BioSense: Using Health Data for Early Event Detection and Situational Awareness

1
BioSense Using Health Data for Early Event
Detection and Situational Awareness

• September 2005
• Lynn Steele
• Senior Advisor
• Coordinating Office for Terrorism Preparedness
  Emergency Response
• Detailed to BioSense
• National Center for Public Health Informatics
• Centers for Disease Control and Prevention

2
Summarize

• Concept of Health Situational Awareness
• BioSense Clinical Connections Priority - Vision
  and Approach
• Clinical Data of Interest
• Benefits of Participation
• Legal Authorities
• Funding

3
CDCs Health Protection Goals

• Healthy People in Every Stage of Life
• All people, and especially those at greater risk
  of health disparities, will achieve their optimal
  lifespan with the best possible quality of health
  in every stage of life.
• Healthy People in Healthy Places
• The places where people live, work, learn, and
  play will protect and promote their health and
  safety, especially those at greater risk of
  health disparities.
• People Prepared for Emerging Health Threats
• People in all communities will be protected from
  infectious, occupational environmental, and
  terrorist threats.
• Healthy People in a Healthy World
• People around the world will live safer,
  healthier, and longer lives through health
  promotion, health protection, and health
  diplomacy.

4
CDC Preparedness Goals
Pre Event Event Post-Event
Prevent Increase the use and development of interventions known to prevent human illness from chemical, biological, radiological agents, and naturally occurring health threats. Detect Decrease the time needed to classify health events as terrorism or naturally occurring in partnership with other agencies. Decrease the time needed to detect and report chemical, biological, radiological agents in tissue, food or environmental samples that cause threats to the publics health. Improve the timeliness and accuracy of communications regarding threats to the publics health. Investigate Decrease the time to identify causes, risk factors, and appropriate interventions for those affected by threats to the publics health. Recover Decrease the time needed to restore health services and environmental safety to pre-event levels. Improve the long-term follow-up provided to those affected by threats to the publics health.
Prevent Increase the use and development of interventions known to prevent human illness from chemical, biological, radiological agents, and naturally occurring health threats. Detect Decrease the time needed to classify health events as terrorism or naturally occurring in partnership with other agencies. Decrease the time needed to detect and report chemical, biological, radiological agents in tissue, food or environmental samples that cause threats to the publics health. Improve the timeliness and accuracy of communications regarding threats to the publics health. Control Decrease the time needed to provide countermeasures and health guidance to those affected by threats to the publics health. Improve Decrease the time needed to implement recommendations from after-action reports following threats to the publics health.
5
Public Health Information Network - Preparedness
Early Event Detection and Situational
Awareness Outbreak Management Connecting Lab
Systems Partner Communications
Alerting Countermeasure Response
Administration
Federal Health Architecture National Health
Information Network
6
Early Event Detection and Situational Awareness

• Great promise in using health related data,
  analysis, and visualization for initial event
  detection
• Established value in public health decision
  makers knowing
• Is there really something going on?
• Where is it?
• How big is it?
• Is it spreading?
• Is our response working?
• Situational awareness needs exist at the local,
  state, and federal levels

7
West Nile - 1999

• Clinical care data can be supportive of many
  information needs even after initial event has
  been detected

8
Initial Event Detection vs. Situational
Awareness

• Similar data sources situational awareness
  emphasizes health care data (including hospital
  utilization)
• Similar data types situational awareness
  emphasizes clinical diagnoses over chief
  complaints
• Similar analytic approaches situational
  awareness emphasizes visualization over alerting
• Slightly different use cases

9
Situational Awareness Use Cases

• Use case
• An environmental sensor in a major city detects
  anthrax. Is it a real event? A real threat?
• Need
• Visualize trends in severe respiratory illness
  and skin lesions

10
Situational Awareness Use Cases

• Use case
• Patients are presenting to a hospital emergency
  department with symptoms of acute atypical liver
  toxicity. Is this a new disease threat?
• Need
• Review similar case presentations occurring
  elsewhere, assess if numbers are increasing,
  determine other clinical attributes

11
Situational Awareness Use Cases

• Use case
• An outbreak is in progress affecting several
  large cities
• What locations are affected within each
  jurisdiction?
• Are numbers increasing? Decreasing?
• Is outbreak spreading to new areas? How rapidly?
• Need
• Visualize illness pattern changes using
  geospatial mapping, temporal charting, broader
  graphical views across jurisdictions

12
BioSense Real-time Clinical Connections

• Vision
• Provide situational awareness for suspect illness
  and possible disease cases before, during, and
  after a health event
• Help confirm or refute the existence of an event,
  monitor its size, location, and rate of spread
• Approach
• Real-time delivery of emergency room and acute
  care data from hospitals to BioSense
• Electronic views, analytics, and reports for
  national, state, and local public health,
  hospital, and government officials

13
BioSense System

• Currently, the BioSense system provides analytics
  and geographical displays of data to assist in
  early event detection
• CDC staff review data on a daily basis
  (BioIntelligence Center)

14
Priority

• Real-time data from acute care settings
• Emergency room diagnoses, lab orders and results,
  ICU diagnoses, other clinically descriptive data
• Real-time streaming data from hospital data
  networks to CDC
• Views, analytics, reports, and data available to
  state / local public health
• 2005 - sentinel hospitals in at least 10 large
  cities
• 2006 - sentinel hospitals in at least 21
  additional cities
• 2007 beyond additional volunteer hospitals
  throughout US

15
Hospital Recruitment

• Hospitals as Phase 1 data sources will be
  prioritized
• Large metropolitan area
• High-volume ED
• Health systems with multiple hospitals
• Existing hospital IT (i.e. ED system)
• Timeliness of data
• Support of local public health
• Existing data/reporting relationships with CDC

16
Implementation Concepts

• Effort to be coordinated with local and state
  public health for early event detection,
  situational awareness, outbreak characterization
• Real-time data connections of existing clinical
  diagnostic and health information required
• Industry-accepted standards to be applied in the
  coding and transmission of data
• Funding available to address incremental costs of
  hospital / health system participation
• Data feed from the hospital can be split to
  provide data to CDC and local public health
  simultaneously

17
Connection Models
Direct Connection
1
State / Local Public Health
Hospital or Healthcare System Data
Hospital / Healthcare System
Dual Submission
2
State / Local Public Health
State / Local Public Health
Hospital or Healthcare System Data
Hospital / Healthcare System
18
Clinical Data of Interest

• Primary Target Data Types
• Hospital Resources and Utilization
• Patient Demographics (obvious identifiers
  removed)
• Diagnoses and Procedure Codes
• Chief Complaints / Symptoms / Vital Signs
• Discharge Disposition
• Orders (Lab, Radiology, Pharmacy)
• Laboratory Results

19
Value to Public Health

• Simultaneous access of health data by all levels
  of public health decreases delays in recognition
  of a problem
• Neighboring jurisdictions have more information
• A national system means broader data availability
  possible by combining local and national sources
• A step in the right direction for establishing a
  foundation for electronic reporting
• Increased capacity for biosurveillance using
  existing clinical and diagnostic real-time data
  from hospital information systems

20
Value to Hospital / Healthcare System

• By using existing data for public health
  purposes, providing a window on community health
  status
• Reducing information that needs to be relayed via
  phone calls to local public health
• CDC BioSense analytics and surveillance reports
  available to hospital / health system
• Funding available can advance hospital technical
  activities needed for standards-based data
  extraction, transmission, and linkages
• Participation can support interoperability with
  local public health, and advance development of
  electronic health record activities

21
Legal Basis for Clinical Data Shared with Public
Health

• The Secretaryshall provide for the
  establishment of an integrated system or systems
  of public health alert communications and
  surveillance networks between and among
• Federal, State, and local public health
  officials
• Public and private health-related laboratories,
  hospitals, and other health care facilities
• United States Code Annotated Currentness
• Title 42. The Public Health and Welfare
• Chapter 6A. Public Health Service (Refs and
  Annos)
• Subchapter II. General Powers and Duties
• Part B. Federal-state Cooperation

22
Health Insurance Portability and Accountability
Act (HIPAA)

• Pursuant to 45 CFR 164.512(b) of the Privacy
  Rule, covered entities may disclose protected
  health information to public health authorities
• " . . . authorized by law to collect or receive
  such information for the purpose ofpublic health
  surveillance, public health investigations, and
  public health interventions . . . "

23
Funding Support

• Funding is available to compensate hospitals for
  costs associated with data transmission
• Examples of reimbursable costs
• Data standard interfaces (e.g., HL7)
• Data formatting, mapping, coding
• Necessary hardware/software components
• Incremental internal IT support costs
• Funds available via IT contractors and
  subcontractors to support needs of hospital

24
BioSense Key Principles

• Sharing, sharing, sharing what can / should
  public health do with already existing clinical,
  community health data
• Not buying data -- rather, CDC is mitigating
  costs for hospitals able to provide it
• Using PHIN standards for vocabulary, messaging,
  and security
• Balancing the need for broad coverage and
  supporting interoperability standards ---
  Progressing from sentinel hospital approach to
  wide-spread implementation

25
BioSense Real-time Clinical Connections -
Situational Awareness Use Case Scenarios

• Confirm 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

26
For Additional Information

• Web www.cdc.gov/phin/biosense
• Email BioSenseHelp_at_cdc.gov
• Phone [phone]
• Lynn Steele
• 404-639-7142
• LSteele_at_cdc.gov