TM Emerging Health Threats and Health Information Systems: Getting Public Health and Clinical Medicine to Real Time Response John W. Loonsk, M.D. Associate

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Emerging Health Threats and Health Information Systems:

Getting Public Health and Clinical Medicine to Real Time Response

John W. Loonsk, M.D.

Associate Director for InformaticsCenters for Disease Control and Prevention

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Emerging Health Threats and Health Information Systems:

Getting Public Health and Clinical Medicine to Real Time

Response• John Lumpkin – NCVHS and clinical care

standards activities • Richard Platt – Using health plan data for

public health• John Loonsk – The Public Health

Information Network and background on public health / clinical care connection

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“The New Normal”

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PublicHealthInformationNetwork

Health Department

Public HealthLab

CDC and Other

Federal Organizations

Public

VaccinationCenter

AmbulatoryCare

Hospital orHealth Plan

Investigation Team

Law Enforcement and First Responders

RXPharmaceutical

Stockpile

Early DetectionSources

Preparedness Information Architecture

Data Exchange andInformation Management

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What is PHIN?

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 support other

organizations public health systems needs

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• 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

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Public Health Information Network - Process

1. Document functional requirements to support public health activities (starting with preparedness)

2. Identify relevant industry standards - technical and data

3. Develop specifications based on the standards that are concrete enough to do work

4. Fund through the functions, standards and specifications

5. Make systems available to support these functions and that use these standards - now

6. Develop software elements and artifacts to be used in other systems that implement the standards

7. Support certification of the functions and specifications

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Early Event DetectionBioSense

Outbreak Management

Outbreak Management System

SurveillanceNEDSS

Secure CommunicationsEpi-X

Analysis & InterpretationBioIntelligence

analytic technology

Information Dissemination & KM

CDC WebsiteHealth alerting

PH ResponseCountermeasure

administrationLab, vaccine,

prophylaxis

Federal Health Architecture, NHII

& Consolidated Health Informatics

Public Health Information Network

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Outbreak Management

Outbreak Management

System, lab result reporting

SurveillanceNEDSS



analytic technology




administration; isolation, vaccine, prophylaxis

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BioSense - Setting

One of the new national bioterrorism initiatives: BioShield -rapid development of new vaccines and therapeutics

BioWatch - deployment of environmental air samplers in key locations

BioSense - early event detection through accessing and analyzing pre-existing diagnostic and pre-diagnostic health data

BioSense is a major part of the DHHS / DHS 2005 biosurveillance initiative.

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Outbreakor Attack

Hours Days Weeks

All Hazards Detection and Response Data

Initial detection

Outbreak management, contact tracing, case confirmation

Countermeasure administration, isolation, prophylaxis, Rx

Subsequent detection, quantification, localization

Ambulatory care visits

Health seeking behaviors

Tertiary Care, morbidity and mortality (traditional)

Traditional case reporting

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“Traditional” Public Health Reporting

Public HealthCase Reports

Local Health Department

Case ReportName: JaneAge 46Sex FemaleWeight____Height_____Temp_____ BP_______

• Most reporting steps are still paper- based and manual

• Most reportable disease cases are not reported

• Can take as long as 26 days for a bioterrorism related disease to be reported

• Inconsistent coverage of major cities and no timely cross-jurisdictional coverage

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BioSense - Secondary Use of Health Data

• Near real-time data analysis

• No clinical reporting burden

• Analytic tools allow for identification of subtle trends not visible to individual MD’s

• Critical for next steps of secondary detection, investigation, quantification, localization, and outbreak management

ClinicalDiagnoses and Lab Results

Other EarlyDetection Data

BioSense

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Early Detection Plans

•Establish test beds with adequate community based health data

•Advance infrastructure for, and provisioning of, substantiated data sources

• Implement standards for data exchange at all levels of public health

•Advance consistent application of approaches that ensure confidentiality

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Early Detection Research

•Evaluation of early health seeking behavior data sources

•Algorithm and visualization evaluation

•Population-based presentation profiles of health events / outbreaks

•Multi-data source integration for increased sensitivity and specificity

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Public Health Information NetworkEarly Event Detection

BioSense

Outbreak Management

Outbreak Management


SurveillanceNEDSS



analytic technology





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Outbreak ManagementManaging outbreaks includes:

−Exchanging possible case data at the individual level among involved organizations

−Linking contacts, exposures, lab results, etc.

Bogatti SP. Reprinted in MMWR 5-9-03

SARS cases in Singapore

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Outbreak Management Activities

•Foster data standards for exchange and automated linkage

•Modeling of disease conveyance

•Structured data management tools and techniques

•Methods for automating the association data at the individual level

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Outbreak Management

Outbreak Management


SurveillanceNEDSS



analytic technology








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Countermeasure and Response Administration

•Systems and infrastructure to rapidly administer prophylaxis, vaccination and isolation

•Research optimization of clinic structure and administration systems support

•Support societal findings relative to behaviors in different levels of emergencies

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Public Health Information NetworkEarly Event Detection

BioSense

Outbreak Management

Outbreak Management


SurveillanceNEDSS



analytic technology





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Communications and Knowledge Management

•Targeted just in time and just in case information delivery for emergent and routine public health outcomes

• Knowledge storage, coding and management

•Portal and content optimization for information access and delivery

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Documents

TM Emerging Health Threats and Health Information Systems: Getting Public Health and Clinical Medicine to Real Time Response John W. Loonsk, M.D. Associate