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This documentation describes a proposed governance process for the designation of "preferred" content in the Surveillance Data Platform Vocabulary Service (SDP-V, or the SDP Vocabulary Service). The "preferred" designation is important to promote reuse of existing content in SDP-V to create efficiency in public health surveillance. This selection of “preferred” content is generally the outcome of a data harmonization effort that sought to simplify and streamline the choices of terminology to express a concept. It is expected that a clear and understandable process will ensure that the meaning of “preferred” is recognized and trusted by stakeholders.

The Surveillance Data Standards Management and Harmonization Steering Committee (SMaHSC) is proposed to be a CDC-wide governance group body that promotes collaboration and coordination across CDC’s surveillance data standards and data harmonization practitioners to help CDC achieve its vision for Public Health Surveillance public health surveillance in the 21st century. The purpose of SMaHSC is to increase the visibility of public health surveillance data standards management and harmonization activities across CDC, promote best practices, identify challenges, and prioritize opportunities for surveillance data harmonization and standards adoption. The SMaHSC will serve as an authoritative body for cross-program surveillance standards management, implementation, and data harmonization by providing strategic oversight and advocating for initiatives that will impact standards use, adoption, effectiveness, and data harmonization practices that are mutually valuable across program areas. SMaHSC will serve as the decision-making jurisdiction that authorizes the use of “preferred” in the SDP Vocabulary Service. In doing so, SMaHSC will observe the basic tenets of good governance, which are participatory, consensus-oriented, accountable, transparent, responsive, effective and efficient, equitable, and inclusive.

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A methodical approach to marking content in the SDP Vocabulary Service as “preferred”, such as the one described here, will ensure that the SMaHSC:

• Considers prospective changes to the SDP Vocabulary Service content from a technical and a business perspective.
• Consults all key stakeholders so that they have a voice in the final decision.
• Documents and publicizes decisions.

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This process is meant to be used as a starting point by SMaHSC or its equivalent, when such an organization a governance body is established.

Assumptions

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• Harmonization of CDC questions and response sets is an ongoing process. Harmonization will can take place informally at the program level as well as in larger cross-agency work groups. The output of these harmonization efforts will need to be incorporated into CDC tools and workflows to be fully useful.
• Incorporating harmonization results into the SDP Vocabulary Service will help standardize terminology at the point that where data collection instruments are developed.
• A governance group body to oversee harmonization activities CDC-wide will be established.

Background

SMaHSC

SMaHSC, when established, will support CDC’s mission to protect the public’s health and will align to the Public Health Surveillance Strategy. The goals of SMaHSC are as follows:

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1. Identify and support priority areas for standards management and harmonization.
2. Establish a communication mechanism, which is understandable and accessible by both surveillance practitioners and public health informaticists, in order to improve comprehension of surveillance data standards management and harmonization activities.
3. Integrate CDC’s strategic priorities on managing surveillance standards and harmonizing surveillance data by facilitating collaboration and coordination for surveillance practitioners and public health informaticists.
4. Promote shared resources and educational opportunities on standards.
5. Encourage data harmonization through vocabulary repositories, such as reviewing content in the SDP Vocabulary Service to promote reuse.
6. Initiate cross-program working work groups to increase understanding and solve challenges regarding standards management and harmonization.
7. Report to the Surveillance Leadership Board (or alternative authorizing body) on progress and challenges and make recommendations on standards and harmonization priorities, as well as other steering committee activities.

SMaHSC membership will represent a broad range of CDC expertise, perspectives, and familiarity with public health surveillance data needs, initiatives, and priorities of external stakeholders including surveillance partners (e.g., State, Tribal, Local, and Territorial (STLT) partners, CSTE, APHL), standards development organizations (SDOs) (e.g., SNOMED, LOINC), and other government agencies (e.g., Office of Management and Budget, Office of the National Coordinator).

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• Public Health data standards management practitioners across CDC (e.g., informaticistinformaticists, vocabularistvocabularists, terminologistterminologists) who are knowledgeable of vocabularies, data exchange specifications, SDO activities and repositories, and standards development processes. Members should represent diverse standards management perspectives from different domains, including infectious disease, non-infectious disease, laboratory data exchange, vital statistics, emergency preparedness, and research.

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The SDP Vocabulary Service provides a repository of questions, response sets, and groupings of questions (called Sections and SDP-V Surveys) that allow public health professionals to more rapidly discover, reuse or create, and deploy data collection instruments. The SDP Vocabulary Service also provides transparency across published content from multiple programs and enables use of harmonized questions and response sets. The goal of the SDP Vocabulary Service is to facilitate discovery and reuse of existing vocabulary content, thereby reducing the number of different ways the Centers for Disease Control and Prevention (CDC) asks for the same type of information across programs and surveillance systems. This will help to reduce state, tribal, local, and territorial ( STLT ) partner reporting burden, as well as drive towards harmonization in data collection instruments.

Content that can be marked as “preferred” in the SDP Vocabulary Service includes questions, response sets, sections (groupings of questions) or SDP-V surveys (grouping of sections). "Preferred" content in the SDP Vocabulary Service is selected through an established process as the way CDC wants to collect data for a particular concept. Designating content as "preferred" helps to standardize surveys and other data collection efforts, which reduces the response burden of CDC partners and simplifies data collection, analysis, and reporting.

The SDP Vocabulary Service includes an attribute that can be toggled to identify any content in the service as “preferred”; search results are sorted by the “preferred” attribute so that such content is displayed at the top of a user’s search results to promote use.  

Data Harmonization Terminology in the SDP Vocabulary Service

When the curator role for the SDP Vocabulary Service is staffed and the necessary development coding has been completed in the SDP Vocabulary Service application, SDP-V content may be identified in three possible ways. The SDP team collaborated with SDP, which were identified by SDP-V users to identify the need for three data harmonization terms in the service. The goal of using these labels is greater data harmonization.

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1. Preferred – Content that has been selected as CDC’s first choice to express a concept
2. Similar To to – Content that is similar in meaning to another selected piece of content
3. Do not use – Content that is outdated and that CDC does not consider appropriate for data collection instruments

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The label “Preferred” is presently available in SDP-V. The other terms will require further development in the SDP Vocabulary Service application. The governance process presented here addresses the first label and can easily be used for the other two.

“Preferred” Content Governance Process

We describe a process suited to SMaHSC. For other authorities, and other time scales, other created specifically for SMaHSC. Other processes might be better suited for other authorities.

There are at least four pathways that by which SMaHSC might receive proposals to consider conferring "preferred" status on content in the SDP Vocabulary Service for “preferred” status:

1. A recommendation from a harmonization working group may suggest standardizing on work group to designate specific content as "preferred."
2. Curation of SDP Vocabulary Service content may reveal an evolving consensus as to "preferred" content usage across programs.
3. Programs may nominate content they favor to be "preferred" over other content with similar meaning.
4. Regulation or policy changes from external sources such as the Department of Health and Human Services may require specific content to be "preferred.

However By whatever pathway a proposal reaches SMaHSC, the approach to evaluate it the proposal will be the same. An overview of the input and outputs of the process are is displayed in the picture below. A proposal for to designate content as "preferred" in SDP-V is needed required as an input, which is then used for the governance process for SMaHSC to review reviewed and evaluated by SMaHSC. Then the The output of the process is a the decision from SMaHSC. 

Roles and Responsibilities

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• Curator of the SDP Vocabulary Service: This person is envisioned as an authoritative overseer of content in the SDP Vocabulary Service, identifying informal consensus on specific content as well as synonymous content. The curator will be responsible for tagging content as “preferred”.
• SMaHSC Coordinator for "preferred" review: This person will review the standard form that proposes content as "preferred" and ensures that it is complete. This person may also poll stakeholders as to their thoughts on the proposal or may delegate the task. He or she will then forward the completed proposal with stakeholder comments to the SMaHSC membership for their action.
• SMaHSC Members: The members of SMaHSC will be identified as described in the charter for the groupgovernance body. The charter also describes the voting process.
• Stakeholders: Stakeholders are specific to each proposal as users of the SDP-V content under consideration. They will likely have already participated in the harmonization activity that resulted in the recommendation of "preferred."

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Every proposal to designate content in the SDP Vocabulary Service as “preferred” will be submitted to SMaHSC on a standard form. 

The standard form will explain why the content should be flagged "preferred." Supporting artifacts such as a harmonization work group report might be included. Artifacts should include the the following:

• The business case for the designation of "preferred"

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• The problem it solves

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• The proposed SDP-V specification

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The completed standard form will list all known key stakeholders who will be affected by the change. It is likely that the key stakeholders were part of the harmonization work group that made the recommendation to begin with. It may include programs, individuals, systems, or documents. Forms lacking a mandatory field will be returned to the proposer. An sample form for a SMaHSC "preferred" proposal is pictured below.

Proposal Review

The SMaHSC "preferred" coordinator will solicit each stakeholder’s approval for adding the tag “preferred” to the identified SDP Vocabulary Service content and will document it along with stakeholder comments on the form as part of the proposal review process.

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The proposal with stakeholder feedback will be distributed to the members of SMaHSC, who may invite other stakeholders to provide input on the request. The proposal will be added to the next meeting agenda for discussion and voting.

SMaHSC voting members will decide to approve or deny the proposed changedesignation, voting in accordance with the SMaHSC charter. The charter states: “Decisions shall be reached by achieving a simple majority of voting members present at a meeting. In the event of a tie vote, the Co-Chairs will have the deciding vote, or may call for a re-vote after further discussion by the Committee.” The decision will be documented on the form, which will become part of the committee’s working files.

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The figure below displays in the first two swim lanes the general “preferred” governance process and in the next three first two swim lanes details and the subsequent steps to implement and publicize the content change among users of designation in the SDP Vocabulary Service in the next three swim lanes. The general "preferred" governance process involves a CDC program user or submitter and SMaHSC and is described in more detail in previous sections.

The implementation process involves three user roles (designated with an asterisk in the figure) within the SDP-V Service: the administrationadministrator/curator, publishers, and authors. Once SMaHSC accepts votes on the "preferred" proposaldesignation, the first step for implementation is to identify the content in the SDP Vocabulary Service. If the content has not been created, it is developed at this point and added to the service. Once the content is located in the service, it is marked “preferred” by the service administrator or curator.

The administrator or curator submits information on the newly tagged "preferred" content for the “What’s New” tab in the SDP Vocabulary Service to the SDP-V Development Team. Adding this information to the service will highlight the change designation to users.

Additional harmonization opportunities are identified by the administrator or curator, who searches the SDP Vocabulary Service for content similar to the newly designated "preferred" content. If similar content is located, the administrator or curator notifies the program publishers of the harmonization opportunity.

The program publishers promote the "preferred" content for author this use if content is under current development or during the next tool revision cycle for that data collection instruction. They encourage authors to review the content for potential applicability to the data collection instruments they are currently developing. Authors assess the content and incorporate it into their development projects where it fits.

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