Current Projects

Digital Bridge is a multi-sector collaboration that incubates projects focused on improving data exchange between healthcare and public health. As an incubator, it lays foundational elements in place (i.e., gaining stakeholder buy-in, designing technical infrastructure, etc.) that prepare the use case for adoption and national scale-up under the management of a separate entity.

ExeCC (Expanding eCR’s Capacity and Capability) Workgroup

At its Fall 2020 meetings, the Collaborative Body voted to move forward with the Newly Reportable Conditions and Cancer Registries use cases that were incubated over the course of the year. Due to capacity constraints of volunteer members, Digital Bridge decided to merge the two use cases into the ExeCC (Expanding eCR’s Capacity and Capability) use case workgroup. ExeCC is focused on generic enhancements to the existing eCR infrastructure that would support additional reporting beyond nationally notifiable conditions. As the network of potential exchange partners increases, additional centrally maintained decision support functionality is needed to ensure that report content is routed only to the authorized recipient. To utilize the existing eCR infrastructure, test cases must be based on clinical encounters and be easily identiﬁed using well deﬁned clinical code sets. The workgroup is focused on cancer registries initially.

Implementing cancer registries in the enhanced architecture described above would allow cancer registries to reach real-time cancer case data exchange by establishing trigger-based electronic cancer case reporting, from EHRs to state- and territory-based central cancer registries. It currently takes approximately six months to populate a longitudinal record, within central cancer registries, for a cancer patient. Cancer Registrars collect information on history, diagnosis, treatment, and health status for every cancer patient in the United States. Each central cancer registry (CCR) in the US is population-based and therefore each CCR must identify all possible cancer cases in their catchment area. The process of identifying new cancers, called case finding, can be very costly and resource-intensive. Because radiology and pathology are typically the first reports of a cancer case, they are used as the basis for case finding. It is important to have complete data so public health can appropriately gauge patterns of cancer diagnoses, types of treatment, and progression of treatment. This pilot project intends to pull data directly from EHRs, which would help public health publish more complete and timely information on reportable cancer cases for a given year and area (currently, CDC cannot publish data on a specific area that has less than 95 percent of all cases for that area) and helps the clinical side, for example using reports to find cases for clinical trials and understanding the efficacy of treatments at an aggregate level.

The workgroup is chaired by Richard Hornaday, Allscripts and Joe Rogers, CDC.

Status of Digital Bridge Workgroups

Public Health API Concept Paper

Digital Bridge’s Public Health API Concept Paper – Published Version

The Digital Bridge is pleased to announce the release of its “Public Health API Concept Paper – Version 1.0”. The paper is available on our website.

Over the past five years, there has been a major transformation in the way health care organizations exchange health information with each other and with their customers. In addition to the rapid adoption of electronic health records and health IT standards, this transformation has been accelerated by the widespread adoption and use of Application Programming Interfaces, commonly known as APIs, third-party apps, mobile devices, and new technical standards, such as HL7 Fast Healthcare Interoperability Resource (FHIR).

One area where APIs are beginning to have an impact and show promising opportunities is public health. Many interactions between health care providers, health plans, and community-based organizations with public health are still extensively performed today through manual processes, paper forms, and asynchronous electronic information exchanges using a variety of technical standards and proprietary or heavily customized solutions. Electronic case reporting, lab reporting, contact tracing, and immunization registries, in the time of COVID-19, are perfect examples of different approaches currently in use for data reporting. As we move to more interactive, real-time, public health reporting, API technologies become more useful.

To address COVID-19 related case reporting, CDC developed “eCR Now,” that includes a FHIR-based reporting app that takes advantage of these new and innovative technologies to obtain faster, more reliable COVID-19 case reports that include more detailed clinical data. One key intent of the development of a common generic API Infrastructure for public health is to enable public health agencies to have direct, secure, and interactive access to up-to-date clinical information about specific patient-cases, as well as population data and metrics.

This Digital Bridge public health API concept paper is intended to serve as a reference and provide valuable information and tools for public health professionals as they look to develop and implement their agency’s or organization’s public health API strategy. The paper includes an introductory overview of APIs in general and as they apply to public health, a summary of recent health policy developments related to API, basic technical API concepts and building blocks, public health use cases, policy and privacy issues, steps needed to implement a public health API strategy, and a listing of tools and resources available to support implementation of an API strategy. The paper is intended primarily for public health professionals in local, state, and federal agencies, industry groups, and professional associations. The paper also targets groups implementing or developing a set of common, generic API Infrastructure capabilities so they can understand and support any capabilities or variations on capabilities needed to support public health. It is not intended to serve as a roadmap for implementation of an API platform or program. Rather, to be a resource to better understand the basic API concepts and opportunities for public health.

Immunization Registries Workgroup

Co-chairs: Malini DeSilva (HealthPartners) and Danny Wise (AllScripts)

This workgroup decided that due to the current work of the IZ Gateway and other immunization information system initiatives, and limited capacity, it will pause its work but meet regularly to stay abreast of similar initiatives. Workgroup members will identify potential gaps they could fill in the future.

NHSN Reporting of Healthcare Acquired Infections Reporting by Skilled Nursing Facilities

Co-chairs: Jeneita Bell (CDC) and Grace Mandel (CDC)

This workgroup incubated a use case that examined innovating solutions to advance skilled nursing facility surveillance and quality measurement, via a collaboration between Digital Bridge and CDC’s National Healthcare Safety Network (NHSN). The workgroup is revising its proposal to another end-state deliverable such as a white paper.