Leveraging public health’s experience with information

standards and health improvement

Claire Broome, M.D.Centers for Disease Control and Prevention (CDC)

June 24, 2004Connecting Communities for Better Health

What is the “business” of public health?

Surveillance Detect outbreaks—bioterrorist, foodborne, etc Assess health status of population Assist in health planning

Investigation of causes and transmission pattern Development of effective interventions to prevent disease

and promote health Real time interoperable network needed for data and

communication exchange with myriad partners

Public HealthInformation

Network (PHIN)

Health Department

Public HealthLab

CDC and Other

Federal Organizations

Public

VaccinationCenter

AmbulatoryCare

Hospital orHealth Plan

Investigation Team

Law Enforcement and First Responders

RXPharmaceutical

Stockpile

Non-Clinical SourcesOTC, 911, etc.

Early Event DetectionBioSense

Outbreak Management

Outbreak Management

System

SurveillanceNEDSS

Secure CommunicationsEpi-X

Analysis & InterpretationBioIntelligence

analytic technology

Information Dissemination & KM

CDC WebsiteHealth alerting

PH ResponseLab, vaccine

administration, etc.

Federal Health Architecture, NHII

& Consolidated Health Informatics

Public Health Information Network

Detection and monitoring – support of disease and threat surveillance, national health status indicators

Analysis – facilitating real-time evaluation of live data feeds, turning data into information for people at all levels of public health and clinical care

Information resources and knowledge management - reference information, distance learning, decision support

Alerting and communications – transmission of emergency alerts, routine professional discussions, collaborative activities

Response – management support of recommendations, prophylaxis, vaccination, etc.

PHIN Coordinated Functions

How do we get to standards based interoperable systems?

Gartner Group project on PHIN implementation – PHIN is a multi-organizational business and technical architecture Technical standards Data standards Specifications to do work

Is also a process Commitment to the use of standards Commitment to participating in development and

implementation of specifications

PHIN Components

Services/Tools Health Alert Network (HAN) – Internet

connectivity, alerting and distance learning PHIN Vocabulary Services – standard

vocabulary versioning, and provisioning CDC Web Redesign – public health

information architecture--better access PHIN Messaging System – secure bi-

directional data transport (ebXML)

PHIN Components

Applications National Electronic Disease Surveillance

System (NEDSS)

• web entry for disease surveillance

• automatic electronic reporting of laboratory results indicating a notifiable disease

BioSense – early event detection

Laboratory Response Network (LRN) – diagnostic capacity for threat agents

PHIN funding

September 2002: Public Health and Social Services Emergency Fund provides >$1 billion for state and local public health preparedness capacity guidance from CDC and HRSA to use PHIN

standards for IT investments Guidance explicitly includes NEDSS as part of

surveillance September 2003 : second year Preparedness funding

HRSA grants $498 million ; CDC $870 million

Example of a potentially useful “tool”: PHIN Messaging System

(PHIN-MS)Software for industry standards based inter-institutional message

transport available from CDC ebXML “handshake”, PKI encryption and security Payload agnostic (HL-7, text file, etc) Bi-directional data exchange

PHIN-MS in use by state and local partners for point to point messaging (ED and lab to state; state to CDC)

Several commercial systems planning to incorporate

integration broker

laboratory information system

How can public health accelerate interoperable standards based health information systems?

Public health intrinsically must exchange information with all clinical partners in a population Shouldn’t all LHII’s have a public health participant?

Evident public value—outbreak detection, preparedness Concrete solutions for standards based interoperability – e.g.

bidirectional secure messages (ebXML) HL7 V 3 messages implementation guides

Development of data use agreements

Background Information

What does PHIN have to do with HIPAA?

HIPAA mandates national health care data standards and policies in four areas: Transaction content; unique identifiers for providers, health plans;

security; privacy PHIN architecture standards are HIPAA compliant:

supports “dual use” for security, messaging elements Approach to PHIN data standards is HIPAA compliant:

Adopting HIPAA standards where relevant Advocating inclusion of data elements relevant to public health with

SDO’s

What does PHIN have to do with HIPAA Privacy Rule?

Privacy Rule allows current practice of sharing data with public health Rule permits health care providers to share

individually identifiable information with legally authorized public health entities for public health activities

Public health activities include surveillance (NEDSS), investigation, intervention

Early event detection is critical for Bioterrorism management and response

The most useful tools will be dual use; Bioterrorism capable and regularly exercised for “routine” public health activities

Multiple data sources should be co-ordinated to facilitate signal evaluation and reduce user burden

Both diagnostic and pre-diagnostic (syndromic) data exist in electronic form in many yet untapped health-related data stores

BioSense - Principles

What is Biosense?

Near real-time data access Analysis capabilities at local, state

and national levels Shareable outbreak detection

algorithms and analytic capabilities National coverage

BioSense System INational andRegional Data

Sources City / StateRecipients

National labstest requests & results

Nurse CallLine Data

Over-the-counterdrug sales

DoD and VA sentinel clinical data

Lab Response Network(including BioWatch)

Analysis and Visualization

Clinical lab orders

BioSense System II (proposed)

National andRegional Data

Sources

City / StateRecipients

National labstest requests & results

Nurse CallLine Data

Over-the-counterdrug sales

DoD and VA sentinel clinical data

Lab Response Network(including BioWatch)

State and MetropolitanSurveillance and

Response Systems(others)

Analysis and Alerts

Electronic Investigation

Regional clinicalnetworks

Next Steps

BioSense system infrastructure is in use at CDC System I released for state and city use April

2004 For public health users, AND as a platform for

evaluation of early detection analytics Actively seeking additional:

Outbreak analytic approaches Display approaches for multiple data sources Interested groups-> jloonsk@cdc.gov

National Electronic Disease Surveillance System (NEDSS)-- PHIN surveillance component

Browser-based data entry over Internet Person-centric Case investigation capabilities Electronic Laboratory Results HL 7

messages (2.x) can be received Security that meets HIPAA standards HL7 Version 3 case notification message

from state to CDC

NEDSS Base System

NEDSS compatible system for state and local use developed by an experienced web software developer (Computer Sciences Corporation)

Also useful as a specific implementation of NEDSS e.g. standard messages, database model

Version 1 includes 93 notifiable diseases, and modules for vaccine preventable diseases, hepatitis, bacterial meningitis and pneumonia

Now at Version 1.1.3; includes expanded data entry capacity, reporting capacity, locally defined fields

NBS Deployment Planned - 19

NBS Collaborative Development - 1

NBS Deployment Underway - 8

NBS In Use – 4

Los Angeles

Chicago

Houston

Washington D.C.

Philadelphia

New York City

NEDSS – Compatible State/Jurisdiction Development - 26

NBS = NEDSS Base System (CDC-developed)

31 Total NBS Sites

NEDSS Site Status as of 04/21/23