By Sherene Chen-See
January 13, 2003
| Imagine a system where all public health records are kept in one central database that can be accessed by a multitude of authorized health-care providers at any given time. Isolated outbreaks of a serious disease could be tracked in real time to determine common links between cases. Public health professionals could use the data to make rapid interventions, thereby preventing a localized health concern from getting out of hand. And in these days of bioterrorism fears and increasingly dangerous bacterial outbreaks, the technology could become an invaluable tool.
The Canadian Public Health Information System (PHIS) aims to do all of this and more. PHIS is an automated, Web-enabled, integrated, secure system that allows access to client records by many public health providers. The system supports public health tracking, interventions, case management, communicable disease surveillance, sharing of immunization information, and, eventually, inspection reports. This database could form the public health component of an overall "electronic health record," which would make each patient's critical health information available in real time, anywhere in Canada.
PHIS is managed by the Canadian Integrated Public Health Surveillance (CIPHS) system. CIPHS is a series of integrated computer database applications that enables systematic collection and collation of medical surveillance data and makes this information available to public health professionals at the local, provincial, territorial, and national levels. Both programs are run by Health Canada under the leadership of project authority Margaret Litt, a public health nurse specializing in outbreak management and epidemiology. Currently, eight provinces are conducting pilot programs with PHIS. The remaining provinces and territories have all expressed their commitment to the program.
The idea for PHIS came about in 1998. "Back then, all of our public health offices were collecting their information with different systems," says Ron Sussey, senior IT manager. "There was no real way to collect this information together to look at the population at large." Sussey has managed informatics programs for Health Canada since 1987 and has directed the IT sector of PHIS for the past 18 months.
After some searching, Health Canada decided to pattern PHIS after an existing provincial program at the British Columbia Centre for Disease Control (BCCDC). The contract to develop PHIS was awarded in 2000 to BCCDC, which subsequently contracted much of the programming and development to Pangaea Systems Inc., the Internet business solutions provider that developed the original provincial program at BCCDC.
Meeting Different Data Requirements
Over the next two years, Pangaea and the BCCDC created PHIS. According to Sussey and his team, the overall objective of PHIS is to build a common public health data manage-ment system and communications architecture for the use of public health partners. Local pub-lic health offices input vital data — for example, on patient demographics, communicable dis-eases, outbreaks, and immunizations — into the system.
While these jurisdictions are encouraged to use the Cognos Impromptu reporting tool, which has been set up specifically for PHIS to support the common public health data model, they have other choices. To expand the base of people writing consistent reports, Sussey says, "we chose Cognos Impromptu, because it seems to be the industry standard. Many people know the software." Litt adds: "However, for jurisdictions [that] do not adopt our tools based on the common data model, the information can still be transferred if they send it in the standard format that we have identified."
Once reported, the data enters the database, entitled Core-PHIS, where it is organized, as applicable, into six production modules: demographics, communicable diseases, public health surveillance, sexually transmitted diseases, tuberculosis, and outbreak. Every 24 hours, the data in the production modules are transferred to a data warehouse. Attached to this warehouse is a data catalog, which allows easy ad hoc access for surveillance reporting and monitoring. A master catalog of reports is maintained for access by the jurisdictions.
In order to accommodate the varying needs of public health professionals, Sussey says that PHIS can function independently as a complete system or be used in conjunction with existing complementary systems. PHIS can be customized to meet specific requirements by implementing different modules.
Jurisdictions maintain the data under the provisions of their respective privacy legislation and regulations. PHIS incorporates various levels of security, both on the database level and by functionality. "For example, if you are a nurse specializing in sexually transmitted diseases, you would not be able to access the results for tuberculosis," Sussey says. "In the application, we have also built in audit trails so we know who has changed records."
The system was programmed for the Internet using Java, Java Beans, Java Virtual Machine, Java Server Pages, and Java Servlets. It is designed to be compatible with any Web server and was developed with an Oracle back end. "We used Oracle Designer to design [not only] the database but also the common data model," Sussey says. "We chose Oracle because it is one of the leading standards for major companies."
To ensure consistent tracking of data, PHIS heavily emphasizes the use of the common public health data model. Health Canada is currently using Oracle to redesign the common data model (which deals specifically with human data) so it can accommodate any type of data that may be associated with adverse effects on health, whether that involves environmental, animal, chemical, or bacteriological information. "Our goal is to have seamless integration and have all the feeder systems using the same data system," Sussey says.
PHIS is complemented by another component of CIPHS: the laboratory data management system (LDMS), which can store relevant patient data related to specimens being tested. LDMS can hold information on case investigations and link this to a particular specimen or group of specimens. LDMS, which is already up and running, allows electronic transmittance of laboratory test results into the PHIS program. "By building a public health system equipped with an in-house lab system, we have ensured that the necessary interoperabilities are done easily," Sussey says.
"Our development phase for PHIS is coming to a close, and we have just posted another contract for the implementation phase," Litt says. The CIPHS Collaborative — a diverse group of public health officials, IT professionals, and managers independent of Health Canada — has been involved throughout the development process and will take over the entire program in 2005.
PHIS has faced several challenges in its lifetime, such as differences in privacy legislation and diverse technology bases between the jurisdictions. However, the CIPHS Collaborative provides a forum for each jurisdiction to discuss these issues and overcome such hurdles. For example, before the institution of PHIS, the information managed by each jurisdiction was saved in a multitude of different spreadsheet programs. "The CIPHS Collaborative worked with Health Canada to determine one common, streamlined application," Litt says.
Both Sussey and Litt stress the importance of having all players — IT and program managers — at the table when developing a program such as PHIS. "That upfront communication to get everyone on board is important to the development," Sussey says. "I believe that 75 percent of developing the application is not the coding — it's getting all the players together, taking ownership and responsibility for the final product. Once you have that together, then you can build it."
"Much of the infrastructure that we put in place in order for this to work in public health is equally applicable in other environments," Sussey explains. As a result, the technology developed for PHIS may eventually be applied to other facilities within Health Canada, such as the corrections, water quality, or environmental departments.
Sherene Chen-See is a writer based in Ontario. She can be reached at firstname.lastname@example.org.