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

Updates on the BioSense Program Redesign

2011 Public Health Preparedness Summit
Session WS-16—Location International 10
Tuesday, February 22, 2011 1:30 PM- 5:30 PM
Atlanta, GA, USA – February 22-25, 2011

Taha A. Kass-Hout, MD, MS
Deputy 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.

Public Health Surveillance Program Office
Office of Surveillance, Epidemiology, and Laboratory Services

The Public Health Surveillance Challenge
 Public Health  Limitations of
Surveillance is a global traditional reporting
challenge systems
 The importance of  Hierarchical lines of
timely detection 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, “Federal agencies must focus on consolidating existing data
specifications, and lessons centers, reducing the need for infrastructure growth by
implementing a “Cloud First” policy for services, and
learned 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 Redesign
Updated 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 3-Pronged Approach

Building Connecting Sharing
the Base the Dots Information

A User-Centered Approach

Technical Expert Panel (TEP)—Current Status
 David Buckeridge  Judy Murphy
 McGill University  Aurora Health System
 Julia Gunn  Marc Paladini
 National Association of County  NYC Department of Health
and City Health Officials and Mental Hygiene
(NACCHO)  Tom Safranek, Lisa Ferland,
 Jim Kirkwood Richard Hopkins
 Association of State and  Council of State and Territorial
Territorial Health Officers Epidemiologists (CSTE)
(ASTHO)
 Walter G. Suarez
 Denise Love  Kaiser Permanente
 National Association of Health
Data Organizations (NAHDO)

Selected 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

Selected Stakeholders

Stakeholder Involvement

 Seeking individuals from
professional
organizations to
participate in redesign
effort Coverage Map
 Coordinating presence at
national conferences
 Identifying individuals to Requirements Gathering
update the map on the
collaboration site
 Disseminating redesign Community Forum
project information
through communication http://biosenseredesign.org

channels

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

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

Cities
10%

Regions
29%
States
61%

Percentage of ED Coverage by Jurisdiction
(n=42)

Average ED coverage is 58%

Frequency of Jurisdictions Using BioSense
(n=42)

Using BioSense
34%

Not Using BioSense
66%

Percentage of Systems (other than BioSense)
Used (n=27)
ESSENCE, RODS
Orion
3% 3%
ESSENCE, Other
ESSENCE, EARS, SAS 3%
3%
EARS, Orion, Other
3% ESSENCE
23%
AEGIS
SAS 3%
3%

EARS, Other
3%

RODS
8%

Other
EARS 15%
8%

SAS, Other
HMS
11%
11%


September 1st thru January 17th 2011

One-on-One
User Sessions

Data sharing policies, memorandums of
Graphs and charts, maps, understanding, contracts, and/or formal
aggregate data, detailed-level Data validation agreements between jurisdictions
data, and tabulated data

Group User Webinars
Sessions
BIOSENSE REDESIGN
USER REQUIREMENTS
-BioSense program Data for an event
Canned vs. customized
-BioSense system vs.
reports routine surveillance

Skilled workers: data analysis,
interpretation and reporting,
and technical support Data views within and across
jurisdictions

Collaboration
Web Site
Feedback Forums

Online Public Health Situation Awareness (PHSA)
Feedback Forums to Date
*Respondents
PHSA Feedback
Forums Dates Local State National Hospital Reg. HIE Unknown Total

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

8 7 0 0 2 2 19
PHSA Post 2 11/02/10

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

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

Core Processes and EHR Reqs for PH SS:
Consensus-Driven Development
ISDS MUse Workgroup informed 41 stakeholders commented; ~ 20%
early iterations. Stakeholder input corporations or professional
validated, refined and better organizations
contextualized the 4 EP or Hospital
recommendations. 9 Vendors
20 Public Health
2 Other

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

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

Acknowledgements
 US CDC  TEP Members
 James Buehler*, Samuel
Groseclose*, Laura Conn*, Seth  David Buckeridge*, Julia Gunn,
Foldy*, Nedra Garrett* Jim Kirkwood, Denise Love, Judy
Murphy, Marc Paladini, Tom
Safranek, Lisa Ferland, Richard
 RTI International
Hopkins, Walter Suarez
 Barbara Massoudi*, Lucia Rojas-
Smith, S. Cornelia Kaydos-
Daniels, Annette Casoglos, Rita
Sembajwe, Dean Jackman, Ross  ISDS
Loomis, Alan O'Connor, Taya  Charlie Ishikawa*, Anne Gifford,
McMillan, Amanda Flynn, Tonya
Farris, Alison Banger, Robert Rachel Viola, Emily Cain
Furberg

 Epidemico
 John Brownstein*, Clark Freifeld,
Deanna Aho, Nabarun Dasgupta,
Susan Aman, Katelynn O'Brien * Co-authors

Thank You!
BioSense Redesign ISDS MUse Workgroup
http://biosenseredesign.org http://syndromic.org/projects/meaningful-use
biosense.redesign2010 AT gmail DOT com

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.

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