1. Applying the Public Health Conceptual Data Model to the Implementation of the National Electronic Disease Surveillance System
Abdul-Malik Shakir, Senior Advisor
IDX eIntelligence Solutions Group
August 30, 2000

2. Presentation Overview
PHCDM Project Update
NEDSS Cooperative Agreement Initiatives
NEDSS Development Coordination Issues
IDX eSG Participation in NEDSS
Identification of next steps
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

3. PHCDM Governments Project Special Interest Group Presentation
PHCDM Project Update
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

4. PHCDM Governments Project Special Interest Group Presentation
PHCDM Project Purpose
The purpose of the Public Health Conceptual Data Model (PHCDM) project is to document the information needs of public health so that Centers for Disease Control and Prevention (CDC) and its state and local partners in public health can:
Establish data standards for public health, including data definitions, component structures, code values, and use;
Collaborate with national health informatics standards setting bodies to define standards for the exchange of information among public health agencies, and healthcare providers;
Construct computerized information systems that conform to established data and data interchange standards for use in the management of data relevant to public health.
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

5. PHCDM Governments Project Special Interest Group Presentation
Overall Scope of Work
Development and maintenance of the Public Health Conceptual Data Model (PHCDM)
Development and maintenance of the Public Health High-level Process Model (PHHPM)
Implementation of the PHCDM and PHHPM
Coordination with national data-related standards
Coordination with CDC Program, State, and Local public health data-related initiatives
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

6. PHCDM Governments Project Special Interest Group Presentation
PHCDM Project Goals
Provide a framework for organizing public health data standards and guidelines
Reduce development effort for computerized information systems for public health surveillance
Enhance data exchange capabilities among public health agencies and healthcare providers
Represent public health data needs to national standards setting bodies
Facilitate collaboration between CDC and their state and local partners in public health.
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

7. PHCDM Jun-Dec 1999 Accomplishments
Created a data model for public health based upon analysis of the database structures of current CDC disease surveillance systems, CIPHER data standards, the HL7 RIM, and other health related information models, and defined a maintenance process for the model.
Reviewed the PHCDM with epidemiologists from within certain program areas of CDC and from state and local public health agencies and updated the PHCDM based upon their critique.
Selected a computerized information system development project to make use of the PHCDM and CIPHER data standards within CDC and developed a workplan for applying the standards to the development effort.
Established Jan-Jun 2000 objectives for the PHCDM project.
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

8. PHCDM Jan-Jun 2000 Accomplishment
Published the premiere edition of the PHCDM
Participated in the HL7 Reference Information Model (RIM) harmonization process to introduce public health related information needs.
Began development of a public health high-level process model (PHHPM) to provide context for the PHCDM.
Continued to coordinate with CDC programs and partners to endure that their information needs are represented in the PHCDM
Established Jun-Dec 2000 objectives for the PHCDM project.
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

9. Publication of the Premiere PHCDM
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

10. PHCDM Governments Project Special Interest Group Presentation
ACTOR PARTICIPATION
HEALTH RELATED ACTIVITY 1 1
PARTY
0..*
0..*
Actor Type Code : CV
Activity Identifier : SET<II>
PARTY TO PARTY RELATIONSHIP 1 1 1 1
Actor Time Range : IVL<TS>
0..*
0..*
Activity Mood Code : CV
Activity Type Code : CV 1 1
Relationship Date Time Range : IVL<TS>
0..*
0..*
Party Identifier : SET<II>
Activity Descriptive Text : FTX
0..*
0..*
Relationship Type Code : CV 1 1
0..1
0..1
TARGET PARTICIPATION
Activity Status Code : CV
ACTIVITY RELATIONSHIP
0..*
0..* 1 1
0..*
0..*
Target Type Code : CV 1 1
Activity Date Time : GTS
Activity Relationship Code : CV
Target Time Range : IVL<TS>
Activity Critical Date Time : GTS 1 1
0..*
0..*
Target Awareness Code : CV
0..*
0..*
Activity Method Code : CV
0..*
0..*
Parties
Subject Site Code : CV
INDIVIDUAL
MATERIAL RESPONSIBILITY
0..*
0..*
0..*
0..*
Birth Date : TS
Responsibility Type Code : CV
Interpretation Code : CV
Confidentiality Code : CV
Death Date : TS
Responsibility Date Time Range : IVL<TS>
0..*
0..*
Maximum Repetition Number : INT 1 1
Sex Code : CV
Material Identifier : II
Materials
Priority Code : CV 1 1
0..1
0..1
OBSERVATION
PERSON 1 1
MATERIAL
Observation Value : ANY
Ethnicity Code : CV
Derivation Expression Text : ST
Race Code : SET<CV>
0..*
0..*
Material Identifier : SET<II>
Material Type Code : CV
Occupation Code : CV
MATERIAL RELATIONSHIP
Material Description : FTX
Person Name : SET<PN>
Material Relationship Type Code : CV
Material Date Time Range : IVL<TS>
CASE
0..*
0..*
Handling Code : CV
Confirmation Method Code : CV
NON PERSON LIVING ORGANISM
Danger Code : CV 1 1
Material Quantity : PQ
Detection Method Code : CV
Species Name : CV
Transmission Mode Code : CV
Organism Name : ST
Material Name : ST
Disease Imported Code : CV 1 1
Etiologic Status Code : CV
SPECIMEN
ORGANIZATION
Source Site Code : CV
OUTBREAK
Organization Name : SET<ON>
Outbreak Extent Code : CV
Outbreak Peak Date : TS
0..*
0..*
Outbreak Time Range : IVL<TS>
FORMAL ORGANIZATION
PARTY LOCATION PARTICIPATION
0..*
0..*
Industry Code : CV
Participation Date Time Range : IVL<TS>
MATERIAL LOCATION PARTICIPATION
Participation Type Code : CV
Participation Date Time Range : IVL<TS>
INTERVENTION
Current Status Code : CV
INFORMAL ORGANIZATION
Current Status Effective Date : TS
Intervention Reason Code
0..*
0..*
Intervention Form Code : CV
Group Type Code : CV
0..*
0..*
Locations
Intervention Route Code : CV
Intervention Quantity : PQ
Strength Quantity : PQ
Rate Quantity : PQ 1 1
LOCATION
LOCATION RELATIONSHIP 1 1
Location Identifier : SET<II>
0..*
0..*
Location Setting Code : CV
REFERRAL
Relationship Type Code : CV
Location Type Code : CV 1 1
Referral Reason Text
Relationship Date Time Range : IVL<TS> 1 1
Location Status Code : CV
Authorized Visit Amount
0..*
0..*
Current Status Effective Date : TS
0..1
0..1
Referral Description
Location Narrative Text : FTX
POSTAL LOCATION
NOTIFICATION
Street Address Text : AD
PHYSICAL LOCATION
Notification Reason Code : CV
Health-Related
Activities
Address Directions Text : FTX
Latitude Quantity : ST
Longitude Quantity : ST
Location Name : ST
TELECOMMUNICATION LOCATION
Property Location Text : FTX
Personal Identification Number : ST
Time Zone Text : ST
Electronic Address Text : TEL
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

11. Mapping of the PHCDM to the HL7 RIM
ORGANIZATION
INFORMAL ORGANIZATION
FORMAL ORGANIZATION
<<Organization>>
INDIVIDUAL
NON PERSON LIVING ORGANISM
<<Living_subject>>
ENTITY
PERSON
<<Person>>
OUTBREAK
REFERRAL
<<Referral>>
MEDICATION
<<Medication>>
ELECTRONIC LOCATION
TELEPHONE LOCATION
POSTAL LOCATION
PHYSICAL LOCATION
OBSERVATION
<<Observation>>
SPECIMEN
<<Specimen>>
CASE
PUBLIC HEALTH NOTIFICATION
ACTIVITY RELATIONSHIP
<<Service_relationship>>
LOCATION RELATIONSHIP
PARTY TO PARTY RELATIONSHIP
<<Stakeholder_affiliation>>
ACTOR PARTICIPATION
<<Active_participation>>
PARTY LOCATION PARTICIPATION
HEALTH RELATED ACTIVITY
<<Service>> 1
0..*
+associates
+associates_to
+is_target_for
+relates
+is_source_for
PARTY
<<Stakeholder>>
+relates to
MATERIAL RELATIONSHIP
<<Material_relationship>>
MATERIAL LOCATION PARTICIPATION
TARGET PARTICIPATION
<<Target>>
MATERIAL RESPONSIBILITY
MATERIAL
<<Material>>
0..1
INTERVENTION
LOCATION INFORMATION
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

12. PHCDM Parties Subject Area
Party to Party
Relationship
<Stakeholder Affiliation>
Party
<Stakeholder>
Individual
Non-Person
Living Organism
<Living Subject>
Person
<Person>
Organization
<Organization>
New!
Formal
Organization
Informal
Revised
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

13. HL7 RIM Change Proposals
Desired Changes to the RIM
Add Informal Organization as a specialization of Organization
Add Formal Organization as a specialization of Organization
Add Individual as a specialization of Stakeholder
Make Person a specialization of Individual
Make Living Subject a specialization of Individual
Additional Changes to the RIM
Change the name of Stakeholder to Party
Change the name of Stakeholder Affiliation to Party Affiliation
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

14. Public Health High-Level Process Model
Surveillance Planning
Identify the health-related problem to be addressed
Understand the setting in which surveillance and response activities will take place
Define the scope of surveillance
Develop policies and procedures for conducting surveillance
Case Monitoring
Identify parties meeting case definitions and record information about them
Report cases to responsible parties
Analyze data to identify problems and trends
Investigate and confirm suspected cases
Communicate results of analyses and investigations
Disease Intervention
Take action to prevent or control disease
Evaluate usefulness of surveillance and effectiveness of outbreak response activities
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

15. PHCDM Jun-Dec 2000 Objectives
Develop and implement a PHCDM change management process
Finalize the PHHPM process decomposition and its mapping to the PHCDM
Develop a procedure for transforming the PHCDM into project specific database implementations
Implement automation to support the mapping of project specific database implementations to the PHCDM
Complete harmonization of the PHCDM with the HL7 RIM
Adopt the HL7 vocabulary processes and begin to define PHCDM vocabularies
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

16. NEDSS Cooperative Agreement Initiatives
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

17. PHCDM Governments Project Special Interest Group Presentation
PHCDM and NEDSS
The PHCDM project is one of many interrelated activities supporting CDC’s National Electronic Disease Surveillance System (NEDSS) initiative.
The long-term vision for NEDSS is a collection of complementary computerized information systems that automate the process of gathering health data, facilitate the monitoring of the health of communities, assist in the analysis of trends and detection of emerging public health problems, and provide information for setting public health policy.
The focus of the NEDSS initiative is the development, testing, and implementation of information management technology standards that will support more complete and comprehensive integration of computerized health information systems for use in public health.
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

18. NEDSS Systems Architecture
Brings structure, standards and interoperability to the information systems elements of surveillance
Allows the latitude for states and local health departments to do specific implementations and fulfill public health needs
Is respectful of local / state / federal data flow issues
Provides a structure around which CDC systems can be integrated
Facilitates the ready exchange of comparable data and reports between public health organizations without reprogramming
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

19. PHCDM Governments Project Special Interest Group Presentation
Integrated State
/ Local Data
Repository
Implement an integrated data repository
able to be patient centered, non-categorical
support “thick” client and web applications
(ODBC, JDBC and ANSI SQL)
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

20. PHCDM Governments Project Special Interest Group Presentation
Integrated State
/ Local Data
Repository
Security
Implement a security system and appropriate security policies (Internet-based, with a firewall and certificates or tokens)
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

21. PHCDM Governments Project Special Interest Group Presentation
Local Health
Department Or
Clinical
Site
State Health
Department
Integrated State
/ Local Data
Repository
Security
Conduct and support web browser-based data entry and data management.
Internet presentable, but not necessary
Multi-tiered including an application server to run web “forms” from others
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

22. PHCDM Governments Project Special Interest Group Presentation
Local Health
Department Or
Clinical
Site
State Health
Department
Electronic
Laboratory
Messages
Integrated State
/ Local Data
Repository
Security
HL7
Clinical
Database
Accept, route and process electronic HL7 messages containing laboratory and clinical content (LOINC, SNOMED).
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

23. PHCDM Governments Project Special Interest Group Presentation
Local Health
Department Or
Clinical
Site
State Health
Department
Electronic
Laboratory
Messages
Integrated State
/ Local Data
Repository
Security
Clinical
Database
HL7
XML
Data
Exchange
Develop active data translation and exchange (integration broker) functionality (XML, DTD’s HTTPS).
CDC and Other
Health Depts.
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

24. Local Health
Department Or
Clinical
Site
State Health
Department
Reporting, GIS and Analysis
Electronic
Laboratory
Messages
Integrated State
/ Local Data
Repository
Security
Clinical
Database
HL7
XML
Data
Exchange
Develop data reporting and visualization capability (messaging and import/export ODBC, JDBC, ANSI SQL).
CDC and Other
Health Depts.
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

25. Local Health
Department Or
Clinical
Site
State Health
Department
Reporting, GIS and Analysis
Electronic
Laboratory
Messages
Integrated State
/ Local Data
Repository
Security
Clinical
Database
HL7
Shareable
Directory of
PH Personnel
XML
Data
Exchange
CDC and Other
Health Depts.
Implement a shareable directory of public health personnel (LDAP).
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

26. Local Health
Department Or
Clinical
Site
State Health
Department
Transportable
“Business”
Logic
Reporting, GIS and Analysis
Electronic
Laboratory
Messages
Integrated State
/ Local Data
Repository
Security
Clinical
Database
HL7
Shareable
Directory of
PH Personnel
XML
Data
Exchange
CDC and Other
Health Depts.
Develop transportable business logic capability (COM, CORBA, EJB).
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

27. NEDSS System Architecture Elements
Conduct and support web browser-based data entry and data management.
Accept, route and process electronic HL7 messages containing laboratory and clinical content.
Implement an integrated data repository.
Develop active data translation and exchange (integration broker) functionality.
Develop transportable business logic capability.
Develop data reporting and visualization capability.
Implement a shareable directory of public health personnel.
Implement a security system and appropriate security policies.
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

28. NEDSS Cooperative Agreement Initiatives
Assessment and Planning – Assess current information systems personnel and technical infrastructure, evaluate that infrastructure against the NEDSS systems architecture and develop plans to migrate to the NEDSS architecture as needed.
Element Development – Implement between one and four of the NEDSS system architecture elements and use in the setting of identified public health activities.
Charter Sites - Conduct activities to implement and demonstrate the fully described systems architecture. Charter sites will receive funds for implementation of up to four system architecture elements and to ensure that new and existing elements work together as an integrated whole by prototyping the use of the full systems architecture to supply validated data for existing surveillance systems.
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

29. PHCDM Governments Project Special Interest Group Presentation
Availability of Funds
Approximately $9,300,000 is available in FY 2000 to fund approximately 45 total awards
35 NEDSS Planning and Assessment awards, $65, ,000
07 NEDSS Element Development Awards, $200,000 - $730,000
03 NEDSS Charter Awards, $600,000 - $1,200,000
Supplemental awards will begin on or about September 30, 2000
Applicants may request time-limited specialized technical consultation, software, and equipment as direct assistance, in lieu of a portion of financial assistance.
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

30. NEDSS Development Coordination
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

31. Development Coordination
Shared Components and Standards
Project
Specific
Intra-
Enterprise
Inter-
SDG
SME
Shared Components
and Standards
Site 1
Site 2
Site 3
Shared Components
and Standards
SDG
SME
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

32. Development Coordination Example
Shared Components and Standards
Inter-
Enterprise
PHCDM, CIPHER, Vocabulary, Architecture, PHHPM
Shared Components and Standards
Intra-
Enterprise
Web based UI, HL7, IDR, XML, Business Logic, visualization, Directory, Security
Core Demographic
Database
Electronic
Lab-based Reporting
NETSS
Project
Specific
Demographic Data
Subject Matter Experts
Lab
Subject Matter Experts
Case Reporting
Subject Matter Experts
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

33. PHCDM Governments Project Special Interest Group Presentation
People (Roles)
Project Mangers
Project Sponsors
Project Liaisons
Technical Experts
Subject Matter Experts
Component Sharing Facilitators
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

34. PHCDM Governments Project Special Interest Group Presentation
Process
Project plans, phases, tasks, sub-tasks, and activities
Policies and procedures for shared components and standards
Project / program monitoring and status reporting
Inter-project dependencies and coordination
Shared components development and maintenance
Shared component refinement and implementation
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

35. PHCDM Governments Project Special Interest Group Presentation
Technology
Analysis, design, and construction tools
Meta-data repositories
Repository management software
Registries and directories
Project management tools
Desktop publishing tools
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

36. Development Coordination PPT
Technology
Process
People
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

37. Transforming the PHCDM for the IDR
Define the implementation subset of the PHCDM
Expand complex, interval, and repeating attributes
Add / modify classes, attributes, and relationships
Document data integrity constraints
Identify class keys and inversion entries
Normalize the implementation subset
Define implementation tables and columns
Denormalize the implementation subset
Implement enforcement of data integrity constraints
Document departures from the published PHCDM
Domain
Project
Teams
IDR
Project
Team
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

38. Allocating Responsibility
Define the implementation subset of the PHCDM
Expand complex, interval, and repeating attributes
Add / modify classes, attributes, and relationships
Document data integrity constraints
Define the implementation subset of the PHCDM
Expand complex, interval, and repeating attributes
Add / modify classes, attributes, and relationships
Document data integrity constraints
Core Demographic
Database
Electronic
Lab-based
Reporting
Identify class keys and inversion entries
Normalize the implementation subset
Define implementation tables and columns
Denormalize the implementation subset
Implement enforcement of data integrity constraints
Document departures from the published PHCDM
Integrated
Data
Repository
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

39. PHCDM Governments Project Special Interest Group Presentation
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

40. eSG Participation in NEDSS
Ongoing PHCDM development and implementation
Application of PHCDM to NEDSS initiatives:
Accept, route and process electronic HL7 messages containing laboratory and clinical content
Implement an integrated data repository
Assistance with NEDSS development coordination:
Shared component/standard use facilitation
Program/project monitoring and status reporting
Inter-project dependencies and coordination
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

41. Ongoing PHCDM Development and Implementation
Develop and implement a PHCDM change management process
Finalize the PHHPM process decomposition and its mapping to the PHCDM
Develop a procedure for transforming the PHCDM into project specific database implementations
Implement automation to support the mapping of project specific database implementations to the PHCDM
Complete harmonization of the PHCDM with the HL7 RIM
Adopt the HL7 vocabulary processes and begin to define PHCDM vocabularies
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

42. Application of PHCDM to NEDSS Initiatives
Core Demographic Database Projects and Electronic Laboratory-based Reporting
Develop of a project-specific logical data models based upon the PHCDM
Coordination of vocabulary development
Development of HL7 XML message specifications
Implementation of integrated data repositories
Development of a physical data model based upon project specific logical data models
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

43. Assistance with NEDSS Development Coordination
Shared component/standard use facilitation
PHCDM, PHHPM, HL7 Vocabularies
Education and mentoring
Program/project monitoring and status reporting
Project planning assistance for data related initiatives
Program level monitoring for data related initiatives
Inter-project dependencies and coordination
Assistance in identification of inter-project dependencies
Assistance in coordination of inter-project dependencies
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

44. Identification of Next Steps
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation

45. PHCDM Governments Project Special Interest Group Presentation
Questions
January 27, 2000
PHCDM Governments Project Special Interest Group Presentation