The Office of the National Coordinator for Health Information Technology is actively supporting the Centers for Disease Control and Prevention’s response to the U.S. outbreak of the Zika virus, with health IT playing a critical role, according to James Daniel, public health coordinator in the ONC Office of Policy.
Speaking at a recent joint meeting of the Health IT Policy and Standards committees, Daniel provided a detailed look at HIT activities to date in support of the CDC’s Emergency Operations Center (EOC), which is monitoring and coordinating the Zika response.
“This has been a very collaborative effort with the Centers for Disease Control,” said Daniel, who coordinates ONC activities with state and local health departments as well as the CDC around the implementation of Meaningful Use objectives. “We are in very close contact with them.”
He told the HIT and Standards Committees that the agencies are building on the lessons learned from responses to Ebola and the Middle East Respiratory Syndrome (MERS), including “looking back at the things that the health IT developer community found helpful” during those public health emergencies.
As the principal contact between ONC and CDC, participating on all key HIT-related issues, Daniel outlined for the committees several initiatives that are currently underway, including:
- Developing algorithms
- Standardizing vocabulary sets
- Incorporating Zika order sets into HIT products
- Reaching out to HIT vendors
Vendor outreach includes “ongoing webinars where every time we have updates to the clinical guidance from CDC, we present our version of the updated guidance from ONC,” according to Daniel, who said that the agency also conducts additional webinars to ensure they understand vendor needs.
“The crux of what we’re doing is taking the guidance that comes out of CDC from the Zika EOC—what you might see in the Morbidity and Mortality Weekly Report (MMWR)—and really translating that into something more applicable for health IT developers,” he added. “Every time there is updated guidance, we create these new algorithms. The health IT developers found this very useful during Ebola, and they find this very useful during Zika as well.”
According to Daniel, one of the biggest challenges is that the CDC’s guidance on Zika is “being constantly updated” which makes it difficult to keep up with changes. As a result, he said ONC is looking at ways to potentially automate the process.
In addition, Daniel commented that the Zika vocabulary for vendors is very important, as are value sets for implementing the CDC’s interim guidelines which could be used by the EHR community for decision support.
“We want to make sure that everyone is using the same value sets and everyone knows, for example, the Zika affected areas and that we’ve got the right value sets for those,” he said.
When it comes to order sets related to Zika, Daniel made the point that the local variation challenge has introduced complexity-mapping variations that have “made it impossible” for ONC to develop standard order sets and have prohibited an automated push of orders sets. However, he noted that current documentation (i.e., vocabulary standards) on order sets as related to the clinical guidance documents remain useful.
“It’s really the current documentation that we have that allows people to then implement those order sets in their products by either the vendor or the local level,” according to Daniel, who remarked that clinical decision support modules on the Zika workflow are still built at the local level (i.e., practice/hospital).
Another major challenge ONC has discovered with Zika is the capture of pregnancy status and other data related to case management, he said.
“It turns out that current pregnancy status is a little difficult to actually pull from electronic health records, and getting that information to public health has been a challenge as well,” Daniel lamented. “Public health would very much like to know—at the point that a lab test is ordered—what the pregnancy status of that person is because it not only means that they might need to follow that person for outcomes, but it also plays a role in how they prioritize the testing.”
He said ONC is working closely with health IT developers and public health partners to try to come up with a best practice in how to get pregnancy status information in a timely manner, as well as ensure linkages to state and local health departments and the U.S. Zika Pregnancy Registry.
Citing the most recent data from the U.S. Zika Pregnancy Registry and the Zika Active Pregnancy Surveillance System in Puerto Rico, Daniel reported that there are more than 800 pregnant women in the United States and District of Columbia with lab evidence of virus infection, and an additional 1,490 in the U.S. territories. He added that there have been 21 confirmed live-born infants with birth defects and five pregnancy losses with birth defects in the U.S. and D.C. to date.
Going forward, Daniel said one of the goals of the Zika coordination between CDC and ONC is building an “all-hazards approach” that meets the requirements in dealing with not only infectious diseases but other types of public health events. This all-hazards approach would be based on common “building blocks” for the workflow and movement of data.
For a given situation, the order of the building blocks may change and certain blocks may be of less importance, according to Daniel, but the objective is to determine the right blocks and where they belong.
“As we’ve done this for Ebola and as we did this for MERS as well, we’ve realized that we’re really doing the same sets of processes over and over,” he said. “We want to make sure that we’re thinking about this at a higher level so that we’re not starting from scratch every time, and that we can start thinking about the standards to make some of this information flow between public health and our health IT developers more automated.”
Daniel added that ONC did some work at the recent HL7 Connectathon and Public Health Informatics Conference looking at structured data capture using HL7’s emerging Fast Healthcare Interoperability Resources (FHIR) standards to collect some of the information around pregnancy status, as well as CDS Hooks for links to travel history/testing recommendations, and Clinical Quality Framework/FHIR Clinical Reasoning for standard terminology for measures and clinical decision support.
“These are the things that we’re starting to think about so that we can start moving forward and have an infrastructure in place that could help support us to do this in a more automated fashion with Zika and with other infectious diseases and public health responses that come up in the future,” Daniel concluded.
In response, Paul Tang, MD, co-chair of the Health IT Policy Committee, called ONC’s efforts in this area a “fabulous example” of the power of HIT. “It’s really bringing public health to the point of care and vice versa,” Tang said.
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