Standards & Vocabulary. Public Health Informatics: An Overview of Key Issues Standards in Informatics Why use standards? Exchange data and share information

Standards & Vocabulary

Public Health Informatics: An Overview of Key Issues

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)


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


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


Vocabulary

Big tables of codes that describe thingsNumbers 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-definedLumpers vs splitters


Vocabulary Examples LOINC-Logical Observation

Identifiers Names and Codes (www.regenstrief.org/loinc) Developed for billing purposes in early 1990s Gathers concepts into a single code “13951-9” = “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


Vocabulary Examples

SNOMED CT-Systematized Nomenclature of Medicine Clinical Terms (www.snomed.org) Pathologist developed – mid – 1960s Teases out concepts into atomic elements “Enzyme immunoassay”, “Serum”, “Hepatitis A

Virus”, “Antibody” PHIN standard for reportable disease test results


Vocabulary Examples - UMLS UMLS - Unified Medical Language

System (1994-present) (http://www.nlm.nih.gov/research/umls/)

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


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


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


Grammar Examples

Storage: comma-delimited, tab-delimited, MS Access, SAS

Message: HL7-Health Level Seven (www.hl7.org) 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


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||78893565||DOE^JOHN||490 Elm St^Phoenix^AZ

OBR|1||05099409000|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|14468-3^CHLAMYDIA ANTIGEN^LN||G-A201^NEGATIVE


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


Context Example

What it the NHIN?


Nationwide Health Information Network

Nationwide “system” Interoperable Exchange of Data,

Information, Knowledge (ultimately) Secure Containing multiple Regional Health

Information Organizations (RHIOs)


NHIN - RHIOs

RHIOs – at the regional / local levelProvide:

Leadership Oversight Governance Funding Coordination


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

Privacy, Security & Confidentiality


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


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


HIPAA

Health Insurance Portability and Accountability Act (1996) (www.hipaa.org)

Improved efficiency and effectiveness of healthcare through standardization of shared electronic information including financial and administrative data

Improved privacy of personal informationPublic health exemption


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


HIPAA Personal identifiers that cannot be included in shared

data: Names, address, zip codes Telephone numbers, Fax numbers, Email 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

Documents

Standards & Vocabulary. Public Health Informatics: An Overview of Key Issues Standards in Informatics Why use standards? Exchange data and share information