an update to ISDS 9th Annual Conference

introducing

BioSense Program Redesign

Office of Surveillance, Epidemiology, and Laboratory Services

Public Health Surveillance Program Office

Taha A. Kass-Hout, MD, MSDeputy Director for Information Science

BioSense Program Manager

Samuel L. Groseclose, DVM, MPHDirector (Acting)

Division of Healthcare Information (DHI)

Public Health Surveillance Program Office (PHSPO)

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

Centers for Disease Control & Prevention (CDC)

Barbara L. Massoudi, MPH, PhDSenior Research Health Scientist

BioSense Redesign, Project Director

RTI International

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

Thursday, December 2nd, 2010

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 thoseevents

– Multiple uses to support your public health Situation Awareness; routine public healthpractice; and improved health outcomes and public health

• Our strategy is to increase BioSense Program participation and utility andto support local and state jurisdictions’ health monitoring infrastructureand workforce capacity– Requires collaboration with other CDC Programs and federal agencies

Let’s not throw the baby out with the bath water…– 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)

Working with you every step of the way

Building the Base

Connecting the Dots

Sharing Information

A 3-Pronged Approach

Update: FY 2010

• Improved and consolidated internal contract management for theBioSense system, with savings being applied directly to increase funding tosupport local and state health departments’ (SHD) syndromic surveillanceefforts

– BioSense provided ~11% ofallocated funding to 16 states, DC,and 4 cities through ELC [awardedSeptember 2010] supporting ~37FTEs at the S&L levels

– Funded (>$1M) CSTE, ASTHO,NACCHO, and ISDS to assist withBioSense redesign and MUseinitiative

– Only one contract: RTI Internationalto assist with the redesign effort

FY 2010, provided ~$3M in funding to 16 states, 4 cities,

and Washington, DC through ELC Cooperative Agreement

The challenge is to keep BioSense simple

It is where organizations, people, networksand communications, and systems cometogether

CollaborationCollaborationCollaboration

• 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 Dept of Health, NCDetect

• Rabies post-exposure prophylaxis– Poxvirus & Rabies Branch

• Influenza-like illness surveillance– Influenza Division

– Contribution to Distribute

• ISDS– MUse Workgroup

Selected BioSense Program Collaborations

ISDS MUse Workgroup

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

– Core elements defined (< 30)

– Draft message format in review

– Current work includes use case development and workflow mapping

– Public comment period: December 1-17, 2010

Selected Stakeholders

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

Stakeholder 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

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

Syndromic Coverage Map

Requirements Gathering

Community Forum

Environmental Scan

The purpose of the environmental scan is to assess current best practices insurveillance 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 the Distribute project.

Stakeholder Involvement

September 1st thru November 29th 2010

Stakeholder Input: Feedback Forum Posts

Post Name Post Post Date Data Pull DateTotal

Responders

State-Level

Respondents

Local-Level

RespondentsForum Post Direct Link

Public Health

Situation AwarenessFeedback Forum 1 09/24/2010 10/29/2010 10 3 3

https://spreadsheets1.google.com/ccc?ke

y=tHPow-

vIOUKUAq_VZHD3lgQ&authkey=CKix6v

8O&hl=en&authkey=CKix6v8O#gid=0

Public Health

Situation Awareness:Feedback Forum 2 10/15/2010 11/2/2010 14 6 8

https://spreadsheets0.google.com/ccc?ke

y=t0YWgbihc0PUeQM2JgPYk7g&authke

y=COn3lrcK&hl=en&authkey=COn3lrcK#

gid=0

Public Health

Situation Awareness:Feedback Forum 3 10/29/2010) 11/12/2010 15 7 7

https://spreadsheets0.google.com/ccc?ke

y=tEJKGc3QzLhxe4YI3jTOE6w&authkey

=CIKS2n8&hl=en&authkey=CIKS2n8#gid

=0

Source: Feedback Forum Posts 1-3, Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign

Total Number of Respondents = 39 [Answers Range: 4-15]; September 1 – November 12, 2010

Stakeholder Input: Summary

• The BioSense Redesign Collaboration Site has been visited by abroad range of public health stakeholders from all jurisdictionlevels

– Most (87%) felt there is value in viewing a regional or national surveillance picture

• The value provided by BioSense is focused on identifying andtracking outbreaks and understanding disease transmissionpatterns

• While preferences for presenting information changes little duringa public health event, the types of data required do change

• There are many barriers to data sharing, including the lack ofestablished policies and agreements

Hospital3%

Local51%

National3%

State43%

• Many syndromes or conditions (including bioterrorism-related) need to be captured to supportPH situation awareness

• Lack of funding and workforce deficiencies are the most common infrastructure needs

• Data sharing across jurisdictions is the most common data analysis requested

• Lack of tools, skills, and time account for all barriers related to data analysis

N=39 Responders

September 1st thru November 12th 2010

Source: Feedback Forum Posts 1-3, Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign

Total Number of Respondents = 39; September 1 – November 12, 2010

No13%

Yes87%

Track trends and detect outbreaks

to prepare jurisdiction

29%

Follow, understand and predict disease

transmission patterns

29%

Compare trends across

jurisdictions7%

Distinguish jurisdiction specific or

regional trends7%

Learn from other jurisdictions

7%

Determine magnitude of

disease7%

Determine at risk populations

7%

Determine best allocation of

countermeasures and resources

7%

Public Health Situation AwarenessNeed for regional or national picture Value in regional or national picture

Feedback Forum Post 3, Question 6, Number of Respondents = 15

Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

Feedback Forum Post 3, Question 6b, Number of Respondents = 15

Aggregate25%

Graphs and Charts

25%Tabulated

17%

Dynamic Maps17%

Detail-level16%

Dynamic Maps23%

Graphs and Charts

21%

Aggregate19%

Detail-level19%

Tabulated18%

Public Health Situation AwarenessInformation presentation during routine surveillance Information presentation during an event

Feedback Forum Post 3, Question 3, Number of Respondents = 15

Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

Feedback Forum Post 3, Question 4, Number of Respondents = 15

EMS13%

Inpatient10%

Lab Requests10%

Lab Results10%

Poison control10%

OTC treatmentsales

10%

Injury7%

Law enforcement

6%

Prescription sales6%

Absenteeism6%

Syndromic6%

Weather6% EMS

15%

Inpatient 11%

Injury 11%

Lab Requests11%Poison control

11%

OTC treatment sales 11%

Lab Results 8%

Prescription sales 8%

Absenteeism7%

Psychological7%

Public Health Situation AwarenessData needed for PH SA during routine surveillance Data needed for PH SA during an event

Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

Feedback Forum Post 1, Question 3, Number of Respondents = 10 Feedback Forum Post 1, Question 4, Number of Respondents = 10

Data-sharing MOUs,

contracts, agreements

between jurisdictions

53%

Data-sharing POLICIES

20%

Automation13%

Investment in personnel

7%

Good relationships

and trust7%

Non-existent data-sharing

policies, MOUs, contracts,

agreements13%

Lack of financial resources

13%

Reportable disease laws

13%

Identifiable data13%

Lack of common data definitions

6%

Non-existent data-sharing

policies, MOUs, contracts,

agreements for LOCAL data

6%

No "triggers" indicating what

data needs to be shared

6%

Lack of automation

6%Lack of workforce capacity

6%

Politics6%

Confidentiality Concerns

6%

Lack of interest in surveillance

after event6%

Public Health Situation AwarenessPolicies that facilitate data sharing Policies that hinder data sharing

Data aggregation (e.g., weekly ILI); Community-driven models; such as Distribute, and Epi-X

Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

Feedback Forum Post 2, Question 3, Number of Respondents = 13 Feedback Forum Post 2, Question 2, Number of Respondents = 13

Lack of understanding of

Data or data sharing

(perceived to be of no value)

27%

Agencies reluctant to share data

13%

Cultural barriers

6%Cost of data6%

Complicated systems

6%

Date reporting burdens

7%

Lack of data validation

7%

Time and responsibilities

7%

Fear of data being

compromised7%

Politics7%

Adopting a centralized

system7%

Consistent50%

Inconsistent50%

Public Health Situation AwarenessBarriers to obtain data for PH SA Data sharing consistency during routine surveillance or an event

Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

Feedback Forum Post 2, Question 5, Number of Respondents = 11 Feedback Forum Post 2, Question Y, Number of Respondents = 14

GI17%

Bioterrorism Agents

13%

ILI8%

Injury8%

Neurological8%

communicable disease

4%

Trauma4%

Reportable4%

Seasonal4%

Acute lllness4%

Respiratory4%

Rash4%

EIS syndromes4%

Fever4%

User-defined 4%

11 BioSense syndromes

4%

Funding capacity (to maintain

infrastructure)22%

Workforce IT/Informatics

skillsets11%

Workforce public health skillsets

(epi, data analysis)

11%No infrastructure needs11%

Access to data11%

Standard specifications:

data transmission,

reporting 5%

Analysis tools5%

Automation6%

Governance6%

ELR to HDs6%

Infectious disease

Morbidity reporting to HDs

6%

Public Health Situation AwarenessPriority syndromes or conditions to track for situation awareness Information technology (IT) and infrastructure needs

Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

Feedback Forum Post 1, Question 5, Number of Respondents = 10 Feedback Forum Post 3, Question 2, Number of Respondents = 15

Data views across

jurisdictions38%

Support data sharing

15%

Financial support

7%

increase local level input

8%

consistent cross functional

system infrastructure

(tools for collection,

analysis, and reporting)

8%

Evaluating existing systems

8%

View zip-code level data

8%

interoperable system

8%

Lack of personnel or

time45%

Inadequate skills33%

Inadequate analysis tools

22%

Public Health Situation AwarenessAnalysis needs Analysis barriers

Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

Feedback Forum Post 3, Question 5b, Number of Respondents = 8 Feedback Forum Post 3, Question 5c, Number of Respondents = 4

Acknowledgements

• CDC– James Buehler*, Laura Conn,

Seth Foldy

• RTI International– 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

Please Join Us @biosense.redesign2010 AT gmail DOT comhttps://sites.google.com/site/biosenseredesign

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