Revised ver. July 9, 2003
This report summarizes the meeting of the PHIN (Public Health Information Network) Special Interest Group held from 7:00 -- 8:30 pm, Tuesday, July 1, at the NHII (National Health Information Infrastructure) conference in Washington, D.C. Dr. Dan Pollock of the CDC’s IRMO (Information Resources Management Office) began the session with a review of PHIN and the PHIN standards that have been developed by the CDC in Atlanta.
Following Dr. Pollock’s presentation, the group engaged in a very active and animated discussion of the relationship of PHIN to the NHII initiative. While the group considered a wide variety of topics, two major themes of the session emerged. These resolutions were passed unanimously, with a strong sense of determination, even impassioned conviction:
- The role of public health must be fully and adequately addressed in development of the NHII; group members were concerned the NHII conference had failed to afford public health informatics the attention it richly deserves.
- It is imperative that PHIN standards be given very prominent attention and consideration in the development of NHII standards to avoid duplication and redundancy. PHIN and NHII must be harmonized to work together in parallel successfully under the umbrella of NHII.
Larry Streepy presented these resolutions to the plenary session on Wednesday.
Harmonization of PHIN and NHII
Larry Streepy began the discussion saying that PHIN and NHII must be “harmonized” in a number of different ways, including in technology, architecture, theory and in governance. He said that there will be a proposal to create an NHII architecture board, and if such a board is indeed created, public health interests must be fully and properly taken into consideration in its work. Clinical events, he maintained, require PHIN, but techniques beyond PHIN are also needed for the NHII. He advocated that the PHIN SIG should foster attention to PHIN in development of the NHII.
Bob Kambic noted that in the Financial group, discussions had centered around clinical data issues, with little attention given to public health data questions. There is need for more depth of attention to public health data issues in NHII, he concluded. Patina Zarcone reminded the group that there are many different types of public health activities that all need to use PHIN. She asked why the group thought PHIN standards had not been placed on the agenda of the NHII conference and suggested that organizations such as CDC, APHL, ASTHO, NACCHO and the Public Health Data Standards Consortium are among those that need Public health data is needed at the local level, and needed quickly. “All data is local,” said Ted. Dan noted that BioWatch and BioSense are designed to assist with that need.
Gora stressed that the PHIN SIG must make sure that PHIN “is built into NHII” and asked why PHIN was not on the agenda of the conference and why only one PHIN expert was attending. Patina addressed the “fit” between NHII and PHIN and said that “both are immense initiatives” and asked the question: How should PHIN be harmonized with NHII? PHIN, she said, is as of today “farther along” than NHII and asked how we envision these two great initiatives “coming together.”
John Dulcey said that NHII must accommodate PHIN; the two should be in parallel, he proposed. Ted Klein said that NHII is the “umbrella” for health information both domestically and internationally; PHIN, he maintained, is a “focus of interest” within NHII: They need to be harmonized. NHII, he felt, is “tied in with clinical medicine” but PHIN and NHII must “play together.”
Patina felt that the PHIN SIG must voice its concern that the purpose of standards is to reduce redundancy. PHIN and NHII must be harmonized to reduce redundancy. Bill recounted that the Architecture group had brought up several standards that are contradictory to PHIN, including Vista and IHE, which has been proposed by radiology, based on DICOM standards. Larry said that good brainpower had gone into PHIN and we must not now not lose what’s been done so far. PHIN, said Patina, is an integral component of NHII.
Bill asked What is the goal of the PHIN SIG? And Sam replied that it must be to get public health a “seat at the table of NHII.” Larry underscored that the purpose of NHII is to “fix a very broken healthcare system,” and the purpose of public health is different.
HL7 and Data Models
Ted Klein reported that for HL7 to be used for public health, a number of public health extensions to HL7 were required. For example, data on non-patient events, such as epidemiological investigations and collection of lead levels, were needed, as were water sampling data and food safety data. Information sharing among different centers, he said, is critically needed by the CDC. Larry stated that to have an NHII there must be a data model so we can deal with commonalities and recognize differences. There must be sharable components. Gora Datta related that when LA County began to build a data warehouse, the data model did not at all include public health data structures.
John Dulcey said that the HL7 RIM has a prominent role in NHII, but that it is based on clinical health and care for a patient, not on public health needs. Bill Lober felt that the range of NHII use cases being considered at the NHII conference don’t adequately address public health concerns. Larry said sardonically that a “national health infrastructure is not a clinical health infrastructure.” There must be a network of data; the NHII data model must expand beyond clinical data.
PHIN, said Gora, is a “customer” of NHII; it will use services that NHII provides. Architecture, said Ted, is so important. Sometimes, he said, you make decisions that are inappropriate for the dissemination of all clinical health data; the challenge is to build multiple interoperable systems that work together.
Larry Streepy returned to the question of governance: Both PHIN and NHII, he said, “live on the same highway”. There are many common data elements between public health and clinical/personal health. Someone, somewhere, must have the power to make these two initiatives work together. Who governs this to make it all work together? Bill said that PHIN is real, and more thought out, so is less flexible, but the two must have harmonized architectures.
Bill Lober noted that the Architecture group will propose creation of an NHII Architecture Board. This Board could have the power to harmonize PHIN and NHII and generate “reconciliation.” How are PHIN and NHII going to work together? he asked. Sam Spicer asked if an even higher authority will be needed to generate harmonization. “There must be coordination between the two,” he stressed.
Ted said that the architecture of NHII is yet to be decided. He spoke that NHII is too big for a single architecture. The solution, he maintained, is to have interoperable capabilities in all different components. The harmonization process must be managed, since the two initiatives overlap. There must be “measurable, achievable, goals for the two initiatives,” he stressed. Mel asked if FDA had been included in PHIN, and Dan said Yes.
On the Other Hand
Bill Lober said that public health “has not been ignored” in NHII. Constance Malpas agreed, and reminded the group that the “three circles” of the NHII logo include mention of public health. Sam Spicer pointed out that some homeland security studies that will be recommended will be based on population data, not on individual patients. Bill Lober added that the homeland security group has included public health use cases.
Larry Streepy said that what is missing is education on public health data needs. Bob Kambic agreed, saying that when he taught public health informatics at Johns Hopkins, he found a serious need for fellowships in this area, and for the training of PhD’s in the field. Larry said that we need to be educators to “remove the blinders.”
“Population Health” vs. “Public Health”
John Dulcey asked just what is “population health,” a term that has been used prominently at the NHII conference. Bill Lober said that “population health” includes “public health,” but also includes topics such as quality improvement, safety, prevention, and outcomes research. Dan Pollock agreed, saying that population health is very much in keeping with the prevention orientation of public health but emanating in practice from health care organizations rather than local, state, or national public health agencies. Mel Greberman agreed, saying that “population health” usually refers to a “defined population.” Gora said that “population health” and “public health” overlap; “public health” is not a subset of “population health.
Attendees, Meeting of PHIN Special Interest Group
NHII Conference, July 1, 2003
Willis Bradwell Jr. Washington DC CIO firstname.lastname@example.org
Fletcher Crowe SAIC Atlanta email@example.com
Gora Datta Cal2Cal Corp. firstname.lastname@example.org
John Dulcey NextGen email@example.com
Mel Greberman Walter Reed .firstname.lastname@example.org' Health Care System
Bob Kambic HHS Robert.email@example.com
Maureen Kitchelt AT&T Government Solutions firstname.lastname@example.org
Ted Klein KCL email@example.com
Eileen Koski Quest Diagnostics firstname.lastname@example.org
Rita Kukafka Columbia Univ. email@example.com
Marty Laventure Minn. Dept. of Health Martin.Laventure@health.state.mn.us
Bill Lober Univ. of Washington firstname.lastname@example.org
Constance Malpas NY Academy of Medicine email@example.com
Dan Pollock CDC Atlanta firstname.lastname@example.org
Dave Roberts HIMSS email@example.com
Scott Smith UNC Chapel Hill firstname.lastname@example.org
Sam Spicer NCEDD email@example.com
Jay Srini StrategicSolutions firstname.lastname@example.org
Larry Streepy Health Language Inc. email@example.com
Patina Zarcone APHL firstname.lastname@example.org