TM Report on the Population Health Surveillance Committee Federal Information Architecture Steven J Steindel, Ph.D. Senior Advisor, Data Standards and Vocabulary Centers for Disease Control and Prevention

TM CHI FHA Consolidated Health Informatics (CHI) OMB eGov project started 2004 Focus on Federal terminology exchange standards Investigated 24 health care domains and selected standards in about half FHA Outgrowth of CHI Expands scope to all Federal heath care IT Intent is to form common IT architecture across ALL agencies Both FHA and CHI now under ONCHIT

TM CHI Terminology Domains Lab Results Name* Messaging* Medications* Interventions/ Procedures Lab Test Orders* Non-laboratory* Demographics* Immunizations* Lab Results Content* Clinical Encounters* Nursing* Diagnosis/ Problem List* Medical Devices/ Supplies Anatomy*/ Physiology Population Health History and Physical Multimedia Text Based Reports* Genes and Proteins Disability * Recommendation Made

TM CHI Summary Terminology Recommendations HL7 Messaging Demographics Immunizations Clinical Encounters Text Based Reports (CDA) SNOMED CT Interventions/ Procedures: Non-lab Lab Results Content Nursing Diagnosis/ Problem List Anatomy LOINC Lab Results Name Lab Test Orders

TM FHA Workgroups Food Safety Safety of food supply USDA and FDA primary agencies CDC monitor role Health Services and EHR Clinical care systems DoD and VA primary agencies No CDC involvement Interoperability Technical interoperability specifications Initial focus on exchange protocols ONCHIT and HHS primary Active CDC role PH Surveillance Surveillance architecture CDC and VA primary

TM FHA Line of Business Initiative (current) Consumer Health and Safety Population education Facility Registration and Certification Product Approval Health Alerts Promotion of Preventive Practices Agriculture Trade Management Ensuring a Healthy Food Chain Monitor Food and Drug Supply Investigative Operations Laboratory Operations Conduct Recalls Product Inspection Import/Export Activities Facility Inspection Conduct Compliance Create Standards & Guidance Health Advancement Diagnostics and Clinical management Quality of Care-improving Illness Prevention Conduct Health Related Research Laboratory Research Epidemiologic Methods Research Prevention Research Survey and Statistical Methods Research Health Effects Research Diagnostic Lab Testing and Quality Assurance Program Evaluations Health Training and Education Conservation of Endangered Species with Medical Properties Infrastructure Assessment and Development Conservation of Endangered Species with Medical Properties Planning and Forecasting Health Care Services Patient Education Immunization Management Managed Services Quality of Care- sustaining Emergency Response Outbreak Investigation and Intervention Technical Assistance and Consultation Program Implementation Assess Beneficiary Health Status Plan Health Services Deliver Health Services Manage Information/Manage Documentation Coordinate and Integrate Health Services Ensure Quality of Health Services Population Health Mgmt. Public Health Surveillance Health Determinants Epidemiologic Studies Vital Statistics Health Surveys Health Risk Assessment Detection Information Dissemination Prevention & Exclusion of Animal and Plant Pests and Diseases Invasive Species Management Interdiction of Smuggled or Illegal Trade/Transport Animals or Plants Define and Assess Population Develop Population Health Management Practices Implement Tools / Manage Processes Evaluate Population Health Management Access to Care Food and Nutrition Assistance Manage Enrollment and Eligibility Perform Assessment and Plan for Care Schedule Services and Check-in Manage Patient Movement and Patient Encounter Support Beneficiary Services Assess Effectiveness of Access to Care Support Community Outreach

TM FHA Line of Business Initiative Work-in-progress Manage Access to Care Is beneficiary eligible for this care? Manage Population Health and Consumer Safety PH domain. Manage the Health Care Business Are federal funds spent properly? Deliver Health Care Services Clinical care Conduct Health Care Research NIH domain, now includes training.

TM Scope of CHI Population Health Reporting Domain Public Health Reporting Population Health Statistics Billing Data/Statistics Institution Health Statistics: not in scope, but recommended to be similar to external uses

TM Recommendation The diversity of terminology needs found lead to the conclusion that a specific CHI Recommendation is inappropriate at this time. In some circumstances, however, population health data is identical to clinical data such as reporting of infectious disease cases to public health departments or cancer rapid case ascertainment and other disease registry information to appropriate state registries. In those cases, the appropriate CHI domain recommendations for the underlying clinical data can be used.

TM Report Considerations The extent to which mapping between two terminologies can satisfy multiple needs, including population health reporting A description of the forms and complexity of the maps Ability of mapped clinical data to relate to longitudinal data The problem of using a dual system where part of population health data is derived from computer mapped clinical data to a reporting terminology and part reported as now using human interpretation to the reporting terminology needs enumeration. It is anticipated that the NCVHS, the Board of Scientific Counselors of the NCHS and The National Library of Medicine would participate in these studies

TM FHA Population Health WG Data Gathering CategoryDefinition / Notes Emerging Threats Includes syndromic surveillance systems, other early event detection systems and detection of new agents Infectious Disease may subdivide into Air, Food & Water Borne as work progresses Chronic Diseaseincludes registries Environment includes air, water, site, occupation, workplace, injury Population Health Statisticsincludes Vital Records Patient Safety adverse event reporting for drugs, vaccines, medical devices, etc.

TM Contact Information Steven J Steindel, Ph.D. Senior Advisor, Data Standards and Vocabulary Centers for Disease Control and Prevention Office of the Director U.S. Department of Health and Human Services 1600 Clifton Road, MS D-45 Atlanta, GA (tel) (fax)