1. TM State of the Science: Preparedness Informatics John W. Loonsk, M.D. Associate Director for Informatics Centers for Disease Control and Prevention

2. TM Informatics - the Science Medical Informatics - the rapidly developing scientific field that deals with resources, devices and formalized methods for optimizing the storage, retrieval and management of biomedical information for problem solving and decision making. - Edward Shortliffe Public Health Informatics – “Improving the way public health is practiced by taking advantage of what technology affords…” The Science of Informatics – We are not interested that your hard drive needs backing up or you can’t log into e-mail

3. TM Why Now? A Unique Moment in Time for Public Health Information Technology −Clinical care - becoming computerized – best opportunity ever to get clinical data −Improved ability to share data because of standards – now engaged at the federal level −Informatics – have seen ways that IT can help public health do more −Technology more available – connectivity, software, development and resources

4. TM Why Now? A Unique Moment in Time for Public Health Information Technology −Anthrax attacks – there are compelling and urgent needs −Recognition of public health’s role – a unique part of homeland defense −West Nile – threat isn’t only terrorism −SARS – must depend on international colleagues

5. TM Information systems and informatics are becoming an assumed part of what public health is In transition from: −Information systems can help and you should use these standards if you build them. to −You need to have systems that do specific things and they must be regularly used to achieve optimal public health outcomes. Having these systems consistently in place (and in clinical care) = new public health benefits State of the Science: National Center for Public Health Informatics

6. TM IT Needs of a Major PH Event

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8. State of the Science: Interoperable Systems Systems that can directly exchange information and services −Shared data standards −Shared technical standards −Shared information architecture Federal Health Architecture, NHII & Consolidated Health Informatics

9. TM State of the Science: Interoperable Systems HL7 B Integration A

10. 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 Coordinated Organizations and Systems

11. TM Event 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 isolation, prophylaxis, vaccination, etc. PHIN Coordinated Functions

12. TM State of the Science: Early Event Detection Health care data are available to public health, in real time, for early event detection, localization, quantification, and monitoring −Clinical care diagnoses, lab results, procedures −Other health related data (e.g. test orders, prescriptions, early health seeking behaviors) offer promise also

13. TM Public Health Case Reports Case Report Name : Jane Age 46 Sex Female Weight____ Height_____ Temp_____ BP_______ Traditional Case Reporting Most reporting steps are still paper-based and manual Many, if not most, reportable disease cases are not reported Can take as long as 26 days for a bioterrorism related disease to be reported to the CDC Inconsistent coverage of major cities and no timely cross- jurisdictional coverage Diagnoses and Procedures from Clinical Care Sites Secondary Reporting of Health Care Data Near real-time data analysis No clinical reporting burden Critical for next steps of secondary detection, investigation, quantification, localization, and outbreak management Early Detection Data Investigative Early Detection Data Sources Over the counter drug sales School / work absenteeism Other data State of the Science: Early Event Detection

14. TM Clinical care data supportive of many information needs – even after an event has been identified West Nile Virus NYC - 1999 Epi investigation started 0 1 2 3 8-Aug 15-Aug22-Aug Date of Admission Number of cases Unreported cases Reported cases NYC DOHMH – Marci Layton State of the Science: Early Event Detection

15. TM Detection algorithms can identify and monitor outbreaks and events −Complement the well trained clinician – don’t replace them −Can detect subtle events in data early – may not be visible at any single site −Use algorithm across multiple data sources to increase sensitivity and specificity BioSense Demonstration Data State of the Science: Early Event Detection

16. TM State of the Science: Early Event Detection A bi-directional network for getting detection data can enhance privacy protection −Patient names and medical record numbers can be kept out of reporting −Privacy can be protected −Appropriate public health investigation (query), can be supported through linking Reported data – no names or medical record numbers Appropriate Public Health Investigation

17. TM State of the Science: Outbreak Management Systems for managing outbreaks −Outbreaks are frequently about relationships  Lab results to possible cases  Person to person  Vector to person  Location to person Bogatti SP. Reprinted in MMWR 5-9-03 SARS cases in Singapore

18. TM State of the Science: Outbreak Management Systems for managing outbreaks −Outbreaks are frequently about relationships  Lab results to possible cases  Person to person  Vector to person  Location to person −Computer does the contact tracing / data linking −Public health professionals do the analysis and planning

19. TM State of the Science: Information Dissemination Information accessed when and where it is needed for supporting public health outcomes −Consistent content descriptors for content indexing (metadata and vocabulary) allow for better searching and multipurposing −Separating content (text) from the presentation (i.e. web page) allows for use on web, in PDA’s in internal documents and in decision support systems

20. TM State of the Science: Information Dissemination Information delivered to those who need it in the way that they want it −Using consistent directories of those who participate in public health with standard roles −Systems that can deliver information with consideration for roles, geographic location, level of urgency and method of delivery (pager, e-mail, call, etc.)

21. TM State of the Science: Counter Measure and Response Administration Support delivery of prophylaxis, vaccination and management of isolation and treatment −Optimization and management of response is very data intensive −Computer systems are necessary to monitor the effectiveness and completeness of response

22. 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

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