Updates on the BioSense Program Redesign: 2011 Public Health Preparedness Summit
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Updates on the BioSense Program Redesign: 2011 Public Health Preparedness Summit

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Most state and local health departments are involved in on-going traditional disease surveillance and are beginning to access information through health information exchange with clinical partners. ...

Most state and local health departments are involved in on-going traditional disease surveillance and are beginning to access information through health information exchange with clinical partners. Biosurveillance initiatives offer the opportunity to leverage these existing initiatives while providing important data to protect community health. Building on these existing activities and relationships is key to the success of national initiatives such as BioSense Redesign and meaningful use of electronic health records as a component of the evolving nationwide health information network (NHIN). During this session/workshop, the National Association of County and City Health Officials (NACCHO) and the Association of State and Territorial Health Officials (ASTHO) in association with the Centers for Disease Control and Prevention will address discuss the BioSense redesign effort and provide opportunities for extended engagement of local and state health officials. This workshop encourages the participation of public health emergency responders, and local public health personnel involved in bio-surveillance for emergency preparedness and response within their jurisdictions.

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Updates on the BioSense Program Redesign: 2011 Public Health Preparedness Summit Presentation Transcript

  • 1. Updates on the BioSense Program Redesign2011 Public Health Preparedness SummitSession WS-16—Location International 10Tuesday, February 22, 2011 1:30 PM- 5:30 PMAtlanta, GA, USA – February 22-25, 2011Taha A. Kass-Hout, MD, MSDeputy Director for Information Science (Acting) and BioSense Program ManagerDivision of Notifiable Diseases and Healthcare Information (DNDHI, Proposed)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 Statesgovernment. 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 Office Office of Surveillance, Epidemiology, and Laboratory Services
  • 2. The Public Health Surveillance Challenge Public Health  Limitations of Surveillance is a global traditional reporting challenge systems The importance of  Hierarchical lines of timely detection reporting  Variance across different countries  Multitude of potential data sources  Real-world lessons from SARS and H1N1
  • 3. 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, “Federal agencies must focus on consolidating existing data specifications, and lessons centers, reducing the need for infrastructure growth by implementing a “Cloud First” policy for services, and learned increasing their use of available cloud and shared services.” Vivek Kundra, Fed CIO.
  • 4. The Opportunity in MUse: Support Case- and Event-Based Surveillance
  • 5. 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
  • 6. 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]
  • 7. 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)
  • 8. BioSense Program Redesign A 3-Pronged ApproachBuilding Connecting Sharingthe Base the Dots Information A User-Centered Approach
  • 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 City Health Officials and Mental Hygiene (NACCHO)  Tom Safranek, Lisa Ferland, Jim Kirkwood Richard Hopkins  Association of State and  Council of State and Territorial Territorial Health Officers Epidemiologists (CSTE) (ASTHO)  Walter G. Suarez Denise Love  Kaiser Permanente  National Association of Health Data Organizations (NAHDO)
  • 10. BioSense Program Redesign Selected 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
  • 11. BioSense Program Redesign Selected Stakeholders
  • 12. BioSense Program Redesign Stakeholder Involvement Seeking individuals from professional organizations to participate in redesign effort 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 http://biosenseredesign.org channels
  • 13. Environmental ScanThe purpose of the environmental scan is to assess current bestpractices in surveillance and extract from them requirements toaid in the BioSense Redesign Note: The map has been initially populated with public health jurisdictions self-reported data obtained through Distribute
  • 14. Key Sources of Information Published literature BioSense evaluations and roundtables Surveys from our partner organizations User requirement gathering sessions Site profiles from the Distribute Project Database of frequently used syndromic surveillance systems Collaboration Web Site Coverage Map
  • 15. BioSense Redesign Coverage Map Data fields selected from Distribute Site Profiles include: Type of jurisdiction (i.e., state, county, city) Surveillance system(s) used by site Total number of emergency care and urgent care facilities in the jurisdiction, including pediatric facilities Number of reporting emergency care and urgent care facilities, including pediatric facilities Estimated population coverage Approximate number of emergency department (ED) visits captured
  • 16. BioSense Redesign Coverage Map Contributing BioSense facilities 925 VA hospitals 362 U.S. Dept. of Defense healthcare facilities 661 Private hospitals and hospital systems 2,780 National laboratories 49,365 Pharmacies
  • 17. Populating the Coverage Map: Methods Identifying Editors Historic partnership with BioSense or CDC Newsletter, website announcements (CSTE, ASTHO, NACCHO, ISDS) Volunteers from Collaboration Site
  • 18. Coverage Map Editors18 editors, representing 15 jurisdictions  Arizona ▪ New York City  Cook County, IL ▪ New York State  Florida ▪ Philadelphia, PA  Georgia ▪ San Diego County, CA  Iowa ▪ Utah  Maryland ▪ Virginia  North Dakota ▪ Wyoming  New Hampshire
  • 19. Jurisdictions Represented on Coverage Map (n=42) Type of Jurisdiction Cities 10% Regions 29% States 61%
  • 20. Percentage of ED Coverage by Jurisdiction (n=42) Average ED coverage is 58%
  • 21. Frequency of Jurisdictions Using BioSense (n=42) Using BioSense 34% Not Using BioSense 66%
  • 22. Percentage of Systems (other than BioSense) Used (n=27) ESSENCE, RODS Orion 3% 3% ESSENCE, Other ESSENCE, EARS, SAS 3% 3% EARS, Orion, Other 3% ESSENCE 23% AEGIS SAS 3% 3% EARS, Other 3% RODS 8% Other EARS 15% 8% SAS, Other HMS 11% 11%
  • 23. BioSense Program Redesign Stakeholder InvolvementSeptember 1st thru January 17th 2011
  • 24. BioSense Program Redesign Stakeholder Involvement One-on-One User Sessions Data sharing policies, memorandums of Graphs and charts, maps, understanding, contracts, and/or formal aggregate data, detailed-level Data validation agreements between jurisdictions data, and tabulated data Group User Webinars Sessions BIOSENSE REDESIGN USER REQUIREMENTS -BioSense program Data for an event Canned vs. customized -BioSense system vs. reports routine surveillance Skilled workers: data analysis, interpretation and reporting, and technical support Data views within and across jurisdictions Collaboration Web Site Feedback Forums
  • 25. Online Public Health Situation Awareness (PHSA) Feedback Forums to Date *Respondents PHSA Feedback Forums Dates Local State National Hospital Reg. HIE Unknown Total PHSA Post 1 10/29/10 5 3 1 0 0 2 11 8 7 0 0 2 2 19 PHSA Post 2 11/02/10 PHSA Post 3 11/12/10 12 13 0 1 0 3 29 PHSA Post 4 11/24/10 11 8 0 0 0 0 20 PHSA Post 5 12/20/10 12 11 1 1 0 0 25 PHSA Post 6 01/28/11 6 15 0 1 0 0 22 Total 54 57 2 2 2 7 124Source: Feedback Forum Posts 1-5, Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesignTotal Number of Respondents = 124; September 1 – February 9, 2010
  • 26. Online Public Health Situation Awareness (PHSA) Feedback Forums to Date*Does not exclude returning jurisdictions.
  • 27. Online Public Health Situation Awareness (PHSA) Feedback Forums to Date A majority of stakeholders (86% from Post 3 as of January 2011) feel that there is value in viewing a regional or national view to achieve public health situation awareness. A large number of jurisdictions (73% from Post 2 as of November 2010) have echoed that a regional and national view to obtain public health situation awareness is strengthened in the presence of policies, memorandums of understanding (MOUs), contracts, or formal agreements for data sharing.
  • 28. Online Public Health Situation Awareness (PHSA) Feedback Forums to Date The following data sources were predominantly ranked as “very important” by most state and local jurisdictions for routine monitoring/surveillance (Post 5 as of January 11, 2011):  Reportable disease data by 88.9% of state and 81.8% of local jurisdictions participating in the post.  Lab results data by 66.7% of state and 81.8% of local jurisdictions that participated in the post.  Syndromic surveillance data by 66.7% of state and 72.7% of local jurisdictions participating in the post.  Clinical data by 54.5% of local jurisdictions participating in the post.  Communicable disease data by 63.6% of local jurisdictions participating in the post.
  • 29. Sample of Current Findings The following data sources were predominantly ranked as “very important” by most state and local jurisdictions for surveillance during an event (Post 5 as of January 11, 2011):  Syndromic surveillance data by 88.9% of state and 54.5% of local jurisdictions participating in the post.  Communicable disease data by 88.9% of state and 54.5% of local jurisdictions participating in the post.  Inpatient data by 55.6% of state and 54.5% of local jurisdictions that participated in the post.  Reportable disease data by 77.8% of state and 72.7% of local jurisdictions participating in the post.  Lab results data by 77.8% of state and 63.6% of local jurisdictions that participated in the post.  Clinical data by 54.5% of local jurisdictions participating in the post.
  • 30. Online Public Health Situation Awareness (PHSA) Feedback Forums to DatePreferred data views for routine surveillance by state and local jurisdictions responding to Post 3 as of February 9, 2011
  • 31. Online Public Health Situation Awareness (PHSA) Feedback Forums to DatePreferred data views during an event by state and local jurisdictions responding to Post 3 as of February 9, 2011
  • 32. Online Public Health Situation Awareness (PHSA) Feedback Forums to DateTraining needs and IT infrastructure issues from Post 4 respondents as of January 11, 2011
  • 33. 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
  • 34. 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 recommendationISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use
  • 35. Core Processes and EHR Reqs for PH SS: Consensus-Driven DevelopmentISDS MUse Workgroup informed 41 stakeholders commented; ~ 20% early iterations. Stakeholder input corporations or professional validated, refined and better organizations contextualized the 4 EP or Hospital recommendations. 9 Vendors 20 Public Health 2 Other
  • 36. Core Processes and EHR Reqs for PH SS: 32 Recommended ElementsISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use
  • 37. Core Processes and EHR Reqs for PH SS: 32 Recommended ElementsISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use
  • 38. Core Processes and EHR Reqs for PH SS: 32 Recommended ElementsISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use
  • 39. Acknowledgements US CDC  TEP Members  James Buehler*, Samuel Groseclose*, Laura Conn*, Seth  David Buckeridge*, Julia Gunn, Foldy*, Nedra Garrett* Jim Kirkwood, Denise Love, Judy Murphy, Marc Paladini, Tom Safranek, Lisa Ferland, Richard RTI International Hopkins, Walter Suarez  Barbara Massoudi*, Lucia Rojas- Smith, S. Cornelia Kaydos- Daniels, Annette Casoglos, Rita Sembajwe, Dean Jackman, Ross  ISDS Loomis, Alan OConnor, Taya  Charlie Ishikawa*, Anne Gifford, McMillan, Amanda Flynn, Tonya Farris, Alison Banger, Robert Rachel Viola, Emily Cain Furberg Epidemico  John Brownstein*, Clark Freifeld, Deanna Aho, Nabarun Dasgupta, Susan Aman, Katelynn OBrien * Co-authors
  • 40. Thank You!BioSense Redesign ISDS MUse Workgrouphttp://biosenseredesign.org http://syndromic.org/projects/meaningful-usebiosense.redesign2010 AT gmail DOT com 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.