Public Health Data StandardsA View from the Front Lines

Bethesda, MDMarch 17, 2004

Presentation toPUBLIC HEALTH DATA STANDARDS CONSORTIUM2004 ANNUAL MEETING ON PUBLIC HEALTH DATA STANDARDS

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

• Outreach Operations

• Legacy Systems Integration

• “Total Outreach Management”

• Surveillance

• Case Management

• Reporting to State and CDC

• 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

• HL-7

• version 2.x (Lab orders and results)

• HIPAA

• Privacy/Security

• X12

• NEDSS/PHIN

• HL7 v3.0 RIM

• ebXML

• LDAP

• HIPAA

• LOINC/SNOMED

All About Standards

Public Health Information Network- CDC’s Goals

1. An interoperable network—built on the Internet and using industry standards to work with other networks/systems

2. Support users—provides information and decision support to the public and public health professionals at all levels

3. Live data—continuous monitoring of nation’s health, continuous detection and evaluation of threats

4. Dual use—will meet BT preparedness and response needs and will transform routine public health practice

5. Engage industry—set direction for private sector participation and develop commercial and clinical opportunities

6. A common data language—use of industry standards for comparable data use and exchange (HL7, SNOMED, LOINC)

Technical Review of Version 1 of PHINFINAL BRIEFING – Gartner GroupMay 13, 2003

CDC PHIN Functionsas 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

• 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

“Automated Data Exchange Between Public Health Partners”

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

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

Conclusion

End