novel approaches in public health surveillance
DESCRIPTION
Update to the International Meeting on Emerging Diseases and Surveillance (IMED) community on the latest activities for the BioSense Program redesign and public health syndromic surveillance (PHSS) meaningful use objective.TRANSCRIPT
Office of Surveillance, Epidemiology, and Laboratory Services
Public Health Surveillance Program Office
Novel Approaches in Public Health Surveillance
BioSense Program Redesign, Meaningful Use, and Syndromic Surveillance
Taha A. Kass-Hout, MD, MSDeputy Director for Information Science (Acting) and BioSense Program Manager
Division of Notifiable Diseases and Healthcare Information (DNDHI)
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.
International Meeting on Emerging Diseases and Surveillance (IMED)
Session 13: New Surveillance StrategiesSunday, February 6, 2011: 8:30-10:30 AM
Vienna, Austria – February 4-7, 2011
The Public Health Surveillance Challenge
Surveillance is a global
challenge that knows
no borders
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
A Global Challenge
WHO reported outbreaks, 1996-2009
n=398
Next Generation Public Health SurveillanceAutomated Healthcare data and informal sources,
Community Engagement, and Artificial Intelligence
Automated healthcare data
(laboratory, immunization,
notifiable conditions, syndromic,
personal health records, …)
Informal sources
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
Example 1: The Distribute Project
President’s Council of Advisors on Science and Technologyrecommended expanded use of Emergency Department SS data
New CDC Director accustomed to daily use of ED SS data for influenza and other situation awareness in NYC
CDC funded and worked collaboratively with the Public Health Informatics Institute (PHII) to support rapid scale-up of ISDS Distribute project
Public-access site: http://isdsdistribute.org
Distribute: Philosophy
Public-access site: http://isdsdistribute.org
Distribute: System
Participating Sites (39)
State (26, 67%)
Sub-State (8, 21%)
City (5, 13%)
~67.5 million ED visits
(>140,000 visits/day)
from April 1, 2009 thru
Feb 1, 2010
Buckeridge DL, Brownstein JS, Lober WB, Olson DR, Paladini M, Ross D, Finelli L, Kass-Hout TA, Buehler JW. 2011. The
Distribute Project: Rapid Sharing of Emergency-Department Surveillance Data During the Influenza A/H1N1 Pandemic. In Review.
Distribute: Outcome
Buckeridge DL, Brownstein JS, Lober WB, Olson DR, Paladini M, Ross D, Finelli L, Kass-Hout TA, Buehler JW. 2011. The
Distribute Project: Rapid Sharing of Emergency-Department Surveillance Data During the Influenza A/H1N1 Pandemic. In Review.
Example 2: 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
BioSense Program RedesignSelected Stakeholders
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
http://biosenseredesign.org
Coverage Map
Requirements Gathering
Community Forum
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
BioSense Program RedesignStakeholder Involvement
September 1st thru January 17th 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
Stakeholder Input: Summary
The BioSense Redesign Collaboration Site has been visited
by a broad range of public health stakeholders from all
jurisdiction levels
Most (87%) felt there is value in viewing a regional or national
surveillance picture
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
Hospital3%
Local51%
National3%
State43%
Value in the BioSense Network
Data sharing across jurisdictions is the most common data analysis requested
The value provided by BioSense is focused on identifying and tracking outbreaks and
understanding disease transmission patterns
While preferences for presenting information changes little during a public health event, the
types of data required do change
Many syndromes or conditions (including bioterrorism-related) need to be captured to
support PH situation awareness
Barriers
There are many barriers to data sharing, including the lack of established policies and
agreements
Lack of funding and workforce deficiencies are the most common infrastructure needs
Lack of tools, skills, and time account for all barriers related to data analysis
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
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
ISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use
Core Processes and EHR Reqs for PH SS: 32 Recommended Elements
ISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use
Core Processes and EHR Reqs for PH SS: 32 Recommended Elements
ISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use
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.