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Data systems web_integration_v0 1
The document discusses public health informatics standards and the Public Health Information Network (PHIN) framework. It outlines how PHIN aims to advance interoperability between public health organizations through selecting relevant data standards, describing minimum IT capabilities, and developing standardized software applications. It then summarizes Houston Department of Health and Human Services' (HDHHS) data systems integration project, which will develop a web portal integrating various applications using PHIN recommendations to facilitate data sharing.
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Data systems web_integration_v0 1
- 1. Data Systems WebIntegration: A Public Health Informatics Approach AJ Rosario, M.D., M.P.H. Vishwa Rao Bureau of Epidemiology Office of Surveillance and Public Health Preparedness Houston Department of Health and Human Services February 1, 2006
- 2. Outline Introduction Publichealth practice and standards Data standards in public health Public health informatics Public Health Information Network (PHIN) Current state of Data Systems in HDHHS Data Systems Web Integration Project IT Requirements Summary Q & A
- 3. The Challenge…. Ifpublic health as a field is to become more effective, public health professionals need timely, quality information, better ways to communicate data and information, and better tools to analyze new information . (Friede et al., 1995).
- 4. Public Health Needs Much of what we do in public health is based on the data and information we gather, analyze and disseminate. Efficient access to this data is vital to develop sound public health policy and programs to ensure the health of the nation, and the world.
- 5.
- 6. Information component WisdomData Data Data Knowledge Information Information
- 7. Tenerife Air DisasterMarch 27, 1977: Two Boeing 747 airliners, from Pan-Am and KLM, collided on the island of Tenerife, killing 583 people Causes: Non-standard messages for take-off between KLM pilot and control tower, squelched radio messages Led to sweeping reforms including use of English standard phrases between pilots and control towers Source: http://www.airdisaster.com/
- 8. Polio in 1988Polio in 2004 Polio endemic areas in red From 350,000 cases in 1988 to 1255 cases in 2004 Factor: Certification-standard surveillance and lab networks
- 9. WHY DO STANDARDSMATTER?
- 10.
- 11. Data Standards inPublic Health
- 12. Sources of Datain Public Health Epidemiologic investigations By-products of clinical activities Administrative databases Environmental monitoring School system databases Other related organizations
- 13. Communication Components Wordsused in a conversation The way we put words together The context where we have the conversation
- 14. Figure of SpeechSource: O’Carroll, Public Health Informatics and Information Systems Chapter 11, Data Standards in Public Health Format Grammar Information Architecture Context Vocabulary Words Data Standard Equivalent Conversation Component
- 15. Data Standards sourcerecipient transmission 1 2 3 INFORMATION IN STORAGE MESSAGE CONTROLLED VOCABULARY A STORAGE FORMAT B MESSAGING STANDARDS C
- 16. Vocabulary - ExampleThe gallbladder was enlarged and red with pus easily expressed through the site of rupture SNOMED Source: O’Carroll, Public Health Informatics and Information Systems Chapter 11, Data Standards in Public Health T-63000 Gallbladder M-71000 Enlarged M-01780 Erythematous M-36880 Purulent Discharge M-41611 Ruptured Abscess
- 17. Data Standards sourcerecipient transmission 1 2 3 INFORMATION IN STORAGE MESSAGE CONTROLLED VOCABULARY A STORAGE FORMAT B MESSAGING STANDARDS C
- 18. Storage Format -Examples Microsoft Office formats Word “.DOC” Excel “.XLS” Powerpoint “.PPT” ASCII Text Comma-delimited Tab-delimited SAS “.SAS”
- 19. Data Standards sourcerecipient transmission 1 2 3 INFORMATION IN STORAGE MESSAGE CONTROLLED VOCABULARY A STORAGE FORMAT B MESSAGING STANDARDS C
- 20. HL7 Messages LaboratoryPharmacy Admission Imaging Finance HL7 Messages
- 21. Standards Development OVERLAPSIN COVERAGE Medical Dictionary for Regulatory Activities or MedDRA International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) Coding Symbols for a Thesaurus of Adverse Reaction Terms or COSTART Food and Drug Administration Current Procedural Terminology or CPT4 American Medical Association Logical Observed Identifiers Names and Codes or LOINC Regenstrief Institute Systematic Nomenclature for Medicine or SNOMED American College of Pathologists International Classification of Diseases or ICD , WHO Adverse Reaction Terminology or WHO-ART World Health Organization
- 22.
- 23.
- 24. Transformations DATA INFORMATIONKNOWLEDGE
- 25. Exchange of InformationHuman-human Human-computer Computer-computer SEMANTIC INTEROPERABILITY
- 26. Interoperability Occurs whensome degree of compatibility exists among all elements that must exist for some purpose Based on existence of a single common conceptual view Embodied in architecture or design Implemented through common protocol Source: Carnegie-Mellon Software Engineering Institute
- 27. Informatics Veterinary InformaticsClinical Informatics Medical Informatics Bioinformatics Health Informatics Nursing Informatics Dental Informatics Public Health Informatics
- 28. Public Health InformaticsPublic health informatics is the systematic application of information and computer science and technology to public health practice, research and learning.
- 29. What in informaticsis important to epidemiologists? Data standards Vocabulary standards Messaging standards Technology standards Interoperability Data models Relational databases
- 30. Top 5 reasonswhy informatics is important to epidemiologists Increased need to share data and information in outbreak and emergency situations – efficiently and effectively West Nile Hurricanes 5. Increased reporting and accountability Programmatic goals management
- 31. Top 5 reasonswhy informatics is important to epidemiologists Increased use of technology Electronic health records Electronic laboratory systems Communication systems Digital technology
- 32. Top 5 reasonswhy informatics is important to epidemiologists 2. It can make your life easier Less duplication of data collection effort Data usually takes less cleaning to be useful (especially when structured data entry is used) Standardized datasets can be merged easier Organized and structured datasets are easier to use and validate Controlled vocabularies clarify meanings (less ambiguous)
- 33. Top 5 reasonswhy informatics is important to epidemiologists 1. We can do it the hard way or the right way , but either way the application of information technology to public health practice is inevitable (P. O’Carroll, 2002).
- 34. Health Information StandardsBuilding blocks of effective information systems Essential for efficient and effective public health and health care delivery systems Foundation upon which innovations in health IT are built
- 35. Setting the stage…The first two topics provided the groundwork Why standards are important? What are public health informatics standards? Next Step: What is the Public Health Information Network (PHIN)? How can it be useful to HDHHS?
- 36. CDC and OtherFederal Organizations Pharmaceutical Stockpile The Many public health “players” - Need rapid communication! How? Health Department Public Health Lab Public Vaccination Center Ambulatory Care Hospital or Health Plan Investigation Team Law Enforcement and First Responders R X Early Detection Sources
- 37.
- 38. What is PHIN?CDC’s vision for advancing: Information systems located in the many organizations that participate in public health making them “fully capable” and “interoperable”
- 39. What is PHIN?Given the vision for PHIN: A framework is needed that has: Selection of relevant information standards Description of minimal IT system capabilities Development of standardized applications (software)
- 40. What is PHIN?Given the vision for PHIN: A framework is needed that has: Selection of relevant information standards For the content itself (the data) Vocabulary Standards For the structure of the data Data modeling standards
- 41. What is PHIN?Given the vision for PHIN: A framework is needed that has: Selection of relevant information standards Description of minimal IT system capabilities Secure information transmission Use of standard directory of users Operational policies and procedures Security and privacy requirements
- 42. What is PHIN?Given the vision for PHIN: A framework is needed that has: Selection of relevant information standards Description of minimal IT system capabilities Development of standardized applications (software) for use throughout the Public Health community
- 43. What is PHIN?Standardized applications (software solutions) are being developed in the following areas: Early Event Detection Outbreak Management Connecting Laboratory Systems Countermeasure / Response Admin Partner Communications and Alerting Messaging and Vocabularies
- 44. Data Systems IntegrationIn deciding what our system will need to do… In general: What to capture: Epidemiology How to capture it: Public Health Informatics
- 45. Current State ofHDHHS
- 46. Data Systems WebIntegration Project
- 47.
- 48. IT Deliverables StakeholdersInformation Systems Requirements Architecture of Web Portal Deliverables Features Delivery Maintenance
- 49. Stakeholders End UsersExecutive Team HDHHS, BoE, Partners (Hospitals, Schools, others) Data Team Requirements Design specifications project management – schedules, reports Delivery Team Implementation specifications Development Delivery Support & Maintenance
- 50. Information Systems RequirementsIntegrated Web Portal Single Web console Integrates several applications Multiple data feeds from variety of sources User Role based Authentication & Authorization Customized information Query based Custom Reports, Ad-hoc Reports, EpiInfo Reports Spatial Analysis Monitoring Alerts & Events: Critical Events, Warnings, Information Notifications: emails, paging Infrastructure Fast Response time Reliable Backup and Recovery
- 51. Architecture - WebPortal http://www.hphin.com Stage 1
- 52. Architecture - WebPortal http://www.hphin.com Stage 2
- 53. Deliverables Portal – http:// www.hphin.com Integrated Applications (3-tier) HMMRS, RODS, eHars, casefiles Infrastructure Servers - Primary and backup Databases – Oracle 9i, SQL 2000 Hosting – intranet and internet sites Project Duration – 12 months Resources Data Team – BoE: AJ Rosario & Vishwa Rao Delivery Team – BIS:
- 54. Features Integrated WebConsole Surveillance HMMRS, RODS, eHars, casefiles Grants: PHP, HIV/STD, EPHTN, NEDSS, MMP Reports Customizable reports based on queries Hard coded reports Tools Contacts, Calendar, Document management Notifications Email, paging, Trouble tickets Secure Access Encryption, Secure Socket Layer, Digital Certificates
- 55. Delivery Acceptance testsMeets minimum criterion Application and stress tests End user trails Delivery Installation on production site Source code Help manuals
- 56. Maintenance Hosting 24x 7 Enhancements Steering Committee Recommendations Trouble Ticket System Support Daily and periodical backups Telephone and Email support
- 57. Summary Whether wechoose to: Use a PHIN application or Use PHIN recommendations as we build our own system: We will be facilitating data sharing and integration with other Public Health systems
- 58.
Editor's Notes
- #2 Good Morning. It is our absolute pleasure to be here this morning. We thank you for the opportunity to present.
- #3 We will be covering this topic using this outline. I will give a brief introduction, then talk about where standards come into play in public health practice. Then I will talk about how data standards are used in public health. I will talk a little about public health informatics and PHIN and Vishwa will discuss our current state, the proposed project, IT requirements & he’ll give you a brief summary of what we have talked about. Then, let’s save the Q & A after we complete the presentation.
- #6 Public health practice can be viewed as a set of activities that are all information intensive.
- #8 This is the Tenerife Air Disaster in the Canary Islands in 1977. Two jumbo jets collided because one of them, a veteran KLM pilot had a miscommunication with the control while speaking Dutch and non-standard English phrases. From then on, the use of English phrases became the standard for communication between pilots and control towers.
- #9 This is the world with polio in 1988 to CLICK this is how it is in 2004. Instrumental in this dramatic success of the Global Polio Eradication Program is the certification-standard AFP (Acute Flaccid Paralysis) surveillance systems and laboratory networks to detect ongoing transmission in affected countries and give quality feedback to the polio eradication activities in these countries. The common theme in all these examples is the use of STANDARDS. The presence of standards enables men to build great things like the Pyramids of Giza and eradicate disease on a global scale. And the lack of it can cause destruction and failure of great magnitudes and endanger people’s lives.
- #10 This is the web site of the International Standards Organization. CLICK If you ask them why standards matter, they would say if there were no standards, you would soon notice.
- #11 Daily, we live with standards and we oftentimes take them for granted. CLICK They enable: Global telecommunications Innovations in computer hardware and software Communication of measurements in health care Sending messages and retrieving information across the globe through Internet protocols Drug administration in a variety of settings using interoperable components CLICK
- #12 Let us talk about data standards in public health.
- #13 This requires that we are able to consolidate data and information from a variety of sources both from within the health care domain and outside of it.
- #14 To simplify this scenario, we can think of exchange of health information as a set of the following components. The words we use in the conversation The way we put the words together or grammar And the context in which the conversation occurs
- #15 Carrying on that analogy further, we have words, grammar and context with its equivalents in data standards: vocabulary, format and information architecture. Let us discuss each one in detail. In information exchange, the set of words that we use for everyday conversation we call a vocabulary And for a typical conversation in English we use some 500 words. In specific knowledge domains like health care, we also have vocabularies consisting of codes with agreed upon meanings that we use to convey the same message everytime. And once we put these in context we can talk about information architecture, much like putting together construction components to make a building.
- #16 Much more simply, in public health, and specifically in electronic systems, health data and information move from storage source, is transformed into a message and stored in the recipient We talk about two forms of health information: CLICK Information in storage CLICK Information as a message Health information in these forms use three types of standards. There may be more but these ones are important. CLICK Standards for information in storage include Controlled vocabularies Storage formats CLICK And for standards for messages are called Messaging standards CLICK Let us first talk about controlled vocabularies.
- #17 This is another controlled vocabulary called the Systematized Nomenclature of Medicine or SNOMED, developed by the American College of Pathology. As an example we code the following gory pathology report as follows. We code it as CLICK The GALLBLADDER T-63000 CLICK was ENLARGED M-71000 and CLICK RED OR ERYTHEMATOUS M-01780 CLICK with PUS OR PURULENT DISCHARGE M-36880 easily expressed through the site of CLICK we code rupture as RUPTURED ABSCESS M-41611 In this example, SNOMED tries to assign as many distinct codes to terms as possible.
- #18 Going back to this diagram, let us talk about CLICK storage formats.
- #19 Storage formats are fairly easy since we encounter some of these often. We have MS Office formats, tab- and comma-delimited text files and SAS files
- #20 Going back to this diagram, let us talk about CLICK messaging standards.
- #21 Using HL7 Messages, different parts of a health care facility can exchange health information seamlessly without anymore need for manual translations of inputs and outputs from medical devices and computers.
- #22 When people realized they needed standards to achieve interoperability, several standards development organizations or SDOs, even before people called them such, began developing data standards in specific domains: WHO: International Classification of Diseases for classifying causes of mortality American College of Pathologists: Systematic Nomenclature for Medicine Regenstrief Institute: Logical Observed Identifiers American Medical Association: Current Procedural Terminology Federal Drug Administration: Coding symbols for a Thesaurus of adverse reaction terms or COSTART And MedDRA WHO-ART, COSTART and MedDRA are used in vaccine safety studies. CLICK If you think there are too many standards development organizations here, we definitely have overlaps in content coverage. [TOWER OF BABEL NEXT]
- #23 This is chaos at a different level, or a Tower of Babel for data standards. When we use one language and talk to each other we will understand each other but when we start talking in other languages, there will be chaos. What we need is a way to unify all the concepts contained in the vocabularies so we know which codes in one vocabulary correspond to what in others.
- #24 It is somewhat like worrying about how to plug into electric outlets when you travel a lot to different countries.
- #25 Data in public health also undergo transformations so we can create CLICK Information from data, and CLICK Knowledge from information Within the last decade, with advances in computing power and storage, the use of standards in representing information and knowledge has entered mainstream as we see in the terms information architecture, information infrastructure, information network, knowledge representation and knowledge engineering, ontologies.
- #26 Exchange of data, information and knowledge in health care can happen in three ways: Human-to-human as when we present knowledge in conferences Human-to-computer as when we access web sites and emails using computers Computer-to-computer as when web and email servers automatically keep our Internet functioning or when public health information systems talk to each other as we saw earlier between Oregon and Washington And it is every important that as data, information and knowledge are exchanged there is no loss of meaning. When that happens we say we have CLICK Semantic Interoperability or the ability to work together at the level of meaning.
- #27 The ultimate goal of using standards is to achieve interoperability in health information systems. For logical implementation of health information systems with large scale integration in mind we need to think of a grand design or architecture so that the different components will come together in a seamless manner Like Plug and Play
- #29 At the forefront of the work with implementing standards and interoperability in public health are people from the domain of public health informatics. Public health informatics is the systematic application of information and computer science and technology to public health practice, research and learning.
- #35 In summary, these are the uses of Health information standards in public health We use them as building blocks We use them to make health information exchange more efficient They are the foundation upon which innovations in health IT are built
- #46 Let us talk about data standards in public health.
- #47 Let us talk about data standards in public health.
- #49 Stakeholders - designers, developers, end users Requirements – discuss what is needed by HDHHS, BoE, and others Architecture – Software block diagrams Deliverables – Scope, resources, timeline Features – Portal benefits Delivery – Acceptance procedures, scope of delivery Maintenance – hosting, support, modifications,
- #50 End users – Executive team needs summary and progress information, whereas others need domain specific information Data Team – Gathers user requirements, provides initial design, specs, estimates, project manage delivery and acceptance procedures Delivery Team – Based on spec from Data team prepares implementation specs, gets approval from data team, develops, delivers, and maintains the application.
- #51 Web Portal - Will integrate existing apps and add new apps. Provides ability to input data from variety of users, controls access to domain-specific application functionality based on the nature of user and the group to which user belongs Provide customized information for analysis, interpretation, and dissemination Application monitoring - provides status of events, outbreaks in the community The application should have acceptable response time as judged by the end user and have reliable means of backing up and recovering critical data
- #52 Develop HPHIN Portal http:// www.hphin.com Link existing HMMRS and RODS to the main portal Develop new web enabled applications for eHars and casefiles and link it to the portal Generate reports through Crystal Reports Manage Grants- status and progress of deliverables Leverage iWay to provide document uploading through various hospitals
- #53 Add interoperability with CDC for Biosense and NEDSS Systems Web based Client - Server mechanism Use HL7 to process messages. No need to share sensitive patient data to CDC Allow CDC Server to poll our client and share information only on as needed basis Allow Hospitals, schools, and other to participate
- #54 All apps will be 3-tier: Presentation, business logic, and data layer Host each tier on different servers – 3 nos. Group Internet enabled apps on one server behind firewall and Intranet enabled on another server in front of firewall Total duration - 12 months to deliver portal. Detail timeline will be provided shortly. Data Team will gather requirements, prepare software application design specs, project plans, estimates Delivery Team Resources: Programmers, web designer, DBA
- #55 One Web console shows and tells all Main links: * Surveillance software * Grants – status and progress for grant deliverables with time lines, links to grant proposal documents, reports * Reports – BoE epidemiologists can set up various queries and search for information and generate custom reports Other users get hard coded reports * Tools - Contacts and calendar can be managed by creating forms through Web EOC. Documents can be uploaded to our Server from various hospitals via iWay * Notifications – Send automated emails to executive team/ supervisors/contact persons notifying critical information on events Software will use applicable security mechanisms
- #56 Delivery team will provide timelines. Has to go through acceptance testing before delivery. Delivery includes all code in repository, all manuals in CD
- #57 Delivery team is responsible for hosting the site 24x7 and providing customer support Daily telephone support during office hours Off-hour support will be through email, automated voice response systems Any enhancements will be routed through proper steering committee and delivery team will make necessary modifications. Bugs and problems will be routed through a trouble ticket procedure system.