Table Of ContentUnderlying Standards
that Support Population
Health Improvement
Underlying Standards
that Support Population
Health Improvement
Laura Bright Johanna Goderre
•
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2018 by Taylor & Francis Group, LLC < change as necessary>
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Printed on acid-free paper
International Standard Book Number-13: 978-1-4987-6145-1 (Hardback)
This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been
made to publish reliable data and information, but the author and publisher cannot assume responsibility for the valid-
ity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright
holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this
form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we
may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or
utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including pho-
tocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission
from the publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://
www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923,
978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For orga-
nizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for
identification and explanation without intent to infringe.
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site at
http://www.crcpress.com
Contents
Preface .......................................................................................................vii
Acknowledgments ....................................................................................xi
Editors ......................................................................................................xiii
1 Introduction: Standards and Health IT .......................................1
TONE SOUTHERLAND
2 Early Hearing Detection and Intervention ................................19
DINA DICKERSON, MEUY SWAFFORD, AND HEATHER
MORROW-ALMEIDA
3 Renewing Health Project: Telemedicine in the Veneto Region .....49
CLAUDIO SACCAVINI, GIULIA PELLIZZON, MAURO ZANARDINI,
AND SILVIA MANCIN
4 Immunizations ...........................................................................75
ALEAN KIRNAK
5 Bumrungrad International Hospital Implementation of the
Patient Plan of Care Profile in Bangkok, Thailand .................119
LUANN WHITTENBURG, JIRAPORN LEKDUMRONGSAK, AUNCHISA
MEETIM, AND AMORNRAT KLAIKAEW
6 Diagnostic Imaging at eHealth Ontario ...................................147
LAURA BRIGHT, ANGELA LIANOS, AND SUE SCHNEIDER
7 E-Vital Standards Initiative ......................................................191
MICHELLE WILLIAMSON AND HETTY KHAN
8 Minnesota E-Birth Records Project: Assessing Readiness for
E-Birth Records Standards ......................................................227
KARI GUIDA AND SALLY ALMOND
v
vi ◾ Contents
9 E-Death Records in Utah .........................................................249
JEFFREY DUNCAN
Appendix ................................................................................................259
Index ........................................................................................................261
Preface
The editors of this book came into the field of standards development and
implementation in very different ways. Laura entered the healthcare stan-
dards world from the standpoint of a software developer and systems archi-
tect, two fields where the value of standard representations of data and
communications protocols are well understood; indeed, nothing in software
works without them. From Johanna’ s perspective in public health, her stake-
holders had a much harder time understanding the benefits a standards-
based approach to their projects would bring, in large part because the
standards themselves are too often difficult to understand. This is an all-
too-common problem in the healthcare standards space; the writers of the
standards are very technically focused people, and they write in very techni-
cal ways, which leaves the users and implementers saying, “ Why do I need
to do all this? Why does it have to be so complicated?”
With this book, we hope to address both of those questions by highlight-
ing success stories in implementing health IT standards in clear and easy
terms. Each chapter relates a case study demonstrating how standards fur-
ther interoperable health data exchange, especially in the service of advanc-
ing tools to monitor population health and public health. These are stories
that demonstrate how bringing the right stakeholders together on standards-
based projects can bridge divides between software architects and clinical
end users, health system decision-makers, and standards authors.
Our first chapter begins with an overview of the history of standards,
delving into what exactly we mean by a standard, where the concept of
standards started, and how we got where we are today. It gives a nontech-
nical view into the software and standards architect’ s perspective on the
necessary components of successful implementations to better explain the
“ why” behind standards, the testing of standards, and how to ensure better
end-user experiences.
vii
viii ◾ Preface
Our first case study in Chapter 2 looks at early childhood public health,
and the process behind the early detection of hearing problems in new-
borns. The state of Oregon has implemented the IHE Quality, Research,
and Public Health (QRPH) Early Hearing Detection and Intervention (EHDI)
Profile to receive live newborn hearing screening results electronically from
a partner hospital’ s electronic health records (EHRs) system. The project was
intended to reduce duplicative data entry for hospital screening partners and
improve the timeliness, completeness, and quality of the newborn hearing
screening data received, and has had very positive results.
From Oregon we move on to the Veneto region of Italy, and the Regions
of Europe Working Together for Health (RENEWING HEALTH) project,
whose focus is the use of integrated telemedicine services in the monitoring
of chronic patients suffering from cardiovascular disease, chronic obstructive
pulmonary disease, and diabetes. The use of telemonitoring services allows
for more effective management of chronic patients by ensuring the continu-
ity of care between the various clinical figures, allowing clinicians to have a
constantly updated clinical status of their patients.
Immunizations are a critical tool for the protection of public health and
are the focus of Chapter 4. Immunization information systems (IISs) and
immunization registries have become invaluable tools for tracking immuniza-
tion rates, tracking vaccine availability, and ensuring that children get all of
the immunizations they need. For years, IISs have collected, analyzed, and
reported on immunization-related data across the United States. This chapter
examines how the use of standards and consistent methods of data capture
for immunizations improve both individual health and public health by pro-
viding more accurate and timely data on rates of immunizations, reducing
precautionary vaccinations, managing inventories and programs, and identi-
fying populations at risk.
Our next venture into standards takes us to the Bumrungrad International
Hospital in Bangkok, Thailand, which treats over 1.1 million patients annu-
ally from 190 countries. Bumrungrad International Hospital has a patient
population that presents some unique challenges. A high proportion of the
patients treated in the facility are from other countries, and to treat them,
medical records must be coordinated globally and from a variety of national
health infrastructures. Bumrungrad International Hospital has adapted
the IHE Patient Plan of Care profile, which describes a standard way of
exchanging nursing data and care plans for patients. This chapter describes
the process used by Bumrungrad to adopt this standard for care planning in
Preface ◾ ix
the clinical environment, the interoperability challenges faced, and the solu-
tions developed by the site.
Diagnostic imaging and radiology have been a vital part of healthcare for
many years, but much more recent is the idea that having access to images
can be of benefit to all clinicians, not just those in the radiology depart-
ment. eHealth Ontario, an independent agency of the Ontario Ministry of
Health and Long-Term Care, developed a standards-based system called the
Diagnostic Imaging Common Service (DI CS). DI CS enables the sharing
and viewing of patients’ diagnostic images and reports from across Ontario
to hospital- and community-based healthcare providers anytime, anywhere.
Chapter 6 takes a look at the DI CS system, including the standards used
and related supporting systems, as well as the provincial approach to gover-
nance and data best practices.
The final three chapters deal with vital records (VR): a program most
nations have to track life events such as births, deaths, and marriages.
Across the United States, state departments of health VR programs are
modernizing their information systems with the use of e-vital records— the
electronic exchange of VR information between EHRs and state VR sys-
tems. Over the past several years, the National Center for Health Statistics
(NCHS) has collaborated with the National Association for Public Health
Statistics and Information Systems (NAPHSIS), EHR and VR system vendors,
and other VR stakeholders to create standards for the exchange, sharing,
and retrieval of information required for birth, death, and fetal death report-
ing. Chapter 7 takes us through the process used by NCHS to develop the
standards required, while Chapters 8 and 9 describe projects by individual
states to implement the standards that were developed. Chapter 8 introduces
a project by the state of Minnesota to make their birth reporting electronic.
Chapter 9 explores the other end of VR and the death reporting system
developed by the state of Utah.
Our goal in creating this book is to give you, the users, clinicians, and
administrators of the healthcare system, a better understanding of why stan-
dards exist and maybe spark some ideas for how standards might be able to
improve your own projects. We hope you find it useful.
Laura Bright and Johanna Goderre
