Public Health Data Standards Consortium

1. Public Health Data Standards Consortium Maureen T. Kitchelt March, 2004

2. AT&T Labs – Research: Technologies for Anomaly Detection Partner Data E.g. Hospital Discharge / Lab Data Proprietary Partners Data Knowledge Management Center Quest Diagnostic Data Warehouse CONTROL Portal BEA, Plumtree, Oracle, BRIO Partners Portal Portal BEA, Plumtree, Oracle, BRIO DATA Customer Data Loading “Streaming” Anomaly Detection Anomaly Warehouse Data Warehouse “Forensic” Anomaly Detection FIREWALL AT&T / Quest Alert Management Center Portal BEA, Plumtree, Oracle, BRIO Portal BEA, Plumtree, Oracle, BRIO Alert Distribution AT&T / Quest Statistical Analysis Environment Partner Statistical Analysis Environment FIREWALL Partner Alert Management Center Labs Technology Building Blocks: Rapid deployment, tested in critical applications • Daytona: Massively-scalable open-architecture data management system; e.g. 350M records/day, 500B records online, 92TB data warehouse. • Signature Analytics: • Signatures: Continuously-updated historical profile, physician, geography, test combinations, for real-time anomaly detection • Hancock: Match data streams to pattern templates at very large scale • Community of Interest: Relationship graphs, massively updated, e.g. 500M keys, 63B comparisons daily. • Global Case Management: 1,000’s of alerts daily, managed as cases, rule-based handling by experts; YOIX, a development environment for distributed applications. • SWIFT Dynamic Visualization: US and global mapping to ZIP level and better, comprehensive boundary files, multiple variables and graph types, drill down, pixelmap (terrain) overlay. AT&T / Quest Diagnostics BioSurveillance Engine: Database, Analytics, Visualization, Case Management

3. Business Objectives • Surveillance: Detect outbreaks—bio-terrorist, foodborne, etc • Effective interventions to prevent disease and promote health • Investigation of causes and transmission pattern, MRSA pattern AT&T Solution • Provide Public Health Services directory • Connect securely and reliably with hospitals, labs and public health offices Client Benefits • False Positives Reduced • Serve multiple levels of public health data needs • Limited IT investment • Roll-up of Data at county, State and National levels • Single source elect policy and control access ATT WebService Connect™: CDC/Public HealthReal time interoperable network needed for data and communicationexchange with myriad partners -- Public Health Information NetworkProvide Real-Time Access to Data for bio-surveillanceand health care data needs (treatment, policy, outcomes) CDC/State Public Health Office Integrate and process massive amounts of data Roll-up of data at county state and national levels: Filters and transforms data, manages security access Hospital Health ServicesNetwork Labs CDC or public health office Partners Detection and reporting of anomalous patterns and trends in both tests and results Alerts on conditions of concern and early warning alerts – syndromic surveillance based on unusual patterns of ordered tests Partners Standards-based: SOAP, XML, WSDL, UDDI HL7

4. Knowledge Repository AT&T Bio-Surveillance Solution Overview Users Users Knowledge Management Location services MSN/Yahoo/Jabber Surveillance Knowledge based Surveillance Agent Physicians Surveillance Reporting Messenger Database Pocket PC E-mail KM Engine Universities Hospitals Research / .NET Knowledge CHAIN Database Web App Internet Server Explorer 6.0 Cell Phone First Alerts and (send and Firewall Responders Tracking view Database Pager alerts) Invizeon CHAIN Alert Distribution .NET Web Internet Alert Knowledge Driven Delivery Agent Health Services WAP GW HTTP GW Instant Message GW SMS GW Via HTTP, Receiver Documents AAA Department HTTPS, Web Database (CDC, State, AT&T Mobile Network Service SOAP Local) Profiles E-Mail GW Voice/FAX GW Telnet GW SIP GW User and Participant Various Database Information Internet VPN Server Systems Delivery via SMTP (CDC, State and Local Health Active Dept's, Directory Information Hospitals, Database System Egress Universities) and E-mail to VPN Server Fax Provider pager#@provider.com AT&T Research - Labs Quest Diagnostics ATT WebService Connect™ Pager Authentication Services Cellphone E-mail phone#@provider.com Address provided by FAX user

5. Partner: Quest Diagnostics Leading provider of diagnostic testing, information and services. Clients are consumers, physicians, hospitals, insurers, employers, and government agencies. ANNUAL TESTING PERFORMED • Personal health testing on over 100 million patient encounters • Over 375 million diagnostic laboratory tests • 6.5 Million Genetic tests WORLD’S LARGEST PRIVATE DATABASE OF CLINICAL TEST RESULTS • To provide surveillance of disease trend data across broad populations of patients

6. Partner: Health Language, Inc. • World's leading provider of terminology software, services, and language engines • Dramatically enhances bio-surveillance pattern recognition in • aggregate data with concept-indexing • Enables use of worldwide health data code sets, standards and • terminologies • In use worldwide by major vendors and health ministries

7. Partners: Quovadx Quovadx is a global software company that helps organizations redevelop, extend and integrate customizable applications with the flexibility of open standards. Solutions Architected for Change Integrate Disparate Applications and Automate Information Flow …Rated Number 1 by KLAS for Integration Engine, 2003 • Integrate incompatible applications to effectively share or distribute information • Automate the flow of associated information and processes to create operational efficiencies • Rapidly develop applications, via reusable components, to effectively manage and securely share information via the Web • Built on QDX™ Platform V, the QUOVADX™ Government Adaptive Framework gives local, state and federal agencies the ability to implement integrated, automated business processes that span agencies, geographies and partners. QDX™ Platform V delivers complete business process management and integration on an industry-leading XML Web services platform to help government

8. Use of Data • Standards facilitate collaboration • Collect it once, use it repeatedly • Treatment vs. Policy • Data Analytics • Future policy perspective • Real time data vs. standards-based repository • Just in time data (as needed for application)

9. The AT&T Solution Key Components • AT&T Global Intelligent Network • AT&T WebServices Connect • AT&T Labs Technologies: DB, Signature Analytics, Visualization • Quest Diagnostics’ Syndromic Surveillance; >> 8M tests daily • Health Language Data Transformation tools • Quovadx Hospital Information Integration Systems Key Benefits • Rule-based expert anomaly management before alerts are issued • Unlimited data – No logical limit on data warehouse size • Unlimited analytics – Local surveillance at a national scale • Incorporates multiple levels of health data, local and national • Serve multiple levels of public health surveillance needs • Managed service implementation available • Frees funds for solving identified problems

10. Syndromic Surveillance Standards facilitate collaboration • Analyze once, apply repeatedly • Treatment vs. Policy • Analytics & Visualization • Future policy perspective Real time alerting vs. standards-based repository • Just in time informatics (as needed for application)

11. Back-Up Slides

12. Scenario:Today’s Presentation FocusSyndromic Surveillance Challenges • Signal to Noise Ratio • Excessive False Positives • Inadequate ability to detect signal • Roll Up to National Level Takes Weeks/Months • Extremely Limited Ability to Detect an Unidentified Organism or Bio-agent, or other Unanticipated Event • Volume and Variability of Available Data • Local Efforts Do Not Detect Cross-Jurisdictional Findings • Lack of Data Standards

13. The Solution:Syndromic SurveillanceWith Re-Purposing • Expedite Re-Use of Data Already Being Analyzed • Deep Visibility of Out-patient/physician Office Testing Segment • Roll-up of Data at County, State, and National Levels • Single Source Electronic Reporting of National Surveillance Data for Bio-Terrorism and Emerging Infectious Disease Detection as well as for enhanced surveillance for other issues of public health concern • Properly de-identified for HIPAA Compliance • Availability of Denominator Data

14. The Solution: Quest Diagnostics’Syndromic Surveillance • Complete Nation-wide Coverage • Data Distribution Representative of Population Distribution Based on Comparisons to Census Data • Routine and Esoteric Test Orders and Results • Large Normative Data Pool for Many Routine Tests

15. The Solution:Integration of Other Sourcesand Compliance to Standards • Other Sources • Hospitals • Pharmacies • Others • Standards • Integration with products such as Health Language products • LOINC • SNOMED • HL7

16. The Solution:Syndromic SurveillanceAlgorithms • Detection and Reporting of Anomalous Patterns and Trends in Both Tests and Results • Detectable Bio-terrorist Attack or Disease Outbreak on the Basis of Sudden Spikes in Orders, Even If Results All Negative • Identification of Cross-jurisdictional Outbreaks

17. The Solution:Syndromic Surveillance Alerts • Targeted Alert Messages • Alerts on Conditions of Concern That May Not Currently Be Reportable • Early Warning Alerts – Syndromic Surveillance Based on Unusual Patterns of Ordered Tests • Interface to AT&T’s CHAIN-EMN™ Service • Update and acknowledgement to Public Health Officials (State and Local, roles-based response)

18. Our Value Proposition • Streaming Analysis • Forensic Analysis • Results Presented Using Visualization and Other Reporting Tools • Reduce Investment and Risk • Web-Based Access and Collaboration • Customized Portal • Applying specific funds for public health • Surveillance • Investigation of causes and transmission pattern • Effective interventions to prevent disease and promote health • Real time interoperable network for data and communication exchange with myriad partners

19. Thank you. Maureen T. Kitchelt Director, Strategic Sales Healthcare AT&T Government Solutions 703.506.5870 kitchelt@att.com