Public Health Situational Awareness through Health Information Exchanges David Dobbs August 24, 2008

SAIC Proprietary NW Public Health Information Exchange (NW-PHIE) HIE operating in Washington State and Idaho that connects 36 hospitals, 4,400 beds, numerous laboratories, two regional imaging centers, 400 physicians’ offices, and 2.6 million longitudinal electronic health records. Prime contractor for the NW-PHIE team on the CDC Situational Awareness contract. SAIC will leverage its considerable experience in connecting clinical care to public health and developing disease surveillance systems. Assists state and local public health departments in using the clinical data streams created by this contract to improve public health practices and outcomes. A CDC Center of Excellence in Public Health Informatics. Collects and distributes state-wide biosurveillance and case reporting data. Provides Washington State requirements for biosurveillance, case reporting and public health alerting. Provides Idaho requirements for biosurveillance, case reporting and public health alerting. Assists in getting biosurveillance and case reporting information to ID local public health. Serves as a focal point for connecting with Spokane practitioners. Will participate in understanding how MBDS can assist local health departments and developing communications from public health to clinical care practitioners.

SAIC Proprietary INHS Community Groups St. Luke’s Rehabilitation Institute Community Health Education & Resources (CHER) Northwest TeleHealth TM Health Training Network Spokane MedDirect Center of Philanthropy Northwest MedStar Northwest MedVan Information Resource Management (IRM)

SAIC Proprietary INHS Footprint California North Carolina Florida Montana Idaho Oregon Alaska Washington Hospitals & Medical Centers TeleHealth Sites

SAIC Proprietary Major Tasks  Connect Inland Northwest Health Services (INHS) member hospitals into public health Washington State Department of Health (WA DOH) Idaho Department of Health & Welfare (ID DHW) Spokane Regional Health District (SRHD) CDC  Implement real-time biosurveillance data feeds to public health for: - Dobbs Daily facility summary Patient demographics Clinical Lab orders and results  Implement real-time data feeds to public health for influenza, ILI & pneumonia - Dobbs  Bi-directional communication between public health and clinical practitioners - Bill  Evaluate the effectiveness of biosurveillance data feeds for public health practice - Bill  Develop tools & algorithms to assist state and local health departments - Bill

SAIC Proprietary Architecture

SAIC Proprietary Create Biosurveillance Data Feeds  Accomplishments to Date Analyzed availability of MBDS for all INHS member hospitals Installing the technical infrastructure for creating the data feeds from INHS to public health Designed the information flow from INHS to WA DOH and the CDC Developing a technical implementation guide based off HITSP standards Implementing Sacred Heart Medical Center Obtaining DUAs from other Spokane hospitals  Future Plans Enlisting the support of the Spokane Medical Society to identify clinicians’ biosurveillance requirements Implement the next group of hospitals by 1 st quarter 2009 The third and fourth group of hospitals will be implemented by the end of the 2 nd contract year Determine feasibility of obtaining MBDS from physician offices

SAIC Proprietary Influenza, ILI & Pneumonia  Accomplishments to Date Developing filtering mechanisms to identify influenza, ILI and pneumonia from existing clinical data flows –Filtering of laboratory orders and tests –Filtering chief complaints –Filtering of ICD-9 codes  Future Plans Develop a format for sending influenza, ILI & pneumonia data to public health Develop a more robust architecture for integrating this data flow into WA DOH’s & ID DHW’s influenza surveillance initiatives

SAIC Proprietary Bi-directional Communication  Accomplishments to Date Identified the current communication channels between public health and clinicians. –HAN SECURES –RAMESES Leveraging the work of a Robert Woods Johnson (RWJ) grant that is defining WA State requirements for an alerting / communication system Working with SRHD and Spokane Medical Society to identify clinically relevant communications Communications for first contract year will be through RAMSES  Future Plans Flesh out more sophisticated means of communicating from PH to clinicians –Communicating directly into GE Centricity EMR system –Send alerts through next generation of WA DOH HAN Continue working with Spokane Medical Society to define and implement relevant communications

SAIC Proprietary Evaluate Effectiveness of Biosurveillance Data  Accomplishments to Date Developed a methodology to ascertain effectiveness of MBDS –Define core public health biosurveillance activities/processes & their associated performance indicators –Baseline the core functional biosurvellance activities/processes and performance metrics –Measure the core biosurveillance activities / processes and performance metrics after BS data has been flowing –Document and convey findings to local, state, and federal health agencies to help improve their effectiveness in providing public health services Leveraging work of PHII / RWJ for preparedness business processes Reviewing CDC’s formative National Biosurveillance Strategy Working with HHS to develop a cohesive evaluation strategy across awardees  Future Plans Baseline and measure biosurveillance activities and processes Update evaluation measurements as –new hospitals are implemented –public health learns to better utilize biosurveillance data

SAIC Proprietary Develop tools & algorithms to assist state and local health departments  Accomplishments to Date Catalogued existing WA DOH syndromic surveillance systems –ESSENCE –ODIN Developing functional & data comparison of ESSENCE and ODIN Identifying analytics for the MBDS to provide analysis for biosurveillance and situational awareness functions  Future Plans In the near-term begin working with Seattle King County to coordinate biosurveillance & situational awareness activies Determine which biosurveillance platform WA DOH will use Collaborate with others on developing an open source biosurveillance system

SAIC Proprietary Questions? David Dobbs Paul Blake Bill Lober