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.