TM1

Outbreak Management Interoperability Working

Group WebinarPresented June 17, 2009

Jeanne Tropper, MS, MPH jwu0@cdc.gov, David Nitschke, PMP, den4@cdc.gov,

Gerald Jones, gfj0@cdc.govUlrica Andujar, MPH, CHES, gte0@cdc.gov, CDC

contractor Marty Cicchinelli, MS, PMP, mlc7@cdc.gov CDC

contractor

National Center for Public Health Informatics

TM2

Agenda

• Background and Purpose• PHIN Conference Outbreak Management

Interoperability (OMI) Workshop Summary

• Interoperability Progress on OMI Component

Applications: Epi InfoTM, OMS and CRA • Interoperability Progress on OMI Component

Applications: Epi InfoTM, OMS and CRA • Implications of H1N1 on OMI• Open Discussion• Next Steps

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What is OMI?

• Original concept: • desk top, interoperable tool set to better support the public

health (PH) practitioner during outbreaks• “Microsoft Office” concept for PH initially focused on CDC’s

Epi Info™ (EI), Outbreak Management System (OMS), and Countermeasure and Response Administration (CRA) applications

• Drivers: • feedback from multiple venues including CSTE, PHIN

Conference, component system work groups• multiple disparate systems (including manual), siloed

development and use, lack of standard vocabulary and practice making data sharing difficult, and so on

• COTPER funded project for FY2009 – 2010 to further define, scope, prototype and position for next generation OMI

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Purpose of OMI Working Group

• Bring together subject matter and technical experts at the national, state and local level to:• Develop Vision and Scope for OMI Project• Determine priorities for OMI features• Gather requirements for OMI features for prototype; practical

application in the field

• Workgroup first initiated at 2008 PHIN Conference; most work since then has been at the component application level

• This meeting marks the re-initiation with initial focus on• Updating progress at the component application level: Epi Info™,

OMS, and CRA• Reviewing previously requested OMI features to determine if they

are still appropriate• Considering the implications of H1N1 on initial approach• Determining next steps – meeting schedule, priorities, other

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OMI Activities to Date

• June 2008 – CSTE Conference Workshop: conducted OM business processes requirements gathering and discussion

• August 2008 – PHIN Conference OMS, CRA and Epi InfoTM Workgroup: collected first requirements for OM Interoperability (OMI)

• September 2008 – NCPHI All-hands: established of OM Program as part of reorganization

• September 2008 – present: work on component applications; internal discussions on OMI

• February 2009 – COTPER funding notice: OMI project approval and ceiling

• April – May 2009 - H1N1 Outbreak: implications to OMI? • June 2009 – Board of Scientific Counselors (BSC)

presentation: possible OMI strategy; re-initiation of OMI workgroup

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Summary of PHIN Conference OMI Workgroup

• Used 2005/2006 mumps scenario to illustrate use of OMS, Epi InfoTM and CRA in an outbreak• Illustrated how each application could be used in a

fictional progressive outbreak scenario• Distinguished how each system relates to one

another and their logical connectivity• Solicited partner input on future interoperability:

short, medium and long term

• Demonstrated components of each application used in a progressive outbreak

TM7

CRA 1.9• Web-based with SOA• Highly scalable; supports multiple

users, clinics, sub-jurisdictions, jurisdictions

• HL7 messaging to IIS • Rapid data entry for mass tracking of

countermeasures• Regional & National Aggregate

reporting to CDC

CDC OM Program – Component Applications

Epi InfoTM 3.5.1• Forms generation with

standard vocabulary • Custom Data Entry • Entry Validation• Epi MapTM GIS• Analysis Visualization &

Reporting • Import and Export Tools • Stand-alone application

OMS 1.3• Entity Management• Forms Development Tools• Workload Management• Shareable vocabulary/question

set library• Integration with Epi InfoTM

AVR or SAS• Data synchronization• Version control• Import and Export tools • New HL7 messaging features• Stand-alone, Client Server, and

Citrix-enabled

OMINew projectfunded byCOTPER

2009-2010

OMS 1.3• Entity Management• Forms Development Tools• Workload Management• Shareable vocabulary/question

set library• Integration with Epi InfoTM

AVR or SAS• Data synchronization• Version control• Import and Export tools • New HL7 messaging features• Stand-alone, Client Server, and

Citrix-enabled

TM8

2008 PHIN Conference – Use of OM Component Applications in Progressive

Outbreak

Month 5: linked to UK strain – vaccination campaign continuing

Month 4: additional persons with clinically compatible symptoms investigated in three neighboring states; only 16% of total cases were linked epidemiologically suggesting frequent unapparent transmission – vaccination campaigns begin

Month 3: active surveillance initiated in seven geographical areas, including three largest universities

Month 2: isolate from an unrelated patient cultured; identified as mumps: multiple regions affected

Month 1: first reports of mumps-like illness at a university in a Mid Western state

CRAOMSEpi Info™

Outbreak Scenario

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2008 PHIN Conference Workgroup – OMI

Recommendations• Immediately useful to get questionnaires and data

from Epi InfoTM to OMS and CRA

• Eliminate duplicate data entry among Epi InfoTM, CRA, OMS, NBS, and IIS

• Capture aggregate data in OMS

• Use messaging and interoperability among systems

• One system – “a one stop shop” – to do everything

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2008 PHIN Conference Workgroup – OMI

Recommendations, continued• Need to get OMS case data to surveillance systems

for transfer to CDC and state registries• Need a definition or standard for a minimum data

set for each disease entered• Need open platform coding• Need an application to take into the field

unplugged, plug it back in and synchronize the data• Need for a version of Epi InfoTM to be deployed to a

PDA• Need to understand the entire process with pieces

talking to each other

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Epi Info™ Current Usage

• Number of users unknown – estimated in the hundreds of thousands• Used by 45+ states and their county health

departments• Used by CDC CIOs for research projects; to create

applications for Global Health, Global Immunizations, Division of Nutrition and Physical Activity, Influenza Division

• Heavily relied upon by international public health organizations such as WHO (World Health Organization) and PAHO (Pan-American Health Organization), especially for uses in Africa and South America

• Used by several countries as the foundation for their national monitoring and evaluation systems (including Egypt and El Salvador)

04/18/23 11

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Epi Info™ Current Status

• Current Version in production is 3.5.1• Epi InfoTM Version 7 written with C#.Net

- supports Access, SQL sever, and MySQL; in pre-beta development at http://www.codeplex.com/epiinfo

• Meetings of the stakeholder, user, and partner groups to be conducted:• Get input on future direction of EI• Facilitate open source development (NCPHI

Open Source Framework)

04/18/23 12

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Epi Info™ Interoperability Features

• Stand alone analysis feature – used by OMS, CRA, other applications

• Import / export in multiple formats• Prototyping underway on “light weight”

synchronization platform (Mesh4x) to:• Share data among different sources regardless of

platform or connectivity• Transmit data and maps over internet cloud or SMS

channels• Connect with fellow investigators’ data while in the

field in remote locations• Synchronize with SMS if internet connectivity

unreliable or intermittent

04/18/23 13

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Mesh 4X The Prototype: Architecture

Edgeware, non-secure, lower volume usage

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Generate Google Earth Map in Epi InfoTM Mesh4X Tool

• In order to gain a perspective of the cases, the user can create a KML file to display in Google Earth (map layers); to create the KML file, the user launches the Epi Info™ Mesh4x tool and generates a local map as follows:• Click the “Map Exchange” tab• Specify the data source (EpiInfo.mdb) and the outbreak data table• Click the “Create Map” button and this will generate the KML file

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Generate Google Earth Map, continued

• It takes about 30 seconds to make the KML file. To show the map, open the Google Earth file generated by the Epi Info™ Mesh4x tool.

• The resulting map below shows an example with 28 cases:• 12 patients reported with illness (Red pins) between April 18th and

19th

• 16 interviewers did not show any illness (Yellow pins)

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OMS Current Usage

• Thirteen jurisdictions have received OMS Version 1.3• Two international partners have received OMS Version 1.3

• One jurisdiction has requested to be an initial tester for OMS Messaging

• CDC’s NCEH has used OMS for a radiological exercise

• 25 requests from state health departments / jurisdictions for use of Version 1.2

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OMS 1.3 Current Status

• Version 1.3 completes base system

• Wizard-based setup and configuration

• Developed OMS-HL7 Messaging sub-system

• Messaging beta-testing in place at state level

• Requested by states for use with H1N1

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OMS Interoperability Features

• Conforms to PHIN Outbreak General Message specifications.

• OMS can send data to any 3rd party system capable of consuming HL7 outbreak message.

• In discussions with NEDSS Base System to be first consumer of this message

• OMS allows for data import (Excel format)• OMS allows for data export (variety of formats)• Data analysis: OMS data can be analyzed by Epi

InfoTM, SAS, SPSS, Social Network or GIS Software

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OMS – HL7 Messaging

• Conforms to PHIN Outbreak General Message specifications.

• Allows OMS to send data to any 3rd party system capable of consuming HL7 outbreak message.

• Developed OMS-HL7 Messaging sub-system• OMS-OMS Messaging • OMS-NEDSS Messaging• OMS-3rd Party Messaging

• In discussions with NEDSS Base System to be first consumer of this message.

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OMS – HL7 Messaging

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Messaging Queue Management

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CRA Current Usage

• Used in vaccine doses administered exercises by the 62 PHEP Grantees using seasonal influenza as a proxy for pandemic influenza vaccine tracking via• Option 1 – Data Exchange• Option 2 – Web Based Aggregate• Option 3 – Web Based Patient Detail

• Used in state and local health department emergency preparedness exercises for countermeasure tracking

• Used to support NCIRD, DGMQ, and NCEH efforts for emergency preparedness activities for countermeasure reporting and/or tracking of pharmaceutical and non-pharmaceutical interventions

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CRA Current Status

• Version 1.8.2 in production • Version 1.9 in development to be released

mid July• Complete support for data exchange with state IIS• Synchronization of data using Web Services• AVR capability utilizing Google Earth and Google

Map technologies

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CRA Visualization Capabilities

• Uses Google Maps/Google Earth• Google Maps

Embedded within CRA (shown)

• Generates KML files with CRA data for display by Google Earth

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CRA Interoperability Features

• HL7 Data Exchange with state IIS• Full support for Implementation Guide for Immunization

Data Transactions using version 2.3.1• Allows for bi-directional data exchange• Synchronization of data between CRA and state IIS• Supports both PHIN MS and web-based file upload

• Aggregate Data Exchange• Supports Multiple Data Formats

• Flat file (pipe-delimited) OR• Extensible Markup Language (XML) file OR• Health Level Seven (HL7) Version 2.5

• Supports both PHIN MS and web-based file upload• Import/Export• CRA data can be analyzed using Epi InfoTM

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CRA Current Architecture

Laptops

StateCRA

County CRA

CDCCRA

CRA at Points-of-

Dispensing

StateIIS

sync

HL7 DataExchangeSynchronization

using Web Services

sync

sync

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Recommendations from 2008 PHIN Conference

Request Progress Application to take into the field unplugged, plug it back in and synchronize the data.

Complete – OMS, CRA Prototyped – Epi Info

Eliminate duplicate data entry among Epi Info, CRA, OMS, NBS, and IIS.

Partial – Import/Export

Use messaging and interoperability among systems. Partial – CRA to IIS; OMS to NBS

Open platform coding. Partial – Epi Info

Get questionnaires and data from Epi Info to OMS and CRA.

Partial – Import/Export

Get OMS case data to surveillance systems for transfer to CDC and state registries. Partial

Need for version of Epi InfoTM to deploy to a PDA. None

Definition or standard for a minimum data set for each disease entered.

None

One system – a one stop shop – to do everything None

Capture aggregate data in OMS None

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Epi InfoTM, OMS, and CRA address H1N1

• Epi InfoTM

• Hospitalized patients questionnaire• DGMQ cruise ship outbreak survey

• OMS • Requested by states for use in outbreaks

• CRA • Planned to support tracking vaccine doses

administered in fall 2009 during federal campaign

• Requested by a number of states to be used for antiviral tracking

TM30

How do we best address OMI both short term and long

term? • Community of Practice (CoP)?• Demonstrations and trainings using what

we have?• Messaging between applications?• Forms repository?• Composite application?• Grid-enabled application?• COTS application?

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Summary - OM Interoperability

Short TermToday

• Segregated use with limited interoperability

• Import and export features for data sharing;

• Limited messaging capability

• Some shared analysis tools

• Some forms development tools

• All on different Platforms

• Some SOA features

• CRA ability to send data to CDC

• Deconstruct best components from each existing application

• Build web-enabled composite application prototype (SOA) with forms service, GIS, countermeasure and response administration and linkage to NBS for case reporting

• Use standard vocabulary

• Use same suite of analysis tools

• Joint training and implementation

Mid Term Long Term

• Interoperable platform that becomes “best of breed”, accessed via Web or Grid with open source components

• Data able to remain locally but accessed by CDC

• Used by CDC and field

• Data shared freely across state, local, and regional boundaries

• Segregated use with limited interoperability

• Import and export features for data sharing;

• Limited messaging capability

• Some shared analysis tools

• Some forms development tools

• All on different Platforms

• Some SOA features

• CRA ability to send data to CDC

• Deconstruct best components from each existing application

• Build web-enabled composite application prototype (SOA) with forms service, GIS, countermeasure and response administration and linkage to NBS for case reporting

• Use standard vocabulary

• Use same suite of analysis tools

• Joint training and implementation

• Segregated use with limited interoperability

• Import and export features for data sharing;

• Limited messaging capability

• Some shared analysis tools

• Some forms development tools

• All on different Platforms

• Some SOA features

• CRA ability to send data to CDC

• Deconstruct best components from each existing application

• Build web-enabled composite application prototype (SOA) with forms service, GIS, countermeasure and response administration and linkage to NBS for case reporting

• Use standard vocabulary

• Use same suite of analysis tools

• Joint training and implementation

• CDC/field testing and implementation of SOA modular composite application

• Allow messaging or upload options for partners not using CDC application

• Forms development, contact tracing, analysis tools, GIS, countermeasure and response administration, case reporting services

• Data sharing agreements in place with all Project Areas

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Possible Next Steps

• Determine best frequency and dates for continued Workgroup Meetings

• Start OM Community of Practice

• Collect new feature priorities

• Rank new feature priorities

• Develop draft Vision and Scope based on feature priorities

• Gather new detailed requirements

• Develop interface prototype

• Demonstrate interface prototype

• Develop application horizontal prototypes

TM33

Questions?