Cloud Computing – Federal PerspectiveDesiree Mustaquim

Surveillance Epidemiologist

Centers for Disease Control and Prevention – Influenza Division

Outline for this portion• Flu story

• HL7 messaging• NGS

• CDC• Challenges• CDC initiatives related to cloud

• AMD• SDP• Other exploration of cloud

The Flu Story: Brief Background

• New vaccine developed each year (for northern and southern hemispheres)

• Extensive surveillance system to support this and monitor influenza activity

The Flu Story: PHLIPPublic Health Lab Interoperability Project

• HL7 messaging of lab results• To CDC for Surveillance• State-to-state for Surge capacity

• Infrastructure challenges• Transport – needed assistance - RnR• Evolved into AIMS• AIMS became cloud-based

• Other programs now using this model• VPD-RC• Rabies –processed in cloud

General Message Flow

AIMS – now with more capabilities than just RnR

Current Influenza Laboratory Reporting Methods*

District of Columbia

PHLIPPHLIS2

*As of 4/2017

NYC

DoD

Houston

SLO Co.

NHRC

PHLIP Influenza: ELSM from PHLs to CDC

Influenza testing information and all results for ~80% of specimens tested in PHLs ~75,000 specimens/year). Used for a variety of purposes, including reagent monitoring, specimen submission monitoring, but mainly published each week in FluView and NREVSS.

Four reference centers• Wadsworth Center (NY State

Department of Health)• California Department of Public

Health • Wisconsin State Laboratory of

Hygiene• Minnesota Department of Health,

Public Health Laboratory• NYC submits data – not as an RC

Test for a variety of vaccine preventable pathogens – serving 52 state and county PHLs

• Started with measles, mumps, rubella, varicella, meningitis (S. pneumoniae, N. meningitidis, H. influenza) and B. pertussis

• Expanded to several others in subsequent years

• Developed to provide PHLs with access to reliable testing for these now rare pathogens without having to maintain proficiencies locally

Slide Credit: Linda Cohen, APHL, and Sang Kang, CDC

PHLIP Vaccine Preventable Disease Reference Centers

PHL /USDA-L

CDC-EPI

PHA

ProviderSpecimen / Test Order (paper)

Test Result (paper)

Bite

Rep

ort

(Ele

ctro

nic

/pap

er)

CDC-Lab

Sick animal

bite

Specimen / Test Order

(paper)

Test Result (paper)

AIMS

View /

Download

View /

Download

Rabies – Proposed dataflow/architecture

The Flu Story (cont.) Next Gen Sequencing

• Increased need in 2014-15 season• Drifted Influenza A(H3N2)• Severe flu season• Difficult to grow, decreasing ability to

perform HI testing• Infrastructure not able to support the

need for moving/storing data if this size• Answer = cloud/AIMS

CDC Initiatives around cloud

Challenges:• Security policy – still evolving• Costs/sustainability• Negotiating contracts• Evaluating best uses

Example projects:• Advanced Molecular Detection (AMD)• Surveillance needs• Routing data back to state and local partners

(and other partners)

AMD

Why cloud technology should be considered• Very large data sets• Need for storage• Need for data transport• AMD systems being built with cloud

*Please visit some of the sessions on AMD for more specific information on non-flu AMD projects

Surveillance Data PlatformNeed to Improve existing surveillance infrastructure

• Too many “siloed” systems• Need to update technology• Mandate from funders (Congress) and request

from partnersSurveillance Strategy: Lays out strategies for improving

surveillance, including:• Improving use/reuse of data• Taking advantage of new technology (like

cloud)• More cross-cutting initiatives

Health Data Networks

Public Health Partners

Healthcare providers

Laboratories

State Territorial, Local, and Tribal State Agencies

CommunityPlatforms

(e.g. AIMS,PHCP,HIE)

Surveillance Data Platform

Shared Services

APHL, CSTE, ASTHO, NACCHO, NAPHSIS

OtherSources

CDCPublic Health

ProgramSystems

Definitions:- Shared Services are specific business, science and IT functions that are standardized

and built for reuse by multiple parts of an organization- AIMS is the Association of Public Health Labs Informatics Messaging Services- PHCP is the Public Health Community Platform- HIE is Health information Exchange

Shared Services

Collaboration Vision for Surveillance Data Flow

Other applications of cloud

• Exploring for routing of ELR from CDC• Emergency response uses• New ideas every day

Take-home points

• Use cloud when it makes sense – evaluation important

• Essential infrastructure for some of our current needs

Contact Information

Desiree MustaquimEpidemiologistCDC – Influenza Divisiondwc6@cdc.gov