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. CDC’s 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

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. 3 Epi investigation started 2 Unreported Number of cases cases 1 Reported cases 0 8-Aug 15-Aug 22-Aug NYC DOHMH – Marci Layton Date of Admission 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. 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) BioSense System

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 Secretary…shall 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 of…public 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@cdc.gov Phone: 404-639-7600 Lynn Steele 404-639-7142 LSteele@cdc.gov