Data Systems Web Integration:A Public Health Informatics

Approach

AJ Rosario, M.D., M.P.H.Vishwa Rao

Bureau of EpidemiologyOffice of Surveillance and Public Health PreparednessHouston Department of Health and Human Services

February 1, 2006

Outline

Introduction Public health practice and standards Data standards in public health Public health informatics Public Health Information Network (PHIN) Current state of Data Systems in HDHHS Data Systems Web Integration Project IT Requirements Summary Q & A

The Challenge….

If public health as a field is to become more effective, public health professionals need timely, quality information, better ways to communicate data and information, and better tools to analyze new information. (Friede et al., 1995).

Public Health Needs

 Much of what we do in public health is based on the data and information we gather, analyze and disseminate.

Efficient access to this data is vital to develop sound public health policy and programs to ensure the health of the nation, and the world.

Public Health Practice

Information component

Data Data Data

Wisdom

Knowledge

InformationInformation

Source: http://www.airdisaster.com/

Tenerife Air Disaster

March 27, 1977: Two Boeing 747 airliners, from Pan-Am and KLM, collided on the island of Tenerife, killing 583 people

Causes: Non-standard messages for take-off between KLM pilot and control tower, squelched radio messages

Led to sweeping reforms including use of English standard phrases between pilots and control towers

Polio in 1988Polio in 2004

Polio endemic areas in red From 350,000 cases in 1988 to 1255 cases in 2004 Factor: Certification-standard surveillance and lab

networks

WHY DO STANDARDS MATTER?

STANDARDS

Data Standards in Public Health

Sources of Data in Public Health

Epidemiologic investigations By-products of clinical activities Administrative databases Environmental monitoring School system databases Other related organizations

Communication Components

Words used in a conversation

The way we put words together

The context where we have the conversation

Figure of Speech

Conversation Component

Data Standard Equivalent

Words Vocabulary

Grammar Format

Context Information Architecture

Source: O’Carroll, Public Health Informatics and Information SystemsChapter 11, Data Standards in Public Health

Data Standards

source recipient

transmission

12

3

INFORMATION IN STORAGE

MESSAGE

CONTROLLEDVOCABULARYA STORAGE

FORMATB MESSAGING

STANDARDSC

Vocabulary - Example

The gallbladder was enlarged and red with pus easily expressed through the site of rupture

T-63000 Gallbladder

M-71000 Enlarged

M-01780 Erythematous

M-36880 Purulent Discharge

M-41611 Ruptured Abscess

SNOMEDSource: O’Carroll, Public Health Informatics and Information SystemsChapter 11, Data Standards in Public Health

Data Standards

source recipient

transmission

12

3

INFORMATION IN STORAGE

MESSAGE

CONTROLLEDVOCABULARYA STORAGE

FORMATB MESSAGING

STANDARDSC

Storage Format - Examples

Microsoft Office formats– Word “.DOC”– Excel “.XLS”– Powerpoint “.PPT”

ASCII Text– Comma-delimited– Tab-delimited

SAS “.SAS”

Data Standards

source recipient

transmission

12

3

INFORMATION IN STORAGE

MESSAGE

CONTROLLEDVOCABULARYA STORAGE

FORMATB MESSAGING

STANDARDSC

HL7 Messages

Laboratory

Pharmacy

Admission

Imaging

Finance

HL7 Messages

Standards Development

OVERLAPS IN COVERAGE

World Health Organization International Classification of Diseases or ICD, WHO Adverse Reaction Terminology or WHO-ART

American College of Pathologists Systematic Nomenclature for Medicine or SNOMED

Regenstrief Institute Logical Observed Identifiers Names and Codes or LOINC

Food and Drug Administration Coding Symbols for a Thesaurus of Adverse Reaction Terms or COSTART

American Medical Association Current Procedural Terminology or CPT4

International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH)

Medical Dictionary for Regulatory Activities or MedDRA

Electricity Worldwide

Transformations

DATAINFORMATION KNOWLEDGE

Exchange of Information

Human-human Human-computer Computer-computer

SEMANTIC INTEROPERABILITY

Interoperability

Occurs when some degree of compatibility exists among all elements that must exist for some purpose

Based on existence of a single common conceptual view– Embodied in architecture or design– Implemented through common protocol

Source: Carnegie-Mellon Software Engineering Institute

VeterinaryInformatics

Clinical Informatics

Medical Informatics

Bioinformatics

Health Informatics

Nursing Informatics Dental

Informatics

Public Public Health Health InformaticsInformatics

InformaticsInformatics

Public Health Informatics

Public health informatics is the systematic application of information and computer science and technology to public health practice, research and learning.

What in informatics is important to

epidemiologists?

Data standards

Vocabulary standards

Messaging standards

Technology standards

Interoperability

Data models Relational databases

Top 5 reasons why informatics is important to

epidemiologists

4. Increased need to share data and information in outbreak and emergency situations – efficiently and effectively

– West Nile– Hurricanes

5. Increased reporting and accountability– Programmatic goals management

Top 5 reasons why informatics is important to

epidemiologists

3. Increased use of technology– Electronic health records– Electronic laboratory systems– Communication systems– Digital technology

Top 5 reasons why informatics is important to

epidemiologists

2. It can make your life easier– Less duplication of data collection effort– Data usually takes less cleaning to be useful

(especially when structured data entry is used)

– Standardized datasets can be merged easier– Organized and structured datasets are easier

to use and validate– Controlled vocabularies clarify meanings (less

ambiguous)

Top 5 reasons why informatics is important to

epidemiologists

1. We can do it the hard way or the right way, but either way the application of information technology to public health practice is inevitable

(P. O’Carroll, 2002).

Health Information Standards

Building blocks of effective information systems

Essential for efficient and effective public health and health care delivery systems

Foundation upon which innovations in health IT are built

Setting the stage…

The first two topics provided the groundwork– Why standards are important?– What are public health informatics standards?

Next Step: – What is the Public Health Information

Network (PHIN)?– How can it be useful to HDHHS?

Health Department

Public HealthLab

CDC and OtherFederal

Organizations

Public

VaccinationCenter

AmbulatoryCare

Hospital orHealth Plan

Investigation Team

Law Enforcement and First Responders

RXPharmaceutical

Stockpile

Early DetectionSources

The Many public health “players”

- Need rapid communication!

- How?

What is PHIN?

CDC’s vision for advancing:– Information systems

• located in the many organizations that participate in public health

• making them “fully capable” and “interoperable”

What is PHIN?

Given the vision for PHIN:–A framework is needed that has:

• Selection of relevant information standards

• Description of minimal IT system capabilities

• Development of standardized applications (software)

What is PHIN?

Given the vision for PHIN:–A framework is needed that has:

• Selection of relevant information standards

–For the content itself (the data)»Vocabulary Standards

–For the structure of the data»Data modeling standards

What is PHIN?

Given the vision for PHIN:–A framework is needed that has:

• Selection of relevant information standards

• Description of minimal IT system capabilities– Secure information transmission

– Use of standard directory of users

– Operational policies and procedures

– Security and privacy requirements

What is PHIN?

Given the vision for PHIN:– A framework is needed that has:

• Selection of relevant information standards

• Description of minimal IT system capabilities

• Development of standardized applications (software) for use throughout the Public Health community

What is PHIN?

Standardized applications (software solutions) are being developed in the following areas:

1. Early Event Detection

2. Outbreak Management

3. Connecting Laboratory Systems

4. Countermeasure / Response Admin

5. Partner Communications and Alerting

6. Messaging and Vocabularies

Data Systems Integration

In deciding what our system will need to do…

– In general:• What to capture: Epidemiology• How to capture it: Public Health

Informatics

Current State of HDHHS

Data Systems Web Integration Project

IT Deliverable Details

IT Deliverables

Stakeholders Information Systems Requirements Architecture of Web Portal Deliverables Features Delivery Maintenance

Stakeholders

– End Users• Executive Team• HDHHS, BoE, Partners (Hospitals, Schools, others)

– Data Team• Requirements • Design specifications • project management – schedules, reports

– Delivery Team• Implementation specifications• Development• Delivery• Support & Maintenance

Information Systems Requirements

Integrated Web Portal– Single Web console Integrates several applications– Multiple data feeds from variety of sources– User Role based Authentication & Authorization

Customized information– Query based Custom Reports, Ad-hoc Reports, EpiInfo Reports– Spatial Analysis

Monitoring– Alerts & Events: Critical Events, Warnings, Information– Notifications: emails, paging

Infrastructure– Fast Response time– Reliable Backup and Recovery

Architecture - Web Portal http://www.hphin.com

Stage 1

Hospital 2

Hospital 1

Grants, Reports Management

Internet

hmmrs

rods

casefile

Oracle

Sql 2000

Houston Public Health Information Network (HPHIN)

3-tier architecture – Proposed

App server

Internet & Intranet access

Intranet access only

Web server

DB server

eHars

iWayDocument Management

Crystal Reports, WebFocus

Patient & Infrastructure Management

STAGE I

City of Houston Http://www.hmmrs.net

Architecture - Web Portal http://www.hphin.com

Stage 2

Hospital 2

Hospital 1

Grants, Reports Management

Internet

hmmrs

rods

casefile

Oracle

Sql 2000

Houston Public Health Information Network (HPHIN)

3-tier architecture - Proposed

App server

Internet & Intranet access

Intranet access only

Web server

DB server

eHars

iWayDocument Management

Patient & Infrastructure Management

CDM

CDC web access

NNDM

- City of Houston CDR tables- CDC CDR tables

- Application Server- Messaging- Analysis- GIS

PHINMS Client

CDC NEDSS System

STAGE II

STAGE I

PHINMS Server

CDC BioSense System

- Application Server- Messaging- Analysis

- City of Houston data- CDC data

City of Houston Http://www.hmmrs.net

Crystal Reports, WebFocus

Internet

City of Houston

CDC

Deliverables

Portal – http://www.hphin.com– Integrated Applications (3-tier)

• HMMRS, RODS, eHars, casefiles

– Infrastructure• Servers - Primary and backup• Databases – Oracle 9i, SQL 2000• Hosting – intranet and internet sites

Project Duration – 12 months Resources

– Data Team – BoE: AJ Rosario & Vishwa Rao– Delivery Team – BIS:

Features

– Integrated Web Console– Surveillance

• HMMRS, RODS, eHars, casefiles

– Grants: • PHP, HIV/STD, EPHTN, NEDSS, MMP

– Reports• Customizable reports based on queries• Hard coded reports

– Tools• Contacts, Calendar, Document management

– Notifications• Email, paging, Trouble tickets

– Secure Access• Encryption, Secure Socket Layer, Digital Certificates

Delivery

Acceptance tests– Meets minimum criterion– Application and stress tests– End user trails

Delivery– Installation on production site– Source code– Help manuals

Maintenance

Hosting– 24 x 7

Enhancements– Steering Committee Recommendations– Trouble Ticket System

Support– Daily and periodical backups– Telephone and Email support

Summary

Whether we choose to:– Use a PHIN applicationor– Use PHIN recommendations as we build

our own system:

We will be facilitating data sharing and integration with other Public Health systems

Questions?

Thank you…