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BioSense Program Going Forward: HIMSS10 Conference
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BioSense Program Going Forward: HIMSS10 Conference

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As mandated in the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, CDC’s BioSense program was launched in 2003 with the aim of establishing an integrated system of ...

As mandated in the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, CDC’s BioSense program was launched in 2003 with the aim of establishing an integrated system of nationwide public health surveillance for the early detection and prompt assessment of potential bioterrorism-related illness. Over the following several years, as awareness grew about the limits of syndromic and related automated surveillance systems, including BioSense, in providing early and accurate epidemic alerts, increased emphasis was placed on their use in providing timely situation awareness throughout the course of public health emergencies. In practice, a key application of these systems has been their use in tracking the course of seasonal influenza and, in 2009, the impact of the H1N1 influenza pandemic. While retaining the original purpose of BioSense of early event (or threat) detection and characterization, we believe the most efficient and effective approach to achieve the program’s long-term business case is to build on existing systems and programs. This will have additional public health benefits that can improve the nation’s health at all times, including: 1. Public health situation awareness, 2. Routine public health practice, 3. Improving health outcomes and public health; and 4. Monitoring healthcare quality

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BioSense Program Going Forward: HIMSS10 Conference BioSense Program Going Forward: HIMSS10 Conference Presentation Transcript

  • BioSense Program: Going Forward
    • Taha A. Kass-Hout, MD, MS
    • Deputy Director for Information Science (Acting)
    • Division of Healthcare Information (DHI) (proposed)
    • Public Health Surveillance Program Office (proposed)
    • Office of Surveillance, Epidemiology, & Laboratory Services (OSELS) (proposed)
    • Centers for Disease Control & Prevention (CDC)
    • Thursday March 04, 2010
    HIMSS10 Conference Atlanta, GA, USA 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.
  • Session Objectives
    • Background
    • Provide update on BioSense in the past year
    • Discuss what we learned from stakeholders
      • Provide background on the historical development of the BioSense program
      • Review past opportunities for stakeholder and other input
      • Discuss what we learned from these opportunities
    • Present some options for paving the way forward
  • History of BioSense
    • Launched in 2003 as a nationwide “integrated system” for early detection and assessment of potential BT-related illness
      • VA/DoD clinical info systems automated data feeds— 2005
      • Hospital direct reporting to CDC— Dec 2005
      • State HDs ED-based syndromic surveillance— Dec 2006
      • Additional sources
        • Anti-infective prescription data— Oct 2007
        • Laboratory (LabCorp and Quest)— Dec 2007
  • BioSense: Facilities (N ≈ 2,000)
  • BioSense: Pharmacies (N ≈ 27,000)
  • BioSense: 2009
    • Tracking Novel A(H1N1)
      • Collaboration with ISDS/Distribute and PHII
      • Flu Module
    • Extramural Research
      • Centers of Excellence (CoEs)
      • Health Information Exchanges (HIEs)
      • Regional Collaboratives
      • BioSense Evaluation Cooperative Agreement project
    • Research Prototypes
      • Geocoded Interoperability Population Summary Exchange (GIPSE) Specification
      • NHIN Connect
  • Collaboration with Distribute
    • BioSense contributes ED data from 9 jurisdictions (303 EDs)
      • 4 jurisdictions with HDs SS systems
      • 5 jurisdictions with direct reporting hospitals
    • Temperature and Disposition from a subset of reporters
  • Stakeholder Engagement
    • First BioSense stakeholder meeting— May 2005
    • Information Technology: Federal Agencies Face Challenges in Implementing Initiatives to Improve Public Health Infrastructure, GAO-05-308— Jun 2005
    • BioSense roundtable— Jun 2007
    • Senate Subcommittee on Bioterrorism and Public Health Preparedness— Sep 2007, Mar 2008
    • BioSense roundtable— Nov 2007
    • BioSense roundtable— Apr 2008
    • BioSense strategic plan working group— Aug, Sep 2008
    • Health Information Technology: More Detailed Plans Needed for the Centers for Disease Control and Prevention's Redesigned BioSense Program, GAO-09-100— Nov 20, 2008
      • Further Recommendations for Executive Action— Jul, Sep 2009
  • What We’ve Heard
    • Incorporate State and Local public health partner input into the program
    • Make use of clinical care or EHR records/ interconnect with Health IT systems
    • Promote a proactive, collaborative, and transparent community
    • Move towards an open, distributed computing model
    • Improve the utility of the data/data sources
  • BioSense Next Options for your Consideration
    • Start with updating the purpose of BioSense program objectives
      • In-depth review and analysis of findings and recommendations from various GAO reports and stakeholder meetings
    • Use a model that
      • Accepts inputs (e.g., alerts) from existing surveillance systems
      • Reduces processing and collection burden
    • Complement and strengthen existing systems
    • Keep technology simple and unobtrusive
    • Apply agile development to define outcome measures, be more responsive to users’ needs, and control costs
    BioSense Next: Proposed Strategy Options
  • BioSense Next: Purpose Options
    • Expand beyond early event detection and provide value in timely data for
      • Public health situational awareness
      • Routine public health practice
    • Provide a collaborative environment for all stages of PH preparedness and response activities
    • Help improve the effectiveness of the interactions between HDs electronic surveillance systems and human analysts, decision makers and responders
    BioSense Next: Utility Options
    • Reduce collection and maintenance of raw clinical data
        • De-emphasize direct reporting from hospitals to CDC
          • shift flow from hospitals to HDs if desired by jurisdictions
          • keep going in a few places as R&D type project to develop strategies for using such data
        • Shift towards appropriate national aggregation of data from state/local syndromic systems
        • Make existing warehouse open for mining and research (subject to legal, DUA, confidentiality, de-identification, etc.)
    BioSense Next: Approach Options
  • BioSense Next: Approach Options
    • Rationale for de-emphasizing direct reporting from hospitals to CDC
      • Typical PH reporting structure: Local  State  Federal
      • Response happens at jurisdiction level, no need for a federal agency to maintain detailed data
      • Jurisdictions own the relationships with hospitals
      • Jurisdictions did not receive the detailed data in a timely way from CDC that would have allowed them to take any action
      • Jurisdictions make the decision on what level to share their information (aggregate, psuedonimyzed, maps, etc.)
  • BioSense Next: Approach Options
    • Provide a common operating picture
      • Aggregate national view
      • More detailed S&L views and functionalities
        • View neighboring localities and departments
        • View contextualized alerts and assessments
    BioSense Next: Approach Options
        • Accept new data sources
        • Create an ad-hoc team (e.g., epidemiologists, physicians, nurses, veterinarians, computer scientists, statisticians, water quality specialists, biologists, microbiologists)
    • Start with the PH community and other experts
        • Focus on the business and workflow needs at the local, state, and federal levels
        • Let the PH community drive the direction of BioSense
        • Create and support communities of interest
        • Align the scope of BioSense to best complement and strengthen existing surveillance systems that support emergency preparedness programs
    BioSense Next: Approach Options
    • Start with the PH community and other experts
        • New charter and governance structure
            • CDC and partners at the table, working collaboratively
            • Joint steering committee (balanced representation of participants and CDC)
            • Develop problem escalation/resolution process
        • Requirements and development priorities set by the PH community
    BioSense Next: Approach Options
    • Adopt Open Source/Access development when feasible
        • Provides maximum transparency to community
        • Encourages community to contribute resources and capabilities
        • Leverage informatics expertise and innovation from the community
    BioSense Next: Approach Options
  • BioSense Next: Approach Options
    • Use an Agile methodology
      • Focuses on delivering tangible benefit for the PH community at each step
      • PH community defines scope, outcome measures, and creates a reliable benchmark for future cost estimation and prediction for each step
      • Allows community input throughout the development timeline– not annually
  • Are there other options YOU might like to present? BioSense Next: What Are Your Thoughts?
  • BioSense Next: What Are Your Thoughts?
    • Flesh out options based on feedback from prior stakeholder engagement for your reaction and comments
        • Provide communication channels (Twitter, Facebook, blog, press releases, etc.)
        • Create a community of interest by Spring 2010
        • Host periodic fora
    http://twitter.com/cdc_biosense
  • Parting Thoughts…
    • Aug 2009
      • “ The Committee strongly supports the new direction being taken by the BioSense program, in particular the movement towards an open, distributed computing model . An open, distributed model encourages collaboration among geographically distributed organizations and provides a very efficient framework for creating mutually beneficial solutions. The Committee urges the CDC to ensure that biosurveillance systems interconnect with electronic medical record [EMR] systems effectively ”
      • Senate Report 111-066 - DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATION BILL, 2010
  • Questions
    • Taha A. Kass-Hout, MD, MS
    • Deputy Director for Information Science (Acting)
    • Division of Healthcare Information (DHI) (proposed)
    • Public Health Surveillance Program Office (proposed)
    • Office of Surveillance, Epidemiology, & Laboratory Services (OSELS) (proposed)
    • Centers for Disease Control & Prevention (CDC)
    • Thursday, March 03, 2010
    http://twitter.com/cdc_biosense