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State of the Science:Preparedness Informatics

John W. Loonsk, M.D.

Associate Director for InformaticsCenters for Disease Control and Prevention

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Informatics - the Science

• Medical Informatics - the rapidly developing scientific field that deals with resources, devices and formalized methods for optimizing the storage, retrieval and management of biomedical information for problem solving and decision making. - Edward Shortliffe

• Public Health Informatics – “Improving the way public health is practiced by taking advantage of what technology affords…”

• The Science of Informatics – We are not interested that your hard drive needs backing up or you can’t log into e-mail

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Why Now?

A Unique Moment in Time for Public Health Information Technology

−Clinical care - becoming computerized – best opportunity ever to get clinical data

−Improved ability to share data because of standards – now engaged at the federal level

−Informatics – have seen ways that IT can help public health do more

−Technology more available – connectivity, software, development and resources

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Why Now?

A Unique Moment in Time for Public Health Information Technology

−Anthrax attacks – there are compelling and urgent needs

−Recognition of public health’s role – a unique part of homeland defense

−West Nile – threat isn’t only terrorism

−SARS – must depend on international colleagues

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• Information systems and informatics are becoming an assumed part of what public health is

• In transition from:− Information systems can help and you should use these

standards if you build them.to−You need to have systems that do specific things and

they must be regularly used to achieve optimal public health outcomes.

• Having these systems consistently in place (and in clinical care) = new public health benefits

State of the Science: National Center for Public Health Informatics

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IT Needs of a Major PH Event

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State and Local Public Health Departments Centers For

Disease Control and Prevention

(CDC)

State/Local Response

Team

Other Federal Response

Team

Contractor Response

Team

FBI

Contaminated Bldg.

Regular Lab (non-

LRN)

02.10

Person

010

02N0

0 3 0

04N0

04.110

04P0 04.120

04.1r0

05006N006P0

06.10

04.130

04.20

06.110

06.120

06.20

06.130

0 0 – specimen 0

02P0

Other Federal

Agencies

070

080

01000110

0120

0130

Public Health Partners Messaging Information Flows Ted Klein

0100

0160

016001700170

0150

0150

0150

0140

0140

Affected Community

LRN Labs (may be separate or

combined A/B/C)

0200

0180

0190

Local Responders (police, fire,

etc.)0220

0230

Clinical Site

Hospital Clinic

0240 0250

0260

0270

0270

CDC Response Team

0300

0320

0330

04.30

02.20

04.40

04.1q0

0350

080

080

080090

0370

0390

02800360

04.50

0400

0410

0430

0440

0450

0380

0380

0420

Treatment/Intervention Center

0210

0460

0470

0480

0490

0500

0510

0140

0150 0310

02900140

080

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State of the Science: Interoperable Systems

Systems that can directly exchange information and services

−Shared data standards

−Shared technical standards

−Shared information architecture

Federal Health Architecture, NHII

& Consolidated Health Informatics

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State of the Science: Interoperable Systems

HL7

<?xml version="1.0"?><caseWorkup> <caseResult> <observation></observationResult> <caseResult> <labData> <labTest></labTest> </labData></caseWorkup>

B

Integration

A

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PublicHealthInformationNetwork

Health Department

Public HealthLab

CDC and Other

Federal Organizations

Public

VaccinationCenter

AmbulatoryCare

Hospital orHealth Plan

Investigation Team

Law Enforcement and First Responders

RXPharmaceutical

Stockpile

Early DetectionSources

CoordinatedOrganizationsand Systems

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• Event 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 isolation, prophylaxis, vaccination, etc.

PHIN Coordinated Functions

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State of the Science: Early Event Detection

Health care data are available to public health, in real time, for early event detection, localization, quantification, and monitoring

−Clinical care diagnoses, lab results, procedures

−Other health related data (e.g. test orders, prescriptions, early health seeking behaviors) offer promise also

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Public Health Case

Reports

Case ReportName: JaneAge 46Sex FemaleWeight____Height_____Temp_____ BP_______

Traditional Case Reporting• Most reporting steps are still paper-based and manual• Many, if not most, reportable disease cases are not

reported• Can take as long as 26 days for a bioterrorism related

disease to be reported to the CDC• Inconsistent coverage of major cities and no timely

cross-jurisdictional coverage

Diagnoses and Procedures from

Clinical Care Sites

Secondary Reporting of Health Care Data• Near real-time data analysis• No clinical reporting burden• Critical for next steps of secondary detection,

investigation, quantification, localization, and outbreak management

Early Detection Data

Investigative Early Detection Data Sources• Over the counter drug sales• School / work absenteeism• Other data

State of the Science: Early Event Detection

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Clinical care data supportive of many information needs – even after an event has been identified

West Nile Virus NYC - 1999

Epi investigation started

0

1

2

3

8-Aug

15-A

ug

22-A

ug

Date of Admission

Nu

mb

er o

f ca

ses

Unreportedcases

Reportedcases

NYC DOHMH – Marci Layton

State of the Science: Early Event Detection

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Detection algorithms can identify and monitor outbreaks and events

−Complement the well trained clinician – don’t replace them

−Can detect subtle events in data early – may not be visible at any single site

−Use algorithm across multiple data sources to increase sensitivity and specificity

BioSenseDemonstration Data

State of the Science: Early Event Detection

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State of the Science: Early Event Detection

A bi-directional network for getting detection data can enhance privacy protection

−Patient names and medical record numbers can be kept out of reporting

−Privacy can be protected−Appropriate public health

investigation (query), can be supported through linking

Reported data – no names or

medical record numbers

AppropriatePublic HealthInvestigation

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State of the Science: Outbreak Management

Systems for managing outbreaks

−Outbreaks are frequently about relationships Lab results to possible

cases Person to person Vector to person Location to person

Bogatti SP. Reprinted in MMWR 5-9-03

SARS cases in Singapore

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State of the Science: Outbreak Management

Systems for managing outbreaks

−Outbreaks are frequently about relationships Lab results to possible cases Person to person Vector to person Location to person

−Computer does the contact tracing / data linking

−Public health professionals do the analysis and planning

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State of the Science: Information Dissemination

Information accessed when and where it is needed for supporting public health outcomes

−Consistent content descriptors for content indexing (metadata and vocabulary) allow for better searching and multipurposing

−Separating content (text) from the presentation (i.e. web page) allows for use on web, in PDA’s in internal documents and in decision support systems

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State of the Science: Information Dissemination

Information delivered to those who need it in the way that they want it

−Using consistent directories of those who participate in public health with standard roles

−Systems that can deliver information with consideration for roles, geographic location, level of urgency and method of delivery (pager, e-mail, call, etc.)

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State of the Science: Counter Measure and Response

AdministrationSupport delivery of prophylaxis, vaccination and management of isolation and treatment

−Optimization and management of response is very data intensive

−Computer systems are necessary to monitor the effectiveness and completeness of response

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Early Event DetectionBioSense

Outbreak Management

Outbreak Management System

SurveillanceNEDSS

Secure CommunicationsEpi-X

Analysis & InterpretationBioIntelligence

analytic technology

Information Dissemination & KM

CDC WebsiteHealth alerting

PH ResponseCountermeasure

administrationLab, vaccine,

prophylaxis

Federal Health Architecture, NHII

& Consolidated Health Informatics

Public Health Information Network

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