1. Public Health Data Standards A View from the Front Lines Bethesda, MD March 17, 2004 Presentation to PUBLIC HEALTH DATA STANDARDS CONSORTIUM 2004 ANNUAL MEETING ON PUBLIC HEALTH DATA STANDARDS

2. Atlas Development Corporation Established in 1989 as a consulting practice to develop high performance database applications Demonstrable track record building mission critical systems for financial and healthcare industry leaders. Atlas Medical Software is devoted to marketing the company’s growing suite of clinical connectivity solutions. Atlas Public Health recently launched to market suite of BT/Disease Surveillance solutions

3. Clinical Connectivity Outreach Operations Legacy Systems Integration “Total Outreach Management” Surveillance Case Management Reporting to State and CDC ARNOLD PHIL

4. National and Regional Players Independent Reference Labs Hospital Outreach Programs Client Base

6. LA County Department of Health Services ACDC Inception 1998 – Deployment May 2000 PHIL Phase 1 with Kaiser Permanente So. Cal. 2003- San Diego 2004 - Monterey Public Health and Private Providers Client Base

8. HL-7 version 2.x (Lab orders and results) HIPAA Privacy/Security X12 NEDSS/PHIN HL7 v3.0 RIM ebXML LDAP HIPAA LOINC/SNOMED All About Standards

9. Public Health Information Network - CDC’s Goals 1.An interoperable network—built on the Internet and using industry standards to work with other networks/systems 2.Support users—provides information and decision support to the public and public health professionals at all levels 3.Live data—continuous monitoring of nation’s health, continuous detection and evaluation of threats 4.Dual use—will meet BT preparedness and response needs and will transform routine public health practice 5.Engage industry—set direction for private sector participation and develop commercial and clinical opportunities 6.A common data language—use of industry standards for comparable data use and exchange (HL7, SNOMED, LOINC) Technical Review of Version 1 of PHIN FINAL BRIEFING – Gartner Group May 13, 2003

10. CDC PHIN Functions as of 12/8/2002 1.Automated Data Exchange Between Public Health Partners 2.Use of Electronic Clinical Data for Event Detection 3.Use of Manual Data entry for Event Detection and Management 4.Specimen and Lab Result Information Management and Exchange 5.Management of Possible Case, Contacts, and Threat Data 6.Analysis and Visualization 7.Directories of Public Health and Clinical Personnel 8.Public Health Information Dissemination and Alerting 9.IT Security and Critical Infrastructure Protection CDC PHIN Standards Version 1.2

11. CDC PHIN Function #1 – The details Message “wrapper” - ebXML SOAP Web Service via HTTPS after appropriate authentication ebXML standard format with content in HL7 v. 2.3 HL7 v. 3.0 X12 LDIF Windows NT/2000, UNIX, LINUX Ability to X-Reference Local Codes to SNOMED LOINC ICD and CPT “Automated Data Exchange Between Public Health Partners”

12. CDC PHIN Function #1–Some questions HL7 v3.0 is new  Is CDC going to use new CaseReport observation?  Under what conditions? Role of the CDA (Clinical Document Architecture)  Is CDC going to use it? (Others may)  CDA messages are based on domain-specific templates. Who is defining these templates, what is their status, and when can I get them? There is a lack of public health-oriented codes in the RIM  What steps are being taken to bring evolving public domain information into the RIM?

13. CDC PHIN Function #1– Some questions LOINC is to be used to identify ordered tests in PH messages  Who is to assign LOINC test codes to Labs?  If Labs use internal codes only, is the vendor to convert? SNOMED is to be used for lab test organism identification and disease designation  Not widely used- are vendors to do mappings?

14. The Challenge Success depends upon industry involvement Much needed supplemental investment Working knowledge of current conditions Experience with finding practical solutions Driven by market forces responding to exigencies We understand the “good vs. perfect” conundrum

15. Post 9/11 Funding Total of federal, state and local governmental spending and private sector outlays for Homeland Security now stands at $100 Billion annually, with the Federal government accounting for about 30% of that number. In 2005, the federal number is expected to rise to $56 Billion. -Bill Hoagland, Director of Budget and Appropriations for Senate Majority Leader Bill Frist

16.  Private Sector is engaged  Private Sector must respond to market demands  Lack of clear standards is adding unnecessary time and expense to the process  A central forum for addressing evolving standards is needed  Streamlined communications between Private/Public players  A central web site that publishes Public Health data standards as they evolve with links to standards bodies to facilitate communication Conclusion

17. End