Public Health Information Network:

an update from CDCClaire Broome, M.D.

March 17, 2004

Public Health Data Standards Consortium

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

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

What is PHIN?Gartner 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

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

Topics for presentation Biosense PHIN surveillance (NEDSS) Example of PHIN “tool” --

PHIN Messaging System

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 release for state and city use this month Should belong to the users and those interested in early

detection analytic evaluation as a platform Actively seeking additional:

outbreak analytic approaches Display approaches for multiple data sources Interested groups-> jloonsk@cdc.gov

PHIN surveillance component (NEDSS)

Browser-based data entry over Internet

Person-centric Case investigation capabilities ELR messages can be received Security that meets HIPAA standards

NEDSS funding 50 states, 6 cities, and 1 territory funded for NEDSS:

43 started with Assessment & Planning phase in September 2000

FY2003 NEDSS grants: 31 propose NEDSS Base System; 26 NEDSS compatible approach

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

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 1.0 includes 93 notifiable diseases, and modules for vaccine preventable diseases, hepatitis, bacterial meningitis and pneumonia

Now at Version 1.1.1; includes expanded data entry capacity, reporting capacity, locally defined fields

Added additional contractor, SAIC, to accelerate Program Area Module Development

NBS Deployment Planned - 19

NBS Collaborative Development - 1

NBS Deployment Underway - 10

NBS In Use – 2

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 04/18/23

Public Health Information Network 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

Several commercial systems planning to incorporate

Technical assistance available for public health partners

Second PHIN conference Atlanta, May 24-27, 2004

CDC policy that all IT investments with cooperative agreement funds use PHIN standards

PHIN Alerting and Secure Communications PHIN Vocabulary Provisioning services Integration of outbreak management,

response, and surveillance systems

Background Information

Conclusions from Gartner Group review of PHIN implementation

An independent review of the PHIN Version 1 has been completed

PH partners interviewed agree to the vision and overall direction of the PHIN

The PHIN standards and specifications are a strong start and are appropriate for use in PH, as annotated in this report

Gartner’s incremental steps towards PHIN compatibility...

application development teams should focus first on the data, data model and the use of CMVs (i.e., create data that can be easily aggregated at the national level using XML schema).

next focus on the messaging formats, transport & security standards to easily and securely share this data with its PH partners and CDC.

then, directory services that will allow authorized and controlled access

Tools that can be provided by CDC (e.g., compliant software modules, tools for messaging, etc. built on PHIN standards) should be made available to the states and their partners, for use as interested

Implementation, continued PHIN should allow for multiple solutions for those

components that are more technically challenging or immature in the market (e.g., HL7 v3.0, ebXML). However, the goal of a “live” network must be maintained.

Attach the PHIN standards to the cooperative agreements as was done with the Preparedness awards

Security is required at all levels of state PH infrastructure; independent verification & validation (IV&V) services assist the states with security compliance

Where available, early event detection data based on the diagnostic skills of clinical personnel should be emphasized and certainly integrated

Data stores are aggregated locally, regionally, nationally, and in cross organizational databases that can be actively leveraged for public health purposes

Real-time data acquisition and analysis technologies are still not broadly implemented

Needs for analytic capabilities at the local, state, and national levels

BioSense - Principles

Consequence management is a major issue As much as possible let public health users

control alerting and notifications Systems should minimize reporting burden -

manual reporting of data has limited roles prospectively around major events retrospectively after major occurrences

Support comparative analysis and interpretation by public health professionals

BioSense Principles

Data should be securely managed for public health use with jurisdictional access controls

Be sensitive to patient confidentiality – reported data will not include patient names or medical record numbers – but strive for linkage

Support public health investigation through supplemental electronic queries for information – bidirectional infrastructure; reporting and query

Build on national standards and investments Public Health Information Network (PHIN – required

for BT cooperative agreement spending) (fully aligned with national and industry standards - CHI, NCVHS, Federal Health Architecture…)

BioSense Principles

Early event detection needs to connect to the people and systems for public health response

Systems and evaluation should consider the continuum for:

1. Initial detection

2. Subsequent case identification

3. Quantification of event magnitude to help shape public health response

4. Data exchange and integration with outbreak management and response systems

BioSense Principles