PH+Reporting+User+Story+-+Cardiovascular+Disease+(NDHHS)

include component="page" wikiName="siframework" page="PHRI Header" =User Story: Cardiovascular Disease (Nebraska Department of Health and Human Services)=

Contact Info:
Dr. Tom Safranek (tom.safranek@nebraska.gov, phone: 402.471.0550) -- State Epidemiologist Michelle Hood (michelle.hood@nebraska.gov, phone: 402.471.3727) -- HIE/MU Coordinator

Date Received:
11/18/2011

Cardiovascular Disease (CVD) is a leading cause of preventable illness and death among Americans, including Nebraska residents. To better our ability to track and define the burden of CVD in our state, the Nebraska Department of Health and Human Services (NDHHS) is piloting a novel project to expand the scope of syndromic surveillance. Our ultimate goal is to improve the effective practice of public health in Nebraska to in turn help improve the health of the population. Recently, we were awarded federal funding to expand hospital-based surveillance to include near real-time data from electronic inpatient records. We’re using these funds to develop a statewide inpatient CVD surveillance system aimed to detect, track, and analyze cardiovascular disease events to establish at-risk populations, develop effective prevention plans, monitor trends in morbidity, and ultimately improve population health through better, more timely, disease surveillance.
 * Goal **

As a proof of concept and feasibility, we piloted this project with one Nebraska health system that is now successfully transmitting electronic inpatient records to us on a daily basis. These data are already allowing us to evaluate local CVD morbidity trends from recent months. Once matured, this system will benefit the broad needs of public health across the state. Most importantly, the findings of such population-based surveillance will be valuable to our communities by informing health care providers, facilities, and local public health officials regarding the local burden of CVD, identifying affected populations, severity of illness, and effectiveness of prevention programs or interventions.

CVD Inpatient data can be received in two formats: text delimited flat file and HL7 2.5.1 ADT messaging. The demographic and clinical data elements are sent in separate files when the inpatient data is sent via the text delimited file format. The clinical file is to be transmitted 5 days after admit and the demographic file is transmitted within 24 hours of diagnostic and procedure coding. The timing of the transmission was determined by analyzing the current capabilities of the facility’s EMR and work place policies in regards to data entry and medical records processing/coding. All inpatient admits are captured at the facility to establish a baseline denominator. This denominator will be used to measure disease frequency and describe how common an illness, or other health event, is to the population.
 * Description of Data Reporting Events, Actors and Triggers: **

**Data ** **Demographic Data Set **


 * **Field Name ** || **Description ** ||
 * **Demographic Data Set ** ||  ||
 * Facility Identifier || Code identifying facility from which the patient originated. ||
 * Medical record number || Uniquely identifies an individual and his or her medical record/information for the given facility. ||
 * Visit identifier || Unique identifier for this patient's visit at this care facility. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date of admission || <span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 16px;">Date and time when the patient was admitted as an inpatient. Time precision carried to the minute. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date of discharge || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date when the patient was discharged from this care facility ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Source of admission || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code Indicating the place from which the patient was admitted or referred. Sometimes known as the Referral Source. Code system OID 2.16.840.1.114222.4.11.918 ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Type of admission || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code indicating the circumstances under which the patient was seen or will be admitted. Code System OID: 2.16.840.1.11.3883.12.7 ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Primary final diagnosis || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">ICD9/ICD10 code indicating the primary final diagnosis. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Secondary diagnosis 1 - 25 || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">ICD9/ICD10 code indicating secondary diagnosis ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Discharge disposition || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code indicating the place or setting to which the patient was discharged. Code system OID: 2.16.840.1.113883.12.112 ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Condition POA indicator for primary final diagnosis || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code indicating whether condition for primary final diagnosis was present on admission ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Condition POA indicator for secondary diagnosis 1 - 25 || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code indicating whether condition for secondary diagnosis was present on admission ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">DRG || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Diagnosis Related Group ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Emergency room visit (Y/N) || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code indicating whether patient was in the Emergency Department during any part of the visit. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Visit reason || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Description of the reason for patient visit, most generally patient's chief complaint. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Type of patient visit || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code identifying type of patient visit. Code system OID: 2.16.840.1.113883.12.3 ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Education Level || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Highest level of education attained by patient ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Race of patient || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code indicating race of patient ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Hispanic ethnicity || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code indicating whether patient is of Hispanic ethnicity. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Zip code of patient || <span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 16px;">Zip Code portion of the patient’s home address. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">County of patient || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Text indicating county of home residence ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">State where patient resides || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code indicating state of home residence. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Gender of patient || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code indicating gender of patient ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Patient Date of Birth || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Patient date of birth ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Type of primary payer || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code indicating primary source of payment ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Primary procedure || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">ICD9/ICD10 code indicating the primary procedure. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Secondary procedures 1 – 9 || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">ICD9/ICD10 code indicating the secondary procedure ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Total charges || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Total charges to patient from facility related to visit ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Medical service || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code or free text identifying type of patient visit. (Code set defined by facility providing service) ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Employer of patient || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Name of patient's employer. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Occupation of patient || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Name of patient's occupation ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Employment status of patient || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Employment status of patient ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Employment work hazards of patient || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Text describing work place hazards at patient's work location. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Activity level at employment || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Text describing the patient's activity level at work. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Operate Hazardous Equipment || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code indicating whether patient operates hazardous equipment in the course of doing their job. ||


 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Clinical Data Set **
 * **<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Field Name ** || **<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Description ** ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Facility Identifier || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Code identifying facility from which the patient originated. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Medical record number || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Uniquely identifies an individual and his or her medical record/information for the given facility. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Visit identifier || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Unique identifier for this patient's visit at this care facility. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date of admission || <span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 16px;">Date and time when the patient was admitted as an inpatient. Time precision carried to the minute. ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date of discharge || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date when the patient was discharged from this care facility ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Admit BP (BP) || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">First BP taken upon admission ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Admit BP Date || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date of first BP taken upon admission ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Highest systolic Reading || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Highest systolic reading taken during hospitalization ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">High systolic Date || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date of highest systolic reading taken during hospitalization ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Highest diastolic reading || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Highest diastolic reading taken during hospitalization ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">High diastolic date || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date with highest diastolic reading taken during hospitalization ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Active Medication List || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">List of active medications (name only) ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Height || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Height ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Height Units || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Unit of height measurement (UCUM unit of measure) ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Weight || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Weight ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Weight Units || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Unit of weight measurement (UCUM unit of measure) ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Smoking Status || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Smoking Status ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">EKG Interpretation || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Electrocardiogram interpretation ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">EKG Interpretation Date || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date of electrocardiogram interpretation ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Cause of Death || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Preliminary cause of death ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Discharge Medications || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">List of discharge medications (name only) ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Working Diagnosis || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Working Diagnosis ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">High-density lipoprotein (HDL) Test Result || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Most recent HDL result ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">HDL Reference Range || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Reference Range for HDL ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Low-density lipoprotein (LDL) Test Result || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Most recent LDL result ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">LDL Reference Range || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Reference Range for LDL ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Triglycerides Test Result || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Most recent triglycerides result ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Triglycerides Reference Range || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Reference Range for Triglycerides ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">HDL Test Date || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date of most recent HDL result ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">LDL Test date || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date of most recent LDL result ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Triglyceride Test Date || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date of most recent triglycerides result ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Hemoglobin A1C Result || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Result of most recent Hemoglobin A1C test ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">H1AC Reference Range || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Reference Range for H1AC ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Hemoglobin A1C Test Date || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Date of most recent Hemoglobin A1C test ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Heart Rate || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Number of patient heart beats per minute ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Respiratory Rate || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Number of patient breaths per minute ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Temperature || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Body temperature ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Temperature Units of Measure || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Body temperature units of measure (UCUM unit of measure) ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Pulse Oximetry Percentage || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Oxygenation percentage of the patient's hemoglobin ||


 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Other Information **

The Nebraska Department of Health and Human Services has developed an HL7 2.5.1 Implementation Guide for Inpatient Cardiovascular Disease. This implementation guide contains descriptions of HL7 version 2.5.1 message type ADT (Admit/Discharge/Transfer) to be sent from hospital inpatient visits and urgent care facility visits. These messages are sent to the Syndromic Surveillance Event Detection of Nebraska system as a part of the Nebraska Department of Health and Human services for syndromic surveillance purposes. HL7 does not specify how messages are transmitted. It is flexible enough to be used for both real-time interaction and large batches. The standard defines file header and file trailer segments that are used when a number of messages are gathered into a batch for transmission as a file. SSEDON will use batch files of messages to communicate with outside systems.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Facilities are responsible for sending electronic health records (EHR) to DHHS in the appropriate format (HL7 2.5.1). Current finding indicate that many facilities do not have adequate information technology systems in place to do this. These facilities would then be required to establish or update their EHR system to participate in this project.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">In the fall of 2011, NDHHS will begin work to implement an application for analyzing and disseminating public health indicators for early detection of disease outbreaks called ESSENCE (Electronic Surveillance System for Early Notification of Community-based Epidemics). This is a secure, web-based, and user-friendly tool that will foster and facilitate analysis, visualization, and display of jurisdictionally specific or provider-specific population-based data for local health departments and data providers. Ultimately, we hope to provide a tool that will be available to staff in facilities to better define the health status of the populations served in ways not otherwise possible. The utility will not be limited to CVD as these data can be used to define a vast range of public health threats including infectious diseases or other chronic diseases such as diabetes or asthma. With such expanded uses, these opportunities will prove invaluable to infection control staff among others.


 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Stakeholder Commitment **

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">The Nebraska Department or Health and Human Services has been on the forefront of many cutting edge informatics projects. They include, but are not limited to, emergency room Sydromice Surveillance, in-patient and out-patient syndromic surveillance, electronic lab reporting, cancer registry, immunization data, and electronic exchange with the State’s Health Information Exchange Network.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">In response to national initiatives related to electronic health records, including promotion of health information exchanges, and meaningful use requirements for public health reporting, Nebraska created an integrated public health informatics unit that is taking health information exchange to a new level. Nebraska’s public health organizational structure is particularly suited to offering an informatics fellow a unique and rich experience. NDHHS is actively invested in and dedicated to the current cutting-edge public health informatics challenges.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Our agency has made public health informatics a priority. Our Chief Medical Officer, Dr. Joann Schaefer, is currently serving as a co-lead on the joint Public Health Informatics Task Force. This year our Agency succeeded in getting a statute passed which secured the agency’s ability to conduct syndromic surveillance, and opened the door to establishing a model syndromic surveillance program.

Supporting Files:

 * **Description** || **File** ||
 * This document contains the initial draft user story submission. || [[file:Initial Draft Submission - Cardiovascular Disease (NDHHS) - November 18 2011.docx]] ||  ||

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