Health Information Exchange. A Key Concept for Biosurveillance

Transcription

1 Health Information Exchange A Key Concept for Biosurveillance

2 Key Starting Points Our activities are intertwined with numerous federal initiatives Specifically, NHIN goals and objectives are a key component of our contracts Within the NHIN process CDC focuses on the biosurveillance use case We feel that success is dependent upon meeting local needs and issues, particularly as it relates to sustainability Our funded sites possess a depth and breadth of talent that supports each other

3 Health Information Exchange A View from CDC s Perspective Presidential Directives HHS/ONC/NHIN Biosurveillance Coordination Unit (BCU) HIE Activity - Local Development National Center for Public Health Informatics/CCHIS Biosense

4 HSPD*-21 Calls on HHS to "establish an operational national epidemiologic surveillance system for human health, with international connectivity where appropriate, that is predicated on State, regional, and community-level capabilities and creates a networked system to allow for two -way information flow between and among Federal, State, and local government public health authorities and clinical health care providers." * Homeland Security Presidential Directive

5 PAHPA* IN GENERAL. Not later than 2 years after the date of enactment of the Pandemic and All-Hazards Preparedness Act, the Secretary, in collaboration with State, local, and tribal public health officials, shall establish a near real-time electronic nationwide public health situational awareness capability through an interoperable network of systems to share data and information to enhance early detection of rapid response to, and management of, potentially catastrophic infectious disease outbreaks and other public health emergencies that originate domestically or abroad. Such network shall be built on existing State situational awareness systems or enhanced systems that enable such connectivity. * Pandemic and All-Hazards Preparedness Act

6 Organizational View Population Health & Clinical Care

7 BCU MISSION The BCU will coordinate the development of a strategy and implementation plan for integrated, nationwide public health surveillance to safeguard people from acute events by building upon current capabilities that strengthen local public health practice and provide value to medical care.

8 Stakeholder Coordination CDC Director and Executive Leadership Board Biosurveillance Strategy Meeting (BSM) USG PARTNERS HSPD-21 Working Group Biosurveillance Coordination Plans CDC PARTNERS Biosurveillance Advisory Team (BAT) SLTT PARTNERS SLTT-WG National Biosurveillance Advisory Committee (NBSAC) PUBLIC/PRIVATE PARTNERS

9 Federal Biosurveillance International Human Biosurveillance CDC: BioPHusion: Common Operating Picture CDC: BioSense Electronic Health Information Exchange CDC: Reporting National Reporting Systems (e.g., NNDSS, BioWatch, LRN) CDC: Programs Pathogen and Exposure Surveillance Systems Outbreak Reporting Relationships and Contacts SLTT Public Health and Medical Biosurveillance (Systems, Relationships, and Workforce)

10 All Hazards Approach Biological Natural Event Information Systems Training Planning Nuclear Radiological Communications Chemical Readiness Trauma

11 I. Biosense - Current Approach Intensive data gathering from medical facilities, state & locals into a giant CDC owned data warehouse Heavy use of statistical algorithms to detect anomalies in the data and trigger investigations CDC centric approach developing in house software

12 Current State Medical Facilities Facility System Medical Facilities Local/State Health Dept Syndromic Surveillance CDC BioSense AVR Facility System BioSense Integrator National Data Feeds Hospital, DoD, VA, etc Local/ State Data Clinical data BioSense Integrator Some Feeds BioSense Data Warehouse Lab System BioSense Integrator Medical Facilities Facility System Various Integrator Technologies Local/State Health Dept Local/ State Data Existing Syndromic Surveillance Capacity (RODS, ESSENCE etc) Siloed Data

13 II. Lessons Learned Politics of control of data has been the primary obstacle to formation of a national system Much existing data remains siloed at the Local/ State level Building systems non-collaboratively leads to low adoption rates Getting data direct from medical facilities is challenging; facilities have limited IT resources

14 Use HIE Infrastructure to Support Data Acquisition

15 BioSense - Health Information Exchange Links HIE s with state and local public health and the CDC Focuses on case identification and reporting Supports development of two-way communications Assess new mechanisms to detect emerging problems Supports overall NHIN efforts

16 Case Recognition: Integration with Regional HIE s Case detection occurs at the institutional level Suspected case forwarded to HIE HIE s search other clinical data sources in region for relevant data for suspected case and retrieves this data Suspect case can be confirmed or rejected Composite case forwarded to state and local public health as well as CDC (when indicated)

17 Open Source Collaborative Development Lead a Public Health Informatics Community Community determines technology efforts Community collaborates on strategy Use Open Source Methods Anyone can use the software Anyone can copy & modify the software Only trusted contributors can provide enhancements to the base product

18 End State Local/State Health Dept CDC Facility Local/ State Data Syndromic Surveillance Existing Capacity CDC Data BioPhusion Portal Facility System Data Integrator Syndromic Data Federated Data Grid National Health Surveillance Portal Case Data Data Integrator Disease Surveillance RHIO/HIE Local/ State Data Local/State Health Dept NBIS Portal DHS

19 From a Conceptual Model to a System

20 Our Major Activity A five-year, thirty-eight million dollar effort in three areas WA/ID, IN, NY Initiated in February 08 Coordinators WA/ID SAIC IN Regenstrief Institute NY Health Research Inc. NYSDOH NYCDOHMH

21 Superb Attributes for Team Success WA/ID SAIC Technical expertise Government experience CDC and NHIN IN Regenstrief NY Thirty years of HIE experience Internationally renowned research center Significant state funding Powerful political support for statewide HIE

22 Conceptual Architecture Universal Public Health Architecture New York State Public Health New York City Public Health Local Health Departments Physicians Physicians Labs RHIO 1 RHIO N Labs Consumer PHR Health Plan Hospital EHR Hospital EHR Health Plan Consumer PHR

23 Key Deliverables Year 1 Develop, test, evaluate and implement the biosurveillance use case (BUC) and Minimum Data Set (MDS) Demonstrate successful interchange using NHIN specifications for the BUC Evaluate and exchange the MDS for ID reporting Bidirectional communication Assess analytic tools

24 Other Areas of Exploration Collaboration with DOD Idea accepted for presentation at military meeting How can HIE s support identification of service members with undetected TBI or PTSD Discuss private sector synergies Global access to EMR Possible, new analytic techniques

25 Questions?