PH+Reporting+User+Story+-+Admin+Use+of+Health+Data

include component="page" wikiName="siframework" page="PHRI Header" =User Story: Transmitting Administrative (billing data, claims data, etc.) to Local or State Public Health Departments for Public Health Preparedness from EHR-S, HIE, Payor Information Systems=

Contact Info:
Alla Fridman (afridman@phdsc.org) -- PHDSC-APHL-CSTE Project Manager

Date Received:
11/18/2011

The Public Health Reporting Initiative is looking for several public health program areas that routinely exchange information with healthcare providers and/or hospitals, that have standards in place for how those data are collected and/or exchanged, and who are willing to participate in a pilot to see how well data needs across those several programs can be met in standardized ways with data from EHR systems. The ultimate goal is to simplify public health reporting for both providers and public health. A public health program that is nominated as a candidate for this initiative will be referred to as a “user story,” a specific data exchange scenario with specific sources of data, healthcare and public health goals, and processes for collecting and exchanging the information. This application is intended to identify those characteristics of a program, so that they can be matched with other user stories to create an overall “use case” of harmonizing how data gets reported to public health.
 * 1.1 Introduction**

Billing and administrative data are generated at every patient visit. These data need to be reported to health data organizations or a public health program based on jurisdictional laws. Once administrative/billing data are generated, the provider’s EHR should be able to automatically pre-populate administrative data report forms (Public Health Report) provided by the Public Health program or health data organization. The provider should then be able to review the form, enter additional data on the form and submit the form electronically to the public health information system for the program.
 * 1.2 User Story Narrative**

Administrative use of health data is critical for public health programs. The data is used to provide services to populations addressed by public health programs. In addition, administrative uses of health data include evaluating patient safety, including the tracking of injury rates, inpatient costs, patient characteristics, and outcomes for specific types of injuries, and informing the development of injury prevention programs; health resources; environmental conditions; and socioeconomic characteristics; identifying services that are lacking in a community; planning for better future allocation of resources; and monitoring the occurrence of disease. Data generated across the continuum of public health activities are of interest to patients, healthcare providers and public health agencies.
 * 1.2.1 Goal**

The use case below describes administrative data/billing data generated in the context of a patient's visit to a care provider. This use case is focused on the automation of the submission of:
 * initial case reports for chronic diseases required by law from hospital and ambulatory EHR-S
 * laboratory reports from Laboratory Information Management Systems (LIMS)
 * reports from Payor Information System (Payer IS), and
 * administrative data to local or state PH-IS.

The following is the flow of events that trigger public health reporting:
 * 1.2.2 Description of Data Reporting Events, Actors and Triggers**

//Provider EHR-S (Out of Scope)//
 * A Person (patient) visits a Provider with symptoms indicating chronic disease, e.g., pain, lesion, etc. Visit data are recorded in the EHR-S
 * Provider orders laboratory test. Test order is recorded in the EHR-S

//Payer IS//
 * Bill for a visit is generated in EHR-S and sent to the Payer IS
 * Billing data are sent to PH-IS via Health Information Exchange (HIE)
 * Payor IS staff receive notification from EHR-S via HIE about the new administrative/billing data document. Staff access the sent data
 * Payor IS sends acknowledgement of receipt of document back to EHR-S via HIE.

//LIMS (Out of Scope)//
 * Specimen is collected by Nurse and sent to the Laboratory
 * Laboratory conducts test and records test results in LIMS
 * LIMS sends data to EHR-S directly, or via HIE

//Payer IS//
 * Bill for test is generated in LIMS and sent to the Payer IS
 * Billing data are sent to PH-IS via HIE
 * Payor IS Staff receive notification from LIMS via HIE about the new administrative/billing data document. Clerk accesses the data
 * Payor IS sends acknowledgement of receipt of the document back to LIMS via HIE

//PH-IS//
 * PH-IS Staff receives notification about a new Public Health Report on administrative/billing data
 * Staff access the report
 * PH-IS sends acknowledgement of receipt of the Report back to EHR-S and LIMS via HIE

Below is a swim diagram illustrating the stakeholders and technical dataflow in reporting a communicable disease to the state health department.

APPLICABLE STANDARDS Data standards for information exchanges of health data for administrative uses, including:
 * 1.2.3 Data**
 * 1.2.4 Other information**
 * ASC X12 Messaging Standards
 * National Uniform Billing Committee (NUBC) Standards
 * HL7 (vocabulary, CDA R2, 2.x)
 * IHE Sharing Values Sets
 * PHIN -VADS
 * IHE PIX and PDQ profiles for demographic information
 * HL7 Public Health Reporting Requirements Standard
 * ITI Technical Framework

Standard harmonization activities under this User Story will be supported by the PHDSC project. Our team includes EHR and PH vendors, PHDSC members, who have been participated in the national HIT standardization activities under HITSP, S&I Framework LRI Initiative and IHE. With the support from CDC we anticipate conducting a pilot test of this User Story data exchanges in two state pilot sites in May 2012.
 * 1.3 Stakeholder Commitment**

Participating organization supporting this User Story includes (in alphabetical order):

Centers for Disease Control and Prevention, National Center for Health Statistics Public Health Data Standards Consortium National Association of Health Data Associations CDC Cancer Program (to be invited) Kaiser Permanente (to be invited) Council for Affordable Quality Healthcare (to be invited)

Supporting Files:

 * **Description** || **File** ||
 * This document contains the initial draft user story submission. || [[file:Initial Draft Submission - Admin Use of Health Data - November 18 2011.docx]] ||  ||

Comments:
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