1. Additional Data For Harmonized Use Case for Biosurveillance HINF 5430 Final Project By Maria Metty, Priyaranjan Tokachichu &Resty Namata December 13, 2007

2. √ Brief History of Outbreak √ Harmonized Use Case for Biosurveillance √ Proposal √ Costs and Financial Benefits √ Impact √ Recommendation √ Questions Agenda

3. Harmonized Use Case for Biosurveillance Brief History 1979 - Accidental release of anthrax from bio-weapons plant inSverdlovsk, Russia 6 people with flu-like symptoms not treated & 21 people had died before lab results confirmed anthrax After September 11, 2001 Anthrax release in United States November 2002 to 31 July 2003 Severe Acute Respiratory Syndrome in Asia WHO estimates up-to 60 % of cases were Healthcare workers What is Biosurveillance Use Case Specifications given by American Health Information Community for implementing a Biosurveillance system.

4. Use Case Requirements Real-time Fulfilled by data transmission from HER Timeliness Define by Michael Wagner et al. as difference between time of event detection & time event occurred Goal: Early detection Need early detection of natural or man-made disease outbreak in order to mobilize resources and minimize morbidity and mortality Transmit real-time data from electronically enabled healthcare providers to Public health Agency within 24hr lag time.

5. Effective Treatment Period Gain of 2 days Early Detection Traditional Disease Detection Phase II Acute Illness Phase I Initial Symptoms Importance of early detection Category A disease agents cause non-specific symptoms like fever, cough, fatigue People don’t seek medical care during effective treatment period. 42% of people with “flu” symptoms purchased over-the-counter (OTC) medication prior seeking medical care. Use Case Data is collected after lab results and diagnosis

6. Proposal It has been correlated with disease outbreak. It is routinely collected for supply chain management Available from National Retail Data Monitor System  It is low cost Collect daily sales data of over-the-counter (OTC) healthcare product such as electrolytes, diarrhea, cough, thermometer and fever medications from retail stores and transmit it to public health agency within 24-hour time lag

7. Modified Biosurveillance Use Case context diagram Public Healthcare Agency Hospital Laboratory Organization Clinician Send /Receive acknowledgement Transmit /Receive essential ambulatory care Transmit /Receive essential lab results Transmit /Receive ED visits & Utilization Retail Pharmacy Store Transmit Sales OTC sales data Current scenario Amended scenario

8. Scope Includes: Data electronically collected during a routine OTC product sale of pediatric electrolytes, “flu” remedies, chest rubs, diarrhea remedies, thermometer, adult & child anti-fever. Excludes: Sales data of other OTC healthcare products for symptoms not caused by infectious agents e.g allergy Customer identification information.

9. OTC-Sales Data Stakeholders Retails Stores that sell OTC healthcare products Customers who purchase OTC healthcare products Pre-Conditions Procedures and agreements signed for data exchange Post-Conditions Data transmitted to an authorized Public Health agency Acknowledgement sent back to sender √ Standard Product identifier √ Purchase Date √ Sales Total √ Product Description √ Category √ Store Identifiers √ Other Information

10. Costs

15. Impact

16. Patient Impact

17. Physician Impact

19. Public Health Impact

20. Retail Stores Impact

21. Recommendation We Recommend adding this data with reservations because: 1.It is difficult for public health to understand the data 2.OTC Data is noisy 3. Impossible to identify a person who purchased a product. 4. Due to competitive agreements the store cannot be identified either.

22. 1.Dr. Lael Gatewood 2.Dr. Richard Pham 3.Mr. Joseph Plasek 1.Jayne Griffith Senior Epidemiologist Bioterrorism Unit Minnesota Department of Health 651.201.5085 Jayne.griffith@health.state.mn.us 2.M. Cleat Szczepaniak Program Manager of National Retail Data Monitor and Pennsylvania RODS 412.648.6728 Special Thanks to:

23. Questions?