IBM, the Center for Disease Control and
Prevention, and the New York State Department of Health are piloting a project
to connect public health data with electronic health records (EHR) – which
currently reside across disparate systems – to make access for health care
professionals instantaneous. This access and compatibility, via an clinical
document architecture (CDA) template, will help those providers, as well as
other city and state services quickly react to and prevent the spread of
The following interview with Shannon
Kelley, Director of Programs, Office of Health Information Technology and
Transformation, New York State Department of Health, discusses the progress and
implications of the project.
IBM Research: What's the current state of public health case reporting in
Shannon Kelley: Currently, laboratories (in New York and elsewhere) submit test results to the Electronic Clinical Laboratory
Reporting System (ECLRS) when they have reportable conditions among New York state residents.
Disease Electronic Surveillance System (CDESS) transfers laboratory reports
from ECLRS to trigger public health case investigations conducted by Local
Health Departments (LHDs) in the identification, treatment, and prevention of communicable
diseases. CDESS also provides LHDs the capability to forward a case to another
county to investigate as appropriate and the capability to collect supplemental
forms for specific diseases. Providers may mail paper reports to LHDs for those
diseases that do not need laboratory confirmation (e.g. Lyme disease diagnosed
chronicum migran rash) and these are entered into CDESS.
IBM Research: Why were you interested in pilot testing the project to
create templates for public health case reports that could work with electronic
health record, and what were your results?
SK: Since 2006, New York has been investing in technology, operational capacity, and collaborative
governance structures and processes to support the adoption of EHR technology, and to mobilize state-wide health information exchange to
improve the quality, safety, efficiency, and affordability of health care.
department of health’s Universal Public Health Node (UPHN) is the state's strategic initiative
to transform the health information exchange for public health. The
UPHN streamlines how providers interact with the many public health information
systems that currently exist – to decrease reporting burdens, promote
bidirectional information exchange, and advance public health priorities.
CDA pilot opportunity with IBM and the CDC was well-aligned with our
vision for health care transformation by utilizing healthcare IT (HIT) to drive
clinical and public health practice improvements.
part of this pilot, our partner EHR vendor and Forms Manager vendor successfully created a CDA document according to the existing template
requirements, which could be transported over secure lines to NYSDOH. The department
was able to receive and review the CDA document – completing the correct
transport between the Forms Manager and NYSDOH.
From a public health perspective, the CDA document can be manually
viewed in a viewer as an initial report from a provider. It will require more
collaboration among EHR vendor, form manager vendor, and public health to
integrate CDA document with public health applications.
IBM Research: How does this have the potential to help public health
officials serve their populations better?
SK: Electronic transfer of
a CDA from a provider's EHR to public health offers the ability to improve timeliness of communicable
disease reporting. This would let the local health departments to begin
their investigation earlier; make appropriate control recommendations to the
providers; and offer preventive measures to contacts.
example, measles lab work results can take seven to 10 days to come back from a
commercial laboratory; however, control measures of vaccine administration must
be completed within three days of exposure. If public health officials
know about a suspected case, lab results can be facilitated and
received more quickly so that cases can be prevented.
IBM Research: What are the barriers to implementing this approach today?
SK: Here’s the piloted CDA
a CCD (Continuity of Care Document) – a patient summary commonly
implemented in EHR systems – to extract data about an identified case from
the EHR and make the information available for use in a Reporting Form.
automatically, or at a healthcare provider's instigation, activate this
Reporting Form to open for a user of the EHR system. The Reporting Form
will display the information delivered by the CCD and allow the EHR user
to insert more information.
qualified person using the EHR would have the responsibility of making the
decision to report the case to the Public Health Agency.
an automated method, the information from the Reporting Form would be
formatted as a specific type of CDA (for the pilot, the CDA would follow
the requirements for reporting a case of pertussis) and transmitted to the
Public Health Agency (PHA).
how the information transfer should work, but a few barriers remain:
IBM Research: Where would you like to see this collaboration go moving
PHA would have to gather requirements for the triggering of the Reporting Form and the data
needed for reporting for each type of reportable disease (though there may
be some diseases where a positive lab result is all the information that
- PHA will have to develop a way to populate disease surveillance system
databases from CDA data.
and time involved in implementing new procedures and perhaps new technology
at the EHR system and at the PHA.
- Different EHR systems may
extract different kinds of data to create the CCD (mentioned in the first
bullet above about the CCD approach); this may result in different kinds
of data being reported to the PHA.
forward, we expect that NYSDOH will be closely involved in national initiatives
to develop and implement standardized approaches to electronic public health
reporting from EHR systems to local and state public health program areas.
Consensus around common core data elements and reporting structures for
communicable diseases and other public health use case is essential to
realizing a more efficient public health response system.
of harmonized IT standards for public health offer great promise to alleviate
the administrative burdens that presently reduce the timeliness, completeness
and actionability of data. Once there are standards for EHRs to build to (and
incentives for the vendors to do so), we will use our health information
exchange infrastructure to transition to a fully electronic reporting system
that integrates data from the provider or EHR source to the NYSDOH program application.
data flow is also important, so the ability to generate automated
acknowledgements of data received or requests for additional data is also
important to reducing unnecessary outreach to providers.
Labels: CDC, electronic health records, healthcare, New York State Department of Health, research