Summary of Meeting of PHIN
Special Interest Group
This report
summarizes the meeting of the PHIN (Public Health Information Network) Special
Interest Group held from
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:
1.
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.
2.
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.
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.
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.
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.”
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 willis.bradwell@dc.gov
Fletcher
Crowe SAIC
Atlanta crowef@saic.com
Gora
Datta Cal2Cal
Corp. gora@cal2cal.com
John
Dulcey NextGen jdulcey@nextgen.com
Mel Greberman Walter Reed .greberman@na.amedd.army.mil' Health
Care System
Bob
Kambic HHS Robert.kambic@hhs.gov
Maureen
Kitchelt AT&T
Government Solutions kitchelt@att.com
Ted
Klein KCL kcl@tklein.com
Eileen
Koski Quest
Diagnostics koskie@questdiagnostics.com
Rita
Kukafka Columbia
Univ. rita.kukafka@dmi.columbia.edu
Marty
Laventure Minn.
Dept. of Health Martin.Laventure@health.state.mn.us
Bill
Lober Univ.
of Washington lober@washington.edu
Constance
Malpas NY
Academy of Medicine cmalpas@nyam.org
Dan
Pollock CDC
Atlanta dpollock@cdc.gov
Dave
Roberts HIMSS droberts@himss.org
Scott
Smith UNC
Chapel Hill ssmith@unc.edu
Sam
Spicer NCEDD sspicer@ec.rr.com
Jay
Srini StrategicSolutions jsriniscs@aol.com
Larry
Streepy Health
Language Inc. streepy@healthlanguage.com
Patina
Zarcone APHL pzarcone@aphl.org