The document outlines the WHO Indicator and Measurement Registry (IMR) and the Statistical Data and Metadata Exchange (SDMX) specifically for health, aiming to improve the interoperability of summary data in healthcare. It identifies issues related to varying definitions, insufficient metadata, and lack of standardized formats, proposing solutions through the IMR and SDMX-HD data exchange format. The initiatives aim to harmonize indicator definitions and enhance global data management in health monitoring and evaluation.

1. WHO Indicator and Measurement Registry (IMR)
SDMX-HD Summary Data Format
Patrick Whitaker
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2. Definitions
 M&E – Monitoring and Evaluation
 Summary data – Data summarized from raw, e.g. clinical, data
 Indicator – An indicator quantifies and simplifies phenomena and helps us
understand complex realities. Indicators are aggregates of raw and
processed data but they can be further aggregated to form complex indices.
International Institute for Sustainable Development (IISD)
 IMR – WHO Indicator and Measurement Registry
 SDMX – Statistical Data and Metadata Exchange(ISO/TS 17369:2005)
 SDMX-HD – WHO implementation of SDMX for the health domain
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3. Human Nature?
Content Systems
Computers are dumb and precise.
People are brilliant and less precise.
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4. Focus on Summary Data
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5. Issues Impacting Interoperability
 Multitude of guidelines documents.
 Insufficient metadata in indicator definitions.
 Competing organizational standards.
 Weak harmonization processes.
 Lack of a global repository for indicator (and clinical concept) definitions.
 Lack of a standard exchange format for summary data.
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6. Focus of Presentation
Message Format Content Reference Model
Individual Data HIC HL7, XML SNOMED-CT, LOINC, ICD HL7 V3, ISO 13606 (OpenEHR)
LIC CCR, CCD, HSR SNOMED-CT, LOINC, ICD HL7 V3, ISO 13606 (OpenEHR)
Summary Data SDMX-HD IMR, SDMX MCV, ISO SDMX
CCD HL7 CCR-based Clinical Document Architecture Continuity of Care Document
CCR ASTM Continuity of Care Record (XML)
DCM ISO Detailed Clinical Model
HIC High Income Country
HL7 Health Level Seven
HSR Health Summary Record
ICD WHO International Classification of Diseases
ISO equal', International Organization for Standardization
IMR WHO Indicator and Measurement Registry
LIC Low Income Country
LOINC Logical Observation Identifiers Names and Codes
RIM Reference Information Model
SDMX Statistical Data and Metadata Exchange
SDMX MCV Metadata Common Vocabulary
SDMX-HD WHO Statistical Data and Metadata Exchange – Health Domain
SNOMED-CT Systematized Nomenclature of Medicine – Clinical Terms
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7. Problems
 Varying indicator and measurement definitions.
Solution: WHO Indicator and Measurement Registry (IMR)
Interoperability of computer systems (summary data).
Solution: SDMX-HD data exchange format
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8. Multitude of Guidelines
Documents
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9. Inconsistent and Incomplete Definitions
Source Indicator Name
UNSD Men 15-24 years old with comprehensive correct knowledge of HIV/AIDS, percentage
Percentage of young people aged 15–24 who both correctly identify ways of preventing the sexual
UNAIDS
transmission of HIV and who reject major misconceptions about HIV transmission
Percentage of young women and men aged 15–24 who both correctly identify ways of preventing the sexual
PEPFAR
transmission of HIV and who reject major misconceptions about HIV transmission
Percentage of young women and men aged 15–24 years who both correctly identify ways of preventing the
GFATM
sexual transmission of HIV and who reject the major misconceptions about HIV transmission
WHO Proportion of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS (%)
Indicator Sources:
UNSD mdgs.un.org/unsd/mdg/Metadata.aspx
UNAIDS data.unaids.org/pub/manual/2009/jc1676_core_indicators_2009_en.pdf
PEPFAR www.pepfar.gov/documents/organization/81097.pdf
GFATM www.theglobalfund.org/en/me/guidelines_tools/?lang=en#toolkit
WHO apps.who.int/gho/indicatorregistry/App_Main/browse_indicators.aspx
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10. Metadata Views
All concepts can
have different
names and values
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11. IMR
WHO Indicator and Measurement Registry
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12. Indicator and Measurement Registry (IMR)
 Definition, management, and harmonization of indicator definitions by WHO and
partners.
 Incorporation of international standards.
 Human and computer readable definitions.
 Global definition distribution.
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16. Support for Cross-
Domain Codelists

17. Harmonization
Establishment of processes to reconcile country and organizational
differences in indicator definitions without duplication.
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18. Programme-specific Metadata
Program-specific
profile
Name is an
associated attribute,
inherited from WHO
Program-specific in this case.
metadata

19. Publishing
Human and Computer-readable Indicator Definitions
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20. Reports
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22. SDMX-HD
Statistical Data and Metadata Exchange – Health Domain
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23. Summary Data Interoperability
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24. SDMX History
 Evolved from work on GESMES/TS in Central Banking community.
 Developed in ISO Technical Committee (TC)154 - Processes, data
elements and documents in commerce, industry and administration.
 Note that the version 1.0 of SDMX is ISO Technical Specification (TS)
17369.
 Current SDMX version is 2.1.
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25. ISO/TS 17369:2005
Statistical data and metadata exchange (SDMX)
SDMX 2.1 Technical Specification
 Section 1 – Framework. Introduces the documents and the content of the revised Version 2.1
 Section 2 – Information Model. UML model and functional description, definition of classes, associations and
attributes
 Section 3A – SDMX_ML. Specifies and documents the XML formats for describing structure, data, reference
metadata, and interfaces to the registry
 Section 3B – SDMX-ML. XML schemas, samples, WADL and WSDL (update: 12 May 2011)
 Section 4 – SDMX-EDI. Specifies and documents the UN/EDIFACT format for describing structure and data.
 Section 5 – Registry Specification – Logical Interfaces. Provides the specification for the logical registry
interfaces, including subscription/notification, registration of data and metadata, submission of structural
metadata, and querying
 Section 6 – Technical Notes. Provides some technical information which may be useful for the
implementation (this was called “Implementor’s Guide” in the 2.0 release)
 Section 7 – Web Services Guidelines. Provides guidelines for using SDMX standards to promote
interoperability among SDMX web services
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26.  Data exchange standard for summary data.
 Defines structure and content of data.
 Attributes
– Common
• Interoperability
• Documentation
– Custom
• Local customization
• Harmonization, i.e. support for current definition
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27. XML
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28. SDMX-HD Use
Public Domain Applications
 M&E/Surveillance
– DHIS2
– CRIS (planned)
 HR
– iHRIS
 Clinical
– OSHIP
– OpenMRS
 Logistics
– OpenLMIS
 Lab
– OpenELIS
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29. SDMX-HD Use
Governments
 Implemented
– Sierra Leone
– India
– Netherlands
• National Institute for Public Health and the Environment (RIVM)
• Netherlands Institute for Health Services Research (NIVEL)
 In process
– Philippines
 Planned
– Viet Nam
– Fiji
– Tonga
– Thailand
– Bangladesh
– China
– WHO Regional Offices
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30. SDMX-HD Group

31. Links
 WHO Indicator and Measurement Registry
– Public: www.who.int/gho/indicatorregistry
– Public with write access: extranet.who.int/IndicatorRegistry
Request extranet account from: extranet.who.int/ads
– Web Service www.who.int/gho/indicatorregistryservice
 SDMX: www.sdmx.org
 SDMX-HD: www.sdmx-hd.org
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