ROBERT WOOD JOHNSON FOUNDATION'S CENTER FOR HEALTH INNOVATION FUNDS PUBLIC HEALTH INFORMATICS INSTITUTE

The Public Health Informatics Institute, a program of the Center for Innovation in Health Information Systems, is a new nonprofit entity funded by The Robert Wood Johnson Foundation to advance state and local public health agencies' capacity to use information tools effectively to respond to public health threats. The Institute fosters collaboration among public health agencies in the conception, design, acquisition, and deployment of software tools. The goal is to eliminate redundant efforts, speed up development processes, and reduce costs.

The Institute's approach to public health informatics has received the endorsement of public health executives and practitioners who recognize the value of working together to build better information systems. As they confront urgent information technology priorities, including the need to increase capacity to respond to bioterrorism, they have concluded that the time is right for this initiative. The Association of State and Territorial Health Officials (ASTHO), National Association of County and City Health Officials (NACCHO), Association of Public Health Laboratories (APHL), National Association for Public Health Statistics and Information Systems (NAPHSIS), Council of State and Territorial Epidemiologists (CSTE), and the Association of Public Health Chief Information Officers (APHCIO) will be partners in the Institute's activities.

The Institute will facilitate exchange and collaboration and will provide education and other services to public health agencies. In its initial phase, the Institute will focus on the immediate needs of state and local public health agencies to respond to the threat of bioterrorism. Initiatives include:

* Developing an information clearinghouse that includes ratings of vendor products and capabilities, guides to selecting vendors and products, sample IT system requirements and procurement documents, key IT position descriptions, and more

* Facilitating collaboration among public health laboratories in developing a common set of requirements for public health laboratory information management systems

* Exchanging software for surveillance and epidemiological analysis systems

* Developing a workshop on information technology management principles and practices for public health executives

The Institute subsequently will expand the scope of activities to include a shared library of software components; an expanded clearinghouse; a testing and evaluation lab to validate new tools; technical assistance; skill-building workshops; and regional centers affiliated with academic public health informatics programs.

For more information about the Public Health Informatics Institute, contact David Ross, ScD, Director, at 866-815-9704 or by e-mail at [email protected].

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HEALTH CYBERMAP: MAPPING THE HEALTH CYBERSPACE

An ambitious project, based at the Center for Measurement and Information in Medicine, School of Informatics, City University, London, UK, is beginning to map the Internet's health and medical information resources for clinicians, librarians, patients, and the general public. Health CyberMap aims to be the next-generation World Wide Web by giving machine-readable semantics and context to presentation-based Web pages, thus creating Geographic Information System (GIS)-style maps for the health information cyberspace.

A doctoral research project by Maged N. Kamel Boulos, PhD, Health CyberMap proceeds from the two-dimensional aspect of the Internet. Although it has been said that the Internet is its own map, as surfers navigate sites, only a small part of it can be appreciated at any given time. For example, the relations of the page or site visited to the rest of the Web, how it measures compared to the rest of the Web, or what the rest of a particular Web segment looks like are all hidden behind the presentation of the displayed site. In addition, it can be difficult to navigate back to a resource visited just a few hours ago. Medical health Web resources covering narrower, broader, related, or similar topics are not easily located, and without maps, no Web journey can be planned ahead of time.

Maps build on humans' spatio-cognitive abilities and can be powerful graphic tools used to classify, visualize, communicate, and navigate spatial and/or spatialized relations (ie, relations projected into some conceptual space for mapping) in worlds that are too large and too complex to be seen directly.

GIS maps take simple cartography one step further by providing contextual links between maps and underlying databases (where attributes of features on the maps are stored). On the Web these links can be implemented as sensitive clickable maps (hypermaps). The quality and utility of such maps will depend on the quality of the information in the underlying databases.

Ideally, health-related and clinical questions could be linked to such maps. The maps, or the underlying information, would assist users to find the appropriate answers to these questions in the right place and at the right time.

HealthCyberMap aims to be a Web-based service that maps medical/health information resources in cyberspace in unique and novel ways using semantic indexing, "intelligent" categorization, and interactive hypermedia visualization of the medical/health metadata, clinical codes, and GIS technologies. By making medical Web resources more meaningful to computers, that is, making their context and meaning (semantics), not merely their raw text and formatting, amenable to computer "understanding" and processing, the end result should be an "intelligent" medical Web that is more meaningful to the public, patients, and their caregivers, and more relevant to the medical questions they ask and the specific clinical problems they face. Clinical codes like SNOMED-CT (a terminology or nomenclature) or ICD (a classification) can help achieve this by acting as basic templates of medical ontologies for mapping the health cyberspace. A terminology (or classification) is a kind of ontology by definition and it should preserve (and "understand") the relationships between the thousands of terms in it or else it would become a mere dictionary (or at best a thesaurus). By labeling or tagging a resource with clinical codes, relationships are automatically established (as defined by the coding scheme used to tag the resource) between this resource and related (tagged) resources in the medical Web and also the Electronic Patient Record.

Comprising two main "arms," or layers, a top-level visualization/navigation arm (interface layer) founded upon a robust semantic layer, Health Cybermap's overall objective is a navigational hypermap for browsing collections of Internet information resources, ideally driven by an underlying database that stores meta-information (information about information) describing these resources.

The objectives of the semantic arm include, but are not limited to, defining and modeling a suitable framework that tailors existing generic metadata standards/recommendations to suit the description of medical/health information resources; proposing and examining ways of reasoning semantically with resource metadata (including clinical codes) beyond simple queries; and developing a pilot Medical Semantic Subject Search Engine that outperforms conventional free-text and keyword-based search engines, and supports synonyms, disease variants, and subtypes, as well as some semantic relationships between medical/health terms.

Visualization/navigation arm objectives include finding and using suitable spatialization methods and familiar metaphors to visually browse and navigate medical health information resources on the Internet in different (but complementary) ways, based on clinical codes and other metadata elements in the resource metadata base; and using GIS to automate the classification and generation of spatialized browsing views (navigational cybermaps) of the resource meta-database, based on the above cybermapping methods.

Using a clinical coding scheme as a metric for spatialization ("semantic distance") is a method unique to HealthCyberMap, and is well suited to the semantic categorization and navigation of medical/health Internet information resources. HealthCyberMap also introduces a useful form of cyberspatial analysis for the detection of topical coverage gaps in its resource pool using choropleth (shaded) maps of human body systems.

The project also demonstrates the feasibility of Electronic Patient Record to Online Information Services (like HealthCyberMap) Problem-to-Knowledge Linking using clinical codes as crisp problem-knowledge linkers or knowledge hooks.

The Semantic Subject Search Engine queries the same HealthCyberMap resource metadata base. Explicit concepts in resource metadata map onto a brokering domain ontology (ICD-9-CM) allowing the search engine to infer implicit meanings (synonyms and semantic relationships) not directly mentioned in either the resource or its metadata.

Similarly, user queries would map to the same ontology allowing the search engine to infer the implicit semantics of user queries and use them to optimize retrieval.

For more information about the project as it develops, including a complete listing of objectives and publications, visit Health CyberMap at http://www.healthcybermap.org.

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