3.06 Public Health: Local Community Collaboratives Supporting Public

3.06 Public Health: Local Community Collaboratives Supporting Public

3.06 Public Health: Local Community Collaboratives Supporting Public Health - Examples from North Carolina Holt Anderson, Executive Director North Carolina Healthcare Information and Communications Alliance, Inc. (NCHICA) North Carolina Public Health Initiatives NC-PHIN NC-HAN

NCEDD NCHESS NC PAiRS NCIR NC-PHIN North Carolina Public Health Information Network NC-HAN North Carolina Health Alert Network Characteristics of Projects All have evolved from earlier efforts

All are statewide efforts All involve public and private sector All build toward a North Carolina Local Health Information Infrastructure and are positioned to connect into national PHIN and NHII efforts Expectation is for continued evolution and refinement NC-PHIN Vision: Framework for the Future Automated electronic reporting of data Secure Internet pipeline for reporting information Consistent user interfaces Common data definitions

Reusable software components Shared analysis and dissemination methods, e.g., outbreak detection algorithms Secure, HIPAA-compliant data warehouse Established set of technical standards acceptable and adopted by preparedness partners NC-PHIN Components Health Alert Network NC-HAN

Epi-X (secure interactive communications with CDC and other states) Enhanced Public Health Surveillance Electronic Disease Reporting Hospital Data (ICD-9, UB92 Admin. Data) Syndromic Surveillance Hospital Clinical Data

Poison Control Center PreMIS Aberrancy Detection Medical Examiner Data

Program Area Modules TB Hepatitis Meningitis HIV/STD Vaccine Preventable

Diseases Immunization Registry Multi-Hazard Threat Database GIS Electronic Laboratory Results (LRN) Vital Records Automation NC-PHIN Surveillance Protecting our Citizens - Moving to the Next Level What health events are we trying to sense?

Reportable diseases and conditions Emerging infections and outbreaks (intentional or not) Chemical (intentional or not) Radiological (intentional or not) Injuries What electronic data elements are needed to sense? Diagnosis Clinical symptoms/syndromes

Related non-medical information Where do these data elements exist? How do we get them into PHIN? NC-PHIN Public Health Regional Surveillance Teams 5 6 Epi Lead Nurse Environmental

Admin (Vet) 4 1 7 3 2 4 per team = 28 positions North Carolina Health Alert Network - NC-HAN

The NC-HAN is a secure, Web-based system Designed to automatically issue health alerts to key individuals in : The NC Division of Public Health Local Health Departments Hospitals Laboratories, and Other partners

in the event of bioterrorism or other public health emergency. NC-HAN Design The first piece in the NC Public Health Information Network (PHIN), NC-HAN has met or exceeded all CDC requirements. NC-HAN was designed to provide maximum flexibility to allow for the addition of new user communities NC-HAN is designed to interface with the CDC National Electronic Disease Surveillance System protocols. Both the NC-HAN system and database architectures allow for expansion which reduces development time to include

new groups and organizations. NC-HAN Operation NC-HAN operates on a 24x7 schedule with complete system redundancy. NC-HAN users can issue an alert which automatically contacts subscribed users by email, FAX, pager, and voice until someone takes ownership of the event for resolution. Only an alert number is issued. No confidential patient or event information is transmitted. Only after the NC-HAN user logs into the secure system can they obtain more detailed information about the health alert and course of action.

NC-HAN Users to Date Total to 8/1/2004: NC Division of Public Health: NC Dept. of Agriculture Users: 131 NC Hospitals: 85 Health Departments: Law Enforcement: Emergency Management: 984 78 27 173

692 5 9 NC-HAN Alerts To Date 122 HAN Alerts Categories have included: Smallpox Influenza Hepatitis A Triple Play BT Exercise

SARS Training West Nile Virus Measles NC-HAN Future Enhancements Public Health Directory Surveillance Links (NEDSS, LIMS) Data Feeds Expanded User Manual - business rules for

partner utilization NCEDD North Carolina Emergency Department Database NCHESS North Carolina Hospital Emergency Surveillance System Emergency Department Surveillance in North Carolina Analysis, Decision & Response

Standardization, Analysis & Reporting Data Collection Background and Timeline 1998 Emergency Physicians form Standardizing Electronic Emergency Room Data (STEER) Work Group at NCHICA 1999 CDC funds 3-year project to adopt DEEDS standard and pilot collection and analysis of ED data NC Emergency Department Database Project (NCEDD) formed and managed by UNC-CH Dept. of Emergency Medicine 2002 NC Division of Public Health (NC DPH) funds collection of data for public health BT surveillance purposes

2004 NC Legislature mandates collection of data from NC emergency rooms for public health surveillance purposes 2004 - NC DPH contracts with NC Hospital Association (NCHA) to accelerate collection of data from all 112 EDs in NC effective January 1, 2005 Technical Overview Hospitals securely FTP select data elements from their information system(s) to NCEDD NCEDD standardizes and aggregates the data to CDCs Data Elements for Emergency Department Systems (DEEDS) standard Data quality checks performed to remove duplicates, check for out-of-range values and

unacceptable levels of missing data Provide Web-based reporting access to the data Status Currently receiving data from 24 hospitals 4000 visit records per day on average (including both new and updated records) Total Number of Visits: 928,266 Total Number of Patients: 498,408

Total Number of Final Diagnosis Codes: 2,654,323 Total Number of Cause of Injury Codes: 315,043 Data Elements Patient & Visit IDs ED Disposition DOB, Sex, Race

Vital Signs (when available) City, County, State, 5-digit ZIP ICD-9 Final Diagnosis and Arrival and Disposition Date/Time Chief Complaint and Triage

Nurse Notes (when available) Triage Acuity Rating Transport Mode to ED Insurance Coverage Facility and Data Source Injury (E) codes Procedure Codes Data Users Public Health Epidemiologists (PHEs) In-hospital liaison to LHDs in NCs 12 largest hospitals

Perform in-hospital surveillance for communityacquired infections and for defined syndromes which may be indicative of a terrorist attack NC Division of Public Health Epidemiologists Injury, Occupational Health, Cardiovascular Epidemiology, among others Local Health Directors Authorized users at participating hospitals Reports Portal Basics Data are accessible 24/7/365 from any Internet-ready computer using SSL Updates every morning

Functionality offering report customization Strictly defined user access controls Report Selection Page Aggregate Reports Case Reports Case Reports Case Reports

North Carolina Hospital Emergency Surveillance System (NCHESS) NC Hospital Emergency Surveillance System (NCHESS) Partnership with NC Hospital Association Mandatory reporting law for hospitals with 24-hour emergency rooms Near real time data Monitoring Investigation

Begins to come online in January 2005 NCHESS Architecture Solution Near Real Time Collection MData Solucient Data Processing NC Hospital Database

NCHESS NCHESS NCHESS DATA DATA DATA MMD Real Time Patient Level Filter & Alert NCEDD

Investigat e Key Monitor Analyze Detec t DPH Staff Solucient\KB

Aberration Detection & Alert Mercury MD NCDPH /NCEDD NC PAiRS North Carolina Provider Access to Immunization Registry Securely NCIR North Carolina Immunization Registry

Background and Timeline 1998 Work group formed to develop project demonstrating the secure use of the Internet to access clinical information. Children's immunization records were selected and NCHICA members volunteer to contribute to prototype development. 1999 Initial demonstration sites online 2000 Trial use of PKI technology not successful 2002 NC reviews fully-functional registry technology 2004 - NC DPH awards contract for modification and implementation of WI system in NC beginning in late 2004 NCHI CA PAiRS PROjECT PROVIDER ACCESS TO I MMUNIZATI ON REGISTRY SECURELY

Main Page Search For Patient - Recommended Childhood I mmunization Schedule Tutorial - Policy Guidelines - Help Desk- Main Page Please choose one of the following options: Search For Patient Recommended Childhood I mmunization Schedule Tutorial

Policy Guidelines Help Desk IMPORTANT NOTES AND DISCLAIMERS The immunization information furnished herein has been reported to the PAIRS demonstration project. There may be relevant events (e.g. other immunizations, adverse events) that have not been reported to this authority. Clinical judgement should be used in reviewing the presented information in conjunction with any other information that may be available. The information in this report may only be used or disclosed in accordance with NC Immunization Laws and Rules (G.S. 130A-153, G.S. 130A-155, G.S. 130A-155.1, 15A NCAC 19A .0406). NCHI CA PAiRS PROjECT PROVI DER ACCESS TO I MMUNI ZATI ON REGI STRY SECURELY Search for Patient Search For Patient - Recommended Childhood I mmunization Schedule Tutorial - Policy Guidelines - Help Desk- Main Page

LAST NAME* FI RST NAME* DATE OF BI RTH [MM/ DD/ YYYY]* MOTHER'S MAI DEN NAME SOCI AL SECURI TY NUMBER [###- ##- ####] MEDI CAI D NUMBER

MI DDLE NAME ZI P CODE Search for Patient Clear Fields marked with an asterisk (*) are required and must not be left empty. IMPORTANT NOTES AND DISCLAIMERS The immunization information furnished herein has been reported to the PAIRS demonstration project. There may be relevant events (e.g. other immunizations, adverse events) that have not been reported to this authority. Clinical judgement should be used in reviewing the presented information in conjunction with any other information that may be available.

The information in this report may only be used or disclosed in accordance with NC Immunization Laws and Rules (G.S. 130A-153, G.S. 130A-155, G.S. 130A-155.1, 15A NCAC 19A .0406). Users of the New Registry The NCIR has been deemed to be exempt from the HIPAA Privacy Rule. North Carolina Law requires the sharing of immunization information with the following parties: NC Department of Health and Human Services Local Health Departments

Physicians Schools K-12 Colleges and Universities

Licensed and registered childcare facilities Head Start Health Maintenance Organizations Other state and LHDs outside of NC

(NC public health law (N.C.G.S. 130A-153 c; 10A NCAC 41A .0406) Features of New Registry Similar look and feel to PAiRS for users User-friendly, web-based system Helps to control vaccine-preventable diseases and identify at-risk populations Serves as a clinical tool to identify and track children to allow providers to maintain high immunization coverage Ability to view a patients immunization history and automatically generate recommendations for current/future doses Ability to generate automatic reminder/recall notices. Easy inventory management and on-line ordering of statesupplied vaccine

Benefits of the NC PAiRS Project Immediate and convenient access to records by public AND private providers good will! Experience with the Internet, security methods, and Web access Expanded connections to private sector Prepared private sector for speedy implementation of new registry Secure Internet connectivity can lead to other PH applications such as automation of mandatory reporting, HAN alerts, etc. Thank you !

Questions ??? Holt Anderson, Executive Director [email protected] North Carolina Healthcare Information and Communications Alliance, Inc. (NCHICA) www.nchica.org

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