International Perspectives
Fifth Annual Meeting
Public Health Data Standards
Consortium March 18, 2004
Marjorie S. Greenberg
National Center for Health Statistics
Centers for Disease Control and
Prevention
Presentation Agenda:
International Perspectives
• Brief overview of international standards
activities
• WHO Collaborating Centres for Family of
International Classifications
• Possible future efforts
Overview:
International Perspectives
• Health data standards can be traced
back several centuries
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London Bills of Mortality – 17th Century
Florence Nightingale – mid - 19th Century
Bertillon classification - late 19th century
International Organization for Standardization
(ISO) – mid 20th century
– World Health Organization (WHO) – mid 20th
century
Why Participate in International
Standards Setting?
• Create a global market for products
• Remove barriers to health care in global
setting
• Foster comparable data and statistics in
developed and developing countries
• Learn from other countries
• Improve population health
Main International Standards
Organizations
• International Electrotechnical Commission
(IEC)
• International Organization for
Standardization (ISO)
• International Telecommunication Union
(ITU)
• United Nations
• World Health Organization
International Players in Health
Care Standards
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ISO – TC 215 Health Informatics
CEN – European Standard Development
DICOM – Imaging Standard
UN/EDIFACT – EDI Standards
HL7 – Clinical Messaging Standards
IEEE – Medical Device Standards
NSAI
SIS
DS
SNV
BSI
SCC
ANSI
PKN
INTECO
IPQ
ICONTEC
INEN
UNIT
TTBS
ABNT
NSF
DIN
CSSN
SII
KEBS
KATS
BIS
PSB
BSN
SSUAE
INDECOPI
FONDONORMA
SLSI
DPS
CSM
CYS
JISC
IDHKSAR
ELOT
DGSM
GOST-R
MOLDST
DSM
MSZT
UNI
EOS
MSA
CSNI
EVS
LVS DSTU
TSE
DZNM
ON
SASO
IRAM
SEE
UNMS
SMIS
LST
IBN
AFNOR
SNIMA
DGN
SFS
BASMP
STIR
AENOR
NNI
TISI
BPS
SNZ
TCVN
SAI
ASRO
SZS
U.S. Participation in International
Standards Organizations
• American National Standards Institute
(ANSI) is U.S. voting representative on
IEC, ISO and ITU
• ANSI delegates responsibilities to U.S.
Technical Advisory Groups (TAGs), which
develop and transmit U.S. positions on
activities and ballots
ISO Hallmarks
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Equal footing
Voluntary
Market-driven
Consensus
– Openness, balance, due process, appeal
• World-wide – 145 countries
• Over 200 ISO Technical Committees (TCs)
ISO TC 215
• Founded in 1998
• Scope is standardization in the field of
information for health
• Goal is to achieve compatibility and
interoperability between independent
systems
• Also strives to ensure compatibility of data
for comparative statistical purposes and to
reduce duplication of effort
ISO TC 215 Work Groups
• WG1 – Health Records and Modeling
• WG2 – Messaging and Communication
Architecture
• WG3 – Terminology
• WG4 – Privacy and Security
• WG5 – Smart Cards
• WG6 – ePharmacy and medicine
• Ad Hoc Groups on Consumer Interests and
Mobile Communications.
WHO Collaborating Centres for
International Classifications
• International Statistical Classification of Diseases
and Related Health Problems (ICD) has been
maintained and promoted by WHO and a network
of Collaborating Centres since 1970’s
• Centres have been established by language and
geography
• These and other Centres worked on revision of the
International Classification of Functioning,
Disability and Health (ICF) from 1993-2000
• In 2001, a network of WHO Collaborating Centres
for the Family of International Classifications
(WHO FIC) was established
The WHO Family of International
Classifications (FIC)
Associated Products Main Classifications Adaptations
Mission of WHO FIC
Collaborating Centres
• To develop, disseminate, implement and
update WHO Family of International
Classifications to support national and
international health information systems,
statistics and evidence
WHO FIC Committees
• Update and Revision
– Mortality Reference Group
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Implementation
Education
Electronic Tools
Family Development
– e.g., primary care, external causes of injury,
health interventions, terminologies
North American Collaborating
Center
• Established in 1976
• Housed at National Center for Health
Statistics
• Covers U.S. and Canada and represents
these countries in WHO FIC network
• Maintains and promotes uses of ICD for
mortality and morbidity data and ICF for
functional status and disability data
• http://www.cdc.gov/nchs/about/otheract/icd
9/nacc.htm
United Nations
Statistics Division
• Statistical Yearbook
• Millennium Development Goals and
Indicators Database
• Disability Database
• Demographic and social statistics methods
• City Groups
– Washington Group on Disability Statistics http://www.cdc.gov/nchs/citygroup.htm
Other International Health Data
Activities
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Summary Health Measures
Cancer Data
Environmental Data
Geo-spatial Data
Organization for Economic Cooperation and
Development (OECD) Health Project
– National health accounts
– Healthcare quality indicators
Role for the Consortium
• Learn about US TAG for ISO TC 215 and
other international standard development
activities
• Participate actively in AMIA, HL7 and other
international forums on standard development
• Promote use of international classifications
(e.g., ICD-10-CM, ICF, ICPC)
• Follow terminological development (e.g.,
SNOMED CT) and EHR development
worldwide
• Include educational materials and links on
international standards in Web-based Resource
Center
Role for the Consortium
• Consider forming a committee to explore
international standard development for
population health
• Dr. Orlova has identified the following
potential partners:
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eHealth Initiative, USA
Health Canada, Canada
INSERM, France
Linkopings Universitet, Sweden
Role for the Consortium
Assure a population health
perspective in international
standard development
activities