Leveraging Meaningful Use Standards – Opportunities for Public Health

BACKGROUND: Since Meaningful Use (MU) Stage 1 implementation in 2009 the landscape of electronic data exchange has changed considerably. The public health community has had 4+ years of experience in implementing HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 (ELR-R1).  With the start of MU stage 2 this year, the HL7 Version 2.5.1 Implementation Guide: S&I Framework Lab Results Interface, Release 1- US Realm (LRI-R1) is being added to the capacities of EHR systems in support of laboratory result exchange in the ambulatory arena. With MU Stage 3 on the horizon, expected to include the complimentary HL7 Version 2.5.1 Implementation Guide: S&I Framework Laboratory Orders from EHR, Release 1 - US Realm (LOI-R1) as well as the HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 2 (ELR-R2) as an extension to LRI-R1, Public Health should take notice and consider new opportunities.

METHODS: More EHRsystems are now supporting exchange of structured data which is then natively available in the system. Public Health should consider how this new capacity in EHRsystems will influence the availability of data and their format in which they may be automatically made available for secondary use. To maximize efficiency Public Health should re-examine their data requirements to rely as much as possible on existing clinical care data. With more clinical decision support functionality, Public Health should provide EHRsystems with processable rules on what may constitute a Public Health risk. This is one goal of the Reportable Condition Knowledge Management System (RCKMS). As a future direction these rules should also describe the data to be automatically extracted for the report.

RESULTS: Public Health may be at the beginning of a paradigm shift, if it allows a migration to the new media. For example: Finding new ways of utilizing the standards used in MU, like consider tapping into LOI-R1 based data exchanges as an early warning system, similar to how syndromic surveillance monitors ER visits. Rethinking the reported data to take advantage of EHRsystem- stored data elements and minimizing one-off request. Reformulating Public Health event definitions and reporting requirements so they are machine processable.

CONCLUSIONS: Public Health needs to be proactive, innovative and prepared in order to take advantage of new opportunities created by MU.