Public health reporting and outbreak response: synergies with evolving clinical standards for interoperability

Mishra, Ninad; Duke, Jon; Lenert, Leslie; Karki, Saugat

doi:10.1093/jamia/ocaa059

Cited by 7 publications

(6 citation statements)

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“…The use of FHIR(26) may provide a viable path for automatic of public health case reporting and reduce administrative burden: when combined with an ELR based trigger for a case (in this example, sexually transmitted infection cases), an app that executed a FHIR-based query could complete an electronic case report form in 85% of cases(21). Additionally, all the key components of FHIR based workflows for public health reporting are often in place(27).…”

Section: Discussionmentioning

confidence: 99%

Development of a standards-based city-wide health information exchange for public health in response to COVID-19

Hota

Casey

McIntyre

et al. 2020

Preprint

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Background: Disease surveillance is a critical function of public health, provides essential information about disease burden, clinical and epidemiologic parameters of disease, and is an important element to effective and timely case and contact tracing. The COVID-19 pandemic has demonstrated the essential role these functions have to preserve public health. Syndromic surveillance, electronic laboratory reporting in the meaningful use program, and the growth of the National Healthcare Safety Network (NHSN) have created linkages between hospitals, commercial labs, and public health that can collect and organize data, often through EHR and order workflows, to improve the timeliness and completeness of reporting. In theory, the standard data formats and exchange methods provided by meaningful use should enable rapid healthcare data exchange in the setting of disruptive healthcare events like a pandemic. In reality, access to data remains challenging, and even if available, often lack conformity to regulated standards. Objective: We sought to use regulated interoperability standards already in production to generate regional bed capacity awareness, enhance the capture of epidemiological risk factors and clinical variables among COVID-19 tested patients, and reduce the administrative burden of reporting for stakeholders in a manner that could be replicated by other public health agencies. Methods: Following a public health order mandating data submission, we developed technical infrastructure to combine multiple data feeds from electronic health record systems. We measured the completeness of each feed, and the match rate between feeds. Results: A cloud-based environment was created that received data from electronic lab reporting, consolidated clinical data architecture, and bed capacity data feeds from sites. Data governance was planned from the project beginning to aid in consensus and principles for data use. 88,906 total persons from CCDA data among 14 facilities, and 408,741 persons from ELR records among 88 facilities, were submitted. Fields routinely absent from ELR feeds included travel histories, clinical symptoms, and comorbidities. CCDA data provided an improvement in the quality of data available for surveillance and was highly complete with <5% for all records types with the exception of patient cell phone. 90.1% of records could be matched between CCDA and ELR feeds. Conclusions: We describe the development of a city-wide public health data hub for the surveillance of COVID-19 infection. We were able to assess the completeness of existing ELR feeds, augment these feeds with CCDA documents, establish secure transfer methods for data exchange, develop cloud-based architecture to enable secure data storage and analytics, and produced meaningful dashboards for the monitoring of capacity and disease burden. We see this public health and clinical data registry as an informative example of the power of common standards across electronic records, and a potential template for future extension of the use of standards to improve public health surveillance.

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Section: Discussionmentioning

confidence: 99%

Development of a standards-based city-wide health information exchange for public health in response to COVID-19

Hota

Casey

McIntyre

et al. 2020

Preprint

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“…Another interesting initiative has been reported by Mishra et al . [ 31 ]. Authors adapted the FHIR-based architecture for infectious disease surveillance for sexually transmitted diseases to the general problem of outbreaks, showing the potential of this emerging technology in the COVID-19 scenario.…”

Section: Challenges and Directionsmentioning

confidence: 99%

Health informatics and EHR to support clinical research in the COVID-19 pandemic: an overview

Dagliati

Malovini

Tibollo

et al. 2021

Briefings in Bioinformatics

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The coronavirus disease 2019 (COVID-19) pandemic has clearly shown that major challenges and threats for humankind need to be addressed with global answers and shared decisions. Data and their analytics are crucial components of such decision-making activities. Rather interestingly, one of the most difficult aspects is reusing and sharing of accurate and detailed clinical data collected by Electronic Health Records (EHR), even if these data have a paramount importance. EHR data, in fact, are not only essential for supporting day-by-day activities, but also they can leverage research and support critical decisions about effectiveness of drugs and therapeutic strategies. In this paper, we will concentrate our attention on collaborative data infrastructures to support COVID-19 research and on the open issues of data sharing and data governance that COVID-19 had made emerge. Data interoperability, healthcare processes modelling and representation, shared procedures to deal with different data privacy regulations, and data stewardship and governance are seen as the most important aspects to boost collaborative research. Lessons learned from COVID-19 pandemic can be a strong element to improve international research and our future capability of dealing with fast developing emergencies and needs, which are likely to be more frequent in the future in our connected and intertwined world.

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“…The “without special effort” clause should necessitate that the public API enable this capability without purchasing paywalled features from an EHR vendor. An interoperable apps–based economy could drive down costs, support improved public health surveillance and response [ 8 ], bring machine learning to the point of care [ 9 ], and accelerate genome-informed medicine [ 10 , 11 ].…”

Section: Supporting An Interoperable App Economymentioning

confidence: 99%

The 21st Century Cures Act: A Competitive Apps Market and the Risk of Innovation Blocking

Gordon¹,

Mandl²

2020

J Med Internet Res

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The 21st Century Cures Act and the recently published “final rule” define standardized methods for obtaining electronic copies of electronic health record (EHR) data through application programming interfaces. The rule is meant to create an ecosystem of reusable, substitutable apps that can be built once but run at any hospital system “without special effort.” Yet, despite numerous provisions around information blocking in the final rule, there is concern that the business practices that govern EHR vendors and health care organizations in the United States could still stifle innovation. We describe potential app ecosystems that may form. We caution that misaligned incentives may result in anticompetitive behavior and purposefully limited functionality. Closed proprietary ecosystems may result, limiting the value derived from interoperability. The 21st Century Cures Act and final rule are an exciting step in the direction of improved interoperability. However, realizing the vision of a truly interoperable app ecosystem is not predetermined.

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Public health reporting and outbreak response: synergies with evolving clinical standards for interoperability

Cited by 7 publications

References 0 publications

Development of a standards-based city-wide health information exchange for public health in response to COVID-19

Development of a standards-based city-wide health information exchange for public health in response to COVID-19

Health informatics and EHR to support clinical research in the COVID-19 pandemic: an overview

The 21st Century Cures Act: A Competitive Apps Market and the Risk of Innovation Blocking

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