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
Presentation Agenda:International Perspectives
• Brief overview of international standards activities
• WHO Collaborating Centres for Family of International Classifications
• Possible future efforts
• Health data standards can be traced back several centuries – London Bills of Mortality – 17th Century– Florence Nightingale – mid - 19th Century– Bertillon classification - late 19th century– International Organization for Standardization
(ISO) – mid 20th century– World Health Organization (WHO) – mid 20th
century
Overview:International Perspectives
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
Main International Standards Organizations
• International Electrotechnical Commission (IEC)
• International Organization for Standardization (ISO)
• International Telecommunication Union (ITU)
• United Nations• World Health Organization
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
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
JISCUNI
SIIELOT
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
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
ISO Hallmarks
• Equal footing
• Voluntary
• Market-driven
• Consensus
– Openness, balance, due process, appeal
• World-wide – 145 countries
• Over 200 ISO Technical Committees (TCs)
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
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.
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
The WHO Family of International Classifications (FIC)
Associated Products Main Classifications Adaptations
Mission of WHO FICCollaborating Centres
• To develop, disseminate, implement and update WHO Family of International Classifications to support national and international health information systems, statistics and evidence
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
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/icd9/nacc.htm
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
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
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
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
Role for the Consortium
Assure a population health perspective in international standard development activities