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1 Integrated Architecture – Public Health Perspective Cecil O. Lynch, MD, MS Chief, Office of Informatics & Surveillance, DCDC, California Department of Health Services Chair, Graduate Group Medical Informatics, Assistant Professor, Medical Informatics, University of California - Davis
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2 Infrastructure Entry: in·fra·struc·ture Function: noun 1 : the underlying foundation or basic framework (as of a system or organization) 2 : the permanent installations required for military purposes 3 : the system of public works of a country, state, or region; also : the resources (as personnel, buildings, or equipment) required for an activity Merriam-Webster Online Dictionary
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3 The Problem P PricePiecesPartitionsPrivacyPolitics
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4 Price Technology is expensive Funding has been inadequate compared to expectations Budget constraints at the State level Funding mechanism has restrictions High cost of bureaucracy
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5 Pieces Multiple vendors Disparate technologies Legacy systems and legacy development of new systems Focus on function not on integration
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6 Partitions Department level development Reproduction of infrastructure Persistent stovepipe approach “My needs are special” mentality No “big picture” approach
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7 Privacy HIPAA concerns State legislative barriers Learned behavior Inadequate security I. T. isolation
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8 Politics Maintenance of control Fear of change Out of touch decision makers Publication worries Unaligned priorities
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9 Separate Silos
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10 Common Components Demographic Data Analysis & Reporting Provider Information Mapping Security Privacy Coded terms Messaging
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11 Common Components Patient Registry Analysis Engine Clinician Registry GIS Engine Two Factor Authentication Public Health Directory Central Terminology Server Integration Hub
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12 Active Directory Clinician Registry Patient Registry Two Factor Authentication Public Health Directory HAN
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13 Interoperability Requirements Equivalent data types –Preferably derived from the data model Common terminology –Unambiguous coding Agreed upon format –Must be readable Appropriate connection –Message must be routed appropriately
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14 Interoperability Layers 1 Physical 2 Data Link 7 Application 8 Semantic 6Presentation 5Session 4Transport 3Network Vocabulary Semantic model Data exchange Data encoding Security Communication Medical Informatics Information Technology OSI Network Model Concept for slide from Ted Klein and Tim Morris
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15 Why Code Data? Cold –February is a cold month. –She met his gaze with a cold stare. –Julia is in bed with a cold. February is a 45893009 month. She met his gaze with a 285846001 stare. Julia is in bed with a 82272006.
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16 Why Code Data? myocardial infarction cardiac infarction heart attack infarction of heart MI - Myocardial infarction myocardial infarct 22298006 22298006 22298006 22298006 22298006 22298006 TermConcept ID Description ID 3743601437442013 37443015 37441018 1784872019 1784873012
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17 Vocabulary HL7 V3 messaging is complex Byproduct of semantic necessity A library of post coordinated terms is essential CDC vocabulary mapping has not reached this level of detail yet Example: –Bilateral symmetrical muscle weakness –A prominent symptom of botulism Central Terminology Server
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18 Vocabulary - - - bilateral symmetrical muscle weakness: Present - - -
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19 Vocabulary - - - bilateral symmetrical muscle weakness: Present
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20 Vocabulary -
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21 Vocabulary - -- - -
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22 Messaging Is not –Shared database –Exchange of data on media –FTP of a data file –Submitting a web form Is –High speed asynchronous program to program communication with reliable delivery 1 1. G.Hohpe,B. Woolf Enterprise Integration Patterns
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23 Simple Messaging Sending Application Receiving Application Message Gateway Document Message Message Channel Message Router Message Translator Message Endpoint
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24 Example Application
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25 System Message Excerpt
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26 Real life messaging Integration Hub
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27 STV Example GIS Engine
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28 SaTScan & RNNH Clusters Analysis Engine
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29 CHI NCVHS Data Standards Drugs –Active Ingredients – FDA UNII codes –Clinical Drugs – RxNORM –Manufactured Dosage Form – FDA/CDER –Packaged drug product – NCD –Medication Package – FDA/CDER –Labeling Section Headers - LOINC –Drug Classifications – NDF-RT –Race and ethnicity labeling – HL7 tables
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30 CHI NCVHS Data Standards HL7 for messaging standard (current version) LOINC for laboratory test orders and test results SNOMED CT for clinical terms Immunizations – HL7 2.4 messaging and CVX and MVX codes DICOM for imaging
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31 Resources PHIN Standards http://www.cdc.gov/phin/ http://www.cdc.gov/phin/ PHIN Messaging http://www.cdc.gov/phin/messaging/ http://www.cdc.gov/phin/messaging/ NCVHS/CHI Standards http://www.ncvhs.hhs.gov/ http://www.ncvhs.hhs.gov/ LOINC codes and RELMA http://www.loinc.org http://www.loinc.org HL7 Tools and specifications http://www.hl7.org http://www.hl7.org SNOMED and others http://www.nlm.gov http://www.nlm.gov Jterm http://informatics.ucdavis.edu/jterm/ http://informatics.ucdavis.edu/jterm/
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