Standards & Vocabulary

Standards in Informatics Why use standards? Exchange data and share information efficiently (HIE within RHIOs/NHIN) Correctly interpret data (Males=1 or 0) Improve data quality (Allows for easy grouping) Collaboration opportunities (Multi-state outbreaks) Handle more complex information (Laboratory reports) Public Health Informatics: An Overview of Key Issues

Standards in Informatics Everyone benefits from a common approach to representing and exchanging public health data Those who collect it from outside sources Those who enter it into electronic format Those who analyze it Those who verify the findings Those that communicate the information for public health interventions Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues A Figure of Speech… Conversation Vocabulary The words you choose to use Content standards Grammar The way you put the words together Format standards Context The environment where you have the conversation Software, hardware, and resources required for data exchange Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues Vocabulary Big tables of codes that describe things Numbers as county codes (FIPS) Reportable diseases as numbered codes ICD-9, ICD-9 CM, ICD-10 codes for underlying cause of death Vocabularies can be: Locally-defined vs universally-defined Lumpers vs splitters Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues Vocabulary Examples LOINC-Logical Observation Identifiers Names and Codes (www.regenstrief.org/loinc) Developed for billing purposes in early 1990s Gathers concepts into a single code “13951-9” = “Serum EIA for Hep A Antibody” PHIN standard for reportable disease test requests Codes not assigned in systematic or hierarchical way – the actual number is meaningless Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues Vocabulary Examples SNOMED CT-Systematized Nomenclature of Medicine Clinical Terms (www.snomed.org) Pathologist developed – mid – 1960s Teases out concepts into atomic elements “Enzyme immunoassay”, “Serum”, “Hepatitis A Virus”, “Antibody” PHIN standard for reportable disease test results Public Health Informatics: An Overview of Key Issues

Vocabulary Examples - UMLS UMLS - Unified Medical Language System (1994-present) (http://www.nlm.nih.gov/research/umls/) Goal: To integrate systems by allowing the mapping of concepts to different standardized vocabularies and the development of vocabularies in biomedicine and health that have not been previously developed Public Health Informatics: An Overview of Key Issues

Vocabulary Examples - UMLS Metathesaurus - Very large, multi-purpose, and multi-lingual vocabulary database that links all included vocabularies Lexicon – A dictionary-like database organized by concept or meaning with attributes that help to define its meaning Semantic Network – A database of biomedical and health related concepts, their various names, and the relationships among them Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues Grammar The way you put words together is important “The disinfectant is contaminated with blood” “The blood is contaminated with disinfectant” Critical in Natural Language Processing (NLP) Can be: Storage (database) or Message (transmissions from one database to another over a network) Flat files or Relational databases Mention Natural Language Processing tools Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues Grammar Examples Storage: comma-delimited, tab-delimited, MS Access, SAS Message: HL7-Health Level Seven (www.hl7.org) Clinical and administrative data Standardizes format and protocol Defines the sequence in the message for data elements as well as the data type Currently implemented in immunization and cancer registries, emergency department reporting, and lab reporting Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues Grammar Example HL7 allows multiple patients per message, multiple orders per patient, multiple tests per order, multiple results per test, etc. MSH|^~\&||LABMED-SOUTHWEST^68D089677^CLIA|… PID|1||78893565||DOE^JOHN||490 Elm St^Phoenix^AZ OBR|1||05099409000|220738^STD SCREEN^L|… OBX|1|CE|5292-8^RPR-SYPHILIS^LN||G-A200^POSITIVE^SNM| OBX|2|CE|6487-3^GONNORRHEA ANTIGEN^LN||G-A201^NEGATIVE OBX|3|CE|14468-3^CHLAMYDIA ANTIGEN^LN||G-A201^NEGATIVE Message heading Patient identifier Order requested Order results Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues Context Along with the vocabulary and format, there needs to be an infrastructure to support the data exchange Data model Communication (business rules, protocols, etc.) Security software Support staff Standard approaches to implementation of interoperable systems are needed Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues Context Example What it the NHIN? Public Health Informatics: An Overview of Key Issues

Nationwide Health Information Network Nationwide “system” Interoperable Exchange of Data, Information, Knowledge (ultimately) Secure Containing multiple Regional Health Information Organizations (RHIOs) Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues NHIN - RHIOs RHIOs – at the regional / local level Provide: Leadership Oversight Governance Funding Coordination Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues NHIN Overall Issues that must be (are) being addressed: Organization and Business Framework Privacy and Security Legal Issues Management and Operational Considerations Standards and Policies to Achieve Interoperability Public Health Informatics: An Overview of Key Issues

Privacy, Security & Confidentiality

Public Health Informatics: An Overview of Key Issues Background Technology versus people/practices? Technology Always a moving target Excellent track record overall People Human errors in judgment Social engineering Lack of standardization in laws across states Good record in public health Public Health Informatics: An Overview of Key Issues

NHIN Privacy & Security Project AHRQ, ONC (HIT) collaborative initiative with 34 states/territories Goals: Identify both best practices and challenges Develop consensus-based solutions for interoperable electronic health information exchange (HIE) that protect the privacy and security of health information, and Develop detailed implementation plans to implement solutions. Nationwide report due early summer 2007 Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues HIPAA Health Insurance Portability and Accountability Act (1996) (www.hipaa.org) Improved efficiency and effectiveness of healthcare through standardization of shared electronic information including financial and administrative data Improved privacy of personal information Public health exemption Transactions include: Health insurance enrollment and eligibility, healthcare encounters, and health insurance claims The establishment of identifiers for healthcare providers, payers and individuals, as well as code sets and classification systems used in these transaction Security of these transactions Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues HIPAA Two rules: Security rule Need for hardware security, access security, and transmission security Privacy rule Need for de-identified data to provide for patients’ privacy of personal information Public Health Informatics: An Overview of Key Issues

Public Health Informatics: An Overview of Key Issues HIPAA Personal identifiers that cannot be included in shared data: Names, address, zip codes Telephone numbers, Fax numbers, Email addresses Birth date, admission date, discharge date, date of death, age Social security numbers Medical record numbers, Health plan beneficiary numbers Account numbers, Certificate/license numbers License plate numbers Device identifiers and serial numbers Web URL, IP address numbers Biometric identifiers Full face photographic images Any other unique identifying number, characteristic, or code Public Health Informatics: An Overview of Key Issues