Updates on the BioSense Program Redesign: 2011 Public Health Preparedness Summit

Office of Surveillance, Epidemiology, and Laboratory Services

Public Health Surveillance Program Office

Updates on the BioSense Program Redesign

Taha A. Kass-Hout, MD, MSDeputy Director for Information Science (Acting) and BioSense Program Manager

Division of Notifiable Diseases and Healthcare Information (DNDHI, Proposed)

Public Health Surveillance Program Office (PHSPO)

Office of Surveillance, Epidemiology, and Laboratory Services (OSELS)

Centers for Disease Control & Prevention (CDC)

Any views or opinions expressed here do not necessarily represent the views of the CDC, HHS, or any other entity of the United States

government. Furthermore, the use of any product names, trade names, images, or commercial sources is for identification purposes only,

and does not imply endorsement or government sanction by the U.S. Department of Health and Human Services.

2011 Public Health Preparedness Summit

Session WS-16—Location International 10Tuesday, February 22, 2011 1:30 PM- 5:30 PM

Atlanta, GA, USA – February 22-25, 2011

The Public Health Surveillance Challenge

Public Health

Surveillance is a global

challenge

The importance of

timely detection

Limitations of

traditional reporting

systems

Hierarchical lines of

reporting

Variance across different

countries

Multitude of potential

data sources

Real-world lessons

from SARS and H1N1

Limitations of Current Approaches

Can’t mine

all possible sources

all data types

Delay required for searching,

curating and processing

Massive bandwidth and

processing requirements

Resource limited process

(machine and human)

Policies that hinder data

sharing

Little sharing of standards,

specifications, and lessons

learned

“Federal agencies must focus on consolidating existing data

centers, reducing the need for infrastructure growth by

implementing a “Cloud First” policy for services, and

increasing their use of available cloud and shared services.”

Vivek Kundra, Fed CIO.

The Opportunity in MUse: Support Case- and Event-Based Surveillance

EHRs and Health Information Exchanges can Improve Public Health Surveillance

Enhanced Situation Awareness

Syndromic surveillance exploits more elements from the EHR for earlier characterization

• can limit spread of outbreak or monitor severity of pandemics, and reduce morbidity and mortality

Automated collection and reporting encourages more care provider organizations to participate

Timely and More Complete Notifiable Disease Reporting

Studies have shown that electronically based reporting for STDs averages 7.9 days earlier than

spontaneous reporting, allowing:

• 52% increase in treating patients in 2 weeks

• 28% increase in reaching at risk subject by phone

Automation of this task is popular with healthcare provides since it relieves a perceived burden

Better Prevention and Surveillance or Chronic Conditions

Addresses major factors in rising healthcare costs

Data can be used for outcome-based incentives for best practices

Simple ABCDs (Aspirin Therapy, Blood Pressure Screening, Cholesterol Screening, Smoking Cessation, and

Diabetes) Interventions can reduce the number of avoidable deaths

• CDC’s Demonstrating the Preventive Care Value of HIEs (DPCVCHIE) project is using national standards and

capabilities to evaluate the effectiveness of ABCDs interventions

Consistency of Reporting | Reduced Latency | More Completeness of Reporting

BioSense Program

Civilian Hospitals

• ~640 facilities [~12% ED coverage in US, patchy geo

coverage] [Chief complaints: median 24-hour

latency, Diagnoses: median 6 days latency]

• 8 health department sending data from 482

hospitals

• 165 facilities reporting ED data directly to CDC

or a health department

Veterans Affairs and Department of Defense

• ~1400 facilities in 50 states, District of Columbia, and

Puerto Rico [final diagnosis ~2->5 days latency]

National Labs [LabCorp and Quest]

• 47 states, the District of Columbia, and Puerto Rico

[24-hour latency]

Hospital Labs

• 49 hospital labs in 17 states/jurisdictions [24-hours

latency]

Pharmacies

• 50,000 (27,000 Active) in 50 states [24-hour latency]

BioSense Program RedesignUpdated Vision: Beyond early detection Beyond syndromic

The goal of the redesign effort is to be able to provide

Nationwide and regional Situation Awareness for all hazards health-related

events (beyond bioterrorism) and to support national, state, and local responses

to those events

Multiple uses to support your public health Situation Awareness; routine public

health practice; and improved health outcomes and public health

Our strategy is to increase BioSense Program participation and

utility and to support local and state jurisdictions’ health

monitoring infrastructure and workforce capacity

Requires collaboration with other CDC Programs and federal agencies

– 7 years of experience dealing with timely healthcare data (Outpatient, ED, Inpatient, Census,Laboratory, Radiology, Pharmacy, etc.)

– Infrastructure reconfigured for high performance, scalability and Meaningful Use (MUse)

A User-Centered Approach

Building the Base

Connecting the Dots

Sharing Information

BioSense Program Redesign A 3-Pronged Approach

Technical Expert Panel (TEP)—Current Status

David Buckeridge

McGill University

Julia Gunn

National Association of County

and City Health Officials

(NACCHO)

Jim Kirkwood

Association of State and

Territorial Health Officers

(ASTHO)

Denise Love

National Association of Health

Data Organizations (NAHDO)

Judy Murphy

Aurora Health System

Marc Paladini

NYC Department of Health

and Mental Hygiene

Tom Safranek, Lisa Ferland,

Richard Hopkins

Council of State and Territorial

Epidemiologists (CSTE)

Walter G. Suarez

Kaiser Permanente

BioSense Program RedesignSelected Collaborations

Gulf Oil Spill-associated surveillance AL, FL, LA, MS, TX, NCEH, CDC EOC+

Dengue case detection Dengue Branch, FL Dept of Health, VA

State-based asthma surveillance AL Dept of Health, VA, DoD

Non-acute dental conditions Division of Oral Health, NC DoH, NCDetect

Rabies post-exposure prophylaxis Poxvirus & Rabies Branch

Influenza-like illness surveillance Influenza Division

Contribution to Distribute

ISDS MUse Workgroup

Enhanced analytics methods

https://sites.google.com/site/changepointanalysis

https://sites.google.com/site/changepointanalysis

BioSense Program RedesignSelected Stakeholders

http://www.syndromic.org

BioSense Program RedesignStakeholder Involvement

Seeking individuals from professional organizations to participate in redesign effort

Coordinating presence at national conferences

Identifying individuals to update the map on the collaboration site

Disseminating redesign project information through communication channels

Coverage Map

Requirements Gathering

Community Forum

http://biosenseredesign.org

http://biosenseredesign.org

Environmental Scan

The purpose of the environmental scan is to assess current best

practices in surveillance and extract from them requirements to

aid in the BioSense Redesign

Note: The map has been initially populated with public health

jurisdictions' self-reported data obtained through Distribute

http://www.epidemico.com/biosense-tools

Key Sources of Information

Published literature

BioSense evaluations and roundtables

Surveys from our partner organizations

User requirement gathering sessions

Site profiles from the Distribute Project

Database of frequently used syndromic surveillance

systems

Collaboration Web Site Coverage Map

BioSense Redesign Coverage Map

Data fields selected from Distribute Site Profiles include:

Type of jurisdiction (i.e., state, county, city)

Surveillance system(s) used by site

Total number of emergency care and urgent care facilities in

the jurisdiction, including pediatric facilities

Number of reporting emergency care and urgent care facilities,

including pediatric facilities

Estimated population coverage

Approximate number of emergency department (ED) visits

captured

BioSense Redesign Coverage Map

Contributing BioSense facilities

925 VA hospitals

362 U.S. Dept. of Defense healthcare facilities

661 Private hospitals and hospital systems

2,780 National laboratories

49,365 Pharmacies

Populating the Coverage Map: Methods

Identifying Editors

Historic partnership with BioSense or CDC

Newsletter, website announcements (CSTE, ASTHO,

NACCHO, ISDS)

Volunteers from Collaboration Site

Coverage Map Editors

18 editors, representing 15 jurisdictions

Arizona ▪ New York City

Cook County, IL ▪ New York State

Florida ▪ Philadelphia, PA

Georgia ▪ San Diego County, CA

Iowa ▪ Utah

Maryland ▪ Virginia

North Dakota ▪ Wyoming

New Hampshire

Jurisdictions Represented on Coverage Map (n=42)

Type of Jurisdiction

States

61%

Regions

29%

Cities

10%

Percentage of ED Coverage by Jurisdiction (n=42)

Average ED coverage is 58%

Frequency of Jurisdictions Using BioSense (n=42)

Not Using BioSense

66%

Using BioSense

34%

Percentage of Systems (other than BioSense) Used (n=27)

ESSENCE

23%

Other

15%

HMS

11%

SAS, Other

11%

EARS

8%

RODS

8%

Orion

3%

ESSENCE, RODS

3%

ESSENCE, Other

3%

EARS, Other

3%

SAS

3%

EARS, Orion, Other

3%

ESSENCE, EARS, SAS

3%

AEGIS

3%


September 1st thru January 17th 2011

BIOSENSE REDESIGN USER REQUIREMENTS

-BioSense program-BioSense system Canned vs. customized

reports

Data sharing policies, memorandums of understanding, contracts, and/or formal

agreements between jurisdictions

Skilled workers: data analysis, interpretation and reporting,

and technical support Data views within and across jurisdictions

One-on-One User Sessions

Group User Sessions

Webinars

Collaboration Web Site

Feedback Forums

Data validationGraphs and charts, maps,

aggregate data, detailed-level data, and tabulated data

Data for an event vs.

routine surveillance


Online Public Health Situation Awareness (PHSA)

Feedback Forums to Date

PHSA Feedback

Forums Dates

*Respondents

TotalLocal State National Hospital Reg. HIE Unknown

PHSA Post 1 10/29/10 5 3 1 0 0 2 11

PHSA Post 2 11/02/108 7 0 0 2 2 19

PHSA Post 3 11/12/10 12 13 0 1 0 3 29

PHSA Post 4 11/24/10 11 8 0 0 0 0 20

PHSA Post 5 12/20/10 12 11 1 1 0 0 25

PHSA Post 6 01/28/11 6 15 0 1 0 0 22

Total 54 57 2 2 2 7 124

Source: Feedback Forum Posts 1-5, Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign

Total Number of Respondents = 124; September 1 – February 9, 2010

https://sites.google.com/site/biosenseredesign

Online Public Health Situation Awareness (PHSA) Feedback Forums to Date

*Does not exclude returning jurisdictions.


A majority of stakeholders (86% from Post 3 as of January 2011)

feel that there is value in viewing a regional or national view to

achieve public health situation awareness.

A large number of jurisdictions (73% from Post 2 as of November

2010) have echoed that a regional and national view to obtain public

health situation awareness is strengthened in the presence of

policies, memorandums of understanding (MOUs), contracts, or

formal agreements for data sharing.


The following data sources were predominantly ranked as “very

important” by most state and local jurisdictions for routine

monitoring/surveillance (Post 5 as of January 11, 2011):

Reportable disease data by 88.9% of state and 81.8% of local

jurisdictions participating in the post.

Lab results data by 66.7% of state and 81.8% of local jurisdictions that

participated in the post.

Syndromic surveillance data by 66.7% of state and 72.7% of local


Clinical data by 54.5% of local jurisdictions participating in the post.

Communicable disease data by 63.6% of local jurisdictions

participating in the post.

Sample of Current Findings

The following data sources were predominantly ranked as “very

important” by most state and local jurisdictions for surveillance

during an event (Post 5 as of January 11, 2011):

Syndromic surveillance data by 88.9% of state and 54.5% of local


Communicable disease data by 88.9% of state and 54.5% of local


Inpatient data by 55.6% of state and 54.5% of local jurisdictions that


Reportable disease data by 77.8% of state and 72.7% of local


Lab results data by 77.8% of state and 63.6% of local jurisdictions that


Clinical data by 54.5% of local jurisdictions participating in the post.


Preferred data views for routine surveillance by state and local jurisdictions responding to Post 3 as of February 9, 2011


Preferred data views during an event by state and local jurisdictions responding to Post 3 as of February 9, 2011


Training needs and IT infrastructure issues from Post 4 respondents as of January 11, 2011

HDs Readiness for SS MUse

Many State or Community Health Agencies are not

yet prepared to receive the new wave of EHR data

According to TFAH, ASTHO and BioSense Program redesign

ASTHO’s MUSe Readiness Survey, # of States and Territories Responding = 35

Core Processes and EHR Reqs for PH SS

Data Sources Data on emergency

department (ED) and urgent care (UC)

patient visits captured by health information

system and sent to a public health authority

defines the scope of this recommendation

Surveillance Goal Assessment of

community and population health for all

hazards defines the scope of this

recommendation

Message and Vocabulary Standards

Standards that support current and

continued PHSS improvements, while

maintaining consistency with those

standards required by the CMS EHR

Reimbursement Program define the scope

of this recommendation

ISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use

http://syndromic.org/projects/meaningful-use



Core Processes and EHR Reqs for PH SS:Consensus-Driven Development

ISDS MUse Workgroup informed

early iterations. Stakeholder input

validated, refined and better

contextualized the

recommendations.

41 stakeholders commented; ~ 20%

corporations or professional

organizations

4 EP or Hospital

9 Vendors

20 Public Health

2 Other

Core Processes and EHR Reqs for PH SS: 32 Recommended Elements















Acknowledgements

US CDC James Buehler*, Samuel

Groseclose*, Laura Conn*, Seth Foldy*, Nedra Garrett*

RTI International Barbara Massoudi*, Lucia Rojas-

Smith, S. Cornelia Kaydos-Daniels, Annette Casoglos, Rita Sembajwe, Dean Jackman, Ross Loomis, Alan O'Connor, Taya McMillan, Amanda Flynn, Tonya Farris, Alison Banger, Robert Furberg

Epidemico John Brownstein*, Clark Freifeld,

Deanna Aho, Nabarun Dasgupta, Susan Aman, Katelynn O'Brien

TEP Members

David Buckeridge*, Julia Gunn,

Jim Kirkwood, Denise Love, Judy

Murphy, Marc Paladini, Tom

Safranek, Lisa Ferland, Richard

Hopkins, Walter Suarez

ISDS

Charlie Ishikawa*, Anne Gifford,

Rachel Viola, Emily Cain

* Co-authors

Thank You!

BioSense Redesignhttp://biosenseredesign.org

biosense.redesign2010 AT gmail DOT com

ISDS MUse Workgrouphttp://syndromic.org/projects/meaningful-use

Any views or opinions expressed here do not necessarily represent the views of the CDC, HHS, or any other entity of the United States

government. Furthermore, the use of any product names, trade names, images, or commercial sources is for identification purposes only,

and does not imply endorsement or government sanction by the U.S. Department of Health and Human Services.

http://biosenseredesign.org/




Updates on the BioSense Program Redesign: 2011 Public Health Preparedness Summit

Health & Medicine

department of health

health information exchanges

based surveillance

improved health outcomes

hazards healthrelatedevents

based reporting

ed data

completeness of reporting