**Biosurveillance**

**Background and Options Briefing**

**Data flow**

**Office of the National Coordinator for Health Information Technology\
**

**February 24, 2006**

The following information has been provided to you by the Office of the
National Coordinator and is a synthesis of data collected from
collaboration with the co-chairs, expert members of the community, and
other workgroup members. This information should be carefully reviewed
and factored into the decision-making process at the February 24, 2006
Biosurveillance workgroup meeting. The meeting should focus on deciding
upon recommendations that must be made to the Secretary and the American
Health Information Community at the March 7, 2006 meeting.

**Charges for the Consumer Empowerment Workgroup**

-   **Broad Charge for the Workgroup:** Make recommendations to the
    Community to implement the informational tools and business
    operation to support the real-time nationwide public health event
    monitoring and rapid response management across public health and
    care delivery communities and other authorized government agencies.

-   **Specific Charge for the Workgroup:** Make recommendations to the
    Community so that within one year, essential ambulatory care and
    emergency department visit, utilization, and lab result data from
    electronically enabled health care delivery and public health
    systems can be transmitted in standardized and anonymized format to
    authorized public health agencies within 24 hours.

**Background Information**

Data flow is a critical decision in moving forward the specific charge
of the biosurveillance work group. Implicit in the charge for the
biosurveillance breakthrough area is the need for to advance data
sharing between public health agencies. Three options for such data flow
along with pros and cons of each are described below: The workgroup can
consider which options are appropriate following the critical criteria
listed below.

-   Feasible to implement in 2006.

-   Accomplishes the specific charge, while facilitating the most direct
    path to the broad charge.

-   Illuminates the significant barrier(s) that must be resolved to
    achieve breakthrough success (policy and technical).

-   Delivers the value to the consumer over the next 1-2 years.

-   Leverages all stakeholders, while appropriately balancing
    expectations, responsibilities and authority.

**Options for Data Flow**

**Option 1: Data flow from clinical care → local public health agency →
state public health → federal public health**

-   ***Pros***

    -   This flow represents the traditional data flow for notifiable
        disease surveillance

-   ***Cons***

    -   The functions of biosurveillance are more broad than notifiable
        disease surveillance

    -   Many local and state public health agencies do not have the
        infrastructure in place to accept and share this type of
        electronic data. Building this infrastructure will delay when
        the data can begin to flow.

    -   Time frame for all agencies to access these data is very short
        and data latency at different levels could be problematic.

    -   In circumstances where the data is from a multi-jurisdictional
        area, data provider will need to parse segregate the data to
        send to the appropriate public health jurisdiction -- different
        messages for different jurisdictions.

**Option 2: Data flow from clinical care to all levels of public health
simultaneously**

-   ***Pros***

    -   Allows the different needs at all levels to be met
        simultaneously

    -   There is no delay in getting data to all authorized agencies.

    -   Data can begin to flow immediately to those that can accept it.

-   ***Cons***

    -   Some public health agencies will not be able to accept data
        until the infrastructure is in place.

    -   In circumstances where the data is from a multi-jurisdictional
        area, data provider will segregate the data to send to the
        appropriate public health jurisdiction -- different messages for
        different jurisdictions.

**Option 3: Data flow from clinical care to an intermediary
organization**

-   ***Pros***

    -   Can customize and triage data flow to appropriate jurisdiction
        -- does not require data provider to do this

    -   One group responsible for ensuring the data is flowing (acting
        as a technical steward)

-   ***Cons***

    -   Cost -- who would pay for this intermediary?

    -   Would need appropriate authorizations in place to use this data
        -- agent of public health?

    -   Need assurance data can get distributed in a timely way