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Leveraging public health’s experience with information
standards and health improvement
Claire Broome, M.D.Centers for Disease Control and Prevention (CDC)
June 24, 2004Connecting Communities for Better Health
What is the “business” of public health?
Surveillance Detect outbreaks—bioterrorist, foodborne, etc Assess health status of population Assist in health planning
Investigation of causes and transmission pattern Development of effective interventions to prevent disease
and promote health Real time interoperable network needed for data and
communication exchange with myriad partners
Public HealthInformation
Network (PHIN)
Health Department
Public HealthLab
CDC and Other
Federal Organizations
Public
VaccinationCenter
AmbulatoryCare
Hospital orHealth Plan
Investigation Team
Law Enforcement and First Responders
RXPharmaceutical
Stockpile
Non-Clinical SourcesOTC, 911, etc.
Early Event DetectionBioSense
Outbreak Management
Outbreak Management
System
SurveillanceNEDSS
Secure CommunicationsEpi-X
Analysis & InterpretationBioIntelligence
analytic technology
Information Dissemination & KM
CDC WebsiteHealth alerting
PH ResponseLab, vaccine
administration, etc.
Federal Health Architecture, NHII
& Consolidated Health Informatics
Public Health Information Network
Detection and monitoring – support of disease and threat surveillance, national health status indicators
Analysis – facilitating real-time evaluation of live data feeds, turning data into information for people at all levels of public health and clinical care
Information resources and knowledge management - reference information, distance learning, decision support
Alerting and communications – transmission of emergency alerts, routine professional discussions, collaborative activities
Response – management support of recommendations, prophylaxis, vaccination, etc.
PHIN Coordinated Functions
How do we get to standards based interoperable systems?
Gartner Group project on PHIN implementation – PHIN is a multi-organizational business and technical architecture Technical standards Data standards Specifications to do work
Is also a process Commitment to the use of standards Commitment to participating in development and
implementation of specifications
PHIN Components
Services/Tools Health Alert Network (HAN) – Internet
connectivity, alerting and distance learning PHIN Vocabulary Services – standard
vocabulary versioning, and provisioning CDC Web Redesign – public health
information architecture--better access PHIN Messaging System – secure bi-
directional data transport (ebXML)
PHIN Components
Applications National Electronic Disease Surveillance
System (NEDSS)
• web entry for disease surveillance
• automatic electronic reporting of laboratory results indicating a notifiable disease
BioSense – early event detection
Laboratory Response Network (LRN) – diagnostic capacity for threat agents
PHIN funding
September 2002: Public Health and Social Services Emergency Fund provides >$1 billion for state and local public health preparedness capacity guidance from CDC and HRSA to use PHIN
standards for IT investments Guidance explicitly includes NEDSS as part of
surveillance September 2003 : second year Preparedness funding
HRSA grants $498 million ; CDC $870 million
Example of a potentially useful “tool”: PHIN Messaging System
(PHIN-MS)Software for industry standards based inter-institutional message
transport available from CDC ebXML “handshake”, PKI encryption and security Payload agnostic (HL-7, text file, etc) Bi-directional data exchange
PHIN-MS in use by state and local partners for point to point messaging (ED and lab to state; state to CDC)
Several commercial systems planning to incorporate
integration broker
laboratory information system
How can public health accelerate interoperable standards based health information systems?
Public health intrinsically must exchange information with all clinical partners in a population Shouldn’t all LHII’s have a public health participant?
Evident public value—outbreak detection, preparedness Concrete solutions for standards based interoperability – e.g.
bidirectional secure messages (ebXML) HL7 V 3 messages implementation guides
Development of data use agreements
Background Information
What does PHIN have to do with HIPAA?
HIPAA mandates national health care data standards and policies in four areas: Transaction content; unique identifiers for providers, health plans;
security; privacy PHIN architecture standards are HIPAA compliant:
supports “dual use” for security, messaging elements Approach to PHIN data standards is HIPAA compliant:
Adopting HIPAA standards where relevant Advocating inclusion of data elements relevant to public health with
SDO’s
What does PHIN have to do with HIPAA Privacy Rule?
Privacy Rule allows current practice of sharing data with public health Rule permits health care providers to share
individually identifiable information with legally authorized public health entities for public health activities
Public health activities include surveillance (NEDSS), investigation, intervention
Early event detection is critical for Bioterrorism management and response
The most useful tools will be dual use; Bioterrorism capable and regularly exercised for “routine” public health activities
Multiple data sources should be co-ordinated to facilitate signal evaluation and reduce user burden
Both diagnostic and pre-diagnostic (syndromic) data exist in electronic form in many yet untapped health-related data stores
BioSense - Principles
What is Biosense?
Near real-time data access Analysis capabilities at local, state
and national levels Shareable outbreak detection
algorithms and analytic capabilities National coverage
BioSense System INational andRegional Data
Sources City / StateRecipients
National labstest requests & results
Nurse CallLine Data
Over-the-counterdrug sales
DoD and VA sentinel clinical data
Lab Response Network(including BioWatch)
Analysis and Visualization
Clinical lab orders
BioSense System II (proposed)
National andRegional Data
Sources
City / StateRecipients
National labstest requests & results
Nurse CallLine Data
Over-the-counterdrug sales
DoD and VA sentinel clinical data
Lab Response Network(including BioWatch)
State and MetropolitanSurveillance and
Response Systems(others)
Analysis and Alerts
Electronic Investigation
Regional clinicalnetworks
Next Steps
BioSense system infrastructure is in use at CDC System I released for state and city use April
2004 For public health users, AND as a platform for
evaluation of early detection analytics Actively seeking additional:
Outbreak analytic approaches Display approaches for multiple data sources Interested groups-> [email protected]
National Electronic Disease Surveillance System (NEDSS)-- PHIN surveillance component
Browser-based data entry over Internet Person-centric Case investigation capabilities Electronic Laboratory Results HL 7
messages (2.x) can be received Security that meets HIPAA standards HL7 Version 3 case notification message
from state to CDC
NEDSS Base System
NEDSS compatible system for state and local use developed by an experienced web software developer (Computer Sciences Corporation)
Also useful as a specific implementation of NEDSS e.g. standard messages, database model
Version 1 includes 93 notifiable diseases, and modules for vaccine preventable diseases, hepatitis, bacterial meningitis and pneumonia
Now at Version 1.1.3; includes expanded data entry capacity, reporting capacity, locally defined fields
NBS Deployment Planned - 19
NBS Collaborative Development - 1
NBS Deployment Underway - 8
NBS In Use – 4
Los Angeles
Chicago
Houston
Washington D.C.
Philadelphia
New York City
NEDSS – Compatible State/Jurisdiction Development - 26
NBS = NEDSS Base System (CDC-developed)
31 Total NBS Sites
NEDSS Site Status as of 04/21/23