Assignment Location: Illinois Department of Public Health
Chicago, Illinois
Primary Mentor: Stacey Hoferka, MPH, MSIS
Surveillance & Informatics Epidemiologist
Illinois Department of Public Health
Secondary Mentor: Mary Driscolll, RN, MPH
Division Chief, Patient Safety and Quality
Illinois Department of Public Health
Mentor Information Stacey Hoferka received her MPH from the University of Illinois at Chicago in infectious disease epidemiology and a MS in Information Science, with a concentration in geoinformatics from the University of Pittsburgh. She has been the Surveillance and Informatics Epidemiologist for the Illinois Department of Public Health since 2012. In this role, she works with both state and local health department staff in communicable disease, environmental health, chronic disease and emergency preparedness to increase their utilization of surveillance data at IDPH. Prior to taking the position at IDPH, she worked at the DuPage County Health Department in Wheaton , IL, from 2007‐2012 as the Manager of the Communicable Disease and Epidemiology Program. She has worked on syndromic surveillance systems for several years using various analytic tools including BioSense, ESSENCE and RODS. Her informatics experience includes the review and evaluation of Electronic Laboratory Reporting and syndromic surveillance data. She is a current member of the BioSense 2.0 Governance Group. She is actively involved with the International Society for Disease Surveillance presenting on topics from data sharing, emerging trends in Enterovirus D68, collaboration among BioSense user workgroups, heat‐related morbidity and record linkage supported by the Health Information Exchange. She is a current mentor to an Applied Public Health Informatics Fellow for the class of 2014. She supports the APHI fellow’s informatics training on tools, such as R, Rhapsody and HL7, encouraged her participation in national conferences, including the International Society for Disease Surveillance and provides opportunities for joint collaboration with Northwestern University, the other fellowship site in 2014. In her role as Manager of CD and Epidemiology at DuPage, Ms. Hoferka supervised epidemiologists, CD specialists and interns that supported absenteeism, mandatory reportable disease, syndromic and BMI surveillance system. Staff and interns that she managed were elevated to roles of manager or full‐time positions. Publications: Hoferka S, Handler I, Linthicum S, Jovanov D, Trick W, Kauerauf J. Leveraging the Master Patient Index in Public Health Surveillance through Collaboration between Illinois Department of Public Health and the Illinois Health Information Exchange. 2014 International Society for Disease Surveillance Conference. Hoferka S, Rennick M, Austin E, Burke A, Ergas R, Fiedler J, Streichert L. Community Engagement among
Hoferka S, Wiedeman C, Lall R, Coletta M, Burkom H. Tractable Use Case Problems to Foster Collaboration for the Advancement of Public Health Surveillance. 2014 International Society for Disease Surveillance Conference. Mary Driscoll is currently the Division Chief, Division of Patient Safety and Quality at the Illinois Department of Public Health. Driscoll is responsible for advising the Department on all issues of Patient Safety and Quality Health Care, as well as for the implementation of mandated patient safety and quality initiatives, like the consumer guide to Health Care, the Hospital Report Card, and Adverse Event Reporting. She is also the IDPH liaison to the state Health Information Exchange (HIE) and chair of the Public Health Committee of the HIE. The Hospital Discharge Data, which hospitals report to IDPH by law, resides in Driscoll’s Division. Using the discharge data, she has produced IDPH papers on MRSA, Clostridium difficile, and the rise in Caesarean section deliveries. Driscoll has worked closely with HRSA and the CDC on a number of health initiatives such as building electronic infrastructure and capacity to refer the uninsured and underinsured into specialty care services, universal HIV testing, counseling and education for pregnant women, immunization and flu vaccine initiatives, and organizing Illinois hospitals to participate in infection surveillance through the CDC National Health Safety Network (NHSN Driscoll is part of Illinois overall strategic planning on implementation of Health Reform and service delivery change. She is also one of the developers of the public health node which accepts provider data for meaningful use. Driscoll has worked in health care services for over 30 years, recently leaving the service arena for a more policy focused position at Illinois Department of Public Health. Her extensive background in service delivery, particularly for the underserved, and her current role in quality and patient safety will serve to assist the team in promoting use of data to promote both primary and secondary prevention in clinical settings. Selected publications: Henderson H, German V, Panter A. T, Huba J, Driscoll M, et al. “Systems Change Resulting From HIV/AIDS Education and Training”. Evaluation & The Health Professions December 1999. Panter A. T, Huba J, Melchior L. A, Driscoll M, et al. “Trainee Characteristics And Perceptions Of HIV/AIDS Training Quality” Evaluation & The Health Professions June 2000. Fischer, BS, Martinez, E., Driscoll, M., Conway, T. “ Smarter, Faster, Fairer – an Electronic Referral System for the Urban Safety Net” In Press Health Affairs May 2010. Assignment Description
The fellow will work at Illinois Department of Public Health (IDPH) in the Office of Health Protection and Division of Patient Safety and Quality. IDPH has a strong collaboration with the Governor’s Office of Health Innovation and Technology (GOHIT) that administers the Illinois Health Information Exchange (ILHIE) and the Medical Research Analytics and Informatics Alliance (MRAIA) which supports the Public Health Node (PHN). IDPH is working with both these entities to implement Meaningful Use public health reporting requirements.
This placement provides a fellow with hands‐on learning opportunities in public health informatics working with both a mature, well‐established disease surveillance system and one or more innovative, less‐developed, surveillance system(s). The Illinois‐National Electronic Disease Surveillance System (I‐ NEDSS) was established in 2004 to collect data on mandatory communicable disease reporting in Illinois. Improving the timeliness and completeness of data into I‐NEDSS involves the expansion of Electronic Laboratory Reporting (ELR) to hospitals and the collection of relevant clinical data from provider
Electronic Health Records. State‐wide, syndromic surveillance is a new initiative for IDPH, and the fellow will work extensively on the implementation of syndromic surveillance while gaining insight into the challenges faced when developing new systems.
The projects proposed in this application will provide opportunities to work collaboratively as follows: For syndromic surveillance, the community of practice through the International Society of Disease Surveillance offers numerous opportunities to engage with other jurisdictions nationally. The primary mentor is actively involved in this community.
The STD registry was initially developed through healthcare partners with the Alliance of Chicago (http://www.alliancechicago.org/front), a network of Community Health Centers, Federally Qualified Health Centers and safety net providers that provide care to hard‐to‐reach populations. The mission of the Alliance is to share resources and integrate services in order to more efficiently and effectively deliver accessible quality health care to the communities we serve. The Alliance’s strategic vision is to continue promoting the thoughtful use of Health Information Technology (HIT) in the Safety Net to promote access, improve quality, and efficiency. As the fellow works on the projects, they will engage this organization along with the Chicago Health IT Regional Extension Center http://chitrec.org/.
Day‐to‐ Day Activities • Participate in conference calls and webinars about Meaningful Use, syndromic surveillance, health information exchange and Electronic Laboratory Reporting • Conduct on‐boarding activities that include validation of HL7 messages for quality, recommending corrections, evaluating timeliness and completeness of data, conducting calls with hospital staff as needed and monitoring continuous submissions of data • Support Meaningful Use Stage 2 requirements including registration of providers, acknowledgment of data submissions and maintenance of web content and documentation for public health reporting • Assist with the establishment of an ambulatory care surveillance system • Conduct analysis of syndromic surveillance data to characterize public‐health related events, such as influenza trends, heat‐related illness or health visits due to a unique event or emergency using SAS and GIS • Review the data in BioSense to identify any lapses in submission or incorrect processing of data. • Participate in stakeholder meetings that include staff from IL‐HIE, PHN, Department of Healthcare and Family Services and the IDPH informatics team Potential Projects include:
1.
Ambulatory
Surveillance
IDPH
is
accepting
data
from
Eligible
Professionals
that
will
satisfy
the
Meaningful
Use
Stage
2
public
health
reporting
objective
for
syndromic
surveillance.
Collection
of
this
data
into
a
surveillance
system
will
be
supported
using
a
model
of
the
Chicago
Health
Atlas,
a
project
developed
by
the
primary
mentor,
Abel
Kho,
for
exchanging
patient
health
data
confidentially
while
applying
an
algorithm
that
manages
patient
identity.
The
fellow
will
support
the
system
development
and
initial
on
‐
boarding
of
a
limited
number
of
health
system
providers.
Various
formats
for
exchange
of
health
data
will
be
considered
including,
HL7,
CDA/C32
and
flat
files.
The
data
collected
in
this
pilot
will
be
analyzed
for
quality,
completeness,
public
health
value
and
representativeness
of
the
data.
Project
Activities
and
deliverables:
Understand
and
perform
ETL
(extract,
transform,
load)
services
that
convert
data
from
an
HL7
message
standard
into
a
state
‐
maintained
database.
Analyze
data
using
SAS
or
R
for
disease
trends
or
prevalence
rates
Public
Health
impact:
Outpatient
data
from
500
‐
100
physicians
will
be
submitted
routinely
to
the
IDPH
and
assessed
for
data
quality
and
disease
trends.
2.
Hospital
Syndromic
Surveillance
All hospitals in Illinois will be required to participate in emergency department syndromic surveillance reporting in 2014. Up to 100 new HL7 data feeds will be established and need to be validated during testing. The data are submitted to the Centers for Disease Control and Prevention’s BioSense 2.0 syndromic surveillance system and reviewed weekly to assure completeness of reporting for all hospitals in Illinois. Analysis of data from BioSense will be performed to support public health situational awareness and response activities. Independent epidemiological projects will be supported if the fellow is interested in evaluating specific public health problems using syndromic surveillance data.
Project
Activities
and
deliverables:
Analyze
data
using
R
to
understand
disease
trends
and
data
quality.
Engage
hospitals
for
continuous
quality
improvement
Present
results
of
analysis
in
reports,
conference
presentations
and
publications.
Public
Health
impact:
Continuous monitor data from 185 emergency departments in Illinois for disease trends
3.
Specialized
Registry
for
reporting
clinical
data
on
Sexually
Transmitted
Infections.
Sexually transmitted infections represent the largest volume of communicable disease cases reported each year in Illinois. In addition to ELR, clinical information on treatment and symptoms must be reported by the provider. If this data is contained in the EHR, then it can be reported electronically into INEDSS, saving hours of provider and local health department time performing manual entry and improving the timeliness and completeness of this data. A pilot has already been completed for STI reporting from one health group using the electronic transmission of data from a CDA document to I‐ NEDSS. This project would expand STI reporting to all Eligible Professionals using the menu option in Meaningful Use Stage 2 for specialized registry reporting. Project Activities and deliverables:
Communicate
with
providers
about
reporting
specifications
Perform
data
validations
Analyze
STI
data.
Public Health impact:
Expand public health capacity to receive case reports directly from the Electronic Medical Records into the communicable disease database, I‐NEDSS
4.
PopHealth
PopHealth
is
an
open
source
reference
implementation
software
service
that
automates
the
reporting
of
Meaningful
Use
quality
measures.
PopHealth
integrates
with
a
healthcare
provider's
electronic
health
record
(EHR)
system
using
continuity
of
care
records.
PopHealth
streamlines
the
automated
generation
of
summary
quality
measure
reports
on
the
provider's
patient
population.
PopHealth
is
designed
to
simplify
the
reporting
of
summary
quality
measures,
and
streamline
the
exchange
of
summary
quality
data.
Demonstration
of
Meaningful
Use
requires
the
reporting
of
quality
measure
data.
PopHealth
supports
healthcare
providers
and
EHR
vendors
by
reporting
clinical
quality
measures
from
electronic
health
record
continuity
of
care
files.
PopHealth
runs
on
the
Ruby
on
Rails
web
framework,
the
MongoDB
open
source
document
database,
JavaScript,
and
Redis.
Enhancement:
To
be
able
to
measure
2014
CQM,s
the
providers
needs
to
be
able
to
produce
a
QRDA
cat
I
Clinical
Care
Documents
from
EMR
which
then
will
be
imported
to
the
popHealth
tool
to
produce
QRDA
cat
III
reports
for
CMS.
Most
of
the
providers
are
not
able
to
do
that
from
various
reasons:
•
Don’t
record
all
the
data
elements
•
Their
EMR
is
not
capable
of
creating
the
QRDA
cat
I
reports
•
The
versions
of
the
EMR
they
are
operating
are
not
upgraded
to
the
most
recent
version.
Technical
part
of
this
project
encompasses
development,
evaluation
and
implementation
of
data
processing
mechanisms
and
tools
to
support
near
real
time
extraction,
transformation
and
loading
of
required
data
sets
to
the
Pophealth
measuring
engine.
Project
Activities
and
deliverables:
Working
with
participating
Clinics
and
clinicians
to
identify
and
fix
the
patient
care
workflow
gaps
to
ensure
the
data
recorded
are
compliant
with
the
CQM,s
measures
and
requirements
Making
data
available
for
analytical
and
reports
use,
and
developing/modifying/transitioning
tools
for
analyst
and
report
use.
Identify,
evaluate,
and
apply
new
software
technologies
for
developing,
and
deployment
new
mechanism
and
tools
into
PopHealth
Public Health impact:
Identify
and
engage
3
pilot
sites
in
the
first
3
month
Find
the
missing
elements
in
the
pilot
sites
(4
month)
Propose
the
changes
in
the
workflow
to
start
capturing
the
elements
(5
month)
Help
the
technical
team
to
spec
and
develop
a
transformation
engine(12
month)
5.
XDRO
Registry
development
Carbapenem‐resistant Enterobacteriaceae (CRE) are deadly infections that have few treatment options. Since 2008, CRE infections in Illinois have increased across the spectrum of healthcare facilities. The Centers for Disease Control and Prevention (CDC) identified CRE as one of its top priorities for public health, and created a CRE toolkit that emphasizes regional surveillance and improvement of inter‐facility communication. To address these strategies, the Illinois Department of Public Health (IDPH) and the Chicago CDC Prevention Epicenter (CDC Epicenter) combined expertise in CRE epidemiology, informatics, and public health to create a novel, web‐based informatics tool: the Extensively Drug‐ Resistant Organism (XDRO) registry. Since November 1, 2013, all acute‐care hospitals, long‐term care facilities, and laboratories have been required to report CRE isolates to this registry.
The current XDRO registry allows for inter‐facility communication via manual querying, whereby staff at a healthcare facility can type a patient’s name and date of birth into the XDRO registry website to query the patient’s CRE history. However, manual querying is only feasible for smaller facilities that admit 1 to 25 patients per day. Larger facilities, such as hospitals, require an automated alert of a patient’s CRE status at the time of admission, to effectively assess the CRE status of all patients who are admitted. A pilot is currently underway to develop this automated alerting system at two major hospitals. An APHIF Fellow could work with IDPH and the CDC Epicenter to fully develop this notification system, and possibly expand automated alerting to facilities across the state. Concurrently, IDPH and the CDC Epicenter are exploring the uses of the XDRO registry as a surveillance and outbreak detection tool. Software, such as SatScan, is being integrated with GIS mapping technology to track geographic and social network clusters of CRE over time. The APHIF Fellow would have ample opportunities to further refine this process and participate in developing more sophisticated approaches to outbreak detection and response of CRE. Project Activities and deliverables: Goal 1: Develop a system to automatically search the XDRO registry and send electronic alerts to healthcare facilities where CRE‐positive patients recently have been admitted, to facilitate timely implementation of infection control practices. Objective 1: In the next year, a process for securely notifying appropriate facility personnel will be developed. Objective 2: In the next year, the electronic alert system will be piloted with at least two hospitals. Objective 3: Over the next two years, the alert system will be expanded to additional large healthcare facilities in the state. Goal 2: Integrate SaTScan and ArcGIS software with the XDRO registry to help identify CRE clusters. Objective 1: In the next year, parameters will be identified to determine the best methods to detect geographic clusters. Objective 2: Over the next two years, the best methods to detect patient sharing clusters using hospital discharge data will be identified.
Public Health impact:
Create a bi‐directional surveillance system that can notify healthcare facilities of potential cases of eXtensively drug‐resistant organisms.
