Public Health Vocabulary Services

(a) Gautam Kesarinath – CDC NCPHI Associate Director of Technology, gfk0@cdc.gov

(b) Nikolay Lipskiy – CDC SDO & Interoperability Lead, dgz1@cdc.gov

© Sundak Ganesan – Lead Vocabulary Specialist, Northrop Grumman consultant for CDC, dsq3@cdc.gov

Why do we need to use Standard Vocabulary?

Coded Data is Essential for: Interoperability Early Event Detection Emergency Preparedness & Response Federal Register to use CHI standards for building Federal Systems Vendors – CCHIT Certification, HITSP Standards, IHE Interoperability PHIN Certification, ARRA

Standard Vocabulary for filtering and routing data

Laboratory

Results

•Results that are of interest to public health agencies

Non-interesting results

Program areas

TB

STD

Flu

VZ

Results that are of interest to public health agencies

Public Health Filter

Problem

Integration of Public Health Vocabularies (PHV) with e-Health applications (Electronic Health Record, Public Health, Clinical Decision Support, etc..)

Challenges implementing standard vocabularies especially due to versioning and mapping of local to standard vocabularies.

Without the standard vocabulary, it is difficult to do data filtering, data routing and data analysis.

Validation of coded data present in HL7 messages or Clinical Documents. CDC receives almost one million messages per day. Vocabulary services are needed for validation, routing and filtering incoming data.

Public Health Perspective:- Lack of harmonization effort due to inconsistency of vocabularies and

data elements, legal barriers causing problems with data exchange, lack of standards fostering interoperability of health information.

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Use Case

Respond to an outbreak (e.g. H1N1 Flu)– Distribution of Value Sets (Push /Pull)– Ability to host multiple versions of value sets

Integration of Vocabulary Server using web services (HL7 CTS 2.0) with Public Health Surveillance Applications (e.g NBS), HL7 Integration engine (e.g. Rhapsody) and Decision Support Applications (e.g. Notifiable Conditions, ELR)

Validation of coded data and routing of data to various public health programs (e.g. TB, Flu, AIDS) present in HL7 messages and Clinical Document using Vocabulary Server like PHIN VADS.

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Standards

(1) White House E-Gov Consolidated Health Informatics (CHI):

- Domain recommendations provided guidance regarding the selection of code system.

(2) Health Information Technology Standards Panel (HITSP): C80: Clinical Document and Message Terminology Component defines the vocabulary (value sets) for all the HITSP interoperability Specifications (IS) T66: Sharing Value Set Specification (SVS)

HL7 Vocabulary Technical Committee

- CTS 2.0

Discussion

Reconcile HL7 CTS 2.0 and HITSP T66 Sharing Value Set Specification.

IHE vocabulary implementation profile and technical framework would promote exchange of standardized data between the healthcare information systems, immunization registries and biosurveillance systems. Standardized coded data is essential for clinical decision support, data analysis, data routing and filtering.

Global Public Health Informatics

- CDC / WHO collaborative project- participation in WHO project on building regional/national e-

Health observatories- working with SDOs on submission of new codes and building

public health capacities

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PHIN VADS Overview

Main purpose is to distribute the messaging vocabulary along with the metadata that are needed for messaging or clinical document.

PHIN VADS helps mapping legacy (local) concepts to standard codes

Current Release of PHIN VADS 3.0.1 – http://phinvads.cdc.gov - Easy to use , Versioning, Robust Searches (Synonyms), Standardized

Download files, Web services (API), Bookmarking and enhanced help section, etc.

Navigation of the value sets in VADS can be done by:(a) Views (Implementation Guides / Programs) – TB, BioSense, ELR(b) Domain / Group – Demographics, Laboratory, Medications, Disease,

Procedure

VADS Lite Available to Internal CDC Programs

VADS Web Services Open as of June of 2009

1. Public Health HL7 Messaging or CDA Implementation Guides

2. Public Health BioSurveillance Applications (Eg: NBS, OMS, EpiInfo, PHIN MSS, etc)

3. Public Health Programs – State & Federal (Eg: Influenza H1N1, TB, NHSN, etc)

4. Public Health Partners (Association for Public Health Labs, Environmental Public Health Tracking Network, EPA, etc)

5. Lab Reporting (National Electronic Lab Reporting, Laboratory Response Network, Public Health Lab Interoperability, etc)

6. Health Information Networks (Public Health Grid, BioSense, Poison Control, etc)

7. Collaboration with WHO and other countries (Outbreak Events such as H1N1 in Mexico or SARS in China, CDC Europe / Global Health, National Health Service in the UK, InfoWay in Canada, etc)

8. Vendors

PHIN VADS Key Stakeholders

•

•Authoring•Database

•Web•Application

•Load•Process

•Publish•Database

•Extended•Service Layer

•Service Layer

VA

DS

Lit

e

Universal Authoring Framework VADS Web

•UAF•Application

•3rd Party•Apps

VADS Architecture

Appendix

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Code Systems

SNOMED-CT

LOINC

HL7 v 2.5 HL7 v3

ICD-9 PHIN /CDC

“Specimen Type” - Value Set

SNOMED Specimen Domain

HL7 v2.5 - Specimen Type

HL7 v3 - Null Flavor

PHIN-CDC

PHIN Vocabulary Domain

- Lab

PHIN VADS Views

- BioSense

PHIN VADS