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Public Health Vocabulary Services (a) Gautam Kesarinath – CDC NCPHI Associate Director of Technology, Public Health Vocabulary Services (a) Gautam Kesarinath – CDC NCPHI Associate Director of Technology, gfk [email protected] gov (b) Nikolay Lipskiy – CDC SDO & Interoperability Lead, dgz [email protected] gov © Sundak Ganesan – Lead Vocabulary Specialist, Northrop Grumman consultant for CDC, dsq [email protected] gov

Why do we need to use Standard Vocabulary? Coded Data is Essential for: § Why do we need to use Standard Vocabulary? Coded Data is Essential for: § Interoperability § Early Event Detection § Emergency Preparedness & Response § Federal Register to use CHI standards for building Federal Systems § Vendors – CCHIT Certification, HITSP Standards, IHE Interoperability § PHIN Certification, ARRA

Standard Vocabulary for filtering and routing data Public Health Filter Non-interesting results Results Laboratory Standard Vocabulary for filtering and routing data Public Health Filter Non-interesting results Results Laboratory Program areas TB Results that are of • Results that are of interest to public health agencies STD Flu VZ

Problem q Integration of Public Health Vocabularies (PHV) with e-Health applications (Electronic Health Record, Problem q Integration of Public Health Vocabularies (PHV) with e-Health applications (Electronic Health Record, Public Health, Clinical Decision Support, etc. . ) q Challenges implementing standard vocabularies especially due to versioning and mapping of local to standard vocabularies. q Without the standard vocabulary, it is difficult to do data filtering, data routing and data analysis. q Validation of coded data present in HL 7 messages or Clinical Documents. CDC receives almost one million messages per day. Vocabulary services are needed for validation, routing and filtering incoming data. q Public Health Perspective: - Lack of harmonization effort due to inconsistency of vocabularies and data elements, legal barriers causing problems with data exchange, lack of standards fostering interoperability of health information.

Use Case q Respond to an outbreak (e. g. H 1 N 1 Flu) Use Case q Respond to an outbreak (e. g. H 1 N 1 Flu) – Distribution of Value Sets (Push /Pull) – Ability to host multiple versions of value sets q Integration of Vocabulary Server using web services (HL 7 CTS 2. 0) with Public Health Surveillance Applications (e. g NBS), HL 7 Integration engine (e. g. Rhapsody) and Decision Support Applications (e. g. Notifiable Conditions, ELR) q Validation of coded data and routing of data to various public health programs (e. g. TB, Flu, AIDS) present in HL 7 messages and Clinical Document using Vocabulary Server like PHIN VADS.

Standards (1) White House E-Gov Consolidated Health Informatics (CHI): - Domain recommendations provided guidance Standards (1) White House E-Gov Consolidated Health Informatics (CHI): - Domain recommendations provided guidance regarding the selection of code system. (2) Health Information Technology Standards Panel (HITSP): C 80: Clinical Document and Message Terminology Component defines the vocabulary (value sets) for all the HITSP interoperability Specifications (IS) T 66: Sharing Value Set Specification (SVS) HL 7 Vocabulary Technical Committee - CTS 2. 0

Discussion q Reconcile HL 7 CTS 2. 0 and HITSP T 66 Sharing Value Discussion q Reconcile HL 7 CTS 2. 0 and HITSP T 66 Sharing Value Set Specification. q IHE vocabulary implementation profile and technical framework would promote exchange of standardized data between the healthcare information systems, immunization registries and biosurveillance systems. Standardized coded data is essential for clinical decision support, data analysis, data routing and filtering. q Global Public Health Informatics - CDC / WHO collaborative project - participation in WHO project on building regional/national e-Health observatories - working with SDOs on submission of new codes and building public health capacities

PHIN VADS Overview ØMain purpose is to distribute the messaging vocabulary along with the PHIN VADS Overview ØMain purpose is to distribute the messaging vocabulary along with the metadata that are needed for messaging or clinical document. ØPHIN VADS helps mapping legacy (local) concepts to standard codes ØCurrent Release of PHIN VADS 3. 0. 1 – http: //phinvads. cdc. gov - Easy to use , Versioning, Robust Searches (Synonyms), Standardized Download files, Web services (API), Bookmarking and enhanced help section, etc. ØNavigation of the value sets in VADS can be done by: (a) Views (Implementation Guides / Programs) – TB, Bio. Sense, ELR (b) Domain / Group – Demographics, Laboratory, Medications, Disease, Procedure ØVADS Lite Available to Internal CDC Programs ØVADS Web Services Open as of June of 2009

PHIN VADS Key Stakeholders 1. Public Health HL 7 Messaging or CDA Implementation Guides PHIN VADS Key Stakeholders 1. Public Health HL 7 Messaging or CDA Implementation Guides 2. Public Health Bio. Surveillance Applications (Eg: NBS, OMS, Epi. Info, PHIN MSS, etc) 3. Public Health Programs – State & Federal (Eg: Influenza H 1 N 1, TB, NHSN, etc) 4. Public Health Partners (Association for Public Health Labs, Environmental Public Health Tracking Network, EPA, etc) 5. Lab Reporting (National Electronic Lab Reporting, Laboratory Response Network, Public Health Lab Interoperability, etc) 6. Health Information Networks (Public Health Grid, Bio. Sense, Poison Control, etc) 7. Collaboration with WHO and other countries (Outbreak Events such as H 1 N 1 in Mexico or SARS in China, CDC Europe / Global Health, National Health Service in the UK, Info. Way in Canada, etc) 8. Vendors

VADS Architecture • • 3 rd Party • Apps • Extended • Service Layer VADS Architecture • • 3 rd Party • Apps • Extended • Service Layer • Authoring • Database • Load • Process Universal Authoring Framework • Web • Application • Service Layer • Publish • Database VADS Web VADS Lite • UAF • Application

Appendix Appendix

PHIN VADS Code Systems “Specimen Type” - Value Set SNOMED Specimen Domain HL 7 PHIN VADS Code Systems “Specimen Type” - Value Set SNOMED Specimen Domain HL 7 v 2. 5 - Specimen Type SNOMED-CT HL 7 v 3 - Null Flavor LOINC HL 7 v 2. 5 ICD-9 PHIN-CDC HL 7 v 3 PHIN /CDC PHIN Vocabulary Domain PHIN VADS Views - Lab - Bio. Sense