Harmonized Biosurveillance Use Case

1. Harmonized Biosurveillance Use Case By Resty Namata, Maria Metty & Priyaranjan Tokachichu December 13, 2007

2. Brief History From November 2002 to 31 July 2003 • Severe Acute Respiratory Syndrome in Asia • WHO estimates up-to 60 % of cases were healthcare workers 1979 - Sverdlovsk, Russia • Accidental release of anthrax from bio-weapons plant. • 6 people with flu-like symptoms not treated for anthrax. • 21 people had died before lab results confirmed anthrax Following September 11, 2001 • Anthrax release in United States • Detected early because nation was on heightened alert.

3. Biosurveillance Use Case Requirements Transmit real-time data from healthcare providers to Public health Agency within 24hr lag Attributes: Real-time • Fulfilled by data transmission from HER Timeliness • Define by Michael Wagner et al. as difference between time of event detection & time event occurred Ultimate Goal: Early detection • Need to early detection of natural or man-made disease outbreak in order to mobilize resources and minimize morbidity and mortality

4. Ambulatory - Clinician Hospital Laboratory Organization Public Healthcare Agency BiosurveillanceUse Case context diagram Transmit /Receive essential ambulatory care Transmit /Receive ED visits & Utilization Send /Receive acknowledgement Transmit /Receive essential lab results Data is anonymized & aggregated before transmission from Electronic Medical Record Systems

5. Case for early detection Traditional Disease Detection Early Detection Gain of 2 days Phase II Acute Illness Phase I Initial Symptoms • Category A disease agents cause non-specific symptoms like • fever, cough & fatigue • People don’t seek medical care during effective treatment period. • For example: Consumer Healthcare Products Association survey: • 42% of people with “flu” symptoms purchased over-the-counter(OTC) • medication prior seeking medical care. Effective Treatment Period * Use Case Data is collected after lab results and diagnosis

6. Proposal • Collect sales data of over-the-counter healthcare product such as electrolytes, diarrhea, cough, thermometer and fever medications from retail stores and transmit it to public health agency * It has been correlated with disease outbreak. * It is routinely collected for supply chain management • * Available from National Retail Data Monitor System * It is low cost

7. Clinician Hospital Laboratory Organization Retail Store Public Healthcare Agency Modified BiosurveillanceUse Case context diagram Transmit /Receive essential ambulatory care Transmit /Receive ED visits & Utilization Transmit /Receive essential lab results Send /Receive acknowledgement Transmit Sales OTC sales data Data is anonymized &aggregated before transmission from Electronic Medical Record Systems

8. OTC-Sales Data Required • Universal Product Code • Purchase Date • Sales Total • Product Description • Category • Store Identifiers • Other Information • Stakeholders • Retails Stores that sell OTC healthcare products • Pre-Conditions • Procedures and agreements signed for data exchange • Post-Conditions • Data transmitted to an authorized Public Health agency • Acknowledgement sent back to sender

9. Costs

10. Costs

11. Costs

12. Costs

13. Costs

14. Impact

15. Patient Impact

16. Physician Impact

17. Physician Impact

18. Public Health Impact

19. Retail Stores Impact

20. Recommendation We Recommend adding this data with reservations because: It is difficult for public health to understand the data OTC Data is noisy 3. Hard to identify a person who purchased a product. 4. Due to competitive agreements the store cannot be identified either.

21. Thanks Dr. Lael Gatewood Dr. Richard Pham Mr. Joseph Plasek Special Thanks to: Jayne Griffith Senior Epidemiologist Bioterrorism Unit Minnesota Department of Health 651.201.5085 Jayne.griffith@health.state.mn.us M. Cleat Szczepaniak Program Manager National Retail Data Monitor and Pennsylvania RODS 412.648.6728