Health Information Exchange (HIE)

The NBS is an integrated disease surveillance system deployed in 22 public health jurisdictions to support receipt, investigation, analysis and reporting, and data exchange for state reportable conditions. The NBS is governed by the Centers for Disease Control and Prevention (CDC) and state, local, and territorial users that make up the NBS Community. In the early 2000’s, electronic laboratory results reporting (ELR) was implemented in an effort to improve timeliness and completeness of disease reporting. As standards-based electronic health records (EHRs) are adopted and more surveillance data become available, modern surveillance systems must consume information in an automated way and provide more functionality to automate key surveillance processes. 

Objective

The NEDSS Base System (NBS), an integrated disease surveillance system, implemented extensible functionality to support electronic data exchange for multiple use cases and public health workflow management of incoming messages and documents. 

CRE are drug-resistant bacteria that have a mortality rate of up to 50% in those infected. Several clusters of CRE have been detected in Illinois, often in long-term acute care hospitals. In response, Illinois created the XDRO registry, a mandatory reporting system designed to aid inter-facility communication concerning CRE.

Despite being a high priority for control in the US, the case definition for CRE has been the subject of debate3. There are over 70 Enterobacteriaceae which can have different mechanisms of carbapenem resistance. Criteria for carbapenem resistance include susceptibility results and phenotypic or genotypic detection. The case definition for the XDRO registry is intentionally more exclusive (specific) than that used by CSTE (Table 1). CSTE utilizes a definition designed to maximize sensitivity. Illinois’ XDRO registry’s definition is more specific, meant to reduce unnecessary adoption of contact precautions and the negative consequences some patients may experience.

Currently, case reporting to the XDRO registry is a manual data entry process, which has important advantages. However, transitioning to automatic ELR integration will streamline the reporting process and minimize data entry effort. Unfortunately, the clinical information needed to investigate XDROs is often not captured by ELR. The eCR is a new message type being piloted in Illinois that contains many clinical data elements. We examined the feasibility of combining ELR and eCR into reports for the XDRO registry. In the construction of these reports, we examined the impact of using CRE definitions from CSTE and the XDRO registry. 

Objective

To streamline carbapenem-resistant enterobacteriaceae (CRE) surveillance by integrating electronic laboratory reporting (ELR) data and electronic case reports (eCR) automatically into Illinois’ extensively drug-resistant organism (XDRO) registry. 

Once a facility meets data quality standards and is approved for production, an assumption is made that the quality of data received remains at the same level. When looking at production data quality reports from various states generated using a SAS data quality program, a need for production data quality assessment was identified. By implementing a periodic data quality update on all production facilities, data quality has improved for production data as a whole and for individual facility data. Through this activity several root causes of data quality degradation have been identified, allowing processes to be implemented in order to mitigate impact on data quality. 

Objective

To explore the quality of data submitted once a facility is moved into an ongoing submission status and address the importance of continuing data quality assessments. 

The Minnesota Department of Health (MDH) needs to be able to collect, use, and share clinical, individual-level health data electronically in secure and standardized ways in order to optimize surveillance capabilities, support public health goals, and ensure proper follow-up and action to public health threats. MDH programs, public health departments, and health care providers across the state are facing increasing demands to receive and submit electronic health data through approaches that are secure, coordinated, and efficient; use appropriate data standards; meet state and federal privacy laws; and align with best practices. This framework builds upon existing informatics models and two past studies assessing health information exchange (HIE) conducted by the MDH Office of Health Information Technology (OHIT) to provide MDH surveillance systems with an outline of the key elements and considerations for transitioning to more secure, standards-based, electronic data exchange. 

Objective

To create an informatics framework and provide guidance to help Minnesota’s public health surveillance systems achieve interoperability and transition to standards-based electronic information exchange with external health care providers using the state’s birth defects registry as an initial pilot program. 

Link to publication: 

View the abstract here

Washington State experienced a five-fold increase in deaths from unintentional drug overdoses between 1998 and 2014. The PMP collects data on controlled substances prescribed to patients and makes the data available to healthcare providers, giving providers another tool for patient care and safety. Optimal impact for the program depends on providers regularly accessing the information to review patients’ dispensing history. We have found through provider surveys and work with stakeholders that the best way to increase use is to make data seamlessly accessible through electronic health record systems (EHRs). This approach does not require a separate login to the PMP portal. This linkage works through the Health Information Exchange (HIE) to make PMP data available to providers via EHRs. The HIE facilitates electronic communication of patient information among organizations including hospitals and providers. In addition to the PMP, another resource to address the prescription drug abuse problem is the Emergency Department Information Exchange (EDIE), a web-based technology that specifically connects emergency departments statewide to track patients who visit multiple EDs. We also developed a connection between EDIE and PMP data through the HIE.

Objective

Demonstrate that use of the Washington State health information exchange (HIE) to facilitate access to prescription monitoring program (PMP) data enhances the effectiveness of a PMP. The increased accessibility will lead to improved patient care by giving providers more complete and recent data on patients’ controlled substance prescriptions.