Julia Skapik to ensure everyone can access confluence
everyone to edit use cases and provide feedback to design brief
Friday April 24 10am ET to review use cases and discuss plan to create working teams and to define/refine the desired outcomes
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.
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.
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
Reviewed and updated use case document including list of data elements and high-level workflow
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 Phone Screening Script
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
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
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
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
Emergency department COVID-19 Severity Classification / score
Will be available in the ACEP website.
See File List
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
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
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
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--
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
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
Next Steps:
Test with potential users-- Mindy, Julia, Raymonde
Create an Invitation to Participate: COVID-19 Phone Screening Tool
Create an Invitation to Participate: COVID-19 Population Health and Case Management Tools for Ambulatory Care
Mindy to update process for advancing Phone Screening Tool
Julia to touch base with Leo and Bijan re: Friday handoff
Agenda: 5/15
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)