Leveraging public healths experience with information standards and health improvement

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Leveraging public healths experience with
information standards and health improvement

• Claire Broome, M.D.
• Centers for Disease Control and Prevention (CDC)
• June 24, 2004
• Connecting Communities for Better Health

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What is the business of public health?

• Surveillance
• Detect outbreaksbioterrorist, foodborne, etc
• Assess health status of population
• Assist in health planning
• Investigation of causes and transmission pattern
• Development of effective interventions to prevent
  disease and promote health
• Real time interoperable network needed for data
  and communication exchange with myriad partners

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Public Health Information Network (PHIN)
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Public Health Information Network
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 Lab, vaccine
administration, etc.
Federal Health Architecture, NHII Consolidated
Health Informatics
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PHIN Coordinated Functions

• 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 recommendations,
  prophylaxis, vaccination, etc.

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How do we get to standards based interoperable
systems?

• Gartner Group project on PHIN implementation
  PHIN is a multi-organizational business and
  technical architecture
• Technical standards
• Data standards
• Specifications to do work
• Is also a process
• Commitment to the use of standards
• Commitment to participating in development and
  implementation of specifications

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PHIN Components

• Services/Tools
• Health Alert Network (HAN) Internet
  connectivity, alerting and distance learning
• PHIN Vocabulary Services standard vocabulary
  versioning, and provisioning
• CDC Web Redesign public health information
  architecture--better access
• PHIN Messaging System secure bi-directional
  data transport (ebXML)

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PHIN Components

• Applications
• National Electronic Disease Surveillance System
  (NEDSS)
• web entry for disease surveillance
• automatic electronic reporting of laboratory
  results indicating a notifiable disease
• BioSense early event detection
• Laboratory Response Network (LRN) diagnostic
  capacity for threat agents

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PHIN funding

• September 2002 Public Health and Social
  Services Emergency Fund provides gt1 billion for
  state and local public health preparedness
  capacity
• guidance from CDC and HRSA to use PHIN standards
  for IT investments
• Guidance explicitly includes NEDSS as part of
  surveillance
• September 2003 second year Preparedness funding
• HRSA grants 498 million CDC 870 million

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Example of a potentially useful tool PHIN
Messaging System (PHIN-MS)

• Software for industry standards based
  inter-institutional message transport available
  from CDC
• ebXML handshake, PKI encryption and security
• Payload agnostic (HL-7, text file, etc)
• Bi-directional data exchange
• PHIN-MS in use by state and local partners for
  point to point messaging (ED and lab to state
  state to CDC)
• Several commercial systems planning to
  incorporate
• integration broker
• laboratory information system

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How can public health accelerate interoperable
standards based health information systems?

• Public health intrinsically must exchange
  information with all clinical partners in a
  population
• Shouldnt all LHIIs have a public health
  participant?
• Evident public valueoutbreak detection,
  preparedness
• Concrete solutions for standards based
  interoperability e.g.
• bidirectional secure messages (ebXML)
• HL7 V 3 messages
• implementation guides
• Development of data use agreements

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Background Information
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What does PHIN have to do with HIPAA?

• HIPAA mandates national health care data
  standards and policies in four areas
• Transaction content unique identifiers for
  providers, health plans security privacy
• PHIN architecture standards are HIPAA compliant
• supports dual use for security, messaging
  elements
• Approach to PHIN data standards is HIPAA
  compliant
• Adopting HIPAA standards where relevant
• Advocating inclusion of data elements relevant to
  public health with SDOs

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What does PHIN have to do with HIPAA Privacy Rule?

• Privacy Rule allows current practice of sharing
  data with public health
• Rule permits health care providers to share
  individually identifiable information with
  legally authorized public health entities for
  public health activities
• Public health activities include surveillance
  (NEDSS), investigation, intervention

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BioSense - Principles

• Early event detection is critical for
  Bioterrorism management and response
• The most useful tools will be dual use
  Bioterrorism capable and regularly exercised for
  routine public health activities
• Multiple data sources should be co-ordinated to
  facilitate signal evaluation and reduce user
  burden
• Both diagnostic and pre-diagnostic (syndromic)
  data exist in electronic form in many yet
  untapped health-related data stores

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What is Biosense?

• Near real-time data access
• Analysis capabilities at local, state and
  national levels
• Shareable outbreak detection algorithms and
  analytic capabilities
• National coverage

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BioSense System I
National and Regional Data Sources
City / State Recipients
National labs test requests results
DoD and VA sentinel clinical data
Analysis and Visualization
Clinical lab orders
Nurse Call Line Data
Lab Response Network (including BioWatch)
Over-the-counter drug sales
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BioSense System II (proposed)
National and Regional Data Sources
City / State Recipients
National labs test requests results
DoD and VA sentinel clinical data
Analysis and Alerts
Regional clinical networks
Nurse Call Line Data
Lab Response Network (including BioWatch)
Over-the-counter drug sales
State and Metropolitan Surveillance and Response
Systems
(others)
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Next Steps

• BioSense system infrastructure is in use at CDC
• System I released for state and city use April
  2004
• For public health users, AND as a platform for
  evaluation of early detection analytics
• Actively seeking additional
• Outbreak analytic approaches
• Display approaches for multiple data sources
• Interested groups-gt jloonsk_at_cdc.gov

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National Electronic Disease Surveillance System
(NEDSS)-- PHIN surveillance component

• Browser-based data entry over Internet
• Person-centric
• Case investigation capabilities
• Electronic Laboratory Results HL 7 messages (2.x)
  can be received
• Security that meets HIPAA standards
• HL7 Version 3 case notification message from
  state to CDC

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NEDSS Base System

• NEDSS compatible system for state and local use
  developed by an experienced web software
  developer (Computer Sciences Corporation)
• Also useful as a specific implementation of NEDSS
  e.g. standard messages, database model
• Version 1 includes 93 notifiable diseases, and
  modules for vaccine preventable diseases,
  hepatitis, bacterial meningitis and pneumonia
• Now at Version 1.1.3 includes expanded data
  entry capacity, reporting capacity, locally
  defined fields

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NEDSS Site Status as of 11/21/2009
Chicago
New York City
Philadelphia
Washington D.C.
Los Angeles
Houston
NBS In Use 4
31 Total NBS Sites
NBS Deployment Underway - 8
NBS NEDSS Base System (CDC-developed)
NBS Deployment Planned - 19
NBS Collaborative Development - 1
NEDSS Compatible State/Jurisdiction Development
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