Public Health and Health Information Exchange: New York Public Health Use Case Implementations with the AHIC Minimum Data Set

New York State Department of Health and New York City Department of Health and Mental Hygiene, through the Centers for Disease Control and Prevention (CDC) Accelerating Public Health Situational Awareness Through Health Information Exchanges Project, is implementing and evaluating the AHIC Harmonized Use Case for Biosurveillance (BUC) using the Minimum Biosurveillance Data Set (MDS). During Project Year 1, five Regional Health Information Organizations (RHIOs) participated. Four assessed MDS data availability and messaging, terminology, and document standards at the RHIO. Three assessed availability in Emergency Department, Inpatient, and Outpatient settings. Two implemented the BUC and exchanged MDS with public health (PH).  One applied the PH data filter for influenza, influenza-like-illness, and pneumonia.

MDS assessment identified that limited facility data elements are available. Patient data elements are typically available to PH within eight hours of electronic availability. Some key elements are either not available or within free-text note fields. Three RHIOs provided feedback on the BUC. RHIOs identified a coordinated set of processes necessary to exchange relevant PH-related clinical information for event monitoring across a fragmented delivery system. However, existing technical capability of organizations to share clinical information electronically remains a large gap. Facility census, clinical, and laboratory data files from 17 facilities were successfully exchanged with two RHIOs. Difficulties encountered include delay in clinical data availability, misunderstanding of source data systems, duplicate messages, and high volume of laboratory data.

There were differences in RHIO policies, technical implementation approaches and data readiness. Disparate source data systems and limited use of standardized terminology and processes were identified at the hospital level. Information about the systems, use, and quality control was not readily available.  Usefulness of data without national standards is limited, especially as the number of data exchange partners increases. Methodology to extract relevant findings and perform sensitive and specific analyses is needed.