07/31/20:

Apr 17, 2020

@Mindy Hangsleben

@Julia Skapik

Agenda: 04/17/2020

10:00am ET              Welcome, background and thank you

10:05am ET              Ground rules and operational design

10:15am ET              Use case discussion

10:40am ET              Organizational partners and home for content

10:50am ET              Next steps

1. Friday April 24 10am ET to review use cases and discuss plan to create working teams and to define/refine the desired outcomes

Apr 24, 2020

• Review Use Cases

• Prioritization Discussion ( Webex polling – Julia to make we will have them rank for each use case the importance/high to low impact and the feasibility of how easy or hard it would be to implement a solution for the use case)

• Perform Polling

• Next Steps – I think we will need to calculate the polling data and publish the top use cases and then ask people to sign up for what they want to work on and identify if they want to lead the group.  I will also ask on our next call with the leads about the approach once we start focusing on targeted use cases and if we can all combine together and use it for updates. 

May 1, 2020

Meeting agenda: 5/1/2020

COVID CPG Presentation – Leo & Bijan – University of Manchester

Additional use case walkthrough – Felix – Decision Q

Human Centered Design Process – Mindy

Next Steps – Julia & Mindy

Discussed CPG CAT tool and watched demo. Agreed to prioritize phone screening use case for CAT implementation.

Reviewed HCD process

Felix presented wearables use case for community tracking-- discussion yielded agreement to link to tracking/case management use case.

May 6, 2020

Agenda:

• Use Case Triage—identify top priorities, identify related projects to combine with

• Create Teams for Use Cases

• Work planning for Phone Screening Use Case

• Next Steps

Agreement to advance Phone Screening initially along with Pop Health/Case Management Use Case

May 8, 2020

Phone Screening Use Case working time

https://logica.atlassian.net/wiki/spaces/DAS/pages/852656142

Reviewed and updated use case document including list of data elements and high-level workflow

May 15, 2020

Review of Phone Screening Use Case and Feedback (10 min)

Phone Screening Use Case Process (Mindy 10 min)

Population Health and Case Management Use Case: Use Case Components (20 min)

• Identify Cases or Possible Cases

• Order and complete testing

• Follow up test results

• Reporting and Contact Tracing

• Update Case Status

• Monitor Positive or Probable Cases in Quarantine

• Inpatient/Outpatient handoffs

• Convalescence

Prioritize Components (5 min)

Population Health and Case Management Use Case Next Steps (10 min)

Reviewed the script and made updates.

Need to complete the following:

• Review Terminology

• Content

• Flow Diagram

• Update References List

• Send Request for feedback

Didn’t get to discuss the PopHealth use case but got lots of good feedback on Phone Screening Use Case-- see the page here https://logica.atlassian.net/wiki/spaces/DAS/pages/868515904

05/22/2020

• Update and Next Steps: Phone Screening Use Case and Feedback (10 min)

  Population Health and Case Management Use Case: Use Case Components (30 min)

  • Identify Cases or Possible Cases

  • Order and complete testing

  • Follow up test results

  • Reporting and Contact Tracing

  • Update Case Status

  • Monitor Positive or Probable Cases in Quarantine

  • Inpatient/Outpatient handoffs

  • Convalescence

  Prioritize Components (5 min)

  Population Health and Case Management Use Case Next Steps (10 min)

Reviewed the updated documents that Julia sent out around the phone screen use case and requested for any one that knows sites that would be willing to implement to send them to Julia and Mindy.

Prioritized the use case components for the use case for case management and the top three are below:

Identify Cases or Possible Cases

Order and complete testing

Monitor Positive or Probable Cases in Quarantine

Next Steps to Deep Dive into the three areas

5/29/2020

• Meeting agenda: 5/29/2020

  Phone Screening Update Request for Implementers (5 min)

  Demo: SMART COVID-19 Dashboard – Dave Carlson (10 min)

• Population Health and Case Management Use Case Deep Dive (40 min)

  • Cases or Possible Cases

  • Order and complete testing

  • Monitor Positive or Probable Cases in Quarantine

    Next Steps (5 min)

Demo was deferred to next meeting

Reviewed use cases and created data element list for the data dictionary

6/5/2020

• Meeting agenda: 6/5/2020

  Phone Screening Update Request for Implementers (2 min)

  Demo: SMART COVID-19 Dashboard – Dave Carlson (10 min)

• Population Health and Case Management Use Case Deep Dive (15 min)

  • Requirements for Users

• COVID-19 Data Dictionary

  Next Steps (5 min)

Demo from Dave Carlson on an open source care management tool being developed by AHRQ

6/12/2020

• Meeting agenda: 6/12/2020

  Phone Screening Update: Manchester to provide detailed flow and team to review/edit this coming week

• Review Population Health and Case Management Use Case (15 min)

  • State and Local reporting requirements alignment w/CDC

    • State and local variations may be significant

    • Routine workflow: From clinical care to state/local public health organizations and that flows to the CDC

    • Public health emergency: Reporting of COVID-19 case reporting as a communicable disease comes from clinical organizations to state/local public health agencies → CDC/HHS but may also report to CDC

    • Testing organizations: provide electronic laboratory reporting

• eCR Tool Demo and Discussion (John Loonsk) - (45 min)

  • Laboratory reporting workflow is well-described but level of data specificity was often inadequate

    • New HHS guidance requires labs to achieve new minimum level of data

    • Electronic approach is relatively newer (eLR)

      • Focused on transmitting the data locally then to the state

      • Includes an email address for interest in participation-- eCR-Info@aimsplatform.org

      • Deployment team can support pilot sites – no charge

• Funding cuts to public health agencies has had a significant impact on the readiness of public health reporting and local prevention and mitigation efforts

  • Funding has been released and many organizations are filling in gaps and updating systems

  • Public health agency surveillance systems are functioning with adequate capacity when populated appropriately

• Recent articles:

  • Traditional Barriers to eCR

  • Data Methodology and Quality in COVID-19

• Copy John Loonsk: john.loonsk@jhu.edu

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    •  

6/19/2020

Meeting agenda: 6/19/2020

Review testing use case and COVID-19 Data Dictionary

6/26/2020

• Meeting agenda: 6/26/2020

  Phone Screening Update: Partners Discussion and Manchester Updates - Julia

  • UofM team is working on edits to the tool

  • http://mancar.co.uk/cpmgs.html University of Manchester Repository. CPG-on-FHIR work : search for Department of VA, kidney

• Update Case Management Use Case with workflow additions for reporting - Julia (20 min)

• Mental Health Integration to Use Cases - Sharon (25 min)

• Share upcoming funding opportunities - Sharon (5 min)

• Next Steps - Julia (5 min)

07/17/2020

Updates:

Phone Screening Use Case (5 min)

CDC-NACHC COVID-19 Project (5 min)

Meeting Management for DAS-- restructuring the DAS group? (20 min)

Public Health Case Reporting Follow Up (20 min)

Jodi – Need to review nodes 40-51, need to identify implementers for the triage, looking at the output to utilize cds hooks to integrate into the EHR to transfer that over to the doc, taking the output and utilizing the smart app

Sharon – Can we have a group that has already went through this to take a review? 

Susan - Could we potentially use it at the University student health centers as they are starting to return and even have them create apps?

Michelle Tropper – Would be willing to do the review of the triage as they have been working with similar algorithms.

Ray – He has reached out to his med school and is awaiting to hear back.

Rebecca – Has connections at the U of WI Alumni group that is working on COVID.

Kathy Seward - We'd be interested in considering this within the College of Nursing - from 2 aspects. Internally we're planning to look at effects ON our students. And we have both NI and BMI students.  And we have an NP faculty practice in student health services.

Julia – Come up with a request to send out and see if we can get some interest in participating in developing some sort of app, etc.

Checked in on the meeting structure to see if it is working well.  Feedback was that they like the updates on a weekly basis.  Some are trying to connect others in when it is relevant. 

Julia asked the team to provide feedback on how the DAS group would like to be involved and integrated with the NACHC-CDC project.

Lindsay suggested that active involvement of CHC and HCCN partners who aren’t going to be funded is critical to the work. HealthyArizona is very interested in continuing to participate

Bryant suggested MedMorph collaboration – Maria will follow up with the group to consider how we can collaborate.

Suggestion to formally present to the HL7 public health workgroup. Bryant to follow up with the cochairs to give us an opportunity to present.

Sharon suggested thinking about validating the content of the COVID data dictionary. Consider a targeted presentation from ED/ICU and consumer groups.

Hi - Michelle from HealthEfficient - we
from mtropper@healthefficient.org to everyone:
we've been working with some algorithms here and would be willing to do the review suggested
from mtropper@healthefficient.org to everyone:
by Sharon

from Rebecca Swain-Eng to everyone:
I have connections with the University of Wisconsin, Alumni group who is putting out COVID info as well as the school of medicine and public health.
from Kathy Sward to everyone:
We
from Kathy Sward to everyone:
We'd be interested in considering this within the College of Nursing - from 2 aspects. Internally we're planning to look at effects ON our students. And we have both NI and BMI students.
from Kathy Sward to everyone:
And we have an NP faculty practice in student health services.

from Maria Michaels to everyone:
For anyone who isn't familiar with MedMorph (Making EHR Data More Available for Research and Public Health), here's a quick overview: https://www.cdc.gov/csels/phio/making-ehr-data-more-available.html
from Jodi Wachs (privately):
Would be interested in update on how they are doing the implementation of the anticoagulation use case

Lily Khan: NAACHO

Represent all of the US local health departments-- work with ASTHO (state/territory health departments)

Engaging with healthcare orgs, public health orgs and beyond

NAACHO brings systems perspective and content to COVID perspective

• will follow up with NAACHO presentation in 2 weeks-- had a virtual interoperability showcase at their annual meeting-- talked about FHIR resources and online tools for public health

Bryant: PSA: Bill Lober’s team at UWa StayHome app is now in the process of working with COVID Safe app and created a new effort called CommonCircle.US

07/24/20

Updates from collaborators/related groups:

• ED/ICU

• Consumer group

• eCR Now/AIMS

• HL7 Public Health?

• C19 IA?

• Phone Screening Use Case

HL7 Public Health-- follow up with co-chairs for formal presentation-- has been a lot of activity around bulk HL7 FHIR data extraction led by Aneesh Chopra leveraging Argonauts and working with Chicago public health transformation projects-- COVID is the motivating approach to accelerate the infrastructure/set up

Phone Screening Use Case-- next Friday we will have an update from U of M-- looking still for pilots will

Reviewed CRET framework-- will reach out to them to follow up in a future call

C19 Interoperability Alliance: follow up

07/31/2020

• NACHC-CDC Cooperative Agreement on COVID-19 RFP is out: Click Here to Apply

• Student volunteers/projects

• Consumer group: Danny van Leeuwen/Laura Marcial

• eCR Now/AIMS: John Loonsk

• ED/ICU: update next week

  • triage tool (paper version) attached

• Phone Screening Use Case

• Mental Health Use Case-- will have a small group session on the use case next week or following-- update on next week’s call

Updates from collaborators/related groups:

• NACHC-CDC Cooperative Agreement on COVID-19 RFP is out: Click Here to Apply

  • Informational webinar Tuesday, August 4 4pm ET

  • HCCNs, PCAs and large CHCs

  • jskapik@nachc.com

• Student volunteers/projects

  • Raymonde working on an invitation for students/interns to participate-- Ruy@nachc.com

  • Susan: looking into Georgia Tech university connections

  • AMIA – Julia to follow up

  • AAMC -- Julia to reach out

• Consumer group: Danny van Leeuwen/Laura Marcial

  • See slides

  • Plan to connect on Pandemic Response Network approach at Duke-- will invite the Consumer group to join

• eCR Now/AIMS: John Loonsk john.loonsk@jhu.edu

  • Work is ongoing to automate case reporting

  • Major challenge is getting EHR vendors to automate and implement-- Epic is major vendor online now

    • Cerner and Athena are working to implement the app using SMART on FHIR

    • Allscripts working on CDA implementation for Sunrise

  • Operational challenge is need for legal agreements-- working on a policy framework

  • Working to remove manual reporting requirements where electronic case reporting can be done-- some states/local sites require both

  • eCR now is an allowed alternative approach for HHS “lab data” and “ask on order entry” questions

    • Covers 89 conditions

  • Most of implementation focused on COVID-19 but other conditions in scope

  • 52/58 states have received eICRs in over 3000 sites, and 1.1 million reports

  • Next Steps for interested parties:

    • If Epic: contact the eCR team-- 3-5 day onboarding process and then can basically be “turned on”

    • If other vendor: contact the eCR team and work with the vendor or create a local implementation of the app across the network and support sites directly

  • Electronic laboratory reporting means that local and state public health agencies may get feeds from these data sources but this is not universal

    • AIMS platforms delivers results to state public health agencies and some local ones but usually the state transmits

  • Local/city health departments are working to coordinate processes across the nation to understand and augment transmission of data and the workflows around that

    • from the standpoint of case report-- it is a static patient-level summary of data that is much richer than lab report data (which is limited) and adds a lot of value to many stakeholders

    • Can deliver these reports as html so it acts as a virtual paper report/efax

    •  

• ED/ICU: update next week

  • triage tool (paper version) attached

• Phone Screening Use Case

  • UofM team has completed the coding of the phone screening use case tool

  • Asking for volunteers to

• Mental Health Use Case-- will have a small group session on the use case next week or following-- update on next week’s call

08/07/2020

Craig Newman, Erin Holt, Matthew Burton

1. HL7 Public Health update:

   1. Craig Newman

   2. Erin Holt

2. ED/ICU WG update:

   1. Matthew Burton

3. Website Updates

   1. Julia Skapik and Raymonde Uy

4. Review New Invitation to DAS:

   1. Raymonde Uy

5. Mental Health Use Case Review:

   1. Sharon Hibay

1. Link to the Public Health Work Group page at HL7:

   1. https://confluence.hl7.org/display/PHWG/Public+Health+Work+Group

2. List of the projects the WG has going:

   1. https://confluence.hl7.org/display/PHWG/Public+Health+Project+Roadmap

3. Link to guidance on recent HHS lab result reporting required:

   1. https://confluence.hl7.org/display/OO/Proposed+HHS+ELR+Submission+Guidance+using+HL7+v2+Messages

   2. https://confluence.hl7.org/display/OO/Proposed+HHS+ELR+Submission+Guidance+using+HL7+v2+Messageshttps://confluence.hl7.org/display/OO/Proposed+HHS+ELR+Submission+Guidance+using+HL7+v2+Messages

   3. https://confluence.hl7.org/display/OO/Proposed+HHS+ELR+Submission+Guidance+using+HL7+v2+Messages

4. COVID FHIR Profile Library:

   1. https://covid-19-ig.logicahealth.org/artifacts.html

5. SANER:

   1. http://build.fhir.org/ig/HL7/fhir-saner/index.html

6. Information on the upcoming HL7 virtual working group meeting in September:

   1. http://www.hl7.org/events/working_group_meeting/2020/09/index.cfm

   2. non-HL7 members can sign up for the working group meeting and can attend if they are interested

7. Information on the upcoming September FHIR Connectathon:

   1. https://www.hl7.org/events/fhir/connectathon/2020/09/

8. HL7 agenda page

   1. https://confluence.hl7.org/pages/viewpage.action?pageId=4489402

9. Overview of MedMorph:

   1. https://www.cdc.gov/csels/phio/making-ehr-data-more-available.html

10. PH WG call agendas:

    1. https://confluence.hl7.org/pages/viewpage.action?pageId=4489402

11. eCR Now:

    1. https://ecr.aimsplatform.org/about-us

12. Emergency department COVID-19 Severity Classification / score

    1. Will be available in the ACEP website.

    2. See File List

Aug 14, 2020

Meeting Agenda:

• Forward Health update: Michael Barbouche

• MITRE Public Health Clinical Decision Support: Matt Downs

• CDS for Testing: Julia Skapik

• Mental Health Use Case Review: Sharon Hibay

Confluence update: please let Julia and Mindy know if you are having issues with Confluence edit access-- we will continue to update the site to make it more user friendly

Michael Barbouche Forward Health: michael.barbouche@forwardhealthgroup.com

• Working with FQHCs

• UDS is good but not able to be used in real time

• Being remote affects the clinic’s ability to do QI

• Many FQHC partners use someone else’s system so they can’t modify it for their own needs often

• Forward Health datasets-- creating new data elements for the tracking and follow up of COVID-19 patients

• Data flow and missing data are big challenges for sites

• Forward Health provides a population health snapshot of the testing and results for the population but also to drill into the patient level using data sources from disparate locations

• solution is mapped on the EHR?-- it can be

Matthew Downs: MITRE Decision Support Tool

• C19 HCC--COVID-19 Coalition tool to support data-driven local, state and regional decision-making about COVID-19 case rates, trends and comparisions

• Shows about social distancing trends based on GPS and shelter in place

• Can be used for decisions about opening/closing or in person vs virtual services

• Matthew Downs: medowns@mitre.org

• https://dsd.c19hcc.org/

Testing Use Case Update:

• Join us at 12pm ET for the ACTS weekly meeting where we will discuss advancing the CDS for COVID Testing and Follow up use case

Aug 21, 2020

1. NACCHO

   1. Lilly Kan

   2. Oscar Alleyne

2. Mark Sendak:

   1. Mark.Sendak@duke.edu

What transpired?

1. NACCHO update

2. Duke Pandemic Response Network:

Pending:

1. Mental Health Use Case Review

   1. Sharon Hibay

2. Student invites to participate

   1. Susan and Raymonde

3. CDS for Testing:

   1. Julia Skapik (if time permits)

Student invites: need 30 min meeting this week to discuss the onboarding of partners-- Susan Robinson

• website is updated initially-- will continue to work on it but ok to share

• Georgia Tech is doing advanced mental health response work using sensors-- will try to integrate

• Can meet Weds at 2p-230

NACCHO: city and county public health organizations-- Lilly Kan and Oscar Alleyne

• Working on pandemic response at the local level

• Investments in the public health infrastructure have lagged at the local level

• Challenge for local PH entitiesto keep up with the state of the art in COVID

• Both emerging and established infectious disease are part of the response

• trying to help local health departments access data and improve skills

• Vivian Singletary – public health informatics institute has been supporting the effort

• NAACHO cohosts a public health conference with CDC every 2 years-- in 2020 the meeting was reimagined-- Public Health Informatics Information Technology and Surveillance (PHIITS) (former name was Public Health Information Network (PHIN)

• NAACCHO has partnered with HIMSS and their 2020 conference but this year was interrupted by the pandemic

• Need to think about programs and data simultaneously-- did demos on opioid use and monitoring, the content is archived from the recent meeting

• Handouts from recent meeting will be posted to confluence

• Future COVID work:

  • Helping local sites to understand how data can be effectively used at hand

  • Working to help sites prepare for vaccination programs for COVID-- encouraging plugging into state IIS systems

  • Encouraging local sites to use and supporting digital contact tracing tools including SaraAlert

• Just released 2019 profiles of local health department survey

Duke Pandemic Response Network

Interested parties:

28 Aug 2020

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Meeting Reboot:

NO MEETING SEPT 4 or 11

After this call we will send out a doodle poll to participants asking when a better time later in the day would be to facilitate easier participation from the West coast and Alaska/HI

Meeting frequency will move to every other week and alternate with a community health focused workgroup led by NACHC. Individuals who are interested in participating in that approach are welcome to email jskapik@nachc.com

Anyone interested in supporting the group as a volunteer co-lead would be greatly appreciated-- please let us know ASAP so you can participate in the selection of a new meeting day/time

Testing Use Case:

New guidance from CDC was released but it does not seem to have associated evidence to support it yet--will this change management? The group believes that it is too soon to make any changes in the approach given that the current approach is based on long-standing public health guidance and that the guidance may change again

We are interested in looking at the evidence on testing at our next meeting and moving that into the CPG on FHIR framework-- Maria offered to bring that team to the discussion

There is also an ONC project with HHS CIO/CTO: interested in public health CDS and emergency data deployment approach-- will follow up on next meeting on CDS/testing-- CRET--

• Clinical Response through Emerging Technology:

Mental Health Use Case Review:

Sharon has been bringing together content for the mental health use case-- includes the previously described data elements, the CMS eCQMs on mental health, and other SDOH data

• AMA has some content in Z codes but it is not often populated

• Need to screen for mental health and follow up

• Community health is doing additional screening including PHQ2 and 9--

• High risk patients are likely to be at higher risk

• Consider anxiety, OCD, paranoia, neurologic complications of COVID as well as depression

• Bringing in the viewpoints of SAMHSA, APA and VA would be important

• Initiative in Texas is focused on decreasing documentation requirements so there could be pushback

  • Consider using patient-facing documentation, robocalls?, texts

• plan for follow up call with mental health stakeholders to target a specific implementation approach

COVID-19 Interoperability Alliance: Randy Woodward

Focused on creating alignment across the field for definitions and content

• Includes Logica Health who have developed COVID-19 FHIR IG, MITRE with C19 HCC, Regenstrief who has been approving and creating LOINC codes, CareEvolution has been providing interoperability data, SNOMED-CT has been approving and creating SNOMED-CT content, CA and Apelon have been providing terminology content and QA

• Use cases include federated observational studies and comparable analytics

• C19IA: https://c19ia.org

• SNOMED content: http://snomed.org/cv19

• FHIR IG: https://covid-19-ig/logicahealth.org

• HCC: https://mcovid.org

• Value Set Curation-- building and releasing content

  • also creating groupers across code systems

  • updated every Tuesday and Friday

• C19IA site allows real time feedback and viewing

• All are also published to VSAC and can be found in their homepage at a link that filters the COVID19 value sets-- contains 6 code system groupers that have over 600 value sets total

  • Updated in VSAC monthly