually six measures and the proposal here is that the providers must be in active engagement to submit data to public health except where prohibited by law within these six measures. Eligible professionals must meet three measures and the hospitals must meet four measures. Next slide.

So along with the CMS rule is a new ONC rule for 2015 edition certified technology. So we have decoupled the rules so that this 2015certified technology rule can be applied to other programs besides the meaningful use incentive program. There is a new definition for base EHR products and it’s been redefined a way where there are no optional or required criteria. The developers can choose the criteria that are relevant to their purpose. Next slide. The ONC rule actually calls out the standards for all of the public health measures as well. So I think some of these will look familiar to you. Some of them are actually new. To measure one, immunization registry reporting has actually been in there for both stage one and stage two. There is a new component of it that’s part of the new standard or the new implementation guide that calls for bi-directionality of messaging. So not only do the providers submit their electronic immunization records to the state they also must be able to receive a full history and a forecast back from the IIS.

So that’s a really new and exciting component of what’sin the NPRM on both the CMS side and the ONC side. It’s called out in both the CMS rule, the bi-directionality component, and also within the standard and certification on the rule. Measure two is syndromic surveillance which is probably familiar for everyone as well. The standard here references what hospitals and urgent care facilities should be sent to public health departments. There was nota standard reference for how ambulatory providers would send that data as it was recognized that not that many states are actually accepting ambulatory data at this time. Measure there’s a really exciting new measure that is part of the NPRM for electronic case reporting. So this is a concept where providers are submitting the clinical data that goes along with the lab data that a lab has submitted. Electronic lab reporting has been in there previously but often providers need some additional information that they’re not always getting from the lab. Providers might not always fill out the paper case reports that they’re required to. So this is around getting some of that clinical information around reportable cases to public health.

Health registry reporting

Measure four is a more general objective around public health registry reporting. It includes a measure that was in there previously for reporting to cancer registries along with two new ways to meet this measure which are reporting antibiotic utilization and resistance data to NHSN at a national level and also reporting national health care survey data at a national level to NCHS. So those are two measures that are new and they’re different in the respect that the reporting goes directly to CDC, not to the state. Measure five is also a new measure in stage three around clinical data registry reporting. This is an acknowledgment that some reporting for the good of population health might not always be to a public health agency but there might be non-profits or specialized disease registries set up that providers might want to report to as well. Then measure six is electronic lab reporting which is the hospitals reporting the reportable and notifiable conditions to the appropriate public health jurisdiction that was in there for stage one and stage two as well. So as I said, eligible professionals have to pick three of these.

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