Solano County Health and Social Services
PH Lab HIE project
Linking 4 County PH Labs and linking reports to hospitals
Stephan Betz, Ph.D.
Assistant Director for Operations
Solano County Health and Social Services
March 21, 2013
Solano County Health and Social Services
PH Lab HIE project - Overview
• Link primary care, behavioral health, public health, clinical lab,
public health lab data: ~17,000 current patients
• Regional PH Lab includes Solano, Napa, Yolo, Marin counties.
• 119,962 potential clients of PHP of California in these four counties
• Build HIE while building new PH Lab Information system, using
Mirth Connect, a data channeling system
• Engaged in a partnership with Redwood Mednet to build the HIE
channels.
• Unique opportunity for region wide standardized structured
reporting
Solano County Health and Social Services
PH Lab HIE project
Purpose:
Share developments of Public Health Lab Information System in
3-4 counties
Kick off a process to receive input for standardized reporting
Solano County Health and Social Services
PH Lab HIE project – Why bother?
PH Lab data allow providers to:
• Share communicable disease reports
• Receive lab results electronically in the provider’s EHR as
part of the HITECH Meaningful Use Initiative Phase 2
• Standardize structured reporting (Ron Chapman’s second
day at work)
Solano County Health and Social Services
PH Lab HIE project - Plan
• Link County Nextgen system to PH Lab IMS “Advanced Business
Software”
• Link PH Lab to other Nextgen users: Community Clinics
• Link PH Lab to Marin clinics using Centricity
• Meet Meaningful Use Stage 2 criteria
• Lessons Learned: Keep field and messaging definitions broad and
general, use content to dynamically transmit information
Solano County Health and Social Services
PH Lab HIE project – Plan more
• Get input from communities of interest: Providers, patients, Care
Coordinators, Other County Labs, County Health Officers
• Develop scenarios in partnership with key stakeholders
• Develop functional requirements in partnership with key
stakeholders
• Develop message content requirements in partnership with key
stakeholders
Solano County Health and Social Services
PH Lab HIE project – Status
• Design Jan – May 2013
• Test June – July 2013
• Go Live July 2013
Solano County Health and Social Services
PH Lab HIE project – Potential Components
ABC
PHIMS
Solano County Health and Social Services
PH Lab HIE project – Current Design Steps
Develop a substantial roadmap document resulting in
Standardized Structured Data
Produce a planning document that specifies PH Lab
reporting
Work with Nextgen EHR Connect on linking to the
bundled interface to achieve a 60% discount
Focus on infection report and analysis
Test, then re-test, then test again
Solano County Health and Social Services
PH Lab HIE project – Challenges
Implementation guides not adopted
Format “Forest”
Cost and time for broad adoption too high
Customization of interfaces is common creating a need for
configuration per interface,
Composition of core subsets varies -> issues in decision support and
quality reporting.
Result-reporting formats must conform to CLIA regulation (42 CFR
493.1291(c)) creating data format rigidity
Meaningful Use doesn't provide incentives to change practices.
No compelling ROI
Solano County Health and Social Services
HIE project - Components
• e-Prescribing to improve medication reconciliation at local acute care facilities
• Electronic Labs -- Clinic laboratories receive electronic orders from or deliver
electronic test results into certified EHRs at clinics
• Public health laboratory receives electronic orders and posts electronic test
results to clinics (present) and local hospitals (future)
• Care Transition Messaging -- Eligible providers receive care summaries for
their patients from specialty care (present) and local hospitals (future); Eligible
providers push patient care summaries to other systems via Mirth Connect;
• IZ Reporting -- Submit immunization reports to the California Immunization
Registry (CAIR) (Future)
• DiSTRIBuTE -- Enable hospitals to publish daily syndromic surveillance signals
to CDC / Public Health (future)
Solano County Health and Social Services
HIE project – Data Fields
Demographics
PMISC1
PMISC2
Address line 1 Guarantor Demographics: Name, DOB, Address,
Address line 2 Phone (if different from patient)
City
Insurance Company
State
Referral Number
Policy Number
Zip Code
Group Number
County
Relationship to Patient
Country
Card Holder’s Demographics: Name, DOB, Address,
Phone number City, State, Zip Code, Phone
Patient’s ID 1 Policy Begin Date
Patient’s ID 2 Policy End Date
Solano County Health and Social Services
HIE project – Data Fields
Specimen Collection Date Diagnosis, Analysis, Report, Alerts
Specimen Collection Time
Submitter Name (Hospital / clinic)
Specimen Source/Container
Specimen Information (for specimens Specimen Receive Date
Specimen Receive Time
in series such as TB)
Status Code
Submitter Specimen Number
Bill To
Submitter Medical Record Number
Copy to (for Public Health
Diagnosis Code
notifications)
Reason for Testing
Ordering Physician
License Number
2216
Solano County Health and Social Services
486
MYCOBACTERIUM CULTURE
PH Lab HIE project – Reporting Data
483
MYCOBACTERIUM MICROSCOPIC
156
T-SPOT.TB
152
NEISSERIA GONORRHOEAE PROBE-TEC
152
CHLAMYDIA TRACHOMATIS PROBE-TEC
150
QUANTIFERON-TB GOLD
104
SERUM RPR QUALITATIVE
98
NITRATE CHEMISTRY TESTING
91
HIV EIA SERUM
90
MYCOLOGY CULTURE FOR IDENTIFICATION
87
HIV 1 EIA ORAL FLUID
80
VIRUS PCR TESTING
76
MICROSCOPIC EXAMINATION - GCS
BLOOD LEAD LEVEL
42.0%
9.2%
9.2%
3.0%
2.9%
2.9%
2.8%
2.0%
1.9%
1.7%
1.7%
1.7%
1.5%
1.4%
Solano County Health and Social Services
PH Lab HIE project – Reporting Flow
Lab Results Interface
Solano County Health and Social Services
PH Lab HIE project – Data Flow
Note: Provider and
Laboratory use their
own systems to pull
up reports and
requests.
Solano County Health and Social Services
PH Lab HIE project
Questions?
Linking 4 County PH Labs and linking reports to hospitals
Stephan Betz, Ph.D.
sjbetz@solanocounty.com