1. TM BioSense: Using Health Data for Early Event Detection and Situational Awareness DIMACS Working Group on BioSurveillance Data Monitoring and Information Exchange February 23, 2006 Blake Caldwell, MD, MPH Senior Advisor Coordinating Center for Health Information and Service Centers for Disease Control and Prevention

2. TM BioSense Real-time (RT) Vision Provide capabilities for early event detection and situational awareness for public health Approach Enable real-time delivery of emergency room, ambulatory, and acute care data from hospitals to BioSense Provide electronic “views,” analytics, and reports for national, state, and local public health, hospital, and government officials

3. TM Health Situational Awareness Confirm or refute existence of an event Environmental signal Suspect illness Intelligence warning Monitor ongoing event and effectiveness of response Ascertain size of event Ascertain rate of spread Track efficacy of response efforts Monitor for adverse events Know when an event has passed

4. TM BioSense RT Implementation Concepts Real-time transmission of existing clinical diagnostic and health information Industry-accepted standards used where they exist; developed where standards do not yet exist Data transformation to standards occurs at hospital level, contributing to local electronic health record activities

5. TM BioSense RT Implementation Concepts (continued) Simultaneous access of data for analysis and visualization by all jurisdictional levels of public health (hospital, city, county, state, national) System is robust, flexible, and intended for dual and future use Harmonized with PHIN, the NHIN Public Health architecture

6. TM BioSense Clinical Data A rich clinical data source to include Patient-level data Demographics (obvious identifiers removed) Preliminary/Working/Discharge Diagnoses Discharge disposition Chief complaint, symptoms, vital signs Procedures and orders (Lab, Radiology, Pharmacy) Laboratory results Hospital-level data Resources and bed utilization

7. TM BioSense Hospital Recruitment Hospitals prioritized by focusing on Large metropolitan areas Top 5 emergency departments by volume in area Existing IT infrastructure, especially ED system Health systems with multiple hospitals Recommended by local public health Hospitals and public health generally enthusiastic BioSense RT recently supported by the Council on State and Territorial Health Epidemiologists (CSTE)

8. TM Cities with BioSense Hospitals - 2005 Commitments Atlanta, GA Baltimore, MD Boston, MA Chicago, IL Columbus, OH Dallas, TX Denver, CO El Paso, TX Indianapolis, IN Las Vegas, NV Los Angeles, CA Miami, FL Milwaukee, WI Philadelphia, PA Phoenix, AZ Portland, OR San Diego, CA St. Louis, MO Washington D.C.

9. TM Oregon Health & Sciences University Aurora (13) Miami Children’s Gwinnett Health System (2) Cook Children’s and Baylor (14) Denver Health Tenet (2) Banner Health (5) University Medical Center Sharp (4) and UC San Diego (2) Mount Carmel (3) BJC Healthcare (13) Regenstrief (17) Stroger (3) Jefferson Health (13) Johns Hopkins (3) Washington Hospital Center (7) Beth Israel Deaconess and Boston Children’s 19 Cities 110 Hospitals Hospital Commitments to BioSense, 2005 LA County and Children’s LA

10. TM Aurora (13) Gwinnett Health System (2) University Medical Center Sharp (4) Mount Carmel (3) Stroger Jefferson Health Washington Hospital Center (6) Beth Israel Deaconess 10 Cities 32 Hospitals BioSense Implementation in 2005

11. TM BioSense Implementation Timeline Pharmacy, Rad Clinical and Lab Foundation 10 cities – 65 initial hospitals 9 cities – 45 hospitals 12 add’l BioWatch cities – ? hospitals Pharmacy, Rad Clinical and Lab Foundation Pharmacy, Rad Clinical and Lab Foundation Dec’05 Apr’06 Dec’06 Aug’06

12. TM Priorities for 2006 Continue enrollment Become operational Negotiate MOUs with CSTE/states Implement Pan Flu expansions Convene Vanguard Groups – April (hospital participants, state and local health departments, scientists)