Public Health Data Standards
A View from the Front Lines
Presentation to
PUBLIC HEALTH DATA STANDARDS CONSORTIUM
2004 ANNUAL MEETING ON PUBLIC HEALTH DATA STANDARDS
Bethesda, MD
March 17, 2004
Atlas Development Corporation
Established in 1989 as a consulting practice to
develop high performance database applications
Demonstrable track record building mission critical
systems for financial and healthcare industry
leaders.
Atlas Medical Software is devoted to marketing the
company’s growing suite of clinical connectivity
solutions.
Atlas Public Health recently launched to market suite
of BT/Disease Surveillance solutions
• Clinical Connectivity
• Surveillance
• Outreach Operations
• Case Management
• Legacy Systems Integration
• Reporting to State and CDC
• “Total Outreach Management”
• ARNOLD
• PHIL
• National and Regional Players
• Independent Reference Labs
• Hospital Outreach Programs
Client Base
•LA County Department of Health Services ACDC
• Inception 1998 – Deployment May 2000
• PHIL Phase 1 with Kaiser Permanente So. Cal.
• 2003- San Diego
• 2004 - Monterey
Public Health and Private Providers
Client Base
• NEDSS/PHIN
• HL-7
• version 2.x (Lab orders and results)
• ebXML
• HIPAA
• Privacy/Security
• X12
• HL7 v3.0 RIM
• LDAP
• HIPAA
• LOINC/SNOMED
All About Standards
Public Health Information Network
- CDC’s Goals
1.
2.
3.
4.
5.
6.
An interoperable network—built on the Internet
and using industry standards to work with other
networks/systems
Support users—provides information and
decision support to the public and public health
professionals at all levels
Live data—continuous monitoring of nation’s
health, continuous detection and evaluation of
threats
Dual use—will meet BT preparedness and
response needs and will transform routine public
health practice
Engage industry—set direction for private sector
participation and develop commercial and clinical
opportunities
A common data language—use of industry
standards for comparable data use and exchange
(HL7, SNOMED, LOINC)
Technical Review of Version 1 of PHIN
FINAL BRIEFING – Gartner Group
May 13, 2003
CDC PHIN Functions
as of 12/8/2002
1.
Automated Data Exchange Between Public Health Partners
2.
Use of Electronic Clinical Data for Event Detection
3.
Use of Manual Data entry for Event Detection and Management
4.
Specimen and Lab Result Information Management and
Exchange
5.
Management of Possible Case, Contacts, and Threat Data
6.
Analysis and Visualization
7.
Directories of Public Health and Clinical Personnel
8.
Public Health Information Dissemination and Alerting
9.
IT Security and Critical Infrastructure Protection
CDC PHIN Standards Version 1.2
CDC PHIN Function #1 – The details
“Automated Data Exchange Between Public Health Partners”
• Message “wrapper” - ebXML SOAP Web Service
• via HTTPS after appropriate authentication
• ebXML standard format with content in
 HL7 v. 2.3
 HL7 v. 3.0
 X12
 LDIF
• Windows NT/2000, UNIX, LINUX
• Ability to X-Reference Local Codes to
 SNOMED
 LOINC
 ICD and CPT
CDC PHIN Function #1–Some questions
• HL7 v3.0 is new
 Is CDC going to use new CaseReport observation?
 Under what conditions?
• Role of the CDA (Clinical Document Architecture)
 Is CDC going to use it? (Others may)
 CDA messages are based on domain-specific
templates. Who is defining these templates, what is
their status, and when can I get them?
• There is a lack of public health-oriented codes in the RIM
 What steps are being taken to bring evolving public
domain information into the RIM?
CDC PHIN Function #1– Some questions
• LOINC is to be used to identify ordered tests in PH
messages
 Who is to assign LOINC test codes to Labs?
 If Labs use internal codes only, is the vendor to
convert?
• SNOMED is to be used for lab test organism identification
and disease designation
 Not widely used- are vendors to do mappings?
The Challenge
Success depends upon industry involvement
 Much needed supplemental investment
 Working knowledge of current conditions
 Experience with finding practical solutions
 Driven by market forces responding to exigencies
 We understand the “good vs. perfect” conundrum
Post 9/11 Funding
Total of federal, state and local governmental
spending and private sector outlays for Homeland
Security now stands at $100 Billion annually, with
the Federal government accounting for about 30%
of that number. In 2005, the federal number is
expected to rise to $56 Billion.
-Bill Hoagland,
Director of Budget and Appropriations for
Senate Majority Leader Bill Frist
Conclusion
 Private Sector is engaged
 Private Sector must respond to market demands
 Lack of clear standards is adding unnecessary time
and expense to the process
 A central forum for addressing evolving standards
is needed
 Streamlined communications between
Private/Public players
 A central web site that publishes Public Health
data standards as they evolve with links to
standards bodies to facilitate communication
End