1. International Perspectives Fifth Annual Meeting Public Health Data Standards Consortium March 18, 2004 Marjorie S. Greenberg National Center for Health Statistics Centers for Disease Control and Prevention

2. Presentation Agenda: International Perspectives Brief overview of international standards activities WHO Collaborating Centres for Family of International Classifications Possible future efforts

3. Health data standards can be traced back several centuries –London Bills of Mortality – 17 th Century –Florence Nightingale – mid - 19 th Century –Bertillon classification - late 19 th century – International Organization for Standardization (ISO) – mid 20 th century –World Health Organization (WHO) – mid 20 th century Overview: International Perspectives

4. Why Participate in International Standards Setting? Create a global market for products Remove barriers to health care in global setting Foster comparable data and statistics in developed and developing countries Learn from other countries Improve population health

5. Main International Standards Organizations International Electrotechnical Commission (IEC) International Organization for Standardization (ISO) International Telecommunication Union (ITU) United Nations World Health Organization

6. International Players in Health Care Standards ISO – TC 215 Health Informatics CEN – European Standard Development DICOM – Imaging Standard UN/EDIFACT – EDI Standards HL7 – Clinical Messaging Standards IEEE – Medical Device Standards

7. BSI SAI ON IBN BASMP ABNT CSSN DPS ANSI CSNI IRAM INTECO ICONTEC KATS AFNOR SFS EOS INEN DS DZNM MSZT BSN NSAI STIR BIS IDHKSAR KEBS JISC UNI SII ELOT DIN BPS INDECOPI DGSM NSF SNZ NNI SNIMA MOLDST DGN DSM SEE LST AENOR SMIS UNMS PSB SASO GOST-R IPQ FONDONORMA TCVN UNIT SSUAE TSE TTBS TISI SNV SIS SLSI SCC EVS CSM CYS LVS MSA PKN SZS DSTU ASRO

8. U.S. Participation in International Standards Organizations American National Standards Institute (ANSI) is U.S. voting representative on IEC, ISO and ITU ANSI delegates responsibilities to U.S. Technical Advisory Groups (TAGs), which develop and transmit U.S. positions on activities and ballots

9. ISO Hallmarks Equal footing Voluntary Market-driven Consensus –Openness, balance, due process, appeal World-wide – 145 countries Over 200 ISO Technical Committees (TCs)

10. ISO TC 215 Founded in 1998 Scope is standardization in the field of information for health Goal is to achieve compatibility and interoperability between independent systems Also strives to ensure compatibility of data for comparative statistical purposes and to reduce duplication of effort

11. ISO TC 215 Work Groups WG1 – Health Records and Modeling WG2 – Messaging and Communication Architecture WG3 – Terminology WG4 – Privacy and Security WG5 – Smart Cards WG6 – ePharmacy and medicine Ad Hoc Groups on Consumer Interests and Mobile Communications.

12. WHO Collaborating Centres for International Classifications International Statistical Classification of Diseases and Related Health Problems (ICD) has been maintained and promoted by WHO and a network of Collaborating Centres since 1970’s Centres have been established by language and geography These and other Centres worked on revision of the International Classification of Functioning, Disability and Health (ICF) from 1993-2000 In 2001, a network of WHO Collaborating Centres for the Family of International Classifications (WHO FIC) was established

13. The WHO Family of International Classifications (FIC) Associated Products Main Classifications Adaptations

14. Mission of WHO FIC Collaborating Centres To develop, disseminate, implement and update WHO Family of International Classifications to support national and international health information systems, statistics and evidence

15. WHO FIC Committees Update and Revision –Mortality Reference Group Implementation Education Electronic Tools Family Development –e.g., primary care, external causes of injury, health interventions, terminologies

16. North American Collaborating Center Established in 1976 Housed at National Center for Health Statistics Covers U.S. and Canada and represents these countries in WHO FIC network Maintains and promotes uses of ICD for mortality and morbidity data and ICF for functional status and disability data http://www.cdc.gov/nchs/about/otheract/icd 9/nacc.htm

17. United Nations Statistics Division Statistical Yearbook Millennium Development Goals and Indicators Database Disability Database Demographic and social statistics methods City Groups –Washington Group on Disability Statistics - http://www.cdc.gov/nchs/citygroup.htm

18. Other International Health Data Activities Summary Health Measures Cancer Data Environmental Data Geo-spatial Data Organization for Economic Cooperation and Development (OECD) Health Project –National health accounts –Healthcare quality indicators

19. Role for the Consortium Learn about US TAG for ISO TC 215 and other international standard development activities Participate actively in AMIA, HL7 and other international forums on standard development Promote use of international classifications (e.g., ICD-10-CM, ICF, ICPC) Follow terminological development (e.g., SNOMED CT) and EHR development worldwide Include educational materials and links on international standards in Web-based Resource Center

20. Role for the Consortium Consider forming a committee to explore international standard development for population health Dr. Orlova has identified the following potential partners: –eHealth Initiative, USA –Health Canada, Canada –INSERM, France –Linkopings Universitet, Sweden

21. Role for the Consortium Assure a population health perspective in international standard development activities