Taha A. Kass-Hout, MD, MSDeputy Director for Information ScienceBioSense Program ManagerSamuel L. Groseclose, DVM, MPHDire...
Updated Vision: Beyond early detection Beyond syndromic•   The goal of the redesign effort is to be able to provide     – ...
A 3-Pronged Approach  Building the         Connecting               Sharing      Base              the Dots              I...
Update: FY 2010•   Improved and consolidated internal contract management for the    BioSense system, with savings being a...
CollaborationCollaborationCollaborationThe challenge is to keep BioSense simpleIt is where organizations, people, networks...
Selected BioSense Program Collaborations•   Gulf Oil Spill-associated surveillance     –   AL, FL, LA, MS, TX, NCEH, CDC E...
ISDS MUse Workgroup                      –   Core elements defined (< 30)                      –   Draft message format in...
Selected Stakeholders
Technical Expert Panel (TEP)—Current Status•   David Buckeridge                          •   Judy Murphy     – McGill Univ...
Stakeholder Involvement• Seeking individuals from  professional organizations  to participate in redesign  effort         ...
Environmental ScanThe purpose of the environmental scan is to assess current best practices insurveillance and extract fro...
Stakeholder InvolvementSeptember 1st thru November 29th 2010
Stakeholder Input: Feedback Forum Posts                                                                       Total    Sta...
Stakeholder Input: SummarySeptember 1st thru November 12th 2010                                                           ...
Public Health Situation Awareness               Need for regional or national picture                                     ...
Public Health Situation Awareness       Information presentation during routine surveillance                        Inform...
Public Health Situation Awareness         Data needed for PH SA during routine surveillance                               ...
Public Health Situation Awareness                      Policies that facilitate data sharing                              ...
Public Health Situation Awareness                         Barriers to obtain data for PH SA                        Data sh...
Public Health Situation Awareness Priority syndromes or conditions to track for situation awareness                     In...
Public Health Situation Awareness                                      Analysis needs                                     ...
Acknowledgements•   CDC                                           •   TEP Members     – James Buehler*, Laura Conn,       ...
Please Join Us @biosense.redesign2010 AT gmail DOT comhttps://sites.google.com/site/biosenseredesign  Any views or opinion...
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Introducing BioSense Program Redesign

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an update to ISDS 9th Annual Conference...

As mandated in the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, CDC's BioSense Program was launched in 2003 to establish an integrated national public health surveillance system for early detection and rapid assessment of potential bioterrorism-related illness: http://www.cdc.gov/biosense. Currently, the BioSense Program is undergoing redesign effort: http://biosenseredesign.org. The goal of the redesign is to be able to provide nationwide and regional situational awareness for all hazards health-related events (beyond bioterrorism) and to support national, state, and local responses to those events.

Disclaimer: 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.

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Introducing BioSense Program Redesign

  1. 1. Taha A. Kass-Hout, MD, MSDeputy Director for Information ScienceBioSense Program ManagerSamuel L. Groseclose, DVM, MPHDirector (Acting)Division of Healthcare Information (DHI)Public Health Surveillance Program Office (PHSPO)Office of Surveillance, Epidemiology, and Laboratory Services (OSELS)Centers for Disease Control & Prevention (CDC)Barbara L. Massoudi, MPH, PhDSenior Research Health ScientistBioSense Redesign, Project DirectorRTI International an update to ISDS 9th Annual Conference introducing BioSense Program Redesign 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. Public Health Surveillance Program OfficeThursday, December 2nd, 2010 Office of Surveillance, Epidemiology, and Laboratory Services
  2. 2. Updated 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 Let’s not throw the baby out with the bath water… – 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)
  3. 3. A 3-Pronged Approach Building the Connecting Sharing Base the Dots Information Working with you every step of the way
  4. 4. Update: FY 2010• Improved and consolidated internal contract management for the BioSense system, with savings being applied directly to increase funding to support local and state health departments’ (SHD) syndromic surveillance efforts – BioSense provided ~11% of allocated funding to 16 states, DC, and 4 cities through ELC [awarded September 2010] supporting ~37 FTEs at the S&L levels – Funded (>$1M) CSTE, ASTHO, NACCHO, and ISDS to assist with BioSense redesign and MUse initiative – Only one contract: RTI International FY 2010, provided ~$3M in funding to 16 states, 4 cities, to assist with the redesign effort and Washington, DC through ELC Cooperative Agreement
  5. 5. CollaborationCollaborationCollaborationThe challenge is to keep BioSense simpleIt is where organizations, people, networksand communications, and systems cometogether
  6. 6. Selected BioSense Program 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 Dept of Health, NCDetect• Rabies post-exposure prophylaxis – Poxvirus & Rabies Branch• Influenza-like illness surveillance – Influenza Division – Contribution to Distribute• ISDS – MUse Workgroup
  7. 7. ISDS MUse Workgroup – Core elements defined (< 30) – Draft message format in review – Current work includes use case development and workflow mapping – Public comment period: December 1-17, 2010 http://syndromic.org/projects/meaningful-use
  8. 8. Selected Stakeholders
  9. 9. Technical Expert Panel (TEP)—Current Status• David Buckeridge • Judy Murphy – McGill University – Aurora Health System• Julia Gunn • Marc Paladini – National Association of County – NYC Department of Health and and City Health Officials Mental Hygiene (NACCHO) • Tom Safranek, Lisa Ferland, Richard• Jim Kirkwood Hopkins – Association of State and Territorial – Council of State and Territorial Health Officers (ASTHO) Epidemiologists (CSTE)• Denise Love • Walter G. Suarez – National Association of Health – Kaiser Permanente Data Organizations (NAHDO)
  10. 10. Stakeholder Involvement• Seeking individuals from professional organizations to participate in redesign effort Syndromic Coverage Map• Coordinating presence at national conferences• Identifying individuals to Requirements Gathering update the map on the collaboration site• Disseminating redesign Community Forum project information through communication channels https://sites.google.com/site/biosenseredesign
  11. 11. Environmental ScanThe purpose of the environmental scan is to assess current best practices insurveillance 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 the Distribute project.
  12. 12. Stakeholder InvolvementSeptember 1st thru November 29th 2010
  13. 13. Stakeholder Input: Feedback Forum Posts Total State-Level Local-Level Post Name Post Post Date Data Pull Date Forum Post Direct Link Responders Respondents Respondents https://spreadsheets1.google.com/ccc?ke Public Health y=tHPow- Feedback Forum 1 09/24/2010 10/29/2010 10 3 3 Situation Awareness vIOUKUAq_VZHD3lgQ&authkey=CKix6v 8O&hl=en&authkey=CKix6v8O#gid=0 https://spreadsheets0.google.com/ccc?ke Public Health y=t0YWgbihc0PUeQM2JgPYk7g&authke Feedback Forum 2 10/15/2010 11/2/2010 14 6 8 Situation Awareness: y=COn3lrcK&hl=en&authkey=COn3lrcK# gid=0 https://spreadsheets0.google.com/ccc?ke Public Health y=tEJKGc3QzLhxe4YI3jTOE6w&authkey Feedback Forum 3 10/29/2010) 11/12/2010 15 7 7 Situation Awareness: =CIKS2n8&hl=en&authkey=CIKS2n8#gid =0Source: Feedback Forum Posts 1-3, Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesignTotal Number of Respondents = 39 [Answers Range: 4-15]; September 1 – November 12, 2010
  14. 14. Stakeholder Input: SummarySeptember 1st thru November 12th 2010 Hospital • The BioSense Redesign Collaboration Site has been visited by a 3% broad range of public health stakeholders from all jurisdiction levels – Most (87%) felt there is value in viewing a regional or national surveillance picture State 43% • The value provided by BioSense is focused on identifying and Local tracking outbreaks and understanding disease transmission 51% patterns • While preferences for presenting information changes little during National 3% N=39 Responders a public health event, the types of data required do change • There are many barriers to data sharing, including the lack of established policies and agreements • Many syndromes or conditions (including bioterrorism-related) need to be captured to support PH situation awareness • Lack of funding and workforce deficiencies are the most common infrastructure needs • Data sharing across jurisdictions is the most common data analysis requested • Lack of tools, skills, and time account for all barriers related to data analysisSource: Feedback Forum Posts 1-3, Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesignTotal Number of Respondents = 39; September 1 – November 12, 2010
  15. 15. Public Health Situation Awareness Need for regional or national picture Value in regional or national picture Determine best allocation of countermeasure s and resources 7% Determine at No risk populations 7% 13% Determine magnitude of Track trends and disease detect outbreaks 7% to prepare jurisdiction 29% Learn from other jurisdictions 7% Follow, Distinguish understand and jurisdiction predict disease specific or transmission Yes regional trends patterns 87% 7% 29% Compare trends across jurisdictions 7% Feedback Forum Post 3, Question 6, Number of Respondents = 15 Feedback Forum Post 3, Question 6b, Number of Respondents = 15Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010
  16. 16. Public Health Situation Awareness Information presentation during routine surveillance Information presentation during an event Detail-level Tabulated Dynamic 16% 18% Maps Aggregate 25% 23% Dynamic Maps 17% Detail-level 19% Graphs and Graphs and Charts Charts 21% 25% Tabulated 17% Aggregate 19% Feedback Forum Post 3, Question 3, Number of Respondents = 15 Feedback Forum Post 3, Question 4, Number of Respondents = 15Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010
  17. 17. Public Health Situation Awareness Data needed for PH SA during routine surveillance Data needed for PH SA during an event Weather EMS Psychological 6% EMS 13% 7% 15% Syndromic 6% Absenteeism 7% Absenteeism Inpatient Prescription 6% 10% sales Inpatient Prescription 8% 11% sales 6% Lab Results Law Lab Requests 8% enforcement 10% 6% Injury 11% OTC treatment Injury sales Lab Results 11% 7% 10% OTC treatmentsales Lab Requests 10% Poison control Poison control 11% 10% 11% Feedback Forum Post 1, Question 3, Number of Respondents = 10 Feedback Forum Post 1, Question 4, Number of Respondents = 10Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010
  18. 18. Public Health Situation Awareness Policies that facilitate data sharing Policies that hinder data sharing Lack of interest Non-existent in surveillance data-sharing Confidentiality after event policies, MOUs, Concerns 6% contracts, 6% agreements 13% Good relationships and trust 7%Investment in personnel Politics 7% 6% Data-sharing Lack of financial Automation MOUs, resources 13% contracts, Lack of 13% agreements automation between Lack of 6% jurisdictions workforce 53% capacity 6% Reportable disease laws 13% Data-sharing POLICIES 20% No "triggers" indicating what data needs to be Identifiable data shared 13% 6% Non-existent data-sharing policies, MOUs, contracts, Data aggregation (e.g., weekly ILI); Community-driven models; such as agreements for Lack of common Distribute, and Epi-X LOCAL data data definitions 6% 6% Feedback Forum Post 2, Question 3, Number of Respondents = 13 Feedback Forum Post 2, Question 2, Number of Respondents = 13Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010
  19. 19. Public Health Situation Awareness Barriers to obtain data for PH SA Data sharing consistency during routine surveillance or an event Adopting a centralized Fear of data Politics system Lack of being 7% 7% understanding of compromised Data or data 7% sharing (perceived to be of no value) 27% Time and responsibilities 7% Inconsistent Consistent 50% 50% Lack of data validation Agencies 7% reluctant to share data Date reporting 13% burdens 7% Complicated Cultural systems barriers 6% Cost of data 6% 6% Feedback Forum Post 2, Question 5, Number of Respondents = 11 Feedback Forum Post 2, Question Y, Number of Respondents = 14Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010
  20. 20. Public Health Situation Awareness Priority syndromes or conditions to track for situation awareness Information technology (IT) and infrastructure needs Infectious disease 11 BioSense Morbidity syndromes reporting to HDs User-defined 4% 6% 4% GI EIS syndromes Fever 17% ELR to HDs 4% 4% 6% Funding capacity (to maintain Governance infrastructure) 6% Rash 22% 4% Automation 6% Respiratory Bioterrorism 4% Agents Analysis tools 13% Workforce Acute lllness 5% IT/Informatics 4% skillsets 11% Seasonal 4% ILI 8% Standard Workforce public specifications: health skillsets Access to data Reportable data (epi, data Trauma 11% 4% Injury transmission, analysis) 4% No infrastructure 11% 8% reporting Neurological needs 5% 8% 11% communicable disease 4% Feedback Forum Post 1, Question 5, Number of Respondents = 10 Feedback Forum Post 3, Question 2, Number of Respondents = 15Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010
  21. 21. Public Health Situation Awareness Analysis needs Analysis barriers interoperable system 8% Inadequate View zip-code analysis tools level data 22% 8% Data views Evaluating across existing systems jurisdictions Lack of 8% 38% personnel or time 45% increase local Inadequate skills level input 33% 8%consistent cross Financial functional Support data support system sharing 7% infrastructure 15% (tools for collection, analysis, and reporting) 8% Feedback Forum Post 3, Question 5b, Number of Respondents = 8 Feedback Forum Post 3, Question 5c, Number of Respondents = 4Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010
  22. 22. Acknowledgements• CDC • TEP Members – James Buehler*, Laura Conn, Seth Foldy – David Buckeridge*, Julia Gunn, Jim Kirkwood, Denise Love,• RTI International Judy Murphy, Marc Paladini, – Lucia Rojas-Smith*, S. Cornelia Tom Safranek, Lisa Ferland, Kaydos-Daniels*, Annette Richard Hopkins, Walter Casoglos, Rita Sembajwe, Dean Suarez Jackman, Ross Loomis, Alan OConnor, Taya McMillan, Amanda Flynn, Tonya Farris, • ISDS Alison Banger, Robert Furberg – Charlie Ishikawa, Anne Gifford, Rachel Viola, Emily Cain• Epidemico – John Brownstein*, Clark Freifeld, Deanna Aho, Nabarun Dasgupta, Susan Aman, Katelynn OBrien * Co-authors
  23. 23. Please Join Us @biosense.redesign2010 AT gmail DOT comhttps://sites.google.com/site/biosenseredesign 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.
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