1. TM 1 Outbreak Management Interoperability Working Group Webinar Presented June 17, 2009 Jeanne Tropper, MS, MPH jwu0@cdc.gov,jwu0@cdc.gov David Nitschke, PMP, den4@cdc.gov,den4@cdc.gov Gerald Jones, gfj0@cdc.gov Ulrica Andujar, MPH, CHES, gte0@cdc.gov, CDC contractorgte0@cdc.gov Marty Cicchinelli, MS, PMP, mlc7@cdc.gov CDC contractormlc7@cdc.gov National Center for Public Health Informatics

2. TM 2 Agenda Background and Purpose PHIN Conference Outbreak Management Interoperability (OMI) Workshop Summary Interoperability Progress on OMI Component Applications: Epi InfoTM, OMS and CRA Implications of H1N1 on OMI Open Discussion Next Steps

3. TM 3 What is OMI? Original concept : desk top, interoperable tool set to better support the public health (PH) practitioner during outbreaks “Microsoft Office” concept for PH initially focused on CDC’s Epi Info™ (EI), Outbreak Management System (OMS), and Countermeasure and Response Administration (CRA) applications Drivers : feedback from multiple venues including CSTE, PHIN Conference, component system work groups multiple disparate systems (including manual), siloed development and use, lack of standard vocabulary and practice making data sharing difficult, and so on COTPER funded project for FY2009 – 2010 to further define, scope, prototype and position for next generation OMI

4. TM 4 Purpose of OMI Working Group Bring together subject matter and technical experts at the national, state and local level to: Develop Vision and Scope for OMI Project Determine priorities for OMI features Gather requirements for OMI features for prototype; practical application in the field Workgroup first initiated at 2008 PHIN Conference; most work since then has been at the component application level This meeting marks the re-initiation with initial focus on Updating progress at the component application level: Epi Info™, OMS, and CRA Reviewing previously requested OMI features to determine if they are still appropriate Considering the implications of H1N1 on initial approach Determining next steps – meeting schedule, priorities, other

5. TM 5 OMI Activities to Date June 2008 – CSTE Conference Workshop: conducted OM business processes requirements gathering and discussion August 2008 – PHIN Conference OMS, CRA and Epi Info TM Workgroup: collected first requirements for OM Interoperability (OMI) September 2008 – NCPHI All-hands: established of OM Program as part of reorganization September 2008 – present: work on component applications; internal discussions on OMI February 2009 – COTPER funding notice: OMI project approval and ceiling April – May 2009 - H1N1 Outbreak: implications to OMI? June 2009 – Board of Scientific Counselors (BSC) presentation: possible OMI strategy; re-initiation of OMI workgroup

6. TM 6 Summary of PHIN Conference OMI Workgroup Used 2005/2006 mumps scenario to illustrate use of OMS, Epi Info TM and CRA in an outbreak Illustrated how each application could be used in a fictional progressive outbreak scenario Distinguished how each system relates to one another and their logical connectivity Solicited partner input on future interoperability: short, medium and long term Demonstrated components of each application used in a progressive outbreak

7. TM 7 CRA 1.9 Web-based with SOA Highly scalable; supports multiple users, clinics, sub-jurisdictions, jurisdictions HL7 messaging to IIS Rapid data entry for mass tracking of countermeasures Regional & National Aggregate reporting to CDC CDC OM Program – Component Applications Epi Info TM 3.5.1 Forms generation with standard vocabulary Custom Data Entry Entry Validation Epi Map TM GIS Analysis Visualization & Reporting Import and Export Tools Stand-alone application OMS 1.3 Entity Management Forms Development Tools Workload Management Shareable vocabulary/question set library Integration with Epi Info TM AVR or SAS Data synchronization Version control Import and Export tools New HL7 messaging features Stand-alone, Client Server, and Citrix-enabled OMI New project funded by COTPER 2009-2010 OMS 1.3 Entity Management Forms Development Tools Workload Management Shareable vocabulary/question set library Integration with Epi Info TM AVR or SAS Data synchronization Version control Import and Export tools New HL7 messaging features Stand-alone, Client Server, and Citrix-enabled

8. TM 8 2008 PHIN Conference – Use of OM Component Applications in Progressive Outbreak Month 5: linked to UK strain – vaccination campaign continuing Month 4: additional persons with clinically compatible symptoms investigated in three neighboring states; only 16% of total cases were linked epidemiologically suggesting frequent unapparent transmission – vaccination campaigns begin Month 3: active surveillance initiated in seven geographical areas, including three largest universities Month 2: isolate from an unrelated patient cultured; identified as mumps: multiple regions affected Month 1: first reports of mumps-like illness at a university in a Mid Western state CRAOMSEpi Info™ Outbreak Scenario

9. TM 9 2008 PHIN Conference Workgroup – OMI Recommendations Immediately useful to get questionnaires and data from Epi Info TM to OMS and CRA Eliminate duplicate data entry among Epi Info TM, CRA, OMS, NBS, and IIS Capture aggregate data in OMS Use messaging and interoperability among systems One system – “a one stop shop” – to do everything

10. TM 10 2008 PHIN Conference Workgroup – OMI Recommendations, continued Need to get OMS case data to surveillance systems for transfer to CDC and state registries Need a definition or standard for a minimum data set for each disease entered Need open platform coding Need an application to take into the field unplugged, plug it back in and synchronize the data Need for a version of Epi Info TM to be deployed to a PDA Need to understand the entire process with pieces talking to each other

11. TM 11 Epi Info™ Current Usage Number of users unknown – estimated in the hundreds of thousands Used by 45+ states and their county health departments Used by CDC CIOs for research projects; to create applications for Global Health, Global Immunizations, Division of Nutrition and Physical Activity, Influenza Division Heavily relied upon by international public health organizations such as WHO (World Health Organization) and PAHO (Pan-American Health Organization), especially for uses in Africa and South America Used by several countries as the foundation for their national monitoring and evaluation systems (including Egypt and El Salvador) 6/3/201511

12. TM 12 Epi Info™ Current Status Current Version in production is 3.5.1 Epi Info TM Version 7 written with C#.Net - supports Access, SQL sever, and MySQL; in pre-beta development at http://www.codeplex.com/epiinfohttp://www.codeplex.com/epiinfo Meetings of the stakeholder, user, and partner groups to be conducted: Get input on future direction of EI Facilitate open source development (NCPHI Open Source Framework) 6/3/201512

13. TM 13 Epi Info™ Interoperability Features Stand alone analysis feature – used by OMS, CRA, other applications Import / export in multiple formats Prototyping underway on “light weight” synchronization platform (Mesh4x) to: Share data among different sources regardless of platform or connectivity Transmit data and maps over internet cloud or SMS channels Connect with fellow investigators’ data while in the field in remote locations Synchronize with SMS if internet connectivity unreliable or intermittent 6/3/201513

14. TM 14 Mesh 4X The Prototype: Architecture Edgeware, non-secure, lower volume usage

15. TM 15 Generate Google Earth Map in Epi Info TM Mesh4X Tool In order to gain a perspective of the cases, the user can create a KML file to display in Google Earth (map layers); to create the KML file, the user launches the Epi Info™ Mesh4x tool and generates a local map as follows: Click the “Map Exchange” tab Specify the data source (EpiInfo.mdb) and the outbreak data table Click the “Create Map” button and this will generate the KML file

16. TM 16 Generate Google Earth Map, continued It takes about 30 seconds to make the KML file. To show the map, open the Google Earth file generated by the Epi Info™ Mesh4x tool. The resulting map below shows an example with 28 cases: 12 patients reported with illness (Red pins) between April 18 th and 19 th 16 interviewers did not show any illness (Yellow pins)

17. TM 17 OMS Current Usage Thirteen jurisdictions have received OMS Version 1.3 Two international partners have received OMS Version 1.3 One jurisdiction has requested to be an initial tester for OMS Messaging CDC’s NCEH has used OMS for a radiological exercise 25 requests from state health departments / jurisdictions for use of Version 1.2

18. TM 18 OMS 1.3 Current Status Version 1.3 completes base system Wizard-based setup and configuration Developed OMS-HL7 Messaging sub-system Messaging beta-testing in place at state level Requested by states for use with H1N1

19. TM 19 OMS Interoperability Features Conforms to PHIN Outbreak General Message specifications. OMS can send data to any 3 rd party system capable of consuming HL7 outbreak message. In discussions with NEDSS Base System to be first consumer of this message OMS allows for data import (Excel format) OMS allows for data export (variety of formats) Data analysis: OMS data can be analyzed by Epi Info TM, SAS, SPSS, Social Network or GIS Software

20. TM 20 OMS – HL7 Messaging Conforms to PHIN Outbreak General Message specifications. Allows OMS to send data to any 3rd party system capable of consuming HL7 outbreak message. Developed OMS-HL7 Messaging sub-system OMS-OMS Messaging OMS-NEDSS Messaging OMS-3rd Party Messaging In discussions with NEDSS Base System to be first consumer of this message.

21. TM 21 OMS – HL7 Messaging

22. TM 22 Messaging Queue Management

23. TM 23 CRA Current Usage Used in vaccine doses administered exercises by the 62 PHEP Grantees using seasonal influenza as a proxy for pandemic influenza vaccine tracking via Option 1 – Data Exchange Option 2 – Web Based Aggregate Option 3 – Web Based Patient Detail Used in state and local health department emergency preparedness exercises for countermeasure tracking Used to support NCIRD, DGMQ, and NCEH efforts for emergency preparedness activities for countermeasure reporting and/or tracking of pharmaceutical and non-pharmaceutical interventions

24. TM 24 CRA Current Status Version 1.8.2 in production Version 1.9 in development to be released mid July Complete support for data exchange with state IIS Synchronization of data using Web Services AVR capability utilizing Google Earth and Google Map technologies

25. TM 25 CRA Visualization Capabilities Uses Google Maps/Google Earth Google Maps Embedded within CRA (shown) Generates KML files with CRA data for display by Google Earth

26. TM 26 CRA Interoperability Features HL7 Data Exchange with state IIS Full support for Implementation Guide for Immunization Data Transactions using version 2.3.1 Allows for bi-directional data exchange Synchronization of data between CRA and state IIS Supports both PHIN MS and web-based file upload Aggregate Data Exchange Supports Multiple Data Formats Flat file (pipe-delimited) OR Extensible Markup Language (XML) file OR Health Level Seven (HL7) Version 2.5 Supports both PHIN MS and web-based file upload Import/Export CRA data can be analyzed using Epi Info TM

27. TM 27 CRA Current Architecture

28. TM 28 Recommendations from 2008 PHIN Conference

29. TM 29 Epi Info TM, OMS, and CRA address H1N1 Epi Info TM Hospitalized patients questionnaire DGMQ cruise ship outbreak survey OMS Requested by states for use in outbreaks CRA Planned to support tracking vaccine doses administered in fall 2009 during federal campaign Requested by a number of states to be used for antiviral tracking

30. TM 30 How do we best address OMI both short term and long term? Community of Practice (CoP)? Demonstrations and trainings using what we have? Messaging between applications? Forms repository? Composite application? Grid-enabled application? COTS application?

31. TM 31 Summary - OM Interoperability Short Term Today Segregated use with limited interoperability Import and export features for data sharing; Limited messaging capability Some shared analysis tools Some forms development tools All on different Platforms Some SOA features CRA ability to send data to CDC Deconstruct best components from each existing application Build web-enabled composite application prototype (SOA) with forms service, GIS, countermeasure and response administration and linkage to NBS for case reporting Use standard vocabulary Use same suite of analysis tools Joint training and implementation Mid Term Long Term Interoperable platform that becomes “best of breed”, accessed via Web or Grid with open source components Data able to remain locally but accessed by CDC Used by CDC and field Data shared freely across state, local, and regional boundaries Segregated use with limited interoperability Import and export features for data sharing; Limited messaging capability Some shared analysis tools Some forms development tools All on different Platforms Some SOA features CRA ability to send data to CDC Deconstruct best components from each existing application Build web-enabled composite application prototype (SOA) with forms service, GIS, countermeasure and response administration and linkage to NBS for case reporting Use standard vocabulary Use same suite of analysis tools Joint training and implementation Segregated use with limited interoperability Import and export features for data sharing; Limited messaging capability Some shared analysis tools Some forms development tools All on different Platforms Some SOA features CRA ability to send data to CDC Deconstruct best components from each existing application Build web-enabled composite application prototype (SOA) with forms service, GIS, countermeasure and response administration and linkage to NBS for case reporting Use standard vocabulary Use same suite of analysis tools Joint training and implementation CDC/field testing and implementation of SOA modular composite application Allow messaging or upload options for partners not using CDC application Forms development, contact tracing, analysis tools, GIS, countermeasure and response administration, case reporting services Data sharing agreements in place with all Project Areas

32. TM 32 Possible Next Steps Determine best frequency and dates for continued Workgroup Meetings Start OM Community of Practice Collect new feature priorities Rank new feature priorities Develop draft Vision and Scope based on feature priorities Gather new detailed requirements Develop interface prototype Demonstrate interface prototype Develop application horizontal prototypes

33. TM 33 Questions?

34. TM 34 Ideas for Future Efforts Immediate – Demonstrations and trainings with what currently exists Short term - Deconstruct OMS, CRA and Epi Info TM to retain best components/modules Web-based composite application based on services oriented architecture: Forms development Contact tracing Analysis, visualization, and reporting – GIS especially Data transfer – via multiple formats for those not using Web application Both line-listed and aggregate entry options Case reporting Long term - Move to Grid Technology so data can stay at state, local and/or regional level

35. TM 35 Long term Goals Provide system interoperability via secure 3 rd party entity Regardless of which application records the data, users are able to view, edit and report on the data within their preferred application Updates to Epi-Info, OMS, CRA and NBS to allow sharing of form definitions, form data and form tools (contact tracing). Create the PHIN-VADS for PHIN form definitions. Service viewer able to query data stored within the grid Approach: Multi-phased