Improving Public Health Surveillance Through Interoperability, Data Standards, and Legislation

January 24, 2019|2:13 p.m.| ASTHO Staff

Legislation to Promote Data Sharing and Interoperability

Emerging infectious diseases and natural disasters, as well as the ever-increasing prevalence of chronic disease, greatly increases the need for public health agencies to have more comprehensive knowledge of patients’ health coupled with an understanding of how to appropriately use technology. As patients move around the healthcare ecosystem, information from electronic health records (EHRs) must be available and understandable to help public health agencies identify threats to the health and safety of the population, as well as individuals. EHRs have also afforded patients better access to their own information and provided them with the opportunity to exercise some independence when making decisions for their own healthcare.

People have expressed concern about how their personal health data is managed and shared, whether it be at the provider’s office, a hospital, or even when picking up a prescription at their local pharmacy. As health information has increasingly become more digitized, it is crucial to have laws and policies to encourage common practices and data standards to maintain the public’s trust. Public health agency leaders have a major role to play in assuring this trust through the adoption of legislation, adherence to internationally recognized data standards, and the creation of policies or processes.

A little over a decade ago, hospitals and public health agencies relied heavily on paper, fax, and other manual methods to send and receive protected health information (PHI). Due to the Health Information Technology for Economic and Clinical Health Act of 2009, adoption of EHRs increased and also expanded privacy and security provisions for PHI under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Public health agencies are considered covered entities under the expanded HIPAA Privacy Rule, which permits healthcare to disclose PHI without authorization for specific public health purposes. Therefore, public health agencies are allowed access to PHI, and many states have legislatively mandated disease reporting from health providers to accomplish their mission of ensuring public health and safety.

However, public health agencies and healthcare providers do not use the same information systems, data formats, or even data standards. Interoperability, which supports the ability of different information technology (IT) systems and applications to communicate, as well as exchange and use information, would ensure that the right information can be shared between public health agencies and healthcare providers in a timely manner to address public health crises and epidemics. To achieve interoperability between public health and healthcare, comprehensive data sharing and the adoption and use of data standards is necessary. The 21st Century Cures Act of 2016 further defined interoperability and prohibits information blocking from healthcare to public health, and therefore their ability to safeguard the public’s health. Additionally, in 2011, the Center for Medicare and Medicaid Services established meaningful use, now the Promoting Interoperability program, to encourage further adoption of EHRs by healthcare and outline guidance around information blocking.

Data sharing and the language around it can be very complex. Below is a summary of commonly accepted data standards and terminology used in public health departments across the country.

Data Standards

Since 1987, the non-profit organization Health Level Seven (HL7) has developed information exchange and data standards to automate healthcare data sharing and improve patient care. The standards are divided into multiple reference categories which define how information is packaged and communicated from one party to another and support the management, delivery, and evaluation of health services.

The Fast Healthcare Interoperability Resources (FHIR) Specification aims to simplify implementation of data standards, leveraging existing models to provide a mechanism for exchanging data between healthcare applications. FHIR can be used as a standalone data exchange standard or in partnership with existing standards.

Public health leaders are closely monitoring advancements in HL7 and FHIR. HL7 Version 2 (v2) Messaging is one of its most widely adopted data standards, prominently used in in-patient settings, though also used in a variety of other contexts as well. HL7 v2 uses messages composed of re-usable data to communicate healthcare-related information between a sending and receiving system as well as patient transfers, lab orders, etc. FHIR supports an event-based messaging like HL7 v2 Messaging, though FHIR supports other exchanges of information, such as physicians’ clinical notes. Both FHIR and HL7 v3 Messaging make use of other data sets and have been adopted by several large EHR development efforts. Clinical Document Architecture is HL7's most widely adopted HL7 v3 standard. It provides both a standardized method for categorizing metadata about the document and a wide variety of clinical content.

Healthcare providers and public health agencies that may need to support interoperability between FHIR solutions and other HL7 standards should consider the relationship between these standards families. ASTHO’s Center for Population Health Strategies continues to work with public health agencies, public health professional associations, EHR vendors, and healthcare providers through the Digital Bridge to support the adoption of data standards for emerging technologies that support data exchange and sharing between public health and healthcare.

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