Public Health Data Element Standardization- A Framework for Modeling Data Elements

Used for Public Health Case Reporting

Case Reporting Standardization Workgroup (CRSWg) Members:Jason Jacobs, BA

Catherine Staes, BSN, MPH, PhDSundak Ganesan, MD

John Abellera, MPH (CRSWg Co-Lead)Hwa-Gan Chang , PhD (CRSWg Co-Lead)

Overview

• Background• Problems• Goal• Methods• Results• Feedback

Case Reporting Standardization Workgroup (CRSWg) Project

Background

• University of Utah – Medical Informatics Class Project (Fall 2010)

• CSTE Position Statements include an unstructured section where the epidemiologist specifies the information they want to be included in a case report

• Problem: – Leads to unintended ambiguity and unnecessary variation– Often includes info needed for surveillance, not

investigation

Problems (cont.)- Acute Hepatitis B

Problems (cont.)- Hepatitis A

Problems (cont.)- Chronic Hepatitis C

Problems

• Pre-coordinated concept• Varying time periods of interest• Inconsistent labels for the same concept• Mismatch between public health requests for yes/no

answer and typical health care data storage methods (e.g. Procedure)

Goal

• Evaluate and harmonize data elements present in the 2010 CSTE Position Statements (new / updates).

• Propose a framework for ongoing development and maintenance of CSTE position statement data elements that are used for Public Health Case Reporting (PHCR)

Methods

• Reviewed 7 CSTE Position Statements– Hepatitis group• Hep A• Acute Hep B• Chronic Hep B• Acute Hep C• Chronic Hep C

– Hansen’s– Cryptosporidiosis

Methods (cont.)

• Listed and harmonized data elements across CSTE Position Statements

• Grouped data elements based upon EHR modules such as Problem List, Procedures, Medications, Laboratory, etc…

• Modeled the data elements requested into questions (LOINC) and answers (e.g. SNOMED CT)

Methods (cont.)

• In some situations, the data elements have been mapped to information model (HL7 CDA).– HL7 Information model is the first choice for mapping

the data element. Terminology model is the second choice (i.e. do not want to create or use the LOINC codes for HL7 slots)

• Reviewed current Implementation Guide for HL7 CDA R2 Public Health Case Reports– Used existing Clinical Templates to guide modeling

HL7 CDA PHCR Implementation Guide - Clinical Templates

Results

• In 7 Position Statements, we identified– 57 data elements -> 19 concepts that relate to:• Risk associated procedure ("Procedures")• Actual blood and/or body fluid exposure observation• Possible exposure location and type

– Others…halfway done• Occupation observation• Geotemporal History

HL7 CDA PHCR Implementation Guide - Clinical Templates

Scenario 1: Typical EHR Data• Current

• Proposed (explicit, computable, interoperable)Question AnswerLabel Code System Label Code SystemMedical / Surgical Procedure

XXXX-X LOINC renal dialysis 265764009 SNM

Procedure Performed info (date)

Reason

“Risk Associated Procedure”?

Scenario 1: History of Procedures

Each clinical template has a disease-specific

risk associated procedure.

Scenario 2: Not usually in EHR

• Current

• Problems– Time period of interest is unclear– Answer is numeric, not boolean– LOINC code exists (“55213-3”, “Number of male sexual

partners in 6 months before symptom onset”)– Best method for modeling

• Create new LOINC codes for Public Health reporting needs?

Enable structured data request

Event type Event name Operator (between, before, etc)

Effective time (start/stop)

Procedure organ transplant before 1992/

Procedure surgery

Substance administration

Blood transfusion before 1992/

• Create interface for epidemiologist to author structured data request– Used to build a query– Standardized across position statements– Example: for Hepatitis C, send information about:

Feedback / Summary• Are we taking the right approach for standardizing the public

health data elements present in CSTE position statements?1) Map the data elements to EHR module 2) Distribute the information between Information Model (HL7)

and Terminology Model (LOINC)3) Distribute the data element information between the question

(data element) and answer list (value set)4) Reuse these data elements in Case Notification, Syndromic

Surveillance, Immunization and ELR.5) Apply this framework to all the other CSTE position statements

and work closely with CSTE position statement authors to express the concepts unambiguously (structured format).