standards & vocabulary. public health informatics: an overview of key issues standards in...
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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)
Public Health Informatics: An Overview of Key Issues
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
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
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
Public Health Informatics: An Overview of Key Issues
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
Public Health Informatics: An Overview of Key Issues
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
Public Health Informatics: An Overview of Key Issues
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
Public Health Informatics: An Overview of Key Issues
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
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
Public Health Informatics: An Overview of Key Issues
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
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||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
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
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
NHIN - RHIOs
RHIOs – at the regional / local levelProvide:
Leadership Oversight Governance Funding Coordination
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
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
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
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
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
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