Public Health Data Standards Consortium

Towards Common Work Processes: Business Process Analysis and Functional Requirements Analysis for Public Health Anna Orlova, PhD Public Health Data Standards Consortium PUBLIC HEALTH DATA STANDARDS CONSORTIUM ~ 2009 BUSINESS MEETING OF MEMBERS ~ November 12-13, 2009, Hyattsville, MD

Where We Now

State Health Department: Organizational Chart

All public health activities are supported by customized information systems (databases, registries) developed to address the programmatic needs. Use of IT in Public Health: Where We Now

Our information systems do support our programmatic needs Our information systems cannot exchange data between programs within and across public health agencies and with clinical information systems AND…… HIT Standards in Public Health: Where We Now BUT……

Towards a Nationwide Health Information Network Where Should We Be in 2014 Why Standards - National Context

US Nationwide Health Information Network (NHIN) in 2014 Source: Dr. Peter Elkin, 2006

RHIEs as NHIN Components Source: Dr. Peter Elkin, 2006

Source: Eileen Koski. Quest Diagnostics. PHIN-2004, May, Atlanta GA Percent of Children Tested for Lead with BLL>10 µg/dL in the USA Vision: PH Surveillance under NHIN

Standardizing Health Information Exchanges

From Business Processes to Functional Requirements to Standardized IT Solutions

PHII Common Grounds Project “ We hope to develop a shared understanding of public health work and identify areas of commonality among public health agencies," said Dave Ross, Sc.D., director of the Common Ground National Program Office at the Public Health Informatics Institute. "The Common Ground program offers public health agencies the opportunity to collaboratively develop requirements for more effective information systems and better data exchange.” Source: Public Health Informatics Institute (PHII). URL: Describing Business Processes

Describing Functional Requirements

The purpose of the requirements elicitation is to specify the information system features from user’s perspectives in a structured Functional Requirements Analysis Document (Functional Standard). FRAD Features: Information System Goals (Tasks) Actors Functions (Actions) Data Sources Workflow and Dataflow High Level Architecture Requirements Elicitation

Functional Standard Functional Standard describes work processes that support data exchange between users (e.g., clinicians and public health practitioners) in a format of functional requirements specification for electronic communication between settings (e.g., clinical and public health settings).

Functional Standard Functional standard is a vehicle to assure that the work processes of stakeholders (e.g., clinicians and public health practitioners) related to the electronic data exchange are well understood and agreed upon by stakeholders themselves and then communicated clearly to the developers as functional requirements for the information system.

“Defining system requirements is the most important step in developing or acquiring any information system. A well-conceived and planned health information system can help organizations understand the need to adjust tasks or processes to be more effective or proactive in protecting community health….” Source: Public Health Informatics Institute (PHII). URL: Defining Requirements

 Early Hearing Detection and Intervention Content Profile,  Standards for Public Health Data Exchanges: Working with Vendors (Newborn Screening, Diabetes, Quality), 2009  Standards for Public Health Data Exchanges: Functional Requirements Standard for Diabetes Care Management and Surveillance, 2008  Towards a Functional Standards on Electronic Data Exchange between Clinical Care and Public Health, 2007  Developing a Vision for Functional requirements Specification for Electronic Data Exchange between Clinical and Public Health Settings: Examples of School Health and Syndromic Surveillance in New York City, 2006 PHDSC FRAD Projects* *Supported by Health Resources and Services Administration, URL:

From Business Processes to Functional Requirements to Standardized IT Solutions Using SOA (Service-Oriented Architecture)

Example of Environmental Public Health Tracking

 What are the impacts of pesticide exposure on children’s health?  Are changes in the environment related to dramatic increase in asthma?  Are there increases in Systemic Lupus Erythmetosis (SLE) and multiple sclerosis (MS) in communities with hazardous waste sites?  Track health, disease, and risks to target interventions to those populations most affected by environmental hazards and exposures.  Detect new adverse health events associated with environmental exposures.  Detect unusual occurrences, trends, or clusters of specific health events associated with environmental exposures.  Monitor and assess the effects of policies and the efficacy of interventions and established prevention strategies.  Raise awareness about environmental health issues among consumers, policy makers, health practitioners, industry, the public, and the media. Examples of Tasks to be Addressed by the Environmental Health Tracking Network Source: Dr. Nabil Issa, CDC/NCEH Public Health Questions Public Health Actions – Business Processes

Environmental Public Health Tracking Network Population Census Environmental Exposure Tracking Environmental Hazards Tracking Health Outcomes Tracking State and National Data Collection Systems Integrated Environmental Health Tracking, Analysis, Evaluation And Dissemination Exposure Hazards  Track health, disease, and risk trends Establish program priorities Develop, implement, and evaluate public health policies and program strategies Develop rapid-response mechanisms to investigate outbreaks and clusters Develop guidelines/standards Generate hypotheses and initiate applied research Public Health Actions Source: Dr. Nabil Issa, CDC/NCEH USER VIEW

System Architecture for Environmental Health Risk Detection, Assessment & Management System Architecture for Environmental Health Risk Detection, Assessment & Management GIS/Spatial EpidemiologyRisk AnalysisData Mining & Knowledge DiscoveryStatistical Models Exposure Detection & Risk Analysis Track health, disease, and exposure risk/trends Detect & evaluate risk of exposure to env. hazards Develop & evaluate public health & environmental stewardship policies & programs Develop rapid-response mechanisms to investigate outbreaks and clusters Develop prevention guidelines/standards Generate hypotheses and initiate applied research Environmental Stewardship & Public Health Actions Source: Dr. Nabil Issa, CDC/NCEH (*) Based on risk assessment and national priorities Environmental Hazards, Ecology and Disease Data Collection Systems Disease Tracking * Hospital Discharge Birth Defects BRFSS Cancer Registries Health Surveys Vital Statistics Population Demographi cs * Census Data Exposure Tracking * Human Exposure to Environmental Chemicals Toxic Exposure Surveillance Hazards Tracking * Hazardous Substances- Emergency Event Surveillance Toxic Release Inventory Ecological Tracking * Marine Life Animals Plants Population Disease Indicators Population Demography Health Outcomes Exposure Profile Environmental Hazard Hazardous Material Profile Exposure Integrated Environmental Health Indicators Data Warehouse Biomonitoring Natural Accidental Intentional Ecological Indicators Data Linking/IntegrationMetadataData StandardizationData Quality Assurance Data Integration, Transformation & Geocoding Geocoding Informatician View

System Environmental Public Health Tracking Information Exchanges Developer View Source: HITSP, 2009

State Health Department: Organizational Chart

Use Cases Business Processes Business “Top Down” User Driven (Requirements Driven)

Towa rds a Publi c Healt h Doma in at IHE “Top Down” User Driven (Requirements Driven) Use Case Business Processes Use Case Business

Towa rds a Publi c Healt h Doma in at IHE “Top Down” User Driven (Requirements Driven) Use Case Business Processes Functional Requirements/ Capabilities Use Case Functional Requirements/ Capabilities Use Case Functional Requirements/ Capabilities Business

Towa rds a Publi c Healt h Doma in at IHE “Top Down” User Driven (Requirements Driven) Use Case Business Processes Functional Requirements/ Capabilities Use Case Functional Requirements/ Capabilities Use Case Functional Requirements/ Capabilities Business Working with Developers at the Integrating the Healthcare Enterprise (IHE)

Integration Profile Transaction Towa rds a Publi c Healt h Doma in at IHE Content Profile Actor Transaction Actor Transaction Content Profile Actor IHE Technical Frameworks “Bottom-Up” Health IT Solution Driven PIX, PDQ, RFD, XDS

Integration Profile Transaction Towa rds a Publi c Healt h Doma in at IHE Content Profile Actor Transaction Actor Transaction Content Profile Actor IHE Technical Frameworks “Bottom-Up” Health IT Solution Driven PIX, PDQ, RFD, XDS “Top Down” User Driven (Requirements Driven) Use Case Business Processes Functional Requirements/ Capabilities Use Case Functional Requirements/ Capabilities Use Case Functional Requirements/ Capabilities Business

Task Service Layer Entity Service Layer Utility Service Layer Service Layers Service-Oriented Architecture (SOA)

Entity Services Utility Services / IHE Integration Profiles Task Services PIX MgrPDQ MgrRegistryRepositoryAudit IdentityDocument GetPatientLHR Example of Service Layers / Integration Profile Mapping

Integration Profile Transaction Towa rds a Publi c Healt h Doma in at IHE Content Profile Actor Transaction Actor Transaction Content Profile Actor IHE Technical Frameworks “Bottom-Up” Health IT Solution Driven PIX, PDQ, RFD, XDS “Top Down” User Driven (Requirements Driven) Use Case Business Processes Functional Requirements/ Capabilities Use Case Functional Requirements/ Capabilities Use Case Functional Requirements/ Capabilities Business

IHE & SOA White Paper Integration Profile Transaction Towa rds a Publi c Healt h Doma in at IHE Content Profile Actor Transaction Actor Transaction Content Profile Actor IHE Technical Frameworks “Top Down” User Driven (Requirements Driven) “Bottom-Up” Health IT Solution Driven Task Service Layer Entity Service Layer Utility Service Layer PIX, PDQ, RFD, XDS Use Case Business Processes Functional Requirements/ Capabilities Use Case Functional Requirements/ Capabilities Use Case Functional Requirements/ Capabilities Business

Value of SOA SOA links business and functional requirements to standardized interoperable IT solutions For Users (Public Health Professionals and Clinicians) Ability to navigate and select appropriate IT standards/ products for a service that is understandable for a non-technical audience, ie, identity service, document service, etc. Ability to relate user requirements to IHE technical solutions (capabilities) Ability to see commonalities for technical solutions across business processes

Value of SOA SOA links business and functional requirements to standardized interoperable IT solutions For Developers Help users and their IT vendors to navigate through interoperability standards Help IT vendors to correctly use interoperability products in their applications Develop new IT products for services requested by users, ie, identity service, document service, etc.

Value of SOA SOA links business and functional requirements to standardized interoperable IT solutions So, together we can built interoperable, standards-based IT products that will adhere to user needs to assure “meaningful use” of Health IT

Resources: A Service-Oriented Architecture (SOA) View of IHE Profiles – White Paper at the Integrating the Healthcare Enterprise (IHE). (URL:

Questions?