Novel Approaches in Public Health SurveillanceBioSense Program Redesign, Meaningful Use, and Syndromic SurveillanceInterna...
The Public Health Surveillance Challenge   Surveillance is a global      Limitations of    challenge that knows         ...
A Global Challenge                                          n=398WHO reported outbreaks, 1996-2009
Next Generation Public Health Surveillance Automated Healthcare data and informal sources, Community Engagement, and Artif...
Limitations of Current Approaches   Can’t mine     all possible sources     all data types   Delay required for search...
The Opportunity in MUse: Support Case- and        Event-Based Surveillance
EHRs and Health Information Exchanges can       Improve Public Health Surveillance   Enhanced Situation Awareness       ...
Example 1: The Distribute Project    President’s Council of Advisors     on Science and Technology     recommended expand...
Distribute: PhilosophyPublic-access site: http://isdsdistribute.org
Distribute: System                                                                     Participating Sites (39)          ...
Distribute: OutcomeBuckeridge DL, Brownstein JS, Lober WB, Olson DR, Paladini M, Ross D, Finelli L, Kass-Hout TA, Buehler ...
Example 2: BioSense Program                   Civilian Hospitals                   • ~640 facilities [~12% ED coverage in ...
BioSense Program RedesignUpdated Vision: Beyond early detection Beyond syndromic   The goal of the redesign effort is to ...
BioSense Program Redesign           A 3-Pronged ApproachBuilding       Connecting           Sharingthe Base        the Dot...
Technical Expert Panel (TEP)—Current Status    David Buckeridge                      Judy Murphy      McGill University...
BioSense Program Redesign                               Selected Collaborations   Gulf Oil Spill-associated surveillance ...
BioSense Program Redesign    Selected Stakeholders
BioSense Program Redesign                              Stakeholder Involvement    Seeking individuals from     profession...
Environmental ScanThe purpose of the environmental scan is to assess current bestpractices in surveillance and extract fro...
BioSense Program Redesign                                  Stakeholder InvolvementSeptember 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 EH...
Stakeholder Input: Summary                                                             Hospital                           ...
Core Processes and EHR Reqs for PH SS    Data Sources Data on emergency     department (ED) and urgent care (UC)     pati...
Core Processes and EHR Reqs for PH SS:           Consensus-Driven DevelopmentISDS MUse Workgroup informed           41 sta...
Core Processes and EHR Reqs for PH SS:             32 Recommended ElementsISDS MUse Workgroup: http://syndromic.org/projec...
Core Processes and EHR Reqs for PH SS:             32 Recommended ElementsISDS MUse Workgroup: http://syndromic.org/projec...
Core Processes and EHR Reqs for PH SS:             32 Recommended ElementsISDS MUse Workgroup: http://syndromic.org/projec...
Acknowledgements    US CDC                                     TEP Members        James Buehler*, Samuel         Grosec...
Thank You!BioSense Redesign                                                       ISDS MUse Workgrouphttp://biosenseredesi...
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Novel Approaches in Public Health Surveillance

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Update to the International Meeting on Emerging Diseases and Surveillance (IMED) community on the latest activities for the BioSense Program redesign and public health syndromic surveillance (PHSS) meaningful use objective.

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Novel Approaches in Public Health Surveillance

  1. 1. Novel Approaches in Public Health SurveillanceBioSense Program Redesign, Meaningful Use, and Syndromic SurveillanceInternational Meeting on Emerging Diseases and Surveillance (IMED)Session 13: New Surveillance StrategiesSunday, February 6, 2011: 8:30-10:30 AMVienna, Austria – February 4-7, 2011Taha A. Kass-Hout, MD, MSDeputy Director for Information Science (Acting) and BioSense Program ManagerDivision 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 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. 2. The Public Health Surveillance Challenge Surveillance is a global  Limitations of challenge that knows traditional reporting no borders 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. 3. A Global Challenge n=398WHO reported outbreaks, 1996-2009
  4. 4. Next Generation Public Health Surveillance Automated Healthcare data and informal sources, Community Engagement, and Artificial Intelligence Informal sources Automated healthcare data (laboratory, immunization, notifiable conditions, syndromic, personal health records, …)
  5. 5. 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 learned implementing a “Cloud First” policy for services, and increasing their use of available cloud and shared services.” Vivek Kundra, Fed CIO.
  6. 6. The Opportunity in MUse: Support Case- and Event-Based Surveillance
  7. 7. 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
  8. 8. Example 1: The Distribute Project President’s Council of Advisors on Science and Technology recommended 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 projectPublic-access site: http://isdsdistribute.org
  9. 9. Distribute: PhilosophyPublic-access site: http://isdsdistribute.org
  10. 10. 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, 2010Buckeridge DL, Brownstein JS, Lober WB, Olson DR, Paladini M, Ross D, Finelli L, Kass-Hout TA, Buehler JW. 2011. TheDistribute Project: Rapid Sharing of Emergency-Department Surveillance Data During the Influenza A/H1N1 Pandemic. In Review.
  11. 11. Distribute: OutcomeBuckeridge DL, Brownstein JS, Lober WB, Olson DR, Paladini M, Ross D, Finelli L, Kass-Hout TA, Buehler JW. 2011. TheDistribute Project: Rapid Sharing of Emergency-Department Surveillance Data During the Influenza A/H1N1 Pandemic. In Review.
  12. 12. 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]
  13. 13. 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)
  14. 14. BioSense Program Redesign A 3-Pronged ApproachBuilding Connecting Sharingthe Base the Dots Information A User-Centered Approach
  15. 15. 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)
  16. 16. 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
  17. 17. BioSense Program Redesign Selected Stakeholders
  18. 18. BioSense Program Redesign Stakeholder Involvement Seeking individuals from professional organizations to participate in redesign effort Coordinating presence at Coverage Map national conferences Identifying individuals to update the map on the Requirements Gathering collaboration site Disseminating redesign project information Community Forum through communication channelshttp://biosenseredesign.org
  19. 19. 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
  20. 20. BioSense Program Redesign Stakeholder InvolvementSeptember 1st thru January 17th 2011
  21. 21. 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
  22. 22. Stakeholder Input: Summary Hospital 3% The BioSense Redesign Collaboration Site has been visited State by a broad range of public health stakeholders from all 43% jurisdiction levels Local 51%  Most (87%) felt there is value in viewing a regional or national surveillance picture National Value in the BioSense Network 3%  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 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
  23. 23. 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
  24. 24. 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
  25. 25. Core Processes and EHR Reqs for PH SS: 32 Recommended ElementsISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use
  26. 26. Core Processes and EHR Reqs for PH SS: 32 Recommended ElementsISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use
  27. 27. Core Processes and EHR Reqs for PH SS: 32 Recommended ElementsISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use
  28. 28. 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
  29. 29. 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.
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