Applying the Public Health Conceptual Data Model to the Implementation of the National Electronic Disease Surveillance System

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

3
PHCDM Project Update
4
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.

5
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

6
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.

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.

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.

9
Publication of the Premiere PHCDM
10
ACTOR PARTICIPATION
HEALTH RELATED ACTIVITY
1
1
Actor Type Code CV
Activity Identifier SETltIIgt
0..
0..
0..
0..
PARTY
Actor Time Range IVLltTSgt
Activity Mood Code CV
1
1
1
1
PARTY TO PARTY RELATIONSHIP
Activity Type Code CV
1
1
Party Identifier SETltIIgt
0..
0..
0..
0..
Relationship Date Time Range IVLltTSgt
Activity Descriptive Text FTX
0..1
0..1
1
1
Relationship Type Code CV
ACTIVITY RELATIONSHIP
Activity Status Code CV
TARGET PARTICIPATION
0..
0..
0..
0..
Activity Date Time GTS
1
1
Activity Relationship Code CV
Target Type Code CV
1
1
Activity Critical Date Time GTS
Target Time Range IVLltTSgt
0..
0..
Activity Method Code CV
0..
0..
0..
0..
Target Awareness Code CV
1
1
Subject Site Code CV
Parties
MATERIAL RESPONSIBILITY
0..
0..
Interpretation Code CV
0..
0..
INDIVIDUAL
Responsibility Type Code CV
Confidentiality Code CV
Birth Date TS
1
1
Responsibility Date Time Range IVLltTSgt
0..
0..
Maximum Repetition Number INT
Death Date TS
Material Identifier II
Priority Code CV
Sex Code CV
Materials
0..1
0..1
OBSERVATION
1
1
1
1
PERSON
Observation Value ANY
MATERIAL
Derivation Expression Text ST
Ethnicity Code CV
Material Identifier SETltIIgt
0..
0..
Race Code SETltCVgt
Material Type Code CV
MATERIAL RELATIONSHIP
Occupation Code CV
Material Description FTX
Person Name SETltPNgt
Material Relationship Type Code CV
Material Date Time Range IVLltTSgt
CASE
Handling Code CV
0..
0..
Confirmation Method Code CV
Danger Code CV
NON PERSON LIVING ORGANISM
Detection Method Code CV
1
1
Material Quantity PQ
Species Name CV
Transmission Mode Code CV
Material Name ST
Organism Name ST
Disease Imported Code CV
1
1
Etiologic Status Code CV
SPECIMEN
Source Site Code CV
ORGANIZATION
OUTBREAK
Organization Name SETltONgt
Outbreak Extent Code CV
Outbreak Peak Date TS
Outbreak Time Range IVLltTSgt
0..
0..
0..
0..
FORMAL ORGANIZATION
PARTY LOCATION PARTICIPATION
MATERIAL LOCATION PARTICIPATION
Industry Code CV
Participation Date Time Range IVLltTSgt
Participation Type Code CV
Participation Date Time Range IVLltTSgt
INTERVENTION
Current Status Code CV
Intervention Reason Code
Current Status Effective Date TS
INFORMAL ORGANIZATION
0..
0..
Intervention Form Code CV
Locations
Group Type Code CV
Intervention Route Code CV
0..
0..
Intervention Quantity PQ
Strength Quantity PQ
Rate Quantity PQ
1
1
LOCATION
Location Identifier SETltIIgt
1
1
REFERRAL
LOCATION RELATIONSHIP
Location Setting Code CV
0..
0..
1
1
Referral Reason Text
Relationship Type Code CV
Location Type Code CV
1
1
Authorized Visit Amount
Relationship Date Time Range IVLltTSgt
Location Status Code CV
0..
0..
Referral Description
Current Status Effective Date TS
0..1
0..1
Location Narrative Text FTX
NOTIFICATION
POSTAL LOCATION
PHYSICAL LOCATION
Notification Reason Code CV
Street Address Text AD
Health-Related Activities
Latitude Quantity ST
Address Directions Text FTX
Longitude Quantity ST
Location Name ST
Property Location Text FTX
TELECOMMUNICATION LOCATION
Personal Identification Number ST
Time Zone Text ST
Electronic Address Text TEL
11
Mapping of the PHCDM to the HL7 RIM
12
PHCDM Parties Subject Area
Party ltStakeholdergt
Revised
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

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

15
PHCDMJun-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

16
NEDSS Cooperative Agreement Initiatives
17
PHCDM and NEDSS

• The PHCDM project is one of many interrelated
  activities supporting CDCs 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.

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

19

• Implement an integrated data repository
• able to be patient centered, non-categorical
• support thick client and web applications
• (ODBC, JDBC and ANSI SQL)

20
Security
Implement a security system and appropriate
security policies (Internet-based, with a
firewall and certificates or tokens)
21
State Health Department
Local Health Department Or Clinical Site
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

22
State Health Department
Local Health Department Or Clinical Site
Electronic Laboratory Messages
Security
HL7
Accept, route and process electronic HL7 messages
containing laboratory and clinical content
(LOINC, SNOMED).
23
State Health Department
Local Health Department Or Clinical Site
Electronic Laboratory Messages
Security
HL7
XML Data Exchange
Develop active data translation and exchange
(integration broker) functionality (XML, DTDs
HTTPS).
CDC and Other Health Depts.
24
State Health Department
Local Health Department Or Clinical Site
Reporting, GIS and Analysis
Electronic Laboratory Messages
Security
HL7
XML Data Exchange
Develop data reporting and visualization
capability (messaging and import/export ODBC,
JDBC, ANSI SQL).
CDC and Other Health Depts.
25
State Health Department
Local Health Department Or Clinical Site
Reporting, GIS and Analysis
Electronic Laboratory Messages
Security
HL7
Shareable Directory of PH Personnel
XML Data Exchange
CDC and Other Health Depts.
Implement a shareable directory of public health
personnel (LDAP).
26
State Health Department
Local Health Department Or Clinical Site
Reporting, GIS and Analysis
Electronic Laboratory Messages
Security
HL7
Shareable Directory of PH Personnel
XML Data Exchange
CDC and Other Health Depts.
Develop transportable business logic capability
(COM, CORBA, EJB).
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.

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.

29
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.

30
NEDSS Development Coordination
31
Development Coordination
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
33
People (Roles)

• Project Mangers
• Project Sponsors
• Project Liaisons
• Technical Experts
• Subject Matter Experts
• Component Sharing Facilitators

34
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

35
Technology

• Analysis, design, and construction tools
• Meta-data repositories
• Repository management software
• Registries and directories
• Project management tools
• Desktop publishing tools

36
Development Coordination PPT
Technology
Process
People
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
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
39
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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

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

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

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

44
Identification of Next Steps
45
Questions