International Perspectives

Fifth Annual Meeting

Public Health Data Standards Consortium March 18, 2004

Marjorie S. Greenberg

National Center for Health Statistics

Centers for Disease Control and Prevention

Presentation Agenda:International Perspectives

• Brief overview of international standards activities

• WHO Collaborating Centres for Family of International Classifications

• Possible future efforts

• Health data standards can be traced back several centuries – London Bills of Mortality – 17th Century– Florence Nightingale – mid - 19th Century– Bertillon classification - late 19th century– International Organization for Standardization

(ISO) – mid 20th century– World Health Organization (WHO) – mid 20th

century

Overview:International Perspectives

Why Participate in International Standards Setting?

• Create a global market for products

• Remove barriers to health care in global setting

• Foster comparable data and statistics in developed and developing countries

• Learn from other countries

• Improve population health

Main International Standards Organizations

• International Electrotechnical Commission (IEC)

• International Organization for Standardization (ISO)

• International Telecommunication Union (ITU)

• United Nations• World Health Organization

International Players in Health Care Standards

• ISO – TC 215 Health Informatics

• CEN – European Standard Development

• DICOM – Imaging Standard

• UN/EDIFACT – EDI Standards

• HL7 – Clinical Messaging Standards

• IEEE – Medical Device Standards

BSI

SAI

ON

IBN

BASMP

ABNT

CSSN

DPS

ANSI

CSNI

IRAM

INTECO

ICONTEC

KATS

AFNOR

SFS

EOS

INEN

DS

DZNM

MSZT

BSN

NSAI

STIR

BIS

IDHKSAR

KEBS

JISCUNI

SIIELOT

DIN

BPS

INDECOPI

DGSM

NSF

SNZ

NNI

SNIMA

MOLDST

DGN

DSM

SEE LST

AENOR

SMIS

UNMS

PSB

SASO

GOST-R

IPQ

FONDONORMA

TCVN

UNIT

SSUAE

TSE

TTBS

TISI

SNV

SIS

SLSI

SCC

EVS

CSM

CYS

LVS

MSA

PKN

SZS

DSTU

ASRO

U.S. Participation in International Standards Organizations

• American National Standards Institute (ANSI) is U.S. voting representative on IEC, ISO and ITU

• ANSI delegates responsibilities to U.S. Technical Advisory Groups (TAGs), which develop and transmit U.S. positions on activities and ballots

ISO Hallmarks

• Equal footing

• Voluntary

• Market-driven

• Consensus

– Openness, balance, due process, appeal

• World-wide – 145 countries

• Over 200 ISO Technical Committees (TCs)

ISO TC 215

• Founded in 1998• Scope is standardization in the field of

information for health• Goal is to achieve compatibility and

interoperability between independent systems• Also strives to ensure compatibility of data for

comparative statistical purposes and to reduce duplication of effort

ISO TC 215 Work Groups• WG1 – Health Records and Modeling

• WG2 – Messaging and Communication Architecture

• WG3 – Terminology

• WG4 – Privacy and Security

• WG5 – Smart Cards

• WG6 – ePharmacy and medicine

• Ad Hoc Groups on Consumer Interests and Mobile Communications.

WHO Collaborating Centres for International Classifications

• International Statistical Classification of Diseases and Related Health Problems (ICD) has been maintained and promoted by WHO and a network of Collaborating Centres since 1970’s

• Centres have been established by language and geography• These and other Centres worked on revision of the

International Classification of Functioning, Disability and Health (ICF) from 1993-2000

• In 2001, a network of WHO Collaborating Centres for the Family of International Classifications (WHO FIC) was established

The WHO Family of International Classifications (FIC)

Associated Products Main Classifications Adaptations

Mission of WHO FICCollaborating Centres

• To develop, disseminate, implement and update WHO Family of International Classifications to support national and international health information systems, statistics and evidence

WHO FIC Committees

• Update and Revision– Mortality Reference Group

• Implementation• Education• Electronic Tools• Family Development

– e.g., primary care, external causes of injury, health interventions, terminologies

North American Collaborating Center

• Established in 1976• Housed at National Center for Health Statistics• Covers U.S. and Canada and represents these

countries in WHO FIC network• Maintains and promotes uses of ICD for

mortality and morbidity data and ICF for functional status and disability data

• http://www.cdc.gov/nchs/about/otheract/icd9/nacc.htm

United Nations Statistics Division

• Statistical Yearbook• Millennium Development Goals and

Indicators Database• Disability Database• Demographic and social statistics methods• City Groups

– Washington Group on Disability Statistics - http://www.cdc.gov/nchs/citygroup.htm

Other International Health Data Activities

• Summary Health Measures• Cancer Data• Environmental Data• Geo-spatial Data• Organization for Economic Cooperation

and Development (OECD) Health Project– National health accounts– Healthcare quality indicators

Role for the Consortium

• Learn about US TAG for ISO TC 215 and other international standard development activities

• Participate actively in AMIA, HL7 and other international forums on standard development

• Promote use of international classifications (e.g., ICD-10-CM, ICF, ICPC)

• Follow terminological development (e.g., SNOMED CT) and EHR development worldwide

• Include educational materials and links on international standards in Web-based Resource Center

Role for the Consortium

• Consider forming a committee to explore international standard development for population health

• Dr. Orlova has identified the following potential partners: – eHealth Initiative, USA– Health Canada, Canada– INSERM, France– Linkopings Universitet, Sweden

Role for the Consortium

Assure a population health perspective in international standard development activities