1. Current and Future Partners of PHVCoP
Developing a Public Health Vocabulary Community of Practice: Lessons Learned
JP Abellera1, S Ganesan2, MJ Mabery1, B Venugopalan2, PT Wan4 , KJ Wilson3
CDC/National Center for Public Health Informatics1, CDC/Coordinating Center for Infectious Diseases4, Science Applications International Corporation (SAIC)2, BearingPoint3
Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Table 2. Recommended Steps in Community of Practice Development
Preparation:
Find an advocate/champion
Gain organizational support
Identify known stakeholders
Contact known potential participants
Network to identify potential participants
Develop a participatory space
Identify leaders and “early adopters”
Implementation:
Maintain CoP focus and scope
Allow working groups who remain active
in the CoP
Provide multiple modalities for
participatory spaces, provide relevant
training, maintain and monitor
Remain sensitive to all members‘
knowledge needs
Share successes with others in
organization
Develop an outreach program to identify
additional expertise and participants
Maintain consistency with meeting times
and places
Conduct iterative, formative evaluation of
CoP
Encourage leadership to champion CoP’s
value
Recognize the CoP’s impact on specific
projects
Activities and Results
Abstract
Community of Practice (CoP) Methodology
Recognizing the need for new strategies to develop and adopt public health vocabulary standards, Centers for Disease Control and Prevention (CDC) staff created a Public Health Vocabulary Community of Practice (PHVCoP). The PHVCoP was organized around the following goals:
to identify vocabulary development activities throughout the Agency;
to openly share vocabulary work,
to educate members about vocabulary standards and their implementation; and
to coalesce around collaboration points and encourage vocabulary standards adoption.  
In this poster presentation we describe the organization process used, our steps for community of practice planning and implementation, membership, formalized interactions, first and second year results, and key lessons learned. We demonstrate that the CoP model is another useful methodology in standards development and adoption.
Through monthly Community gatherings and resulting collaborations, the PHVCoP has:
Identified pockets of Vocabulary activity across CDC
Fostered open sharing of vocabulary development and implementation challenges as well as successes
Increased the community’s awareness and knowledge of current vocabulary standards and practices
Invited experts from partners and organizations such as the American Health Information Community (AHIC), the National Library of Medicine (NLM), and the International Health Terminology Standards Development Organization (IHTSDO) to share their perspectives
Opened collaboration with the Electronic Laboratory Reporting (ELR) CoP to provide vocabulary expertise for their HL7 laboratory messaging work
Produced an Issue Brief on vocabulary standards adoption, including the importance to public health information exchange and the challenges of implementation
Held a fun face-to-face networking event at the 2007 PHIN Conference
The PHVCoP success has contributed to CDC/NCPHI leadership’s decision to utilize the communities of practice approach for PHIN. CDC and its Partners have embraced this collaborative framework of community nurturing, engagement, facilitation, and stewardship.
Based on this experience, the PHVCoP recommends a series of steps that were valuable in the development of their CoP ( Table 2).
The PHVCoP operates within and has developed the three crucial elements of a CoP: 2
Domain: the shared interest that provides the incentive and passion for the group to come together, here vocabulary standards.
Community: the group of people who come together with a common interest, that share their perspectives and knowledge with the group.
Practice: the agreed upon ways of institutionalizing the collectively developed knowledge and solutions that furthers the community’s mission. This includes developing / implementing new technology or best practices, innovation and problem solving, conducting research, and developing standards.
2. Wenger, McDermott, Snyder, Cultivating Communities of Practice,
Problem
Current and Future Partners of PHVCoP
Public health has long recognized the need to develop interoperable information systems to share vital public health data and information. Formally recognized biomedical standards such as International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9-CM), Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT), Health Level Seven (HL7), and Logical Observation Identifier Names Codes (LOINC) are the most widely adopted vocabulary standards within public health. In December 2005, the Consolidated Health Informatics (CHI) initiative, one of the 24 e-Government initiatives in the President’s Management Agenda, identified and mandated the use of vocabulary and messaging standards to facilitate electronic data and information exchange among federal government agencies.1
Yet, the standards developing process is fraught with issues associated with the management of information system development, public health practice requirements and public health policy constraints. First, the standards developed are a compromise among participants in the standards development workgroup. Then, the process and results are not as efficient and effective as developing vocabulary codes for an information system that is tailored to a specific solution. Furthermore, mapping of local vocabulary to standard vocabulary is labor intensive. The ability for public health agencies to mine longitudinal data is vital, especially in examining chronic diseases. Additionally, if standards are perceived to be too rigid or narrowly focused, information system developers would have difficulty in utilizing them. Finally, time can be the most important issue in developing public health vocabulary standards. A 1995 study of Internet standards development organizations (SDO) estimated the average development time was between 2 to 5 years.2
Lessons Learned
Participation and networking improves through honest sharing of struggles as well as successes
Providing opportunities to hear all voices during meetings spawns collaboration
Intense or tangential discussions should be taken offline or shifted to the collaborative space
Expanding the membership from CDC-only to all Public Health Vocabulary raises challenges with balancing agendas and defining focus
Maintain connectivity to subgroups while keeping the focus on the primary domain
Shifting modes of communication and meaningful linkages from formal meetings with presentations (synchronous) to discussions in the participatory space (asynchronous) is challenging
Present issues at various levels of expertise, basic to advanced
Proposed Solution
To address the issues surrounding vocabulary standards adoption and to support vocabulary standards development within public health, a Vocabulary Community of Practice was formed in 2005 at CDC. Previous public health informatics initiatives at CDC had drawn together vocabulary specialists to build a specific service project or application, but there was no reason to bind the specialists together beyond the project. A proactive gathering of identified vocabulary specialists and others working with terminologies in CDC programs was clearly needed, The distributed community found value in the informal connectivity and semi-structured knowledge-sharing. In 2006 the Community was expanded to invite participation from state and local health departments and was renamed the Public Health Vocabulary Community of Practice (PHVCoP). Two and half years later, the Community continues to thrive and grow and provide new strategic possibilities for vocabulary standards adoption in public health.
Future Goals of PHVCoP
Engage new partners such as Academic Centers and additional Federal Partners
Expand to include members with interests and expertise in Messaging Standards
Participate in a formal Community Evaluation
Investigate a more easily accessible, user friendly tool for asynchronous collaboration
Acknowledgements
We would like to acknowledge the many contributions and support of our fellow PHVCoP members and our organizational leaders inside and outside of CDC to make this poster possible. 1.
2. Palme, J. None or standards making