This document discusses Utah's strategies for improving population health through statewide clinical and public health data interoperability. It outlines Utah's shared vision for using data exchanges across EHRs, HIEs and public health to support population health goals. Key strategies discussed include developing a shared statewide health IT plan and governance model for a master person index to facilitate identity management and data sharing. The document also highlights challenges in making public health systems more interoperable and developing analytics to support diverse population health needs.

1. Statewide Data Interoperability
For Improving Population Health
Wu Xu, PhD
State Health IT Coordinator
Director, Center for Health Data
& Informatics
Utah Department of Health
May 23, 2016
Iona Thraen, PhD
UT State Innovation Model Grant
Director, Office of Health Systems
Collaboration

2. States as Laboratories
For Nationwide Clinical and Public
Health Data Interoperability
2

3. Discovering Laboratories’ Commonality
Participants from states and large cities/counties share their
interoperability visions, priorities and strategies at the Public
Health Informatics for Leaders Forum
Sponsored by Public Health Informatics Institute, April 26, 2016, Atlanta, GA
3

4. Definitions of Population Health
Population Health Domains*
* Adopted from Public Health 101: Healthy People-Healthy
Population by R. Reigelman, 2010, Sudbury, Jones & Bartlett.
** http://www.improvingpopulationhealth.org/blog/what-is-
population-health.html
Population Health
is defined as
the health outcomes of
a group of individuals,
including the
distribution of
such outcomes
within the group.**
Social &
Human
Services
Public Health
Community
Health
Healthcare
Systems
Individual/Co
nsumer
Health
4

5. http://www.phi.org/news-events/806/85-of-hospitals-committed-to-population-health-says-ahaphi-national-survey
5

6. Key Outcome of Population Health
Utah Department of Health’s Definition of Population Health:
UDOH integrates its practice with health systems and payers to
fully address determinants and outcomes of health in the Utah
population and its sub-populations.
6

7. Public HealthHealth Care
Innovative
Clinical
Prevention
Traditional
Clinical
Prevention
Increase the
use of
evidence-based
services
Provide services
outside the
clinical setting
Total Population or
Community-Wide
Prevention
Implement
interventions that
reach whole
populations
1 2 3
The 3 Buckets of Prevention
• Article by John Auerbach, 2016, available on the Journal of Public Health Management and Practice’s website – www.JPHMP.com
Shared Space: Innovative Clinical Prevention
7

8. Population Health Business Cases with ROI in 5yrs
Promote adoption of evidence-based interventions in
collaboration with health care purchasers, payers, and providers
8

9. Informatics Support to the 6|18
Use Case Informatics Support in Utah
Reduce Tobacco Use  HIE facilitates “quit-line” referrals
Control High Blood
Pressure
 APCD estimates of risk populations and cost
 Population data collection from HIE, systems
Control Asthma
 APCD risk and cost analysis
 BRFSS, Inpatient, ED, clinical asthma patient
distribution
 Outcome evaluation
Control and Prevent
Diabetes
 Local data to supporting health and cost
evidence and monitor progress
 APCD patient risk and cost analysis
9

10. Data Interoperability
for Population Health
=
Information Exchanges & Analysis
across EHR, HIE & Public Health

11. Utah’s Information Exchange Strategies
• Develop a Shared Vision
• Develop a Shared Statewide Health IT Plan
• Develop Governance for The Shared Identification
Services for Utahns (ThSisU)
• Leverage State-Designated Health Information Exchange
(HIE)
• Leverage Public Health Meaningful Use Reporting
• Pilot Other “Meaningful” Public Health Information
Services
• Clinical Data Needs for Population Health Collaborative:
Clinical measures and Advanced Analytics
11

12. Utah Statewide Shared Vision, 2015 -
12

13. Alignment Federal and State Health IT Goals
• Federal ONC Goals:
 Advance Person-Centered
and Self-Managed Health
 Transform Health Care
Delivery and Community
Health
 Foster Research, Scientific
Knowledge, and Innovation
 Enhance Nation’s Health IT
Infrastructure
https://www.healthit.gov/sites/default/files/9
-5-federalhealthitstratplanfinal_0.pdf
• Utah HIT Goals (Draft):
 Advance the Health and Well-
being of Individuals and
Communities through Person-
centered & Self-managed
Health
 Strengthen Health Care
Delivery Transformation
 Enhance Utah's Interoperable
Health It Infrastructure
 Support Research, Innovation,
and Implementation Science
13

14. Need for Statewide Master Person Index
14

15. ThSisU: Governance
15

16. ThSisU: Building Blocks and Initial Use Cases
Patient Identity Service
• Identity proofing
• Link digital identity to patient records
• Match digital identities across organizations
Risk
Indemnification
ThSisU Identity-related Building Blocks to
support appropriate data movement
Selected Care Coordination
Use Cases
Trust framework
Pooled-shared
knowledge
Business case and
financial benefit
Provider Electronic Receiving
Specifics
• Provider digital identity repository
• Provider identity proofing
Care Team
• Message interfaces
• Care team imputation algorithms tested
• Encounter records from member
organizations
Patient Proxy Relationship
Management
• Proxy relationship verification and policy
Case Information Delivery
Newborn data Bundle
• Electronic birth certificate
• Screening orders, tracking
results
• Pediatrician identification and
follow-up
End of Life Care
• Electronic POLST
• Advance Directives
• Emergency Medical Services
Poison Control
• Case coordination with
Emergency Physicians
16

17. Meaningful Use (MU) and Health
Information Exchange (HIE)
are Transforming
Silo Pubic Health Systems’ Data
Communication and Analytics

18. Silo Public Health Information Systems
• UDOH has
 about 1,000 employees
 more than 100 stand along information systems.
 A hospital may report data in about 30 different ways to UDOH
 A program may use 10 different methods to exchange data with
external entities
• Root causes
 Historically categorical funding streams and restrictions
 Decentralized business and IT management structures
 Legacy systems and aging workforce
 Lack of federal-state strategic collaboration and adequate
funding
18

19. Transformation by MU and HIE
• Public Health Meaningful Use Reporting
 Immunization Records (bi-directional)
 Electronic Laboratory Reporting
 Syndromic Surveillance Reporting
 Cancer Registry
• Public Health Uses the Statewide HIE
 Meaningful Use Reproting
 Newborn Hearing Screening Results & Diagnostics Reports
Exchange
 Emergence Medical Services
 Poisoning Control Data exchange through cHIE
19

20. MU Challenges: EHR-IIS complexities
USIIS 20

21. MU Challenges (cont.)
• MU instructions from various sources
 CMS, ONC, Medicaid, EHR vendors, UDOH, USIIS, REC, etc.
• Complexity of EHR systems and EHR-USIIS interfaces
• Multiple possible points of failure
• Understand and undertake responsibility for data quality
– In EHR system and in USIIS
– Clinic workflow and staff practices impact data quality
USIIS 21

22. Shared Service for Interoperability
INTERFACES:
• SFTP
• VPN
• HTTPS
• SOAP Web Service
• PHIN MS
• Secure web portal
GATEWAY and INTEGRATION
ENGINE:
• Mirth Connect
• Rhapsody
• Shared Service Platform
• HIE
“No Door is a Wrong Door” Tradition is Costly.
22

23. PHCP: Electronic Case Reporting
23

24. Direct
1g
HIE
Solution
EHR
System B
HIE
Solution
EHR
System A
My Health
1a
2i
1b
2h
Diagnostics
Test Results
Test Results
HIE Solution
DOH Gateway
Identity Resolver
Public Health
2a
2b
2c
EHDI
Test
Results
Early Hearing
Detection &
Intervention (EHDI)
Standard-based
Message Broker
(eHEX, Direct, HL7v2)
Relationship
Resolver
MessageOrchestrator
MessageRouter
Format
Converter
Identity
Resolver
Alert/
Notification
Central
Repository
2d1c
1d
1e
1f
2e
2g
2f
HIE Use Case 1: EHR sends hearing diagnostics reports to public health registry
HIE Use Case 2: EHR receives hearing test results from public health registry
24

25. Vital Records and EHRs
BIRTH and DEATH records are fundamental public health data
 Registration systems are electronic but silo with manual data entry
• Pilot: Quality of Birth Data Extracted from HER
 Most of the labor, delivery and newborn care information are
available
 PDF information (i.e. prenatal or out of network care) can’t
automated extracted [J. Duncan, et al. CDC 2015-Q-17144)
• EHR Death Certificate Reporting
 EHR and EDEN interoperability for physicians to timely enter the
Cause of Death via their own EHR
• Death Notification for EHR Patient Identity Validation
25

26. Informatics and Opioids Crisis
• Utah ranked the 4th highest for drug poisoning
deaths in the U.S.
• State Interventions:
Prescription Drug Management Program
Controlled Substance Database (CSD)
• Informatics Support
EHR - CSD connection or single login for prescribers
Education and decision-support to prescribers
Automated prescription misuse/abuse surveillance
Timely information for community intervention
26

27. Challenges for Analytics and Visualization
For Population Health Planning
opendata.utah.gov
Public Health Assessment App.
Websites for Consumers
27

28. Expanded Needs for Population Health Analytics
Domain Public Health Informatics Population Health Informatics
Data Source Public health data + clinical & other data
sources
Data Model Disease/event centric + Person, People,
community-centric
Interoperability Silo systems + Linkage and real-time
exchange are required
User Public health profession + Diverse external users
Analytics Standard public health
measures, pre-defined
conditions
+ flexible user-defined
measures and populations
28

29. Develop Population Health Informatics
• Develop shared vision and frameworks
Population health use case driven technical design
• Build interoperability between clinical and public health
data
Standard terminology and data models
Federated infrastructure among all partners
 Standard shared service platforms
• Flexible and shared analytics functionality for various
users
• Standard quality measures for value-based purchasing,
payment reform, and community health improvement
29

30. Questions?
Comments?
Suggestions?
THANK YOU!