Public Health Data Standards Consortium
http://www.phdsc.org
PUBLIC HEALTH DATA STANDARDS CONSORTIUM
~ 2009 BUSINESS MEETING OF MEMBERS ~
November 12-13, 2009, Hyattsville, MD
Business Case for Public Case Participation
in Health Information Technology (HIT)
Standardization
Anna O Orlova, PhD
PHDSC
aorlova@jhsph.edu
Acknowledgements
Project Team:
Walter Suarez, Vicki Hohner, Noam Arzt, Harold Lehmann, and
Sacchi Girde
Business Case Development Expert Team:
Kathleen Cook, Art Davidson, Julia Gunn, Tracy Lockard,
Corey Smith, Lesliann Helmus, David Lawton, Marcy
Parykaza, BethAnn Posey, Eileen Underwood, Cecil Lynch,
Jason Siegel, Lisa Spellman, and Sherry Weingart
Business Case Document Reviewers:
Marjorie Greenberg, Missy Jamisson, Michael Fitzmaurice,
Starla Ledbetter, Bill Brand, Robert Aseltine, Shaun
Grannis, Brook Dupree, Alex Hathaway, Neil Calman,
Acknowledgements
CDC 5-year Cooperative Agreement “Assure HIT Standards for
Public Health”. Started in June 2008
Goal: Represent public health interests in the national HIT
standardization process
Year 1


Develop a Business Case for Public Health Participation
in National HIT Standardization and
Launch the Web-pages on HIT Standards
Year 2

Develop a Web-based Interactive Model on the Business
Case Implementation
Business Case on the Role of Public Health in
the National HIT Standardization
Objectives:
 Define the public health role in the HIT
standardization process
 Help build an understanding across the public
health community of this role and of the need for
participation of local and state public health
agencies in the national HIT standardization
entities and
 Describe the strategy for public health
participation in the HIT standardization entities
Why Standards
Why Standards
Where We Now
State Health Department: Organizational Chart
Use of IT in Public Health: Where We Now
All public health activities are supported by
customized information systems (databases,
registries) developed to address the
programmatic needs.
HIT Standards in Public Health: Where We Now
AND……
Our information systems do support our
programmatic needs
BUT……
Our information systems cannot
exchange data between programs within
and across public health agencies and
with clinical information systems
Why Standards - National Context
Towards a Nationwide Health
Information Network
Where Should We Be in 2014
US Nationwide Health Information Network (NHIN) in 2014
Source: Dr. Peter Elkin, Mayo Clinic, MN
Source: Dr. Peter Elkin, Mayo Clinic, MN, 2006
RHIEs as NHIN Components
Vision: PH Surveillance under NHIN
Percent of Children Tested for Lead with BLL>10 µg/dL in the USA
Source: Eileen Koski. Quest Diagnostics. PHIN-2004, May, Atlanta GA
Building a NHIN
Information Systems Interoperability for
Public Health
Where Should We Be in 2014
Building a NHIN
Information Systems Interoperability for
Public Health
What Would It Take….
Building the Roadmap for Health Information Systems Interoperability for
Public Health. PHDSC White Paper. 2007.
URL: http://static.ihe.net/Technical_Framework/upload/IHE-PHDSC_Public_Health_White_Paper_2008-07-29.pdf
HIT Standards in Public Health: Where We Now





Extensive experience in developing
standards
Focus on data standards, ie, data sets, and
messaging standards, ie, HL7
Program-specific approach, eg, immunization,
vital statistics, infectious diseases, occupational
health, etc.
Jurisdiction-specific approach
Top-down approach,
ie, federal agencies lead
AND……
in the program-specific standardization efforts
HIT Standards in Public Health: Where We Now
AND……
Our information systems do support our
programmatic needs
BUT……
Our information systems cannot
exchange data between programs within
and across public health agencies and
with clinical information systems
HIT Standards in Public Health
What Is Needed
HIT Standards in Public Health: What Is Needed

Learn about the World of Standards and
Standardization Process

Participate in Standardization Process

Enable bottom-up approach, ie, assure that
needs of local and state public health agencies
are met
HIT Standards in Public Health: What Is Needed
Learning about the World of Standards
HIT Standards in Public Health: What Is Needed
Learning about the World of Standards:
HIT Standards Categories
Health IT Standards Categories
1.
2.
3.
4.
5.
6.
7.
Data Standards, eg, vocabularies and
terminologies
Information Content Standards, eg, Reference
Information Models (RIMs)
Information Exchange Standards, eg,
messaging standards
Identifiers Standards, eg, National Provider
Identifier (NPI)
Privacy and Security Standards
Functional Standards, eg, processes/workflow
Other, eg, IT infrastructure standards
This classification of Health IT standards types has been developed by the
Health Information Technology Standards Panel (HITSP, www.hitsp.org) in 2006
National Biosurveillance Use Case
Charge:
“Transmit essential data from electronically
enabled healthcare to authorized public health
agencies in real-time”.
Biosurveillance Use Case
1.
2.
3.
4.
5.
6.
7.
Data Standards - 28
Information Content Standards - 17
Information Exchange Standards - 46
Identifiers Standards - 11
Privacy and Security Standards - 5
Functional Standards - 0
Other – 0
TOTAL = 107 standards
This classification of HIT standards types has been developed by the
Health Information Technology Standards Panel (HITSP, www.hitsp.org) in 2006
HIT Standards in Public Health: What Is Needed
Learning about the World of Standards:
HIT Standardization Process
HIT Standardization Process
•Priority Setting
•Standard Development
•Standards Maintenance
•Standards Harmonization
•Standards Certification
•Standards Adoption
HIT Standardization Process & Entities
•Priority Setting
•Standard Development
•Standards Maintenance
•Standards Harmonization
•Standards Certification
•Standards Adoption
Past: AHIC
Now: HIT Policy Committee &
HIT Standards Committee
Standards Development
Organizations, eg, HL7,
LOINC, IHE, etc.
Health Information
Technology
Standardization Panel (HITSP)
Certification Commission
for Health Information
Technology (CCHIT)
US
Health Information Technology Standardization Phases, Products and Entities
HIT
Standardization
Phases
Priorities
&
Needs
Development
&
Maintenance
Selection
&
Harmonization
Trial
Implementation
Certification
Deployment
Goals
What to
accomplish
What are
the
standards
What
standards
to use
Showcase
what can be
accomplished
Certify
standardsbased
products
Deploy
standardsbased
products
HIT
Standardization
Entities
HIT
Standards
Committee
HIT Policy
Committee
(Formerly
AHIC)
SDOs
(e.g.,
HL7,
SNOMED
(IHTSDO),
LOINC,
ASC X12)
HITSP
IHE
NHIN
IHE
Standards
Documents
Use Cases
(Description
of the health
information
exchanges)
Interoperability
Specifications
Standards
Integration
Profiles &
Technical
Frameworks
Implementation
Reports
Proposed
CCHIT
IHE & PHDSC
Deployment
Workshops
Certification
Criteria
Implementation Reports
HIT Standards in Public Health: What Is Needed
Participation in HIT Standardization Process
Public Health in HIT Standardization Entities
Entities
Number of
Number of Public
Organizations Health Organizations
HIT Standards Committee
23
0
HIT Policy Committee
20
2
HL7
503
27
HITSP
641
30
IHE
251
7
CCHIT
341
3
Total
1779
69
Public Health in HIT Standardization Entities
Public Health in HIT Standardization Entities
Challenges for Public Health Participation in
HIT Standardization Process
Challenges for Public Health Participation in
National HIT Standardization

lack of awareness for the need to participate
and where to participate

limited ability for local and state public health
practitioners to be involved in the national efforts
as they serve particular jurisdictions

lack of technical knowledge and informatics
skills to participate, and

lack of funding to support basic participation,
eg, travel to meetings
Standards World – Where to Participate
Skills and Knowledge Needed
Standards are Technical Documents
Order
Placer
ADT
Department System
Scheduler/
Order Filler
Image
Manager/
PPS Manager
Acquisition
Modality
Register J.Doe
Patient
Registration [RAD-1]
Placer Order
Management–
New [RAD-2]
One or the
other methods
of creating an
order is used
Filler Order
Management New [RAD-3]
Schedule
Procedure
Procedure
Scheduled [RAD-4]
White Papers
Technical Frameworks
Query Modality Worklist [RAD-5]
ADT
Pt. Registration [RAD-1] 
Patient Update [RAD-12] 
DSS/ Order Filler
Filler Order
Mgmt - Status
Update [RAD-3]
 Pt. Registration [RAD-1]
 Patient Update [RAD-12]
 Placer Order Management [RAD-2]
 Filler Order Management [RAD-3]
 Modality PS in Progress [CARD-1]
 Modality PS Completed [RAD-7]
Patient Reconciliation
Order Placer
J.Doe ->
J.Smith
 Procedure Scheduled [RAD-4]
 Patient Update [RAD-12]
 Procedure Updated [RAD-13]
 Instance Availability Notification [RAD-49]
Interoperability Specifications
Requirements Specifications
Integration Profiles
Content Profiles
Certification Criteria
Evidence
Creator
 Modality PS in Progress [CARD-1]
 Modality PS Completed [RAD-7]
Performed
Procedure
Step Manager
Storage 
Commitment
[CARD-3]
Patient Update/
Merge [RAD-12]
Image
Archive
 Modality PS in Progress [CARD-1]
 Modality PS Completed [RAD-7]
Storage
Commitment 
[CARD-3]
Modality Image/Evidence
Stored [CARD-2]
 Modality PS in Progress [CARD-1]
 Modality PS Completed [RAD-7]
 Query Modality Worklist [RAD-5]
Modality Procedure
Step Completed
[RAD-7]
Patient Update/
Merge [RAD-12]
Image Display
 Modality Image/Evidence
Stored [CARD-2]
Image
Manager
Filler Order
Mgmt - Status
Update [RAD-3]
Modality Procedure
Step In Progress
[CARD-1]
Acquisition
Modality
 Query Images [RAD-14]
 Retrieve Images/Evidence [CARD-4]
Modality Procedure
Step In Progress
[CARD-1]
Modality Procedure
Step Completed
[RAD-7]
Perform
Acquisition
Public Health in HIT Standardization: Cost
Qualifications:
 Deep Understanding of Public Health
 Ability to Review HIT Standards Documents
Time:
 25-30% FTE (calls, meetings, document review)
Travel:
 3-4 meetings/year (3-5 days each)
Public Health in HIT Standardization
Proposed Strategy
(a)
(b)
maximize the impact of those who can
participate on behalf of Public Health in
the national HIT standardization process,
and
inform/educate and obtain input, as best
as possible, from those who cannot.
What to Achieve?
National HIT standardization process requires
collective input from Public Health on what
public health issues need to be addressed in
national interoperable HIT standards.
This input needs to be collaboratively developed,
put through the national HIT standardization
process and uniformly implemented.
Public Health’s “Organized Voice on HIT
Standards” will have to take on a character
What to Achieve?
We define Public Health’s Organized
Voice on HIT Standards as an open,
transparent, participatory process of
harmonizing program-specific and
jurisdictional needs with national HIT
interoperability standards by working with
HIT standardization entities on various
phases of HIT standardization
Business Case: Public Health in HIT Standardization
Target Audience:






National HIT leadership
Governors
State and Local Health Commissioners
Federal Agencies Leadership
Leadership of Professional Associations
Leadership of Schools of Public Health
Building Public Health’s Organized Voice on
HIT Standards



Why Participate?
Where to Participate?
Who Should Participate and How to
Participate?

Role of Local and State Agencies
 Role of Professional Organizations
 Need for Coordination

Resources for Participation

educational and informational resources
Why Participate?
or Risks of Non-participation







threaten public health data gathering activities
diminish effectiveness of public health interventions
diminish efficiency of public health operations
reduce ability to communicate public health
information back to clinicians electronically
jeopardize adoption of modern interoperable HIT
applications in Public Health
jeopardize achieving population-level goals of
Nationwide Health Information Network
minimize the potential of state and local Public Health
Where to Participate?
Entities
Number of
Number of Public
Organizations Health Organizations
HIT Standards Committee
23
0
HIT Policy Committee
20
2
HL7
503
27
HITSP
641
30
IHE
251
7
CCHIT
341
3
Total
1779
69
How to Participate: State and Local Agencies






Recognize HIT standardization efforts as a distinct role for senior
program staff, senior informaticians and/or IT professionals in the
agency
Devote one or more staff members in a leadership position to carry
out an agency’s HIT standardization activities
For smaller agencies, outsource HIT standardization efforts where
possible to experts-consultants with extensive knowledge of public
health
Recognize the need for continuing education in public health
informatics and HIT standards for agency’s workforce
Band together within a region and share the costs associated with
the deployment of professionals to represent agency on HIT
standardization efforts
Participate in and leverage memberships in public health
professional associations involved in standardization activities as a
How to Participate: Role of Professional Associations
Immunization
American Immunization Registry Association (AIRA)
Laboratory
Association of Public Health Laboratories (APHL)
Epidemiology &
Council for State and Territorial Epidemiologists (CSTE)
Disease Reporting
Cancer
North-American Association of Central Cancer Registries
(NAACCR)
Vital Statistics
National Association of Public Health Statistics and
Information Systems (NAPHSIS)
Newborn
Screening
Public Health Informatics Institute, Maternal and Child Health
Bureau, HRSA
Healthcare
Management
National Association of Health Data Organization (NAHDO) &
American Health Information Management Association
(AHIMA)
Public Health in HIT Standardization:
Need for Coordination







Facilitate public health involvement in various HIT
standardization entities
Coordinate activities of professional organizations
Assist local, state and federal agencies
Help identify new public health areas for developing
new standards and carry out activities needed to initiate
standards development efforts in these areas;
Conduct outreach activities on public health
participation in HIT standardization
Educate public health workforce on HIT standards
and
Help identify and secure resources needed to support
Resources
 Participate in HIT standardization and learn
PHDSC Web-based Resource Center
New HIT Standards Web-pages launched in June 2009
(http://www.phdsc.org/standards/health-informationtech-standards.asp)

PHDSC Quarterly Standard e-Newsletter
(http://www.phdsc.com)

Business Case: Public Health in HIT Standardization
Join our efforts to launch
Coordinated Public Health Action Plan on
HIT Standards
Get Involved!
Anna Orlova, PhD, Executive Director
624 N. Broadway Room 325 Baltimore MD 21205
Phone: 410-614-3463 Fax: 410-614-3097 E-mail: aorlova@jhsph.edu
Business Case: Public Health in HIT Standardization
“…Coordinated, collective action is required at
almost every level of the healthcare system
to realize the full benefits of HIT. This makes
it unlikely that individual actors, pursuing
their own self-interests, would be able to take
the full advantage of HIT. The importance of
collective action is most apparent in
securing effective communication – so-called
interoperability – across providers of care in
the United States” –
David Blumenthal, National Coordinator for
Questions?