201809 Public Health

Return to Fall 2018 Proposals

DRAFT Public Health (Case Reporting, Registries, and Referrals)

Draft for Fall 2018 FHIR Connectathon proposal review

Submitting WG/Project/Implementer Group

Public Health (PH)

Justification

Public health includes a number of use cases involving the exchange of information between Electronic Health Records in clinical care and governmental Public Health Agencies (PHAs) or other extra-clinical organizations. The use cases can differ, but frequently share a number of common design elements as well. This track will build on the previous public health electronic case reporting (eCR) track to provide a home and critical mass for these use cases as they develop and grow.

Electronic case reporting (eCR) has existing CDA product family standards, had a FHIR "for comment" ballot in January of 2018, and now has a September FHIR STU ballot. This use case will focus on the FHIR subscription dissemination of public health reporting trigger codes in a PlanDefinition construct and also establish a path for distribution of reporting criteria and more complex business logic. It will also involve the triggering and creation of the electronic Initial Case Report (eICR) in EHRs, the messaging and exchange of the eICR, and the creation and transmission of Reportability Response information back to providers of care and clinical care reporters as appropriate. The FHIR electronic Case Reporting implementation guide currently in ballot can be found here: XXXXXX

Public health registry reporting shares numerous design elements with eCR. These elements include knowledge distribution from public health, appropriate triggering in EHRs, the application of more complex inclusion/exclusion and reporting logic, unsolicited push messaging, supplemental data acquisition, and provider information provisioning. The Coverdell stroke registry and others are exploring approaches to implementation that support needed program outcomes from clinical workflow and data and leverage commonalities with other public health reporting.

Bidirectional Services eReferrals (BSeRs) are closed-loop exchanges between EHRs in clinical care and mostly extra-clinical social services and lifestyle change programs. There is a FHIR BSeR September ballot with transactions to support the transmission of a referral and response and update communications from the program back to the referring provider. Numerous Centers for Disease Control and Prevention and other agency programs seek to facilitate cessation and prevention programs to increase health and decrease healthcare costs. Unlike referrals between clinicians, specific data segmentation is appropriate to provide these programs relevant data they need without revealing unrelated patient information. The FHIR Bidirectional Services eReferral specification can be found here: XXXXXX

Proposed Track Lead

• Rick Geimer
• John Loonsk
• Arun Srinivasan

See Connectathon_Track_Lead_Responsibilities

Expected participants

• Association of Public Health Laboratories
• AthenaHealth
• Centers for Disease Control and Prevention
• Cerner Corporation
• CGI Federal
• Epic Corporation
• Lantana Consulting Group
• Northrup Grumman
• YMCAs of America

Roles

Please include information here regarding how much advance preparation will be required if creating a client and/or server.

Public Health

Responsible for managing and disseminating trigger codes, decision logic, and knowledge resources. It fosters disease control and prevention programs and activities.

Public Health Agencies

Agencies that receive and manage electronic Initial Case Reports (eICRs), and at times send and/or receive Reportability Responses. Some Public Health Agencies support lifestyle and social services programs.

Intermediaries

Organizations in the information flow between a health care organization and a public health agency or extra-clinical program. Examples include Health Information Exchanges, the shared platform supported by APHL and CSTE that performs routing, RCKMS decision support and, at times, creates Reportability Responses, etc.

Health Care Organization

An organization that submits electronic Initial Case Reports (eICRs) based on trigger code matches, and receives trigger code updates and Reportability Responses. Health Care Organizations also report to public health registries and initiate referrals to extra-clinical social services programs. The health care organization can be supported by an EHR vendor in these roles.

Social Services and Lifestyle Change Programs

Organizations that provide classes, planning, counseling, and/or expertise in the control and prevention of chronic and acute diseases, tobacco cessation, diabetes prevention and others.

EHR Document / Report Creator

Organization responsible for creating an electronic initial case report (eICR) or another report and sending it to a EHR Document Report Receiver. Examples: EHR vendors and specialty reporting companies.

EHR Document / Report Receiver

Organization responsible for receiving and processing an electronic initial case report (eICR) and registry submissions. Examples: APHL, public health registry, or a public health agency (PHA). The eICR Document Participant may also play the role of a Reportability Response Document Creator.

Reportability Response Creator

Organization responsible for creating a Reportability Response (RR) and sending it to a Reportability Response Document Consumer. Examples: APHL or a public health agency (PHA). The Reportability Response Document Creator may also play the role of an eICR Document Participant.

Reportability Response Consumer

Organization responsible for receiving and processing a Reportability Response (RR). Examples: EHR vendors and specialty reporting companies). The Reportability Response Document Consumer may also play the role of an eICR Document Creator.

Scenarios (Reporting)

Update Trigger Codes / Reporting Logic on Public Health FHIR Server

In this scenario and elsewhere we refer to “trigger codes / reporting logic” which is used to refer to distributable knowledge resources that will be used by clinical care / EHRs to support triggering and reporting. Coordinated through a PlanDefinition, they include value set bundles and other reporting metadata and eventually CQL and other knowledge resources. For some time, the value set bundles may be the only machine processable XML and JSON content, but the additional information provides human processable context and a standards-based wrapper to coordinate these elements.

Action: Public Health determines that the current trigger code value sets / reporting logic require an update. The appropriate value sets are updated using PUT. Also update trigger codes as a Bundle of ValueSet resources referenced by the PlanDefinition so they can be updated as a set and linked to other reporting criteria.

Precondition: Original trigger code value sets / reporting logic exists on test server

Success Criteria: Value sets are successfully updated and can be retrieved on demand with GET