Opportunities for Strengthening Public Health Surveillance

1. Opportunities for Strengthening Public Health Surveillance Kathleen Gallagher D.Sc, MPH PH Surveillance & Informatics Program Office OSELS, CDC CSTE Pre-Conference Workshop, Pasadena CA June 9, 2013 Office of Surveillance, Epidemiology, and Laboratory Services Public Health Surveillance & Informatics Program Office

2. Agenda • CDC OSELS update • NNDSS (8:45-12:00) • BioSense (1:30-5:00

3. NNDSS Agenda • 8:45am – 9:15am Actions taken in response to NNDSS Evaluation Phase I (Kathleen Gallagher, Jeffrey Kriseman) • 9:15am – 9:45am Overview of the NNDSS Evaluation Phase II – (Perry Smith) • 9:45am – 10:00am CDC Office of Infectious Disease perspective about surveillance issues and future (Tonya Martin) • 10:00am – 10:15am Break • 10:15am – 10:45am Results from the 2012 CSTE NEDSS Assessment (Erin Holt, Kathryn Turner) • 10:45am – 12:00pm Local, State, and Territorial Perspectives/Discussion • 12:00pm – 1:30pm Lunch on your own

4. External Evaluation of NNDSS • External Evaluators • 1 former state epidemiologist, 2 informaticians • Purpose • Identify issues/problems with current NNDSS without the biases of persons ( within CDC ) invested in the system • Recommend solutions • Scope • Phase I –focused on data and business processes within CDC • Phase II - identify issues/challenges/problems experienced by SLT health departments • Methods • Conducted interviews with 81 staff from 14 CDC divisions • Reviewed documentation

5. Focus of External Evaluation of NNDSS Evaluation Phase 1 Health Depts. Local Healthcare Providers, inc. Labs CDC/OID National Centers CDC/OSELS NNDSS State

6. External Evaluation of NNDSS Findings • Organizational • No consistent, national long-term oversight governance • Inconsistent leadership and poor organizational support • History of poor project management practices • Inadequate capacity of internal staff to oversee contracts • Technical • Numerous data streams and transformations (that occur at OSELS) prevent delivery of quality data to CDC programs

7. Data ProcessesCommon Data Store

8. Recommendations for Improvement • Implement long-term oversight of NNDSS • FACA, subcommittee • Organizational Support • Upper level management must be engaged (OID, CGH,OSELS, OD) • Lines of responsibility within OSELS need to be addressed • Improve Project Management • All levels of staff should be knowledgeable about good project management practices • All stakeholders must be actively involved • Primary responsibility for checking data quality should reside with the CDC programs • CDC FTE’s must actively oversee all contract work

9. Recommendations for improvement (cont’d) • Revise system design and current data processing procedures • Further collaborative review by stakeholders • Retire NETSS format • Conduct full evaluation of the NEDSS base system (NBS) • Revise Common Data Store (CDS) to use technology smarter • Avoid creating dependencies on single standards, domains or vendors

10. Getting the Data Out to CDC ProgramsProposed Initial Design Before Proposed

11. Ongoing Challenges • Organizational/operational barriers to success • Staff capacity • Hiring • Budget • MASO • Dependencies on contractors • Expensive and may hamper our ability to get the most innovative and cost-effective approaches

12. Conclusions • Technical issues exist but current technologies and computational practices can solve these • Simplifying the approach can improve performance and reduce costs • Organization challenges will be more difficult to overcome • Will require high level organizational support and stamina • Collaborative support needed may be hampered by our “image problems” • Need to build internal capacity to reduce reliance on contractors

13. Action Steps Taken To Date • Staff who need project management training have been identified and training has been or is being scheduled • Contracts for IT services have been critically reviewed/ new contracts have been awarded • Continue development of simplified data processing and provisioning strategy • Reorganization should help to improve efficiency and focus • Internal high level discussions at CDC have occurred about governance and support. • FACA is scheduled to “ stood up” by end of 2013

14. Ideal • Strong local and state disease reporting systems that meet information needs • Shared and disease-specific • Local to state to national • IT services enhance efficiency & minimize duplication • Platform(s) for multiple forms of surveillance • Consistent with emerging national information standards • Healthcare and laboratory information systems • Information exchange • “Meaningful Use” program • Exploit “cloud” computing environment • Support collaboration across jurisdictions and with CDC • Reduce data storage costs • Facilitate access to analysis tools

15. Vision for the Public Health Platform 6/10/2013 PHP Advisory Group FedRAMP Cloud Service Provider (CSP) Immunization Data POTENTIAL DATA ANALYSIS & EXPLORATION SERVICES STANDARDIZATION & NORMALIZATION SERVICES STORAGE & DATABASING SERVICES DATA ACCESS SERVICES TRANSPORT SERVICES Flat Files CMS Data MySQL PHIN MS Potential Authorized Users Object Identification Validation XML Files Vital Statistics Data WEAT Other VPN Mirth Vocabulary Authorization Data Quality Dash Board HL7 2.x API Syndromic Surveillance Data sFTP Message Guides Potential Mobile Apps Development Rules CDA Notifiable Disease Data Direct Authentication Other Other Formats Potential Public Users Other Cancer Data Connect API Public Data Other Data LEGEND Secure Access Secure Transmission Data flow (2-way) Client Data source Application Application Programming Interface (API) Elastic Data Storage Users Public Access Input data (2-way) Web Service Mobile Client Encryption Message

17. QUESTIONS? Office of Surveillance, Epidemiology, and Laboratory Services Public Health Surveillance & Informatics Program Office

18. NNDSS Message Guides Proposed Priority List • Priority Group 1 • NETSS Core • NBS Core • Generic Case (v1,v2, HL7) • Mumps • Pertussis • TB (v2, HL7) • Varicella (v2, HL7) • Hepatitis (HL7) • STD (NETSS) • Other NND’s ( to allow for retirement of all current NETSS feeds)

19. National Public Health Surveillance and Biosurveillance Advisory Committee • Established to support CDC’s continued leadership in public health surveillance and biosurveillance.  • Advises the Director of CDC regarding the broad range of issues impacting public health surveillance and the human health component of biosurveillance.  • Chartered for 15 members.

20. National Public Health Surveillance and Biosurveillance Advisory Committee- Timeline • November 6, 2012, MASO published through the federal register notice the request for nominations for candidate’s submission • Submission for nominees closed December 21, 2012. • January 2013, CDC Vetting Panel formed. • February 2013, CDC Vetting Panel process complete. • Next Steps: • Finalize proposed slate of potential candidates • Submit proposed slate to CDC’s MASO for final round of vetting   • Submit slate to CDC Director and HHS Secretary for final approval