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Electronic Health Record - Public Health Task Force

Re-Evaluation of HL7 EHR-S Functional Model from Public Health Perspectives - Phase 4

Overview | Phase 1 | Phase 2 | Phase 3 | Phase 4

The Public Health Data Standards Consortium (PHDSC) Electronic Health Records-Public Health (EHR-PH) Task Force, in collaboration with the Centers for Disease Control (CDC) / National Center for Health Statistics (NCHS) and the Health Level Seven, International (HL7) Electronic Health Record Work Group (EHR WG), transitioned eight domains of the Public Health Functional Profile Release 2 (PHFP R2) to the new format and structure of the HL7 EHR System Functional Model Release 2 (EHR-S FM R2).

BACKGROUND

As an open standards development organization, HL7 (through its EHR WG) gathered input from a variety of sources as the EHR-S FM R2 was being developed to:

  • provide updated, consensus-based guidance to the healthcare industry;
  • cover current and anticipated needs of healthcare providers in
  • hospital, ambulatory care, long-term care, behavioral health and other care settings, both U.S. and internationally;
  • cover the needs of Public Health stakeholders;
  • provide updated guidance to vendors and EHR-S developers; and
  • provide benchmark requirements and criteria for EHR-S certification
  • activities.

The PHFP defines the subset of functional requirements and conformance criteria for EHR-based information exchanges between clinical and public health information systems stakeholders including, but not limited to state, local, and federal agencies and covers the following public health domains/programs:

  • Vital Records (VR)
  • Early Hearing Detection and Intervention (EHDI)
  • Chronic Diseases Cancer Surveillance (CAN)
  • Public Health Laboratory Interactions (Orders/Reports) (PHLI)
  • Health Statistics (HS)
  • Occupational Disease, Injury and Fatality (ODIF)
  • Birth Defects (BD)
  • Deep Vein Thrombosis and Pulmonary Embolism (DVT/PE)

PUBLIC HEALTH FUNCTIONAL PROFILE PURPOSE AND VISION

The PHFP may serve as a reference for certification of EHR systems that include functionality to support PH domains. The PHFP may also serve as a foundation for developing a Public Health Information Systems (PHIS) Functional Model. As such, a PHIS Functional Model could appear in a framework with existing FMs (i.e., the EHR-S FM and the Personal Health Record System FM) and other, yet-to-be-developed FMs (e.g., Population Health FM, Mobile Health FM; Social Media-related Health FM, and/or Sports/Athletic Training FM).

Standards-based Functional Models and Functional Profiles benefit the healthcare industry by promoting uniformity between systems that are based on the collective knowledge of domain experts. Incentives can then be extended to industry stakeholders regarding the purchase and meaningful use of certified systems. In the U.S., ONC, CMS, and NIST have an important role in reviewing and promoting the proposed standards and encouraging the purchase and use of certified systems.

STATUS OF THE PHFP R2

The Public Health domain experts offered the May 2013 PHFP R2 as a "Comment- Only" ballot in response to HL7's rule prohibiting a ballot from being offered as an Informative ballot against a ballot that has not yet achieved Normative status. Once the EHR-S FM R2 document achieves Normative status, the PHFP R2 can be balloted as an "Informative" document

The PHFP staff extracted updates/recommendations from the PHFP R2 and offered them as EHR-S FM R2 ballot comments in order to better accommodate PH stakeholders’ needs in the base EHR-S FM R2 document. Suggestions were also made to the EHR WG during the May 2013 WGM in Atlanta based on the results of the PHFP domain experts' work. The PHFP team received 94 comments from the May 2013 ballot and is undergoing ballot-reconciliation. The PHFP team also generated 261 comments on the R2 ballot and offered them to the EHR WG for reconciliation. Highlights of the comments that were offered to the FM team include:

  • Functionality that enables the reception and use of Public Health –related notices, request-for-action, and educational materials, and support for standards-oriented queries and reports.
  • Management of statistical information regarding providers.
  • Types of "fuzzy time", namely, fuzziness with respect to patient-related data (e.g., The children's flu-like symptoms began appearing approximately two or three weeks ago).
  • Population-based query support (e.g., the ability to TAG and UNTAG items as Population Health analysts iteratively execute queries on certain cohorts in order to perfect a specific query).
  • More fully clarified communications and handshaking between providers and other stakeholders.
  • Data-validation rules for patient demographic data (e.g., synchronization of a patient's records where the values for the patient's sex are Male="1" in one record, and Male="m" in another record).
  • A Function STATEMENT was upgraded to include Structured Message (in addition to Application and Structured-Document) Interchange Standards.

Since the PHFP is a subset of the EHR-S FM R2 document, the outcome of the EHR-S FM R2 ballot reconciliation is very likely to impact the PHFP.

NEXT STEPS

The PHFP team intends to harmonize the Comment-Only version of the PHFP with the updated EHR-S FM R2 ballot in mid-2013. Also, the team desires to identify a "Core" set of Functionality that spans all PHFPs.

The PHFP will be offered to Certification Bodies in the USA and should be introduced to other certification bodies internationally. If accepted, national and international vendors will benefit because they will be able to offer a product that can claim conformance to a standard that meets PH stakeholder's needs. Additionally, provider organizations can tailor their current and future business activities according to the requirements listed in the PHFPs.

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