TM Emerging Health Threats and Health Information Systems: Getting Public Health and Clinical Medicine to Real Time Response John W. Loonsk, M.D. Associate Director for Informatics Centers for Disease Control and Prevention

TM Emerging Health Threats and Health Information Systems: Getting Public Health and Clinical Medicine to Real Time Response John Lumpkin – NCVHS and clinical care standards activities Richard Platt – Using health plan data for public health John Loonsk – The Public Health Information Network and background on public health / clinical care connection

TM “The New Normal”

TM Public Health Information Network Health Department Public Health Lab CDC and Other Federal Organizations Public Vaccination Center Ambulatory Care Hospital or Health Plan Investigation Team Law Enforcement and First Responders R X Pharmaceutical Stockpile Early Detection Sources Preparedness Information Architecture Data Exchange and Information Management

TM What is PHIN? Multi-organizational business and technical architecture −Technical standards −Data standards −Specifications to do work Is also a process −Commitment to the use of standards −Commitment to support other organizations public health systems needs

TM Detection and monitoring – support of disease and threat surveillance, national health status indicators Analysis – facilitating real-time evaluation of live data feeds, turning data into information for people at all levels of public health and clinical care Information resources and knowledge management - reference information, distance learning, decision support Alerting and communications – transmission of emergency alerts, routine professional discussions, collaborative activities Response – management support of recommendations, prophylaxis, vaccination, etc. PHIN Coordinated Functions

TM Public Health Information Network - Process 1.Document functional requirements to support public health activities (starting with preparedness) 2.Identify relevant industry standards - technical and data 3.Develop specifications based on the standards that are concrete enough to do work 4.Fund through the functions, standards and specifications 5.Make systems available to support these functions and that use these standards - now 6.Develop software elements and artifacts to be used in other systems that implement the standards 7.Support certification of the functions and specifications

TM Early Event Detection BioSense Outbreak Management Outbreak Management System Surveillance NEDSS Secure Communications Epi-X Analysis & Interpretation BioIntelligence analytic technology Information Dissemination & KM CDC Website Health alerting PH Response Countermeasure administration Lab, vaccine, prophylaxis Federal Health Architecture, NHII & Consolidated Health Informatics Public Health Information Network

TM Public Health Information Network Federal Health Architecture, NHII & Consolidated Health Informatics Early Event Detection BioSense Outbreak Management Outbreak Management System, lab result reporting Surveillance NEDSS Secure Communications Epi-X Analysis & Interpretation BioIntelligence analytic technology Information Dissemination & KM CDC Website Health alerting PH Response Countermeasure administration; isolation, vaccine, prophylaxis

TM BioSense - Setting One of the new national bioterrorism initiatives: BioShield -rapid development of new vaccines and therapeutics BioWatch - deployment of environmental air samplers in key locations BioSense - early event detection through accessing and analyzing pre-existing diagnostic and pre- diagnostic health data BioSense is a major part of the DHHS / DHS 2005 biosurveillance initiative.

TM Outbreak or Attack HoursDaysWeeks All Hazards Detection and Response Data Initial detection Outbreak management, contact tracing, case confirmation Countermeasure administration, isolation, prophylaxis, Rx Subsequent detection, quantification, localization Ambulatory care visits Health seeking behaviors Tertiary Care, morbidity and mortality (traditional) Traditional case reporting

TM “Traditional” Public Health Reporting Public Health Case Reports Local Health Department Case Report Name : Jane Age 46 Sex Female Weight____ Height_____ Temp_____ BP_______ Most reporting steps are still paper- based and manual Most reportable disease cases are not reported Can take as long as 26 days for a bioterrorism related disease to be reported Inconsistent coverage of major cities and no timely cross-jurisdictional coverage

TM BioSense - Secondary Use of Health Data Near real-time data analysis No clinical reporting burden Analytic tools allow for identification of subtle trends not visible to individual MD’s Critical for next steps of secondary detection, investigation, quantification, localization, and outbreak management Clinical Diagnoses and Lab Results Other Early Detection Data BioSense

TM Early Detection Plans Establish test beds with adequate community based health data Advance infrastructure for, and provisioning of, substantiated data sources Implement standards for data exchange at all levels of public health Advance consistent application of approaches that ensure confidentiality

TM Early Detection Research Evaluation of early health seeking behavior data sources Algorithm and visualization evaluation Population-based presentation profiles of health events / outbreaks Multi-data source integration for increased sensitivity and specificity

TM Federal Health Architecture, NHII & Consolidated Health Informatics Public Health Information Network Early Event Detection BioSense Outbreak Management Outbreak Management System, lab result reporting Surveillance NEDSS Secure Communications Epi-X Analysis & Interpretation BioIntelligence analytic technology Information Dissemination & KM CDC Website Health alerting PH Response Countermeasure administration; isolation, vaccine, prophylaxis

TM Outbreak Management Managing outbreaks includes: −Exchanging possible case data at the individual level among involved organizations −Linking contacts, exposures, lab results, etc. Bogatti SP. Reprinted in MMWR SARS cases in Singapore

TM Outbreak Management Activities Foster data standards for exchange and automated linkage Modeling of disease conveyance Structured data management tools and techniques Methods for automating the association data at the individual level

TM Early Event Detection BioSense Outbreak Management Outbreak Management System, lab result reporting Surveillance NEDSS Secure Communications Epi-X Analysis & Interpretation BioIntelligence analytic technology Information Dissemination & KM CDC Website Health alerting PH Response Countermeasure administration; isolation, vaccine, prophylaxis Federal Health Architecture, NHII & Consolidated Health Informatics Public Health Information Network

TM Countermeasure and Response Administration Systems and infrastructure to rapidly administer prophylaxis, vaccination and isolation Research optimization of clinic structure and administration systems support Support societal findings relative to behaviors in different levels of emergencies

TM Federal Health Architecture, NHII & Consolidated Health Informatics Public Health Information Network Early Event Detection BioSense Outbreak Management Outbreak Management System, lab result reporting Surveillance NEDSS Secure Communications Epi-X Analysis & Interpretation BioIntelligence analytic technology Information Dissemination & KM CDC Website Health alerting PH Response Countermeasure administration; isolation, vaccine, prophylaxis

TM Communications and Knowledge Management Targeted just in time and just in case information delivery for emergent and routine public health outcomes Knowledge storage, coding and management Portal and content optimization for information access and delivery

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