Applying the Public Health Conceptual Data Model to

Applying the Public Health Conceptual Data Model to the Implementation of the National Electronic Disease Surveillance System Abdul-Malik Shakir, Senior Advisor IDX e. Intelligence Solutions Group August 30, 2000 January 27, 2000 PHCDM Governments Project Special Interest Group Presentation

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

PHCDM Project Update January 27, 2000 PHCDM Governments Project Special Interest 3

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 4

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 datarelated initiatives January 27, 2000 PHCDM Governments Project Special Interest 5

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 6

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 HL 7 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 7

PHCDM Jan-Jun 2000 Accomplishment • Published the premiere edition of the PHCDM • Participated in the HL 7 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 8

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

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

Mapping of the PHCDM to the HL 7 RIM +relates to 0. . * 1 +is_target_for <<Stakeholder_affiliation>> PARTY TO PARTY RELATIONSHIP 0. . * +relates to <<Stakeholder>> PARTY +associates 1 0. . * +associates_to <<Active_participation>> ACTOR PARTICIPATION +associates_to 1 0. . * +associates 1 1 +associates 1+associates +is_source_for +associates_to 0. . * 1 MATERIAL RESPONSIBILITY <<Organization>> FORMAL ORGANIZATION ENTITY <<Material_relationship>> +associates_to MATERIAL RELATIONSHIP 1 <<Living_subject>> NON PERSON LIVING ORGANISM +associates_to 0. . * +associates_to +associates 1 1 LOCATION INFORMATION +associates 0. . * +relates <<Service_relationship>> ACTIVITY RELATIONSHIP 0. . * +relates +is_source_for 1 0. . 1 <<Material>> MATERIAL +is_source_for +relates 1 +is_target_for 0. . * 1 PARTY LOCATION PARTICIPATION <<Person>> PERSON 0. . * +associates_to +associates 0. . * +associates_to 1 +associates 0. . * +relates INDIVIDUAL +associates_to 1 0. . * +associates ORGANIZATION INFORMAL ORGANIZATION <<Target>> TARGET PARTICIPATION +is_target_for <<Service>> HEALTH RELATED ACTIVITY <<Observation>> OBSERVATION INTERVENTION <<Referral>> REFERRAL +associates 0. . * MATERIAL LOCATION PARTICIPATION <<Specimen>> SPECIMEN PUBLIC HEALTH NOTIFICATION CASE +associates 0. . 1 +is_target_for 1 +relates <<Medication>> MEDICATION 0. . * LOCATION RELATIONSHIP +is_source_for 1 ELECTRONIC LOCATION POSTAL LOCATION January 27, 2000 0. . * +relates OUTBREAK TELEPHONE LOCATION PHYSICAL LOCATION PHCDM Governments Project Special Interest 11

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

HL 7 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 13

Public Health High-Level Process Model • Surveillance Planning – – • Case Monitoring – – – • 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 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 14

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 HL 7 RIM • Adopt the HL 7 vocabulary processes and begin to define PHCDM vocabularies January 27, 2000 PHCDM Governments Project Special Interest 15

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

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 17

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 18

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 19

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 20

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 21

Local Health Department Or Clinical Site Electronic Laboratory Messages HL 7 State Health Department Integrated State / Local Data Repository Security Clinical Database Accept, route and process electronic HL 7 messages containing laboratory and clinical content (LOINC, SNOMED). January 27, 2000 PHCDM Governments Project Special Interest 22

Local Health Department Or Clinical Site State Health Department Electronic Laboratory Messages Integrated State / Local Data Repository HL 7 Security Clinical Database CDC and Other Health Depts. January 27, 2000 XML Data Exchange Develop active data translation and exchange (integration broker) functionality (XML, DTD’s HTTPS). PHCDM Governments Project Special Interest 23

Local Health Department Or Clinical Site State Health Department Reporting, GIS and Analysis Electronic Laboratory Messages Integrated State / Local Data Repository HL 7 Security Clinical Database CDC and Other Health Depts. January 27, 2000 XML Data Exchange Develop data reporting and visualization capability (messaging and import/export ODBC, JDBC, ANSI SQL). PHCDM Governments Project Special Interest 24

Local Health Department Or Clinical Site State Health Department Reporting, GIS and Analysis Electronic Laboratory Messages Integrated State / Local Data Repository HL 7 Security Clinical Database CDC and Other Health Depts. January 27, 2000 Shareable Directory of PH Personnel XML Data Exchange Implement a shareable directory of public health personnel (LDAP). PHCDM Governments Project Special Interest 25

Local Health Department Or Clinical Site State Health Department Reporting, GIS and Analysis Electronic Laboratory Messages Integrated State / Local Data Repository HL 7 Security Clinical Database CDC and Other Health Depts. January 27, 2000 XML Data Exchange Transportable “Business” Logic Shareable Directory of PH Personnel Develop transportable business logic capability (COM, CORBA, EJB). PHCDM Governments Project Special Interest 26

NEDSS System Architecture Elements • Conduct and support web browser-based data entry and data management. • Accept, route and process electronic HL 7 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 27

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 28

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 - 95, 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 29

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

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

Development Coordination Example Shared Components and Standards Inter. Enterprise PHCDM, CIPHER, Vocabulary, Architecture, PHHPM Shared Components and Standards Intra. Enterprise Web based UI, HL 7, IDR, XML, Business Logic, visualization, Directory, Security Core Demographic Database Electronic Lab-based Reporting NETSS Demographic Data Subject Matter Experts Lab Subject Matter Experts Case Reporting Subject Matter Experts Project Specific January 27, 2000 PHCDM Governments Project Special Interest 32

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

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 34

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 35

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

Transforming the PHCDM for the IDR Domain Project Teams IDR Project Team • • • January 27, 2000 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 Governments Project Special Interest 37

Allocating Responsibility • Define the implementation subset of the PHCDM Core • Expand complex, interval, and repeating attributes Demographic • Add / modify classes, attributes, and relationships Database • Document data integrity constraints • Define the implementation subset of the PHCDM • Expand complex, interval, and repeating attributes • Add / modify classes, attributes, and relationships Electronic Lab-based Reporting • Document data integrity constraints • Identify class keys and inversion entries Integrated Data Repository • 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 January 27, 2000 PHCDM Governments Project Special Interest 38

January 27, 2000 PHCDM Governments Project Special Interest 39

e. SG Participation in NEDSS • Ongoing PHCDM development and implementation • Application of PHCDM to NEDSS initiatives: – Accept, route and process electronic HL 7 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 40

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 HL 7 RIM • Adopt the HL 7 vocabulary processes and begin to define PHCDM vocabularies January 27, 2000 PHCDM Governments Project Special Interest 41

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 HL 7 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 42

Assistance with NEDSS Development Coordination • Shared component/standard use facilitation – PHCDM, PHHPM, HL 7 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 43

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

Questions January 27, 2000 PHCDM Governments Project Special Interest 45