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Small Working Group: Out-of-Hospital Surveillance - Dr. Joseph Ornato, Group Leader

What we need to track

  • Sudden cardiac death
  • Stroke
  • Acute & chronic coronary syndromes
    • Myocardial infarction
    • Unstable angina
    • Stable angina
  • Heart failure

Where we need to track CVD data

  • Emergency medical services (EMS)
  • Office/clinic setting
  • Emergency department
  • Observation visits
  • Deaths before entry into healthcare system

Where we want to be in 10 years

  • Coordinated, cost-effective system of CVD surveillance that has core data (i.e., counts) on national level, more detail at state & local levels
  • Provides a return on investment
  • Uniform data definitions & data transfer standards
  • Required, automatic population of data from electronic medical record (EMR) systems

Major Gaps

  • No one entity owns the problem
  • Paucity of electronic data & linkages
    • Out of hospital vs. in-hospital
    • Agency to agency, entity to entity
  • Paucity of CVD incidence & outcome rates
  • No uniform healthcare identifier
  • No public mandate to share the data

Optimizing Existing Data Systems

  • Look at other models as examples
  • Inventory & map existing data systems
  • Require compliance with data standards (e.g., HL7, PHIN) for federal funding
  • Need national coordinating entity
  • Need to test & validate existing data

Need new data strategies or optimize existing?

  • Combination of both
  • Need to accelerate EMR infrastructure
  • Need uniform healthcare identifier
  • Could benefit from new technologies such as health information data cards
  • Make CVD a reportable disease as records become electronic

Immediate Steps

  • Inventory & map existing data systems
  • Stakeholder meeting to develop a vision document
    • Similar to EMS Agenda of the Future
    • Establish who should lead the effort
    • Establish a strategy for achieving the vision
  • Continue to standardize disease and outcome definitions, incorporating standard vocabulary amenable to electronic capture
  • Link current databases from federal, state, local, and private institutions
  • Could require institutional compliance with electronic data standards before providing federal funding to grantees/contractors

Long Term Steps

  • National uniform healthcare identifier
  • National uniform definitions for reporting clinical data on CVD
  • Make CVD encounters reportable as electronic medical record systems become operational

Where we want to be in 10 years

  • Coordinated, cost-effective system of CVD surveillance that has core data (i.e., counts) on national level, more detail at state & local levels
    • Provides a return on investment
  • Uniform data definitions & data transfer standards
  • Required, automatic population of data from electronic medical record systems

Back to Workshop Agenda

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