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• Preface
• Executive Summary
• Document Introduction
• Program/Network Context
• Stakeholder and User Descriptions
• System Overview
• Features
• Constraints
• Appendix

This Vision Document is designed to:

• Describe, at a conceptual level, the vision and purpose of the Environmental Public Health Tracking (EPHT) Network,
• Identify potential users and stakeholders whose needs will be met by the EPHT Network; and
• Outline major features of the EPHT Network.

See the “Environmental Public Health Tracking Network: Technical Glossary” [1] for a definition of terms used in this document.

1. Environmental Public Health Tracking Network Standards/Network Development Workgroup. Environmental public health tracking network: technical glossary. 1.0, TBD.
2. Pew Environmental Health Commission, Johns Hopkins School of Public Health. America’s environmental health gap: why the country needs a nationwide health tracking network. 2001.
3. Thacker S, Stroup D, Parrish G, Anderson H. Surveillance in environmental public health: issues, systems, and sources. American journal of public health, May 1996; 86(5): 633-8.
4. Hertz-Picciotto I. Comment: toward a coordinated system for the surveillance of environmental health hazards. American Journal of Public Health May 1996; 86(5):638-41
5. Macdonald S, Pertowski C, Jackson R Environmental public health surveillance. Journal of public health management practice 1996; 2(4), 45-9.
6. US Department of Health and Human Services, Healthy people 2010: Understanding and Improving Health, 2nd ed. Washington: US Department of Health and Human Services November 2000.

The environment plays an important role in human development and health. Researchers have identified associations between exposures to some environmental hazards and specific diseases, such as exposure to asbestos and lung cancer. Other interactions between environmental exposures and health effects are suspected but need further research, such as the association between exposure to disinfectant by-products and bladder cancer.

Surveillance systems that capture data on public health effects and monitoring systems that capture environmental data currently exist. They are, however, separate systems, often developed by different agencies and for different purposes, making it difficult to track environmental hazards and investigate possible associated health effects. The environmental monitoring and health/exposure surveillance systems that exist currently are generally not compatible with each other because of differences in the purposes of the systems. There is a lack of common standards in how data are collected, including where data are collected, frequency of collection, characteristics collected, and data formats. Therefore, linking environmental and health systems can be very complex and time-consuming.

The issue of environmental public health tracking was identified in a 2001 Pew Environmental Health Commission report called “America's Environmental Health Gap: Why the Country Needs a Nationwide Health Tracking Network” [2]. In this report, the Commission stated that the existing environmental health system was inadequate and fragmented, and they recommended a “Nationwide Health Tracking Network for disease and exposures.”

Surveys conducted by the Pew Commission in the 50 states and selected local jurisdictions found that many of the public health departments have little capacity for environmental public health tracking. As a result, fundamental information about community health status and environmental exposures is often not available for disease prevention, policy, and scientific purposes. Congress responded in 2002 by appropriating funding for CDC to begin developing and implementing a nationwide environmental public health tracking program and to develop environmental health capacity in state and local health departments. CDC has issued solicitations for two rounds of cooperative agreements with state, university, and local partners to begin developing the Environmental Public Health Tracking Network (the Network). (http://www.cdc.gov/nceh/tracking/). This focuses on both noninfectious conditions with long latency (chronic diseases) and noninfectious conditions with short latency (toxic effects, such as acute poisoning) that may be related to environmental exposures.

Environmental public health issues exist nationally and locally. In some cases, states are responsible for public health, but in other cases, the responsibility is shared between federal and state agencies. Some environmental hazards are specific to local or state areas, but other environmental hazards have no boundaries and are regional or national. Therefore, the need for coordination and data sharing is essential. Developing a national Network together with state efforts will improve awareness, communication, and standards.

The EPHT Program has been established to address the problems outlined above. The EPHT Network will support the purposes of the EPHT Program. This Network will make data and tools available to support activities of the EPHT Program and other public health and environmental health programs.

The Environmental Public Health Tracking Program has three purposes:

• Provide information to initiate public health actions, both immediate or long term, as warranted
• Conduct planning and evaluation (e.g., estimate the magnitude of the problem, track trends, identify high risk groups and modifiable risk factors, and evaluate the effectiveness of interventions) and
• Establish a basis for etiologic studies

The EPHT Program will facilitate the integration of data on environmental hazards, environmental exposures, and health effects to protect and improve public health. The EPHT Network will support data integration by both owners and users. Integrated data will provide public health agencies with information that can be used to plan, apply, and evaluate actions that prevent and control environmentally related diseases. The Program will provide the flexibility to address national, regional, state, and local environmental public health needs.

The EPHT Network will be a distributed, web-based network that provides access to environmental and health data collected by a wide variety of agencies. It will be comprised of individual state networks and a national network, will comply with PHIN standards, and will be able to exchange data with the EPA Exchange Network, where applicable.

The scope of the EPHT Network is characterized by the following set of principles developed as part of the Standards and Network Development Workgroup efforts:

• The EPHT Network provides access to and support of both centralized and de-centralized data stores and repositories
• The EPHT Network supports data exchanges and data linkages within states, across states and regions, and nationally
• The EPHT Network enables the discovery and access to environmental data, health data, and linked environmental-health data
• The EPHT Network provides access to centralized and decentralized tools (e.g., methods, software, and algorithms to link data).

A stakeholder is an individual or group that has a stake or interest in the development of the Network. Identified system stakeholders are listed in the table below along with governmental and nongovernmental affiliation or agency. In some cases, groups of individuals, such as teams or grantees associated with a particular governmental affiliate or agency, are listed below the applicable governmental affiliate or agency. For example, the office of the Director, Public Health Information Network (PHIN) Program Management Office is an affiliate of the CDC, and the associated team is the PHIN Development Team. Table 1 [opens in new window] includes a description of some stakeholders and a summary of responsibilities with regard to the system.

A user is a person or group for whom the system is designed. System users are listed in the table below. Table 2 [opens in new window] describes each user and a summary of responsibilities with regard to the system. To identify users of the system, a joint application development (JAD) session was convened with a cross section of grantees. In addition, a matrix provided by the Network Architecture Subgroup was used as a cross-reference to ensure all users were identified with consistency. Users are anticipated to use the Network in the following ways: 1) Data Seeker – searches for data within the Network, 2) Data Discoverer – uses the Network without an intended data purpose but finds data of interest, 3) Data Owner – provides data to the Network, or 4) Data Steward – shares data with the Network but not as the original provider. Examples listed in the table are not exclusive.

The key anticipated needs and problems as perceived by a sub-set of stakeholders and users are listed below. The list encompasses the needs of stakeholders and users at all levels (national, state, regional, tribal, and local). It should be noted that the stakeholder needs may not be all inclusive because complete stakeholder input is forthcoming. The list will expand as necessary to include additional needs as they are identified.

• Integrated data
• Compatible data¹
• Ability to expand
• Linkable data²
• Ability to assess data quality
• Ability to secure (to protect confidentiality)
• Reliability
• User friendliness
• Usefulness for environmental public health actions (such as immediate response, planning and evaluation, policy making, and etiologic studies)
• Provisions for access to and reporting of data at multiple time scales (e.g., multi-year for trend data and real-time)
• Tools to support various types of analyses (e.g., trend analysis, geo-coding) and communication of results from those analyses
• Tools to search for and find data (e.g., inventories, metadata, search engines)

¹Compatible data are data that can be exchanged among different systems and work together.

²Linkable data are data that can be associated epidemiologically. Linked data may also refer to data that are created when two or more datasets are physically combined using a common data element.

The Environmental Public Health Tracking (EPHT) Network will be a nationwide network that integrates environmental and public health systems at the national, state, and local levels. It will consist of both national summarized data repositories and a system of distributed, diverse data sources that can allow data owners to share their data. By integrating various hazard, exposure, and health effect information systems, the EPHT Network will allow data to be linked at local, state, regional, or national levels. The Network will also protect sensitive data (such as data that include individual identifiers) from unauthorized use and allow the secure exchange of data within and between local, state, and federal agencies. Through use of standards, such as PHIN standards and the EPA Exchange Network, the EPHT Network will implement a common data “vocabulary” for environmental public health tracking that will improve collaboration and allow direct electronic data sharing. The Network will include an extensive security model, based on PHIN standards, to ensure that appropriate protections for data are provided.

The key benefits of the Environmental Public Health Tracking Network are shown in the table below.

The following assumptions and dependencies are related to the Environmental Public Health Tracking Network:

• The EPHT Network will be compliant with the architecture and data/messaging standards of the Public Health Information Network (PHIN).
• The EPHT Network will be compliant with federal privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA).
• The EPHT Network will respect state regulations.
• The EPHT Network must adhere to regulations and standards of the Family Educational Rights and Privacy Act (FERPA).
• The EPHT Network efforts may contribute to the development of PHIN standards.
• The EPHT Network will be compatible with EPA Exchange Network data and messaging standards, where applicable.
• The EPHT Network must have the capability to accept, route, and process HL7 version 3 messages.
• The EPHT Network must be independent of a specific technology platform.
• The EPHT Network will comply with the Americans with Disabilities Act (ADA) – section 508(a).
• Stakeholders will be available to provide appropriate input to define requirements.

Licensing and installation requirements to implement the EPHT Network are unknown. These will be identified in a later release of this document.

Some key features of the operating environment are:

• browser-based interfaces,
• secure Internet-based network,
• distributed data sources and a central summary data repository,
• data access within states, and across state and regional boundaries,
• tools for data visualization, analysis, and reporting.

This section identifies additional options that were considered as possible alternatives for the solution described in this document, but are no longer thought to be feasible. Strengths and weaknesses for each alternative considered are presented.

Commercial Off-The-Shelf (COTS) System
An alternative to the EPHT Network is to use a single commercial off-the-shelf (COTS) system to track environmental and public health data and manage the release and sharing of data according to the agreed-upon guidelines for data exchange (Trading Partner Agreement (TPA)). However, no such system exists. A slight variation to this would be to use components of the COTS software, along with messaging software, to implement various portions of the Network. This would involve using the EPHT Program’s development standards and customizing the COTS software package to create a network that can send environmental and public health data by the TPA data-exchange process. Components of COTS software will most likely be used as part of the Network.

National data warehouse of all EPHT data
The proposed solution of a central data warehouse or repository of all EPHT data was discussed, but the volume of data was thought to be too large to make this a practical alternative. Privacy issues also make this a non-viable alternative. Although the EPHT Network will not comprise of a single data repository, several other smaller data repositories may exist within the Network, including one or more national databases.

The primary feature of the EPHT Network is that it allows access to a variety of environmental and public health data that are distributed in widely dispersed databases and repositories. The Network will provide access to both “linkable” and “linked” data and will also support the two-way exchange of data between partners.

Some data available through the EPHT Network will be stored at a central physical location. The Network will provide expandability to access new data sources as they become available. Data available in the Network will be accessible in standard formats, and data of varying vintage (e.g., historic, trends, “real-time”) will be accessible in the EPHT Network.

The Network will provide various levels of access to users depending on their role and purpose. Access to data will be granted by the data provider, with different rights of access possible. Access to data will be granted to the maximum extent possible, considering confidentiality, legality, and technical feasibility. Some data sets will be accessible without constraint, but other data sets will be accessible using tools such as a Trading Partner Agreements (TPA) to specify details of access. Components of TPAs will be implemented through technology to manage access to and use of data sets (e.g., set security levels). The EPHT Network will provide the capability to facilitate and manage electronic TPAs and provide an authentication process when data are requested. Data owners will have the ability to restrict the release of data because of reliability or privacy concerns.

The EPHT Network will provide access to national, state, regional, and local data. Metadata are required for all data sets that will be available through the EPHT Network, and metadata will consist of a standard set of elements. Metadata will be presented in a manner to allow easy searching and discovery of data (e.g., through the use of key words).

The EPHT Network will enable the systematic linking of health effects, exposures, and/or hazard datasets. This will consist of standardized protocols, methodologies, and toolsets that are generic and flexible enough to account for varying linkage scenarios on datasets that are distributed across the Network. Network users can use these tools to link data on an ad-hoc or ongoing basis, based on data access conditions described in Section 5.1. Linkages will take into account text-based, spatial, and temporal attributes.

The EPHT Network will support the means to generate visual displays of data (e.g., maps, charts, tables, and graphs), to perform pre-defined routine types of analyses, and to assess data quality. The Network will also provide the capability that allows users to download data to perform more complex analysis using external statistical, analytic, and visualization (e.g., Geographic Information System [GIS]) tools.

The Network will provide the capability to disseminate information in various formats, including standardized reports, web-based query results, emails, and alerts. It will expand on the functionality provided through PHIN to provide a configurable method that will trigger an alert when a pre-determined parameter exceeds a given threshold. The Network will monitor continuously to determine whether a pre-defined alert state has occurred. If so, an alert or notification will be issued using a various techniques, including electronic mail, electronic paging, manual telephony, and automated voice-synthesized telephony. The Network will also have the capability of either sending or receiving data. A communications planning effort by the EHT Branch is identifying the information needs of potential users to determine how to package the data for a various audiences (e.g. summary tables, graphs, interpretation of trends, or web design).

To determine patterns of use, the EPHT Network will also provide a means for monitoring queries and database access. This could be used in a various ways, such as providing statistical information on network usage (e.g., the most accessed databases), suggesting the creation of new reports, or keeping track of past queries that users have run so that they can be run again.

The EPHT Network will provide the necessary security and protection to ensure, as required by PHIN specifications, that sensitive or critical data and systems are not lost, destroyed, corrupted, or misappropriated.