Discussion: Advanced Analysis of Community Health Data and Surveillance in Public Health

Discussion: Advanced Analysis of Community Health Data and Surveillance in Public Health ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Advanced Analysis of Community Health Data and Surveillance in Public Health Important notes to take into consideration: Discussion: Advanced Analysis of Community Health Data and Surveillance in Public Health I need tutor that have experience in the following domain (Advanced Analysis of Community Health Data and Surveillance in Public Health) The tutor must review the data set, and select the research topic based on the chosen data set variables Identifying the appropriate dataset to answer your question may pose more challenges than just access to the source. After developing your research question, the first challenge is to find a dataset with enough information to answer that question, even though the dataset might originally have been designed to answer a different question. Working with secondary data will require a judicious analysis of its content, design methods, and validity in order to determine whether it will suit your research needs. Discussion: Advanced Analysis of Community Health Data and Surveillance in Public Health This week, you will select a topic that you would like to research using one or more of the provided data sets. To prepare: Review this week’s Learning Resources. Review the data sets (located in this week’s Learning Resources), , and the Checklist included in the syllabus. Select the data sets provided in this week’s Learning Resources for your Scholar-Practitioner Project. After reviewing the data set, select the research topic of your project submit a 1- to 2-page paper that includes the following: An introduction/problem statement on the importance of your research topic as a public health issue. Support your response, with a limited review of the current literature (3–5 references). Translate your research topic into research question(s). Use of APA formatting for your paper and citations for your resources . new_compressed__zipped__folder.zip phissuebrief04_24_14.pdf usw1_pubh_8545_week01_publichealthinformatics.pdf new_compressed__zipped__folder__2_.zip Issue Brief: Health IT for Public Health Reporting and Information Systems Date: April 29, 2014 Author: Lauren Wu, Office of Policy and Planning, ONC Acknowledgements: Rachel Abbey, Office of State and Community Programs, ONC James Daniel, Office of Provider Adoption and Support, ONC Jodi Daniel, Office of Policy and Planning, ONC Dawn Heisey-Grove, Office of Economic Analysis, Evaluation, and Modeling, ONC Michelle Murray, Office of Policy and Planning, ONC Steven Posnack, Office of Policy and Planning, ONC Table of Contents What’s the Issue? ………………………………………………………………………………….. 3 What Has Happened So Far? ………………………………………………………………….. 4 Public Health Reporting Medicare and Medicaid EHR Incentive Programs Meaningful Use Public Health Measures Meaningful Use for Public Health Data Collection Standardization of Public Health Reporting What Are the Opportunities? ………………………………………………………………….. 8 Implementation of Standards for Public Health Reporting Collaboration Between Public Health and Health Information Exchanges Emerging Standards Can be Leveraged for Population Health and to Address Disparities Medicaid 90/10 Funding Opportunities for Public Health Infrastructure Health Information Technology for Public Health Preparedness and Situational Awareness What Are the Concerns? ………………………………………………………………………. 14 Resources for Public Health Reporting Infrastructure What’s Next? ……………………………………………………………………………………….. 14 ONC Issue Brief: Public Health Reporting and Information Systems 2 What’s the Issue? Public health agencies collect health information to prevent and contain outbreaks, analyze population health trends, and educate and promote healthy choices for populations. Discussion: Advanced Analysis of Community Health Data and Surveillance in Public Health For example, public health agencies track immunizations and cases of infectious diseases. With an aging population and increase in noninfectious diseases, public health agencies have also started collecting information on cancers and other chronic diseases. Traditionally, health care providers report to public health agencies periodically using paper or through electronic means to specialty registries or systems. Health care providers are also typically required by local, state, or federal law to report certain public health data and conditions. Public health reporting incentives in the Medicare and Medicaid EHR Incentive Programs (“meaningful use”) are spurring development of public health infrastructure and its use of health information technology (health IT). This development enables the public health infrastructure to receive data from electronic health records (EHRs), is increasing partnerships between health information exchanges (HIEs) and public health, and is fostering development of standards for public health reporting. With the increased EHR adoption, public health data can now be more rapidly reported to public health agencies. This public health data can also be formatted in standardized ways and sent using commonly accepted content standards, reducing the amount of translation and need for system updates in order to accept the information. This issue brief describes electronic public health reporting progress and discusses opportunities to further improve public health reporting and information systems. ONC Issue Brief: Public Health Reporting and Information Systems 3 What Has Happened So Far? Public Health Reporting Figure 1 below demonstrates the stages of maturity in public health reporting. The goal is to move to seamless, real-time or near-real-time bidirectional exchange of data. Figure 1: Public Health Reporting: From Paper Records to Bidirectional Data Exchange Paper Reporting Data are recorded on paper. Providers report to the local or state public health agency through paper batch reports. This may require manual data abstraction from paper medical records. Paper reporting is commonly used for lab reporting to public health agencies. Discussion: Advanced Analysis of Community Health Data and Surveillance in Public Health Unidirectional Electronic Reporting Health care providers report data electronically directly to specialty registries or systems. In cancer and syndromic surveillance reporting, health care providers record data in a patient’s EHR. The EHR electronically transmits data to the local or state public health agency. Bidirectional Data Exchange Using common data content and transport standards, data are sent between EHRs and specialty registries or systems on a near-real-time basis. This allows for the most complete and up-to-date record possible. A few states have this capability for immunization information exchange between EHRs and immunization information systems. Medicare and Medicaid EHR Incentive Programs As of data available through May 2013, over half of eligible health providers and nearly 80% of hospitals are using EHRs to improve health care in the U.S. These improvements were driven by the American Recovery and Reinvestment Act’s (ARRA) Health Information Technology for Economic and Clinical Health (HITECH) provisions, which authorized incentives for health care providers if they demonstrate “meaningful use” of certified EHR technology. The Medicare and Medicaid EHR Incentive Programs are administered by the Centers for Medicare & Medicaid Services (CMS). CMS establishes the measures on which eligible providers and hospitals must report to demonstrate meaningful use, and works with the Office of the National Coordinator for Health Information Technology (ONC) to establish the technical requirements for EHR technology. ONC Issue Brief: Public Health Reporting and Information Systems 4 Meaningful Use Public Health Measures The goal of Stage 1 of meaningful use of EHRs is to capture and share data before moving on to advancing clinical processes and improving outcomes in later stages. Both eligible providers and eligible hospitals have the option to choose from a menu of objectives, including reporting immunization information and syndromic surveillance data to the appropriate public health agency; eligible hospitals also have the option to report electronic lab results. Figure 2: Meaningful Use Stages 1 and 2 Public Health Measures Stage 1 Core Menu EP, EH/CAH EH/CAH Stage 2 Core Immunization information EP, EH/CAH Electronic laboratory EH/CAH results Syndromic surveillance EP, EH/CAH EH/CAH Cancer registries Specialized registries EP = eligible provider, EH = eligible hospital, CAH = critical access hospital Notes: Core = required; Menu = optional Menu EP EP EP Some of the earliest participants in the Stage 1 program advanced to Stage 2 in 2014. As shown in Figure 2, eligible hospitals are required to submit syndromic surveillance, electronic lab results, and immunization data to public health agencies in Stage 2. Eligible providers are required to report immunization data. Eligible providers also have the option to choose from a menu of additional objectives including reporting to cancer registries, specialized registries (e.g., birth defects registries, chronic disease registries, traumatic injury registries), and syndromic surveillance. Many of the public health measures become core (required) in Stage 2, which will lead to more providers and hospitals submitting data to public health agencies.Discussion: Advanced Analysis of Community Health Data and Surveillance in Public Health The meaningful use programs require the use of “Certified EHR Technology” as defined by the ONC through its standards and certification criteria. EHR technology certified to perform public health reporting functions require adherence and testing to nationally recognized standards and associated implementation guides. Toward that end, the public health community has made significant progress toward systems that reduce variability and improve the quality of the data collected. Meaningful Use for Public Health Data Collection As described in the following examples, meaningful use is increasing the volume of electronic public health reporting. Eligible providers and hospitals attest to meeting meaningful use objectives to CMS. Since the beginning of the meaningful use program in 2011 through data available for February 2014, 40% of eligible providers have chosen to submit immunization data to registries. Six percent of eligible providers have chosen to submit syndromic surveillance data to public health agencies. Based on data available through November 2013 for eligible hospitals, 54% have submitted data ONC Issue Brief: Public Health Reporting and Information Systems 5 to immunization registries, 20% have submitted syndromic surveillance data, and 15% have submitted lab results to public health agencies. 1 With many of the public health objectives becoming required in Stage 2 beginning in 2014, more and more providers and hospitals will submit electronic data to public health agencies. Figure 3 shows that across the country, hospitals have already made great progress in electronically sending public health data. Figure 3: In 2005, only eight states had the ability to electronically report laboratory results. This has increased to 48 states as of January 2014. 2 Also noted in January 2014: • Sixty-two percent of the total volume of lab reports were sent electronically and 54% of targeted labs were sending lab reports electronically. 1 Medicare & Medicaid EHR Incentive Programs. Presentations given to the Health IT Policy Committee on April 8, 2014. http://www.cms.gov/Regulations-Discussion: Advanced Analysis of Community Health Data and Surveillance in Public Health andGuidance/Legislation/EHRIncentivePrograms/Downloads/HITPC_April2014_Full_Deck.pdf 2 Electronic Laboratory Reporting Updates and Strategic Discussion ONC-CDC. CDC presentation at ONC Annual Meeting on January 25, 2014. ONC Issue Brief: Public Health Reporting and Information Systems 6 • • Thirteen states and one city were sending over 75% of their total volume of lab reports electronically, and 17 states and one city were sending 50-75% of their total volume of lab reports electronically. HIV, lead/toxic, and STD electronic lab reports were the disease categories with the greatest number of lab reports, each area with over 2.5 million reports sent electronically in a 12month period. 3 The last six months of 2012 saw a 68% increase in the number of hospital labs meaningfully using electronic lab reporting. Twenty Centers for Disease Control and Prevention (CDC) grantees have been awarded ARRA funds to support enhanced interoperability of EHRs with immunization information systems (IIS). Due to this funding, a number of grantees have increased their support for standardized transmissions. For example, there has been an increase in the number of grantees able to support the HL7 messaging format required to achieve meaningful use. Over 380 grantee sites, including over 1,800 providers, have enhanced their systems to IIS-EHR bidirectional data exchange. 4 Through these and other related efforts related to meaningful use, 46 public health jurisdictions are capable of receiving immunization data. 5 The BioSense 2.0 program pulls together information on emergency department visits and hospitalizations from multiple sources, including the Department of Veterans Affairs, the Department of Defense, and civilian hospitals from around the country. The BioSense program works with state or local health departments that have agreed to share data from their own emergency department monitoring systems to collect data from civilian hospitals. Analysis of these data provides insight into the health of communities and the country. Such data are vital to guide decision making and actions by public health agencies at local, regional, and national levels. Today, 47 public health jurisdictions are capable of receiving syndromic surveillance data. Discussion: Advanced Analysis of Community Health Data and Surveillance in Public Health 6 A public tool developed by the American Public Health Laboratories lists the public health readiness of health departments across the country for receiving immunization, syndromic surveillance, reportable lab results, cancer registry, and specialized registry data. 3 Electronic Laboratory Reporting Updates and Strategic Discussion ONC-CDC. CDC presentation at ONC Annual Meeting on January 25, 2014. 4 EHR-IIS Interoperability: Progress to Date and Preliminary Outcomes. CDC presentation to ONC on September 20, 2012. 5 http://www.aphl.org/aphlprograms/informatics/Pages/MU2PHAReadiness.aspx 6 http://www.aphl.org/aphlprograms/informatics/Pages/MU2PHAReadiness.aspx ONC Issue Brief: Public Health Reporting and Information Systems 7 Standardization of Public Health Reporting Increased health information technology adoption has also led to a number of initiatives focused on standards for public health reporting that have the potential to increase real-time bidirectional data exchange. Health Information Exchanges (HIEs) are helping connect public health agencies with health care providers, providing certified systems to meet meaningful use measures. HIE involves the electronic sharing of health-related information among organizations and includes an organization to provide services to enable the electronic sharing of health-related information. HIEs are also developing abilities for near real-time public health surveillance, such as for syndromic surveillance and real-time tracking of patients’ physical location during emergencies and disasters. As more patients have access to their health data, more will become empowered to make informed health care decisions. For example, consumer access to immunization information offers a number of benefits. It reduces the need to visit the health care provider to access immunization records during peak times of the year, such as for back-to-school, child daycare, and summer camp. Consumer access also empowers consumers and caregivers with more information about their immunization history records in making decisions about what vaccines may be needed in the future. Discussion: Advanced Analysis of Community Health Data and Surveillance in Public Health However, traditional IIS are developed and administered by public health agencies, and only authorized health care providers have access to the data. HHS is working with states to provide consumers access to their own immunization history information from IIS using secure, easy-to-use online portals. Consumer access to immunization records is already being provided in San Diego, Indiana, and through services offered by health information technology developers. What Are the Opportunities? Implementation of Standards for Public Health Reporting The ONC works with public health agencies, CDC, EHR vendors, and other stakeholders to develop consensus-based implementation guides (IGs) for electronic transmission of immunization, syndromic surveillance, lab reports, and cancer registry data. The IGs promote guidance for designing and implementing systems that are interoperable. Although the IGs allow for a certain amount of local variability, too much variability can limit interoperability 7 between systems. The ONC continues to work in two areas: 1) providing technical assistance to certain stakeholders (e.g., Regional Extension Centers, HIEs, and EHR technology developers) in the implementation of the IGs to reduce local variability that inhibits interoperability, and 2) contributing to the development of updated IGs to fix known issues and limit variability to 7 ONC uses the definition of interoperability from the Institute for Electrical and Electronics Engineering as “the ability of two or more systems or components to exchange information and to use the information that has been exchanged.” ONC Issue Brief: Public Health Reporting and Information Systems 8 promote interoperability. The ONC has adopted these IGs in its standards and certification criteria for EHR technology rules. Eligible Providers (EPs), Eligible Hospitals (EHs), and Critical Access Hospitals (CAHs) must use EHR technology certified to the standards the ONC has adopted in order to qualify for the Medicare and Medicaid EHR Incentive Programs. Collaboration Between Public Health and Health Information Exchanges As previously discussed, HIEs can provide valuable data exchange and infrastructure supports to public health agencies to promote more seamless information exchange. HIEs can also pool together data from many sources, including but not limited to hospitals, providers, laboratories, and pharmacies, which contribute to public health data collection. The ONC serves as key convener bringing together public health agencies with HIE entities, and providing guidance on public health reporting with a focus on streamlining IT systems and preventing duplication. Discussion: Advanced Analysis of Community Health Data and Surveillance in Public Health A few state health departments are requiring providers submit public health data through the state HIE, thereby streamlining the system. For example, starting in 2014, the Virginia Department of Health is requiring that immunization, syndromic surveillance, cancer, and reportable lab data are sent through the state HIE, ConnectVirginia. This will facilitate access to and retrieval of clinical and public health data. The Mississippi Department of Health has also recently mandated that reportable public health data are sent through the Mississippi Health Information Network (MS-HIN). The Mississippi Department of Health features a checklist on their website that demonstrates how to submit meaningful use public health reports via MS-HIN and to qualify for meaningful use for those objectives. Emerging Standards Can be Leveraged for Population Health and to Address Disparities Data Access Framework (also known as QueryHealth) is an ONC-led initiative focused on using distributed networks to analyze data from multiple organizations in aggregate form for secondary uses such as disease surveillance, comparative effectiveness, and medical product safety. The Data Access Framework model takes individual level data, de-identifies the information in compliance with HIPAA, and aggregates information for population health use. Models such as Massachusetts’ PopMedNet allow each network to create, administer, and govern their networks. Pilots include the New York State Department of Public Health’s focus on hypertension, CDC’s focus on disease syndromes and situation awareness, the Massachusetts Department of Public Health focus on diabetes, and the Food and Drug Administration’s (FDA) use to monitor the cardiac outcomes of particular drugs. The Data Access Framework initiative allows public health agencies to query across populations in their community to identify characteristics of the target population. Discussion: Advanced Analysis of Community Health Data and Surveillance in Public Health This feature can be used to look at health disparities within a community. For example, New York City was able to estimate the prevalence of obesity in neighborhoods across Manhattan and surrounding ONC Issue Brief: Public Health Reporting and Information Systems 9 Boroughs. 8 As shown in Figure 4 below, looking at this data geographically allows for targeted interventions for the populations at highest risk. Figure 4: Obesity Rates in the Primary Care Information Project in New York City Population The utility of EHR data for supplemental purposes such as public health reporting, research, patient-safety event reporting, and coverage determination has been limited due to lack of 8 http://www.iom.edu/~/media/Files/Activity%20Files/PublicHealth/SocialDeterminantsEHR/BuckMichaelIOM2014Ver2.pptx ONC Issue Brief: Public Health Reporting and Information Systems 10 uniformity in the terminology and definitions of data elements across EHRs. In addition, clinicians often report information in unstructured free text. Linking EHR data with other data in a uniform and structured way could accelerate population health, safety and quality improvement, and research. Toward this end, the Structured Data Capture (SDC) Public Health Tiger Team has begun to identify public health use cases, develop and consolidate common data elements, … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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