1. Standards & Vocabulary

2. 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

3. 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

4. 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

5. 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

6. Public Health Informatics: An Overview of Key Issues
Vocabulary Examples
LOINC-Logical Observation Identifiers Names and Codes (
Developed for billing purposes in early 1990s
Gathers concepts into a single code
“ ” = “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

7. Public Health Informatics: An Overview of Key Issues
Vocabulary Examples
SNOMED CT-Systematized Nomenclature of Medicine Clinical Terms (
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

8. Vocabulary Examples - UMLS
UMLS - Unified Medical Language System (1994-present) (
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

9. 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

10. 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

11. Public Health Informatics: An Overview of Key Issues
Grammar Examples
Storage: comma-delimited, tab-delimited, MS Access, SAS
Message: HL7-Health Level Seven (
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

12. 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|| ||DOE^JOHN||490 Elm St^Phoenix^AZ
OBR|1|| |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| ^CHLAMYDIA ANTIGEN^LN||G-A201^NEGATIVE
Message heading
Patient identifier
Order requested
Order results
Public Health Informatics: An Overview of Key Issues

13. 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

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

15. 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

16. 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

17. 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

18. Privacy, Security & Confidentiality

19. 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

20. 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

21. Public Health Informatics: An Overview of Key Issues
HIPAA
Health Insurance Portability and Accountability Act (1996) (
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

22. 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

23. 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, 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