Emerging Health Threats and Health Information Systems: Getting Public Health and Clinical Medicine to Real Time Respon

Emerging Health Threats and Health Information Systems: Getting Public Health and Clinical Medicine to Real Time Response John W. Loonsk, M.D. Associate Director for Informatics Centers for Disease Control and Prevention

Emerging Health Threats and Health Information Systems: Getting Public Health and Clinical Medicine to Real Time Response • John Lumpkin – NCVHS and clinical care standards activities • Richard Platt – Using health plan data for public health • John Loonsk – The Public Health Information Network and background on public health / clinical care connection

“The New Normal”

Public Health Lab Hospital or Health Plan CDC and Other Federal Organizations Investigation Team Health Department Ambulatory Care R X Pharmaceutical Stockpile Early Detection Sources Vaccination Center Law Enforcement and First Responders Public Public Health Information Network Preparedness Information Architecture Data Exchange and Information Management

What is PHIN? 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 support other organizations public health systems needs

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.

Public Health Information Network - Process • Document functional requirements to support public health activities (starting with preparedness) • Identify relevant industry standards - technical and data • Develop specifications based on the standards that are concrete enough to do work • Fund through the functions, standards and specifications • Make systems available to support these functions and that use these standards - now • Develop software elements and artifacts to be used in other systems that implement the standards • Support certificationof the functionsand specifications

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 • Countermeasure administration • Lab, vaccine, • prophylaxis Federal Health Architecture, NHII & Consolidated Health Informatics

Public Health Information Network • Early Event Detection • BioSense • Outbreak Management Outbreak Management System, lab result reporting • Surveillance • NEDSS • Secure Communications • Epi-X • Analysis & Interpretation • BioIntelligence • analytic technology • Information Dissemination & KM • CDC Website • Health alerting • PH Response • Countermeasure administration; isolation, vaccine, prophylaxis Federal Health Architecture, NHII & Consolidated Health Informatics

BioSense - Setting One of the new national bioterrorism initiatives: BioShield -rapid development of new vaccines and therapeutics BioWatch - deployment of environmental air samplers in key locations BioSense - early event detection through accessing and analyzing pre-existing diagnostic and pre-diagnostic health data BioSense is a major part of the DHHS / DHS 2005 biosurveillance initiative.

All Hazards Detection and Response Data Outbreak or Attack Hours Days Weeks Health seeking behaviors Ambulatory care visits Tertiary Care, morbidity and mortality (traditional) Traditional case reporting Initial detection Subsequent detection, quantification, localization Outbreak management, contact tracing, case confirmation Countermeasure administration, isolation, prophylaxis, Rx

Most reporting steps are still paper- based and manual Most reportable disease cases are not reported Can take as long as 26 days for a bioterrorism related disease to be reported Inconsistent coverage of major cities and no timely cross-jurisdictional coverage CaseReport Name: Jane Age 46 Sex Female Weight____ Height_____ Temp_____ BP_______ “Traditional” Public Health Reporting Local Health Department Public Health Case Reports

BioSense BioSense - Secondary Use of Health Data • Near real-time data analysis • No clinical reporting burden • Analytic tools allow for identification of subtle trends not visible to individual MD’s • Critical for next steps of secondary detection, investigation, quantification, localization, and outbreak management Clinical Diagnoses and Lab Results Other Early Detection Data

Early Detection Plans • Establish test beds with adequate community based health data • Advance infrastructure for, and provisioning of, substantiated data sources • Implement standards for data exchange at all levels of public health • Advance consistent application of approaches that ensure confidentiality

Early Detection Research • Evaluation of early health seeking behavior data sources • Algorithm and visualization evaluation • Population-based presentation profiles of health events / outbreaks • Multi-data source integration for increased sensitivity and specificity

Outbreak Management Managing outbreaks includes: • Exchanging possible case data at the individual level among involved organizations • Linking contacts, exposures, lab results, etc. SARS cases in Singapore Bogatti SP. Reprinted in MMWR 5-9-03

Outbreak Management Activities • Foster data standards for exchange and automated linkage • Modeling of disease conveyance • Structured data management tools and techniques • Methods for automating the association data at the individual level

Countermeasure and Response Administration • Systems and infrastructure to rapidly administer prophylaxis, vaccination and isolation • Research optimization of clinic structure and administration systems support • Support societal findings relative to behaviors in different levels of emergencies

Communications and Knowledge Management • Targeted just in time and just in case information delivery for emergent and routine public health outcomes • Knowledge storage, coding and management • Portal and content optimization for information access and delivery

Emerging Health Threats and Health Information Systems: Getting Public Health and Clinical Medicine to Real Time Respon