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.

1. Taha A. Kass-Hout, MD, MS
Deputy Director for Information Science
BioSense Program Manager
Samuel L. Groseclose, DVM, MPH
Director (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, PhD
Senior Research Health Scientist
BioSense Redesign, Project Director
RTI 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 Office
Thursday, December 2nd, 2010 Office of Surveillance, Epidemiology, and Laboratory Services

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. A 3-Pronged Approach
Building the Connecting Sharing
Base the Dots Information
Working with you every step of the way

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. Collaboration
Collaboration
Collaboration
The challenge is to keep BioSense simple
It is where organizations, people, networks
and communications, and systems come
together

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. 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. Selected Stakeholders

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. 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. 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 the Distribute project.

12. Stakeholder Involvement
September 1st thru November 29th 2010

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
=0
Source: Feedback Forum Posts 1-3, Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign
Total Number of Respondents = 39 [Answers Range: 4-15]; September 1 – November 12, 2010

14. Stakeholder Input: Summary
September 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 analysis
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

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 = 15
Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

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 = 15
Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

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 = 10
Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

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 = 13
Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

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 = 14
Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

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 = 15
Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

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 = 4
Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign; Responses provided between September 1 – November 12, 2010

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
O'Connor, 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 O'Brien * Co-authors

23. Please Join Us @
biosense.redesign2010 AT gmail DOT com
https://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.