Centers for Disease Control and Prevention
(CDC)
Electronic Public Health Data Exchange:
Right Time, Right Place
Presenter: John Eichwald, MA
March 4, 2013
CDC Programs Represented Today
Meaningful Use Public Health Technical Assistance
Public Health Reporting Initiative
Cancer Registries
Early Hearing Detection and Intervention
Vital Records
Immunization Information Systems
PHIN Vocabulary Services
National Healthcare Safety Network
Public Health Clinical Decision Support
Supporting Meaningful Use Implementation by CDC
Programs and Jurisdictional Public Health Agencies
Meaningful Use Public Health Technical Assistance (TA) Team
Team’s Purpose and Goals
Assist in resolving issues and problems preventing successful achievement
of the Meaningful Use public health objectives
 Provide focused policy and technical expertise
 Identify successful methods used to resolve similar issues
 Rapidly resolve misunderstandings and simple problems
 Document and learn from the real problems occurring the field
MU TA Team Support:
Request Statistics
Technical Assistance Requests
Categories
Technical Assistance Request
Totals
Immunization
Technical Assistance
Requests
26%
#
%
Requests received via the
Meaningful Use Mailbox
117
64 %
Requests received via
HITRC’s Burning Issues
Workgroup
10
5%
Requests received via other
channels
56
Total Requests
183
Total Closed
175
96 %
8
4%
Total Open (In Process)
26%
Reportable Lab Results
Syndromic Surveillance
4%
Cancer
14%
2%
Multiple Public Health
Measures
meaningfuluse@cdc.gov
31 %
28%
Technical Assistance Requests Categories
Categories
#
%
SS
52
28%
Other (Transport, Policy,
General, etc.)
47
26%
IIS
47
26%
ELR
26
14%
ALL
8
4%
CANCER
3
2%
Total
183
Other (Transport,
Policy, General, etc.)
Supporting Harmonization of Electronic Data Exchange
through the Public Health Reporting Initiative (PHRI)
In 2012 CDC actively participated in the Office of National Coordinator (ONC)
Standard and Interoperability (S&I) PHRI.
PHRI Goal : Harmonize HIT standards and implementation guides for
interoperable communication between clinical care and public health for public
health reporting

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Minimize unnecessary modification of EHRs and their certification by harmonizing
with other ONC-certification criteria and other S&I Framework activities
Develop implementation guides to maximize future extensibility and re-usability for
multiple public health domains
Minimize impact on established Stage 1 MU public health reporting objectives while
potentially simplifying such reporting in the future
Develop implementation guides while accounting for the needs of subsequent interjurisdictional communication (e.g., transfer of cases between jurisdictions and
national notification requirements) and population-level reporting.
Facilitate future certification of public health information systems that are
interoperable with ONC-certified EHRs
2012 PHRI: Processes and Results
Step
Functional
Requirements
Analysis
Data
Harmonization
and Modeling
Harmonizing
Data Exchange
Implementation
Guides
Description
• Document implementation requirements
per Domain / User Stories
• Collect User Story Data Elements
• Achieve consensus regarding common
core data elements across user story
domains
• Update Federal Health Architecture Data
Model with inclusion of classes for public
health
• Access the structure and content of the
Consolidated Clinical Data Architecture
(C-CDA) Implementation Guide (IG)
• Reconcile PHRI common core data
elements with C-CDA and 2009 HL7
Public Health Case Reporting IG
Outputs/Artifacts
Documented functional
requirements, including
data classes
Public Health Data
Harmonization Profile
PHRI C-CDA library of
templates
The US Requires Reporting of Cancer to the
National Cancer Programs
Time
Period
Number
of New
Registries
1930
2
1940
2
1960
6
1970
14
1980
14
19901995
5
19962000
8
2001+
2
From: NAACCR CINA:
2001-2005
Cancer Program Accomplishments

Electronic Health Record (EHR) reporting to central
cancer registries (CCRs)
 Cancer Reporting is a new menu item for Eligible Professionals
(EPs) for Meaningful Use (MU) Stage 2 (2014 implementation)
 Development of Implementation Guide for Ambulatory
Healthcare Provider Reporting to Central Cancer Registries
(“Cancer IG”), based on IHE Physician Reporting to a Public
Health Repository – Cancer Registry (PRPH-Ca)
 Two Comparative Effectiveness Research (CER) projects pilot
testing provider EHR cancer reporting (KY and MO)

Electronic pathology reporting (ePath) to CCRs
 Based on IHE Anatomic Pathology Reporting to Public Health –
Cancer Registry (ARPH) profile
 42 states are live with ePath reporting
 7 anatomic pathology laboratories reporting to CCRs
 30 states use eMaRC Plus, CDC-developed software tool, for
receiving and processing ePath reports
Cancer and Meaningful Use

CMS Meaningful Use Stage 2 Final Rule, August 2012:

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ONC 2014 Edition EHR Certification Criteria Final Rule:
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“Capability to identify and report cancer cases to a State
cancer registry “
Requires use of Implementation Guide for Ambulatory Healthcare
Provider Reporting to Central Cancer Registries (“Cancer IG”) for
EHRs to create and transmit cancer reports to cancer registries
Change proposal approved in December 2012 to align
IHE PRPH-Ca profile with the Cancer IG. Both use HL7
Clinical Document Architecture (CDA).
CDC-developed software tool, eMaRC Plus, is freely
available to all states for receiving and processing
CDA reports
Sets stage for other public health (case) reporting
For more information, please contact the Meaningful
Use Public Health Technical Assistance Team
Early Hearing Detection and Intervention
Information System (EHDI-IS)
• CDC’s EHDI Team, as part of the National Center on Birth Defects and
Developmental Disabilities , supports state and territorial EHDI programs
working to advance surveillance capability and interoperable data
systems.
• Newborn screening can potentially capture the entire newborn
population, providing one of the first meaningful interoperability
opportunities in an individual’s healthcare lifespan
• EHDI provides an opportunity to establish bi-directional information
exchange between clinical care and public health in a relatively simple
and feasible way
EHDI Standards-based Information Exchange
IHE Early Hearing
Care Plan
HL7 (EHCP)
CDA R2
Labor & Delivery
HL7 v2
IHE Newborn Admission
Notification Information
(NANI)
Medical Home
IHE EHDI
Cross-enterprise
Care
Workflow
Tasks
Document
State EHDI Program
Specialist
&
States
Newborn Screening
HL7 v2
HL7 EHDI Messaging Data
Standard Trial Use (DSTU)
HL7 HQMF
IHE
Quality Measure
Execution
(QME-EH)
HL7
QRDA
e-Measure
Definition
CQM EHDI
Clinical Quality Measure
(CMS 31v1/NQF 1354)
Federal Reporting
Care Theme: Maternal & Newborn Health
Vital Registration and Care Coordination
for Newborn Hearing Screening
Us Case 5
Interoperability Showcase
In collaboration with IHE
Use Case 16
Electronic Health Record (EHR) and Vital
Record (VR) Systems Information Exchange
•
Background
– The National Vital Statistics System (NVSS) provides essential data on all U.S. births
and deaths
• Over six million vital events are reported annually
• Information collected includes a wide range of demographic, medical, and geographic
data derived from 4 million birth certificates and from about 2.4 million death certificates
and fetal death reports
• Events are registered by 57 registration areas: 50 states, 2 cities, and 5 U.S. territories
• Vital statistics data are widely used to monitor and improve the nation’s health, e.g.,
track and explain trends in cesarean delivery, preterm and low birth weight births, causes
of infant death and disparities in health among populations groups
– Detailed data on all events are transmitted to the Center for Disease Control and
Prevention’s (CDC) National Center for Health Statistics (NCHS)
• Much of the information collected for birth and death certificates and fetal death reports
are captured in hospital medical records
• Vital statistics and standards communities have collaborated to build upon more than a
century’s effort in standardization to encourage EHRs to capture medical and health
information in a format consistent with the vital statistics requirements
GOAL is to improve the timeliness, accuracy, and completeness of vital records data
Capturing birth and death data in
electronic health record systems
Improving the timeliness, accuracy, and
completeness of vital records data
Electronic exchange
using HL7
and IHE-based
standards
Document
Transaction
Status
HL7 Version 3 Domain Analysis Model: Vital Records,
Release 1 (R1)
Domain Analysis Model
Published and freely available during
pilot period that began February 2012
HL7 EHR-System Functional Model (EHR-S FM) Vital
Records Functional Profile, R1
EHR-S Functional Profile
Published and freely available during
pilot period that began February 2012
HL7 EHR-S FM Public Health Functional Profile R1
EHR-S Functional Profile
Published and freely available during
pilot period that began February 2012
HL7 Version 2.5.1 Implementation Guide (IG): Vital Records
Death Reporting, R1 –Draft Standard for Trial Use (DSTU)
Death related information from a clinical setting to the
vital records electronic registration system
Available for download and comments
on the HL7 DSTU Commenting Site
HL7 Version 3 CDA R2 IG: Reporting Death Information
from the EHR to Vital Records, R1 (DSTU)
Death related information from a clinical setting to the
vital records electronic registration system
Balloted in HL7 May 2012 ballot cycle.
Goal to publish as DSTU in early 2013
HL7 Version 2.51 IG: Reporting Birth & Fetal Death
Information from the EHR to Vital Records, R1 (DSTU)
Live birth and fetal death related information from a
clinical setting to the vital records electronic
registration system
Balloted in HL7 Jan. 2012 ballot cycle.
Goal to publish as DSTU in early 2013
HL7 Version 3 CDA R2 IG: Reporting Birth & Fetal Death
Information from the EHR to Vital Records R1 (DSTU)
Live birth and fetal death related information from a
clinical setting to the vital records electronic
registration system
Balloted in HL7 Sept. 2012 ballot
cycle. Goal to publish as DSTU in
early 2013
Integrating the Healthcare Enterprise (IHE) Birth and Fetal
Death Reporting (BFDR) Content Profile
Defines the EHR content that may be used to prepopulate and transmit birth and fetal death
information to vital records systems for vital
registration purposes
IHE published for trial implementation
August 2012
Defines the EHR content that may be used to prepopulate and transmit death information to vital
records systems for vital registration purposes
Under development. Goal to publish
by fall 2013
Integrating the Healthcare Enterprise (IHE) Vital Records
Death Reporting (VRDR) Content Profile
Thank You!!!!!
Special thanks to those who collaborated with us
during the IHE 2013 Connectathon interoperability
testing to support the Vital Records and EHDI
standards development work
Immunization Interoperability:
2012 Successes Indicators

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CDC provided funding to eligible state/city/local Immunization Information
Systems (IIS) to enhance EHR-IIS interoperability using HL7
96% of IIS or their designee are now able to send and receive HL7 2.3.1
and/or HL7 2.5.1 messages
Simple Object Access Protocol (SOAP) web services for immunization data
transport according to CDC Expert Panel’s recommended Web Services
Definition Language (WSDL) implemented by more than 43% of IIS
Published HL7 Version 2.5.1 Implementation Guide for Immunization
Messages, Release 1.4
 Worked with NIST to develop certification testing for MU2 based on the
Implementation Guide
 New effort to use MU2 testing with IIS to improve conformance
Immunization Interoperability: 2012
Successes Indicators (cont.)


Release of 2D Barcode on Vaccines and Vaccine Information
Statements (VIS)
 Pilot testing underway in 10 states and ~220 provider sites
 2D Barcoded Vaccines
• Current: Havrix, Pediatric DT, Menactra, Adacel, Fluzone, IPOL
• Release Soon: Daptacel, Tenivac, Pentacel
 12/25 VIS have 2D barcodes: edition date & type of VIS
CDSi (Clinical Decision Support for Immunizations)
 Released Logic Specification – computable and consistent
representation of childhood vaccine recommendations and schedules
 Resources include logic tables, business rules, supporting data
 For use in clinical EMR and IIS
Vocabulary Access and Distribution System
(VADS): A Web-Based PH Enterprise
Vocabulary System
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In 2004, CDC developed a web-based enterprise vocabulary system called the Public
Health Information Network Vocabulary Access and Distribution System (PHIN VADS) for
accessing, searching, and distributing HL7 messaging value sets used within the PHIN
and NHIN.
Provides all the vocabulary metadata needed for HL7 messaging.
Promotes sharing and reusing of the value sets.
Hosts multiple versions of value sets that allow implementers to have access to the
current, past and the future versions of value sets and value set collections
Provides web services (API) that allows HL7 interface engines, medical and public health
applications to obtain the value sets as well as validate the vocabulary present in HL7
messages.
Provides detailed code system metadata for value set concepts such as context,
hierarchy, synonyms and alternate codes. This will facilitate the implementation of value
sets and improve the quality of local vocabulary mapping to standards.
PHIN VADS can be accessed at a public web site - http://phinvads.cdc.gov
CDC Vocabulary and Messaging team manages the PHIN VADS.
VADS: Developing a Sustainable
Approach for Supporting Partners
Electronic Reporting to the National Healthcare
Safety Network (NHSN) via Clinical Document
Architecture (CDA)
NHSN and CDA Capability
• Currently accepting CDA files for:
 Central line associated bloodstream infection (CLABSI)
 Catheter associated urinary tract infection (CAUTI)
 Surgical site infection (SSI)
 Multi-drug Resistant Organism and C. dfficile laboratory
identified (LabID) events
 Central line insertion practices (CLIP)
 Dialysis events
 Antimicrobial use
• Approximately 500 hospitals are reporting to NHSN via CDA – over
5000 hospitals report to NHSN
Public Health Clinical Decision Support (CDS)

Decision Support
 Providing public health alerts/guidelines to providers in EHR
systems
• GE, Alliance of Chicago & Lehigh Valley
 Working with CDC programs to deliver public health information at
the point of care for screening, diagnostic evaluation, treatment &
education
• HIV/STD & Million Hearts programs

CDS Partnerships
 CDS Consortium, Federal CDS Collaboratory, ONC Health
eDecisions S&I Initiative

Development of Geospatial Community Health Record
 Engaging HD in Memphis & Methodist Le Bonheur Hospital
Dashboard of health indicators e.g. obesity, heart disease & stroke
 Working with Million Hearts program & others in OSELS
Managing Emerging Events:
Public Health EHR Alerting Flow
FB Outbreak
Identified
States/CDC
monitoring
public health
discover
foodborne
outbreak
FB Message
Created
Symptoms
Locations
Event Information
Guidance e.g.
Consumption history
message sits on a
standalone
knowledge
repository
Visit the CDC Public Health Use Case
Interoperability Demonstrations
Use Case #3 – Biosurveillance Monitoring and Detection:
“Updating and Leveraging National Healthcare Registries
in Care Delivery”
Use Case #4: Immunizations Registry Updating and Utilization
- “Updating and Leveraging National Healthcare
Registries in Care Delivery”
Use Case #7 – “Cancer Care Coordination and Ambulatory
Care Reporting to a Central Cancer Registry”
Use Case #16: Maternal & Newborn Health – “Birth Event
Reporting and Care Coordination for Newborn Hearing
Screening”
Us Case 5
Interoperability Showcase
In collaboration with IHE
Thank You
Contacts:
• CDC Standards & Interoperability: Nikolay Lipskiy, NLipskiy@cdc.gov
• Cancer Reporting: Wendy Blumenthal, WBlumenthal@cdc.gov
• Early Hearing Detection and Intervention: John Eichwald,
JEichwald@cdc.gov
• Vital Records Standards: Michelle Williamson, MWilliamson@cdc.gov
• Immunization Information Systems: Warren Williams, WWilliams1@cdc.gov
• PHIN VADS: Roochi Sharma, RSharma@cdc.gov
• Email: phinvs@cdc.gov
• Online Forum: http://www.phconnect.org/group/phinvads
• National Healthcare Safety Network: Daniel Pollock, DPollock@cdc.gov
• Clinical Decision Support: Nedra Garrett, NGarrett@cdc.gov
For more CDC information please contact
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: www.atsdr.cdc.gov
The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the
views of the Centers for Disease Control and Prevention