**Outline for Biosurveillance Workgroup Recommendations to the AHIC**

I.  **Context**

    a.  Specific charge

    b.  Broad charge

    c.  Overarching goal - Build on BioSense program and existing
        capacity in local and state health departments to implement a
        biosurveillance program to transmit minimal data from emergency
        departments and labs across the country simultaneously to local
        state and federal public health departments as feasible.

II. **Definition of functional needs of biosurveillance --** as
    described in the scenario document

    a.  Initial event detection

    b.  Situational awareness

    c.  Outbreak management

    d.  Response management

III. **Differentiate between traditional disease surveillance and using
     extant healthcare data**

IV. **Describe existing activities and capacities of public health
    related to biosurveillance**

    a.  Results of ASTHO survey

    b.  Results of NACCHO survey

    c.  Other ongoing activities

V.  **Data Elements**

    a.  Minimum data set to meet the specific charge -- might not be
        feasible to get all MDS elements from every source -- leads to
        pronged approach

    b.  Discussion of value of subjective and objective types of data --
        subjective may be impacted by worried well, or chief complaint
        notes such as, "my wife made me come to the hospital"

VI. **Scope -- geographic coverage**

    a.  Pronged approach must be considered, where the most gain may be
        realized from a combination of both prongs.

        i.  Prong 1 -- Describes a deep and narrow approach. The focus
            for Prong 1 is narrowly focused potentially to healthcare
            systems from major metropolitan areas, where deep refers to
            data that is at the level of detail described in the minimum
            data set. Healthcare systems would still self-select under
            this approach, and the data provided would support initial
            event detection, outbreak management, situational awareness,
            and response,

        ii. Prong 2 -- Describes a shallow and broad approach. Prong 2
            is directed at highly opportunistic data from sources that
            would potentially provide broader geographic coverage such
            as: hospital systems and health plans that have the
            infrastructure to provide diagnoses now; claims clearing
            houses that can support timely data; preliminary diagnoses
            from laboratory test orders; diagnoses that may be
            interpreted from medication orders; and chief complaint
            data. This data tends to provide coverage for initial event
            detection, some aspects of situational awareness, and
            limited aspects of response.

    b.  Determine what data is available electronically from clinical
        care (data from AHA to support this?)

    c.  Focus on willing health care providers (call for participation
        from AHIC?), in the short term and rely on policy levers to
        incent a larger group of health care providers to meet the broad
        charge of the workgroup.

VII. **Data Flow**

     a.  Data flowing simultaneously to local, state, and federal public
         health

     b.  Continue traditional investigation roles at local and state
         public levels

VIII. **Privacy Safeguards**

      a.  Data will not be for public release, consideration must exist
          to only provide the data that is necessary to meet the
          functions. Link should be provided that can be used by the
          data source to identify the individual in the event of an
          authorized public health investigation. Otherwise, only links,
          not identifiers would be provided.

      b.  HHS should offer practical implementation guidance for HIPAA
          to clarify provider and local and state public health agency
          concerns about transmitting data for public health purposes.

IX. **Evaluation of Data**

    a.  Determine objectives and metrics to evaluate usefulness of data
        in the near-term