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Report on the Population Health Surveillance Committee

Federal Information Architecture

Steven J Steindel, Ph.D.Senior Advisor, Data Standards and

VocabularyCenters for Disease Control and Prevention

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CHI FHA• Consolidated Health Informatics (CHI)

• OMB eGov project started 2004• Focus on Federal terminology exchange standards• Investigated 24 health care domains and selected

standards in about half

• FHA• Outgrowth of CHI• Expands scope to all Federal heath care IT• Intent is to form common IT architecture across ALL

agencies

• Both FHA and CHI now under ONCHIT

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CHI Terminology Domains

• Lab Results Name*• Messaging*• Medications*• Interventions/

Procedures• Lab Test Orders*• Non-laboratory*

• Demographics*• Immunizations*• Lab Results Content*• Clinical Encounters*• Nursing*

• Diagnosis/Problem List*

• Medical Devices/Supplies

• Anatomy*/Physiology

• Population Health• History and Physical• Multimedia• Text Based Reports*• Genes and Proteins• Disability

* Recommendation Made

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CHI Summary Terminology Recommendations

• HL7• Messaging• Demographics• Immunizations• Clinical Encounters• Text Based Reports

(CDA)

• SNOMED CT• Interventions/

Procedures: Non-lab

• Lab Results Content• Nursing• Diagnosis/

Problem List• Anatomy

• LOINC• Lab Results Name• Lab Test Orders

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FHA Workgroups• Food Safety

• Safety of food supply• USDA and FDA

primary agencies• CDC monitor role

• Health Services and EHR• Clinical care systems• DoD and VA primary

agencies• No CDC involvement

• Interoperability• Technical

interoperability specifications

• Initial focus on exchange protocols

• ONCHIT and HHS primary

• Active CDC role

• PH Surveillance• Surveillance

architecture • CDC and VA primary

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FHA Line of Business Initiative (current)Consumer Health and

Safety Population educationFacility Registration and CertificationProduct ApprovalHealth AlertsPromotion of Preventive PracticesAgriculture Trade ManagementEnsuring a Healthy Food ChainMonitor Food and Drug SupplyInvestigative OperationsLaboratory OperationsConduct RecallsProduct Inspection Import/Export Activities Facility Inspection Conduct Compliance Create Standards & Guidance

Health Advanceme

nt Diagnostics and Clinical management Quality of Care-improvingIllness PreventionConduct Health Related Research Laboratory ResearchEpidemiologic Methods ResearchPrevention ResearchSurvey and Statistical Methods ResearchHealth Effects ResearchDiagnostic Lab Testing and Quality AssuranceProgram EvaluationsHealth Training and EducationConservation of Endangered Species with Medical PropertiesInfrastructure Assessment and DevelopmentConservation of Endangered Species with Medical PropertiesPlanning and Forecasting

Health Care Services

Patient EducationImmunization ManagementManaged ServicesQuality of Care-sustainingEmergency ResponseOutbreak Investigation and Intervention Technical Assistance and ConsultationProgram Implementation Assess Beneficiary Health StatusPlan Health ServicesDeliver Health ServicesManage Information/Manage DocumentationCoordinate and Integrate Health ServicesEnsure Quality of Health Services

Population Health Mgmt.

Public Health SurveillanceHealth DeterminantsEpidemiologic StudiesVital StatisticsHealth SurveysHealth Risk AssessmentDetectionInformation DisseminationPrevention & Exclusion of Animal and Plant Pests and DiseasesInvasive Species ManagementInterdiction of Smuggled or Illegal Trade/Transport Animals or PlantsDefine and Assess PopulationDevelop Population Health Management PracticesImplement Tools / Manage ProcessesEvaluate Population Health Management

Access to Care

Food and Nutrition AssistanceManage Enrollment and EligibilityPerform Assessment and Plan for CareSchedule Services and Check-inManage Patient Movement and Patient EncounterSupport Beneficiary ServicesAssess Effectiveness of Access to CareSupport Community Outreach

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FHA Line of Business InitiativeWork-in-progress

• Manage Access to Care• Is beneficiary eligible for this care?

• Manage Population Health and Consumer Safety• PH domain.

• Manage the Health Care Business• Are federal funds spent properly?

• Deliver Health Care Services• Clinical care

• Conduct Health Care Research• NIH domain, now includes training.

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Scope of CHI Population Health Reporting Domain

• Public Health Reporting• Population Health Statistics• Billing Data/Statistics• Institution Health Statistics: not in

scope, but recommended to be similar to external uses

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Recommendation

• The diversity of terminology needs found lead to the conclusion that a specific CHI Recommendation is inappropriate at this time.

• In some circumstances, however, population health data is identical to clinical data such as reporting of infectious disease cases to public health departments or cancer rapid case ascertainment and other disease registry information to appropriate state registries. In those cases, the appropriate CHI domain recommendations for the underlying clinical data can be used.

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Report Considerations

• The extent to which mapping between two terminologies can satisfy multiple needs, including population health reporting

• A description of the forms and complexity of the maps

• Ability of mapped clinical data to relate to longitudinal data

• The problem of using a dual system where part of population health data is derived from computer mapped clinical data to a reporting terminology and part reported as now using human interpretation to the reporting terminology needs enumeration.

• It is anticipated that the NCVHS, the Board of Scientific Counselors of the NCHS and The National Library of Medicine would participate in these studies

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FHA Population Health WGData Gathering

Category Definition / Notes

Emerging Threats

Includes syndromic surveillance systems, other early event detection systems and detection of new agents

Infectious Disease may subdivide into Air, Food & Water

Borne as work progresses

Chronic Disease includes registries

Environment includes air, water, site, occupation,

workplace, injury

Population Health Statistics includes Vital Records

Patient Safety adverse event reporting for drugs,

vaccines, medical devices, etc.

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Contact Information

Steven J Steindel, Ph.D.Senior Advisor, Data Standards and Vocabulary

Centers for Disease Control and Prevention

Office of the DirectorU.S. Department of Health and Human Services

1600 Clifton Road, MS D-45Atlanta, GA 30333(tel) 404-639-7484 (fax) 404-639-7711sns6@cdc.gov