SIREN and MEDSIS

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Arizonas Public Health Information Infrastructure

• SIREN and MEDSIS
• AZ HIMSS - July 23, 2004
• John Nelson
• Ken Komatsu

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Arizona Public Health Information Infrastructure

• Public Health IT initiatives
• Arizona Health Alert Network
• SIREN system infrastructure and features
• Disease surveillance in Arizona
• MEDSIS features
• MEDSIS and hospital systems

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CDC and Arizona initiatives
CDC AZ
Health Alert Network HAN, Secure Integrated Response Electronic Notification System (SIREN)
National Electronic Disease Surveillance System Medical Electronic Disease Surveillance Intelligence System (MEDSIS)
Laboratory Response Network Laboratory Response Network
Epidemiology Information Exchange (Epi-X) Epidemiology Information AZ (Epi-AZ)
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PHINPublic Health Information Network Vision

• To transform public health by coordinating its
  functions and organizations with information
  systems that enable
• real-time data flow
• computer assisted analysis
• decision support
• professional collaboration
• rapid dissemination of information to public
  health, clinical care, and the public

Adapted from John W. Loonsk, M.D. Associate
Director for Informatics, CDC
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PHINPublic Health Information Network

• Provides a unified information technology
  framework and standards for public health
  informatics
• Endorses additional integration of public health
  systems in development of an interoperable
  network to support multiple public health
  activities

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Health Alert Network

• A state-wide system for health alerting of public
  health, public safety, and health care
  professionals
• SIREN (Secure Integrated Response and Electronic
  Notification system) is the centerpiece of
  Arizonas Health Alert Network
• SIREN allows for secure alerting (through
  redundant means), information dissemination, and
  document sharing
• SIREN also acts as a back-bone to several
  emergency response computer applications,
  including MEDSIS (Medical Electronic Disease
  Surveillance and Intelligence System)

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Arizona Health Alert NetworkSIREN System
Infrastructure

• High Availability
• Low Maintenance (no client connections to
  support)
• Scaled to meet existing and proposed 5 year needs
  (3000 4000 simultaneous users)
• No Major Changes needed to address scaling the
  system

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Arizona Health Alert NetworkSIREN
Infrastructure Diagram
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Arizona Health Alert NetworkSIREN System
Features

• The SIREN system infrastructure is designed to
  support various applications and services
• Security and system authentication
• Directory services (Public Health Directory)
• Secure data transfer (messaging)
• Automated alerting by roles
• Document management/portal interface
• Conference bridge/telephony integration
• Email services

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Leveraged Services
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Common Application Platform
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Data Exchange/Messaging
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Arizona Health Alert NetworkSIREN System
Gateway
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Arizona Health Alert NetworkSIREN Alert
Notification

• During an emergency situation, alert
  notifications would be handled via
• Telephone
• Facsimile
• Email
• Pager notification
• Web-page updates

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Arizona Health Alert NetworkSIREN Alert
Notification
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SIREN Summary

• Secure web-based extranet
• Services based architecture
• Supports additional applications
• Provides messaging and notification services

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MEDSIS
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Public Health Surveillance

• Disease surveillance
• Reporting required by Arizona Administrative Code
  R9-6-201 to 203
• Required reporting by physicians, hospital
  administrators and clinical laboratories
• Syndromic surveillance
• Pre-diagnostic, early warning, real time
• Existing electronic data
• reassurance

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Public Health Surveillance
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Disease Surveillance

• Past
• Paper-based reporting relying on mail, fax and
  phone calls
• Unable to detect disease outbreaks at earliest
  point of potential recognition
• MEDSIS
• Secure, web-based application that allows for
  immediate notification of public health of
  reportable diseases and potential outbreaks

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Pre-diagnostic Surveillance
Work/schoolabsence
onset
death
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Pre-diagnostic Surveillance
Work/schoolabsence
onset
death
Over the counter medication
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Pre-diagnostic Surveillance
Work/schoolabsence
onset
death
Over the counter medication
Nurse Call line
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Pre-diagnostic Surveillance
Work/schoolabsence
onset
death
Over the counter medication
Nurse Call line
Urgent care visit
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Pre-diagnostic Surveillance
Lab orders
Work/schoolabsence
onset
death
Over the counter medication
Nurse Call line
Urgent care visit
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Pre-diagnostic Surveillance
Lab orders
Work/schoolabsence
onset
death
Over the counter medication
ED visit
Nurse Call line
Urgent care visit
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Pre-diagnostic Surveillance
Lab orders
Work/schoolabsence
EMSrun
traditional sources
onset
death
Over the counter medication
ED visit
Nurse Call line
Urgent care visit
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• MEDSIS represents Arizonas tie-in to the
  National Electronic Disease Surveillance System
  (NEDSS), proposed by CDC, and funded through
  Bioterrorism
• MEDSIS is the system that addresses Governor
  Napolitanos Homeland Security Action Item 8
  Electronic Disease Surveillance

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MEDSIS is

• Not a state system
• a system funded and supported by the state for
  local health department infectious disease
  surveillance.
• a flexible, expandable system
• Exceeds HIPAA security standards

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MEDSIS specifications

• Uses MS SQL server
• Written in .Net
• Integrated into the SIREN infrastructure
• Meets PHIN specifications
• Uses the Public Health Logical Data Model (based
  on the HL7 RIM)

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MEDSIS Data model
Person
Organization
Reporter
Public Health
Public Health Case
Patient
Laboratory
Risk factors
Investigator
Provider
Lab results
Case details
Clinical information
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MEDSIS Impact

• Timely receipt of disease reports
• Increase in disease reports
• Less data entry of incoming reports
• Better data quality
• Simultaneous County/State access
• Facilitates monitoring trends and analyses
• Access to alternative surveillance data

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MEDSIS Design Functionality

• A browser is the only required software
• Role-based access and rights to data
• Ability to analyze data across diseases
• Ability to query and download or cut and paste
  report data into Excel
• Moving towards automated geocoding

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Key Features of MEDSIS

• Web-based reporting by infection control
  practitioners
• System-to-system data exchange for laboratory
  reporting (ELR)
• ELR data instantly available to county/tribal
  health departments
• Moving towards distributed administration
• SSL security for application access

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MEDSIS pilot

• The initial system was built to replace current
  DOS-based state system
• Initial pilot testing group is providing feedback
  on the data flow, ease of use, bugs, reports,
  data elements, access issues and policy
  guidelines regarding system use.

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User
Organization
Role
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MEDSIS - Analysis

• Automated Analysis Systems
• Early Aberration Recognition System (EARS)
• Spatial Analysis
• ARC-IMS Geographical Information System
• SaTScan Space and Time Cluster Analysis

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Pre-diagnostic Surveillance

• Mesa EMS run data
• National Retail Drug Monitoring System Over the
  Counter Pharmaceutical Sales
• BioSense VA, Drug Sales, Military Hospitals
• National Systems
• BIDS Border Infectious Disease Systems
• SDN CDC Secure Data Network

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MEDSIS 2004

• Pilot electronic data exchange with hospital and
  clinical laboratories
• Add line list reports and extracts
• Pilot system with counties and infection control
  practitioners
• WNV module to include human and non-human
  tracking

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Next MEDSIS Project plan, 04/05

• Refinement of interface and features based on
  feedback
• Rollout to all county health departments
• Outreach to all hospitals and clinical
  laboratories
• Gathering business requirements for an outbreak
  management and a contact tracing modules
• Begin outreach to clinics, providers, and schools

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SIREN/MEDSIS Team

• Team Leaders
• Ken Komatsu
• John Nelson
• Epidemiology Team Members
• Deniz Akinc
• Jennifer Orsi
• Technical Team Members
• Paul Barbeau
• Bryan Christopher
• Tim Colman
• Joseph Urrea

• Partner Development
• County Health Departments
• GITA

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Additional Information

• http//www.cdc.gov/NEDSS
• http//www.cdc.gov/PHIN
• http//www.hl7.org
• http//www.snomed.org/
• http//www.loinc.org/

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Public Health and Hospital Information Systems

• Minimize the time to detection
• Reduce the burden of manual reporting
• Next steps
• Coordinate an assessment of hospital information
  systems related to reporting and data exchange
• Prioritize and begin discussions

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Data Exchange

• Secure Socket Layer (SSL)/ Transport Layer
  Security (TLS)
• Secure Socket Shell (SSH)
• Browse and upload

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Questions?

• For more information contact
• Ken Komatsu, Surveillance Project
  Coordinator603-364-3587kkomatsu_at_siren.az.gov
• John Nelson, Health Alert Network Program
  Manager602-364-3282jnelson_at_siren.az.gov