July 14, 2010
2 p.m. - 3 p.m.
- Mary Driscoll, Illinois Department of Public Health (IDPH)
- Peter Eckart, Illinois Public Health Institute (IPHI)
- Mike Jones, Illinois Department of Healthcare and Family Services
- Bala Hota, MD, Stroger Hospital
- Jessica Ledesma, IDPH
- Miriam Link-Mullison, Jackson County Health Department
- Jill Snider, Chicago Department of Public Health
- Jeffrey Swim, DuPage County Health Department Office of Health Information
- Mark Chudzinski
- Krysta Heaney
Mary Driscoll opened the call at 10 a.m.
Bala Hota began the call with a summary of the Core Public Health Requirements for Interoperability Subcommittee call. Bala acknowledged that the Technical Infrastructure subcommittee has a unique opportunity to provide guidance and technical expertise to the HIE effort; suggesting the subcommittee consider preparing a white paper that addresses public health data needs from a technical perspective and identifies the key public health standards for how data is managed and stored.
As an initial starting point, Bala proposed generating a list of standards already in existence and evaluate how those standards are used, what additional standards should be included, and how to proceed. Bala provided the following list:
- Mapping of test results for micro and lab data using SNOMED and LOINC codes. There is inclusion of SNOMED as a standard in the meaningful use objectives.
- LOINC: the name of a test
- SNOMED: the name of the concept
- Source of a test
- HL7 source codes
- ICD9 codes (ICD10 conversion)
- HAI surveillance. Standardization depends on what agency the data is reported to, e.g., CDC, DHQP, which uses a subset of SNOMED and LOINC codes.
- PHIN VADS (Public Health Information Network Vocabulary Access and Distribution System) has messaging guides.
Mike Jones mentioned that the group be cognizant of how standards evolve over time (e.g., the conversion to ICD10) and allow for enough flexibility in the group's recommendations to address upgrades and shifts to emerging standards.
Bala asked if there was a discussion at the state level for utilizing DRG versus lab data as the way of measuring healthcare associated events. Bala posed the question of whether ICD9/10 and DRGS or other data sources will be used in the future – citing a limitation of administrative data as being relatively specific but not sensitive.
Mary indicated other data sources/elements would be very beneficial for measuring quality, especially if it were possible to link that data to get more granular information. HFS and IDPH are both in the process of implementing activities/programs that will become operational before the HIE is, therefore, there are current limitations in adopting new measures. However, Mary did provide an example of future IDPH adverse events data collection that will not utilize administrative data.
Bala mentioned that not only will standards evolve over time, but the availability of data may also change the way we measure.
Jill Snider asked about what other states are doing regarding data standardization, and suggested reaching out to New York, which appears to be ahead of the game on standards and public health, for lessons learned and best practices. Jill will distribute a recent article on HIE in New York to the group. Bala asked if the group had any contacts in New York. Mary shared that IDPH had previously reached out to New York regarding the hospital report card.
Mary asked for clarification on "standardization" in clinical terms, and how that gets translated into the technical infrastructure. Bala explained that even for hospitals with the same EHR system (e.g., Cook County and UIC), the way in which the data is stored is different. Codes for one particular site cannot be replicated at another site for various reasons including differently named tests and different data models. In his current project, and what would be needed in an HIE environment to aggregate data is a middle layer of software. It would be ideal, if within a single vendor there was no need for this middle layer. At the HIE level, there should be one data model, so rather than giving a flow chart of rules to an individual hospital that will ultimately be modified, you could develop rule engines.
We should insist that vendors build certain standards into their system to control how the data is structured. Rather than developing data models and implementing them on a site-to-site basis, vendors have the scale to accomplish this task and implement across all sites; mentioning that this is, area where federal involvement would be beneficial. Mike indicated this may be a function of how the software becomes certified.
Mary asked what the state is doing in terms of guiding vendor requirements.
Mark Chudzinski suggested this subcommittee coordinate its activities with the Technology and Interoperability Work Group. Mary nominated Bala to serve, time permitting, as the public health liaison to that work group.
Bala asked about the function for reporting various work group recommendations to the ILHIE Advisory Committee. Krysta Heaney indicated that these timelines will become clearer as OHIT completes the process of identifying the milestones and timelines for its Strategic and Operational Plan to be submitted on July 31st to the Office of the National Coordinator.
Mark shared that another anticipated function of the work group is to serve as a forum for reaching agreement within state and local levels of public health agencies. Mike indicated this presents an opportunity to implement part of the State Health Improvement Plan.
Jeff Swim raised the question of legacy systems such as Cornerstone and how the groups' recommendations and the larger HIE effort plans to provide technical guidance and specificity for sending and accessing data to and from existing systems.
Bala opened the call to comments and modifications to the four tasks charged to this subcommittee in the Public Health Work Group Work Plan.
Consensus was reached on the first two tasks, analyze and make recommendations to HIE technical infrastructure and operational plans for the purposes of determining existing HIE elements that will also support population health uses, and provide technical guidance to HIE architects to support sending data to, and accessing data from, existing public health data systems.
The group added and the use of national standards to the third task, identify questions for OHIT to ask vendors regarding interoperability and …
Because public health needs access to granular data the group modified the fourth task as follows, Coordinate with state-level, local-level, and enterprise HIE efforts to support, or replace, existing public health reporting systems and provide comprehensive access, including secure access for public health functions at the patient level, where necessary, and HIPAA-compliant and other federal and state approved population data extract.
The group also reached consensus that the subcommittee will provide its recommendations to the ILHIE Advisory Committee in the form of a white paper. The group will initially meet every two weeks until migrating to a monthly meeting schedule.
The next meeting was scheduled for Wednesday, July 28th from 2 - 3 p.m.
Meeting adjourned at 3 p.m.