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STI eCR Learning Community: Webinar 3 STI eCR Learning Community: Webinar 3

STI eCR Learning Community: Webinar 3 - PowerPoint Presentation

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STI eCR Learning Community: Webinar 3 - PPT Presentation

September 28 2017 1100 1200 pm EDT STI eCR Learning Community Webinar 3 Please use the link below to register for the webinar httpsattendeegotowebinarcomregister8982498011696551425 ID: 714285

case ecr ehr data ecr case data ehr report health alliancechicago pilot phii patient paper 100 sti logic positive

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Slide1

STI eCR Learning Community: Webinar 3September 28, 201711:00 – 12:00 p.m. EDTSlide2

STI eCR Learning Community Webinar 3Please use the link below to register for the webinar: https://attendee.gotowebinar.com/register/8982498011696551425

You are dialed in as an attendee and will be muted until the Q&A portion.

Today’s webinar will be recorded.

Check back at

phii.org/ecr-sti

under Learning resources for this and previous recordings.

Objectives for webinar

Present the AllianceChicago pilot eCR implementation

Overview the evaluation findings

Discuss major lessons learned and next steps for eCRSlide3

Recap from the 2nd WebinarProvided updates from the AllianceChicago pilot eCR implementationIntroduced the evaluation plan

Discussed use of local codes vs standard health IT vocabularies Slide4

Vision for this Learning CommunityToday (Webinar 3) provides a wrap-up of the AllianceChicago pilot implementation progressOutputsRevised PHII Technical GuidanceDocumentation of AllianceChicago experience

New eCR eLearning module available

for

the public health

community (Coming Soon!)Slide5

Webinar 3 Agenda

Time:

Topic:

11:00-11:05

Welcome (Natalie

Viator

, PHII

)

11:05-11:15

Pilot Implementation Updates

(Jeremy Carr, Elizabeth McKnight AllianceChicago)

11:15-11:30

Evaluation

Findings

(

Roxane Padilla,

AllianceChicago; Natalie Viator, PHII)

11:30-11:40

Feedback and

Lessons Learned (Andrew Hamilton, AllianceChicago)

11:40 – 11:55

Questions and Discussion (All)

11:55 – 12:00

Closing Statement and Wrap

Up

(Jim

Jellison, PHII

)Slide6

Pilot Implementation Updates Slide7

Scope of Pilot Implementation

EHR applies case detection logic to patient encounter data in EHR

Patient’s data meet reporting criteria

EHR* builds case report

EHR* sends case report

*may involve middleware

(e.g., 3rd party interface engine)

AllianceChicago (

GE Centricity)

Match to trigger codes

Pull case report elements

Patient’s encounter data entered into EHR

Receive case report

De-duplicate from

ELR

Categorize for case classification

Add case to surveillance system

Conduct case investigation

Case notification to CDC

Illinois Department of Public Health

...

We are hereSlide8

EHR Build Progress – Summer 2017Integrating FHIR eCR into current dayAllianceChicago worked closely with GE around development of the new FHIR integrationAllianceChicago is participating in limited availability testing of FHIR testing

GE Schedule to release FHIR

integration

with CPS version 12.3 in the Fall of 2017Slide9

EHR Build Progress – Summer 2017User (e.g., provider, nurse) enters data in Centricity EHR Updates to problems, medications, or lab results prompt update to interface engine (IE) IE cross references specific trigger logic (per the PHII technical guidance)

IE requests eCR data elements via FHIR and sends positive results to the Department of Health (DoH)

No-DiscardSlide10

PHII/DSTDP Case Detection Logic

Patient Encounter Scenario

Diagnosis

Lab Test Performed

Positive Lab Result (Named Organism)

Positive Lab Result (Presence vs. Absence)

Treatment

Prescribed

Send eCR?

1

ü

û

û

û

û

YES

2

û

û

ü

û

û

YES

3

û

ü

û

ü

û

YES

4

û

ü

û

û

û

NO

5

û

û

ûû

üNO

Note that AllianceChicago’s clinical partners have no equivalent for the Positive Lab Result (Named Organism) codes represented in Patient Encounter Scenario 2. Therefore, eCRs were created only from scenarios 1 and 3 for both gonorrhea and chlamydia.Slide11

Evaluation FindingsSlide12

Evaluation PlanGoalProvide data (both quantitative and qualitative) to analyze the performance of the emerging technical guidance (PHII, HL7)

Will help inform necessary changes for future technical guidance revisions to meet the needs of the STI surveillance communitySlide13

Background and MeasuresNear North Health Service CorporationEight (8) comprehensive Health Center sitesPilot Start Date: May 1st

, 2017

Pilot End Date: June 30

th

, 2017

Age

of pilot population: 15 and

over

USPSTF recommends screening in adults and adolescents ages

15-65

N=12,420

patient encountersSlide14

Background and Measures: Burden of Disease

Case Counts of Gonorrhea:

11,082

(Cook County, 2015)

17,130

(Illinois, 2015)

Case Counts of Chlamydia:

39,539

(Cook County, 2015)

69,610

(Illinois, 2015)Slide15

Evaluation AreasCase detection logic (i.e., triggering) efficacy

Completeness of eCR

Overall feedback and lessons learnedSlide16

Case Detection Logic (i.e., triggering) Efficacy

Did

the trigger code value sets perform as intended in the EMR system?

Frequency

2x2 tables comparing eCR triggers with paper-based case reportsSlide17

Frequency of STI Trigger CodesSlide18

ICD-10: Chlamydial infection, unspecified [A74.9

]

Chlamyd DNA* + Positive

ICD-10: Gonococcal infection, unspecified [

A54.9 ]

GC DNA Probe* + Positive

*Proprietary code with LOINC equivalent

Frequency of STI Trigger CodesSlide19

Methods for Comparing Positive Cases Identified with eCR vs Paper Case ReportsInstructed the 8 clinical sites to continue filling out the paper form per usualCollected physical paper forms at end of study period“Paper” case report considered present if either the physical form or a scanned copy was attached to the patient encounter in EHR

Question:

Will eCR yield an increase in the number of cases reported compared to the paper case reporting method alone? Slide20

2x2 Table for ChlamydiaSensitivity: Chlamydia – 100%Specificity: Chlamydia – 99.5%

The eCR case detection logic identified 56 additional chlamydia cases that were not reported on paper. This represents a 147% increase in reporting from the clinic sites.

Subsequent EHR chart review confirmed that all of the additional cases were triggered appropriately.

Paper Case Report Present

Yes

No

eCR

Identified

Case

Yes

38

56

94

No

0

12,326

12,326

38

12,382

n=12,420 Slide21

2x2 Table for Gonorrhea

Paper Case Report Present

Yes

No

eCR

Identified

Case

Yes

13

16

29

No

0

12,391

12,391

13

12,407

n=12,420

Sensitivity: Gonorrhea – 100%

Specificity:

Gonorrhea

– 99.9%

The use of eCR resulted in 16 additional gonorrhea case reports that would not have been reported using the paper-based case report alone. This represents a 123% increase in reporting.

Subsequent EHR chart review confirmed that all of the additional cases were triggered appropriately. Slide22

Completeness of eCR*

How complete is the

eCR

at the time it is populated?

Data

elements

populated

D

ata

elements

not

populated

No equivalent data elements stored in EHR

Data element not relevant in ambulatory setting

Methods

Examined a sample of 60 of the

eCRs

generated from the pilotConformed to HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 2: the Electronic Initial Case Report (

eICR), Release 1, STU Release 1.1 - US RealmSlide23

eCR Data Element Completeness* (n=60)

Data Element

No. of eCRs with Data Element

Populated

% Complete

Data Element

No. of eCRs with Data Element

Populated

% Complete

Date of the Report

60

100

Patient Ethnicity

60

100

Provider

Name

60

100

Occupation

50

100

Provider Email

4575Visit Date/Time

60100

Facility Phone60

100Symptoms (list)60

100Patient Name

60100Lab Results

60100Patient Phone59

98.3Diagnoses60

100Parent/Guardian Phone16

26.7Medications**

60100

Patient Address60100

Patient Sex

60100

Patient Race60

100

*Selected data elements only.

**Medications listed in eCR not likely to include STI treatment given the timing of the follow-up treatment visit.Slide24

eCR Data Elements Not PopulatedPatient Class, Hospital UnitNot populated as AllianceChicago serves only ambulatory providersDeath DateNot populated in this

context

Pregnant, Immunization Status, Travel History

No single data element equivalent for this in the EHRSlide25

Feedback and Lessons LearnedSlide26

Feedback and Lessons Learned

The

PHII/DSTDP case detection logic was

programmed into the commercial EHR system and successfully generated eCRs as anticipated

Mappings between the standard code systems (LOINC, SNOMED-CT) and the local proprietary codes used in the Centricity EHR were not available

Pilot was a pre-general release of the FHIR technology

Impeded progress and created challenges including lack of a reference build, lack of experience of the technology in a real world setting

Logistical issues with project management 

eCR

case detection logic does

NOT include medications

In ambulatory workflow, an eCR will trigger based on the

lab test performed in conjunction with the positive

lab

result, but

the STI treatment information will not be available at the time the eCR is sent

No trigger to update the eCR when the treatment information becomes availableSlide27

Next Steps/RecommendationsCollaborate with

IDPH/CDPH

as they develop the ability

to receive

eCRs and onboard into their surveillance system

Revising data to capture in the eCR

Medications administered at the follow-up treatment visit

Medications prescribed at the follow-up treatment visit

O

ther follow up (e.g., partner screening referral)

Slide28

General Questions and DiscussionSlide29

Closing Statement and Wrap UpSlide30

Overview of the STI eCR ProjectSlide31

Important MilestonesDemonstrated ability to work with EHR companies and health care providers on eCRUtilizing new HL7 standard for eCRTrigger logic performed well; is based on vocabulary standards for clinical terms

Public health agencies demonstrating capacity to onboard eCRs (Utah, Illinois, others)

Future work:

Work with HL7 to improve eCR standard

Develop capability to capture disease-specific dataSlide32

Wrap-UpSlides will be posted to phii.org/ecr-stiThank you for joining us!Slide33

AcknowledgmentsCDC Division of STD PreventionShelia Dooley-EdwardsNinad Mishra

Mark Stenger

Hillard

Weinstock

CDC OPHSS

Bill MacKenzie

Laura Conn

Nedra Garrett

Sanjeev Tandon

Public Health Informatics Institute

Sheereen Brown

Michael

DeMayo

Tonya Duhart

Jim Jellison

Claire LoeDaniela O’Connell

Natalie ViatorAllianceChicagoJeremy CarrAndrew HamiltonElizabeth McKnight

Roxane PadillaJessica ParkFred RachmanConsultantsTed KleinGib ParrishPartnersJim Daniel (ONC)

Meredith Lichtenstein (CSTE)Janet Hui (CSTE)Slide34

AcknowledgmentsColorado Arthur Davidson (DH)Dean McEwen (DH)Don Ryan (DH)

Mark Thrun (DH)

Diane Weed (DH)

Cindy Loftin (CDHE)

Anita Watkins (CDHE)

Massachusetts

Molly Crockett (MDPH)

Gillian Haney (MDPH)

Michael Klompas (HMS)

Catherine Rocchio (CI)

Sita Smith (MDPH)

Bob Zambarano (CI)

Utah

Rachelle Boulton (UDH)

Joel Hartsell (UDH)

David Jackson (UDH)

Susan Mottice (UDH)Jon Reid (UDH)Amanda Whipple (UDH)Expert Panel (Year 2)Rachelle Azor (VA)

Brendan Bedard (NY)Joan Chow (CA)Gillian Haney (MA)Joel Hartsell (UT)

Kim Pfeifer (WA)Shu McGarvey (consultant to CDC)Susan Mottice (UT)Fred Rachman (AllianceChicago)Jeff Stover (VA)Slide35

AcknowledgmentsIllinois Department of HealthTodd DavisSiva Guntupalli

Stacey Hoferka

Vinay Ugrappa

Chicago Department of Public Health

Cristal Simmons

Marion Tseng

RCKMS

Shu McGarvey

Julie Lipstein

Janet Hui

Catherine Staes

Jeff Benning

Pilot grantees

This project is supported by cooperative agreement number U38OT000216-2 from the

Centers for Disease Control and Prevention, Division of STD Prevention. Slide36

Glossary C-CDAConsolidated Clinical Document Architecture; widely implemented HL7 specification used to standardized the content and structure of clinical care summariesCentricity Practice Solution (CPS)EHR product implemented at AllianceChicago facilitiesFHIR

Fast Healthcare Interoperability Resources; an emerging standard for the electronic exchange of healthcare information developed by HL7

GE

GE Healthcare, a division of General Electric; the vendor that develops and supports the Centricity Practice Solution EHR product