# American Health Information Community

**Workgroup: Biosurveillance Subgroup**

**Draft Meeting Notes**

**Date: Friday, April 21, 2006**

**Time: 12:30 pm ET -- 2:00 pm ET**

## Discussion

### Review of previous subgroup meeting outcome

-   Revisited MDS to achieve consensus on the most needed and most
    useful clinical data fields for public health

-   Reviewed what data was feasible to obtain across a large geographic
    area of the country

-   Proposed a 2 --pronged approach

    -   Prong 1 -- MDS, only applicable to certain locations across
        country

    -   Prong 2 -- Potentially a more limited dataset shared across a
        larger area of the country, capture opportunistic data such as
        health plans, chief complaints, claims clearinghouses

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-   Questions -- none were asked

### Survey Report 

> ASTHO (Angela Fix) and NACCHO (Paula Soper) provided a verbal summary
> of survey results. Written summary will follow on 4/25/06.
>
> **Questions**

1.  Does infrastructure capacity exist to support this effort?

> **Response**

-   Larger jurisdictions which make up 10% of total jurisdictions have
    better capacity

2.  Is there a set of metrics to measure success for meeting the
    specific charge?

> **Response**

-   Charge is high level and relatively subjective, therefore it is
    difficult to measure

### Update on Existing Data --

> Update on existing data was given by Laura Conn

-   CDC has been pleased with response from hospitals willing to provide
    data in real time into BioSense. Hospitals have found it feasible to
    provide the specified level of data.

-   Current BioSense data includes:

    -   Prong-1 Narrow / Deep data -- Phase 1: ADT, ED and Utilization
        data, Phase 2: Laboratory, Radiology and Pharmacy data

    -   Prong-2 Broad and shallow - Lab orders, DOD and VA are providing
        ambulatory care and ED data. This opportunistic data has a
        broader geographic coverage. BioSense has been receiving these
        feeds for several years and is working on getting them in more
        real-time.

-   Assessing Claims Clearinghouse data, it has been expressed that it
    is more timely now than before, we are doing research on what
    they're doing and determining the timeliness of when the data is
    available

### National lab data picture -- Jason Dubois

-   There is a willingness to move forward

-   Labs are capable of moving forward

-   The need for funding is a recurring theme

-   They are already providing Nationally Notifiable Disease reports to
    \~3000 PH departments and have found them to have differing
    infrastructure capabilities which leads to concerns about how the
    data would be provided, particularly in addition to existing data
    feeds

> **Questions**

1.  Will the laboratory feeds be sent using HL7 messaging?

> **Response**

-   Good assumption but it depends on HITSP

### Filtering Approach

MDS -- really refers to types of data, the subsets to be considered for
each type of data need to be determined. This filtering discussion is
relevant for both prongs, and there are implications on what filters
should be considered.

-   Eileen Koski -- Expressed that it is sometimes more difficult to
    filter the data than to send it all

-   PHDSC is collecting data on reportable conditions already being
    sent.

    -   John Loonsk expressed that this differs from what we're
        discussing for biosurveillance. BSV goes beyond this, and relies
        on other types of data to be sent.

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    -   Clarification -- This is not about initial detection, nor is
        this about syndromic surveillance. ICD codes have been mapped to
        syndrome categories by CDC and others. This has been done by
        making syndrome categories from the likely presentations
        associated with each potential bioterrorism agent and aligning
        the ICD-9 codes that may be representative of that presentation
        to the corresponding syndrome category. (e.g. syndrome category
        of respiratory illness corresponds to a clump of representative
        ICD codes). This has been used as a starting point to assess
        what should be filtered out and what should be included. It is
        not conclusive or definitive unless it is a test result that is
        being sent but it may be starting point for the appropriate
        group to consider in driving to a definitive list of codes that
        are needed.

> **Questions**

1.  What approach should be used to determine the filtering approach
    within each data type?

> **Proposal**

-   Identify and convene group of experts in this area

2.  Who is the appropriate group?

> **Proposal**

-   Kelly Cronin will work with co-chairs to determine the subset of
    experts to determine direction

### Scope

Two pronged approach has been proposed. Prong 1 - Narrow and deep
approach targeting MDS; Prong 2 - Broad and shallow, opportunistic data.

-   Currently the following capacities exist

    -   Situational Awareness -- 70% states, 60% locals

    -   Outbreak Management -- 20% states, higher for locals

    -   We're looking at 25% of states that are able to receive data

    -   Haven't teased out timing or method for getting the data

-   Leah Devlin-- Expressed that capacities may be more optimistic than
    reflected by the survey. Many states are doing work that extends
    beyond the 6 month period reported in the survey. ,

-   Acknowledge receipt of Dr Freidman letter by working group.

-   Kelly Cronin- Staging recognition of all work being done that we
    should build off of. As time goes on, opportunistic now, add MDS as
    time goes on and extend

-   Feasibility of the pronged approach was again questioned and a fever
    index was again suggested. This included age group counts of fever
    from any jurisdiction, which would support tracking of influenza. It
    could be entered manually thru a web interface or provided
    electronically by with the capacity. This could also include
    utilization data and would express the concerns expressed in the NYC
    letter and NC letter as well.

-   Kelly Cronin - Community members did come to consensus that the
    specific charge was broader than just the fever meter. Workgroup
    would shift focus to the broad charge over the summer. Right now
    looking to address the specific charge.

-   ACEP is surveying capability of ED information systems to
    electronically capture diagnostic fever and send it electronically.
    Many places record this on paper. Agree that it would be valuable
    but not sure how available it is?

-   John Loonsk -- Capture of fever data electronically is pretty low
    right now. Because it is usually recorded on paper, other sources
    such as preliminary diagnoses from EHR type systems should be
    considered. There is a greater penetration of ER systems than most
    have thought was available.

-   Quest asked if a panel of information has been defined that clinical
    labs would be involved in trying to pull together? In the past,
    reporting out of national labs has largely focused on positive
    reportable disease results. Broader testing results, those that
    might map against syndrome list, are generally not reportable. CDC
    receives test orders, and others are getting results at different
    levels to different programs. CDC is looking at test results, not
    specific to notifiable diseases, that may be indicative of events or
    of monitoring events.

-   Discussion should focus on making sure what is defined is doable
    with funding as a consideration.

-   The Biosurveillance WG of HITSP has been considering a HAVE spec
    which uses web service approach to collect resources from various
    hospitals. The HITSP work is to include the data structure, as well
    as standards to address security and transport. This may assist labs
    with disparate capacities because it will provide some
    standardization for sending data by addressing non-uniform
    standards. Jason Dubois, ACLA, commented that he is not sure if the
    reduction in non-uniform standards will go far enough to resolve
    disparities in lab reporting capabilities.

-   Rick Friedman -- Is there an issue in collecting everything and
    sorting it out later? BSV approach should be piloted but evaluated
    and considered later on.

-   Laura Conn clarified that BioSense was not receiving all the data --
    the data was anonymized at the data source before being sent by the
    source to BioSense.

### Data Flow 

The recommendation is to support simultaneous data flow from healthcare
providers to local, state, federal agencies for either prong.

-   Rick Friedman -- need to coordinate needs up front, and express the
    value that the MDS will have value for PH

-   Privacy concerns -- these are addressed by including a randomized
    data linker in the data that is sent. The data would be anonymized
    and the link would be used by the data source and local public
    health in the event of an authorized public health investigation.

-   Ed Barthell --experience was that during Katrina, some locals wanted
    to control their own data and not even share utilization data except
    in the event of emergency.

-   John Loonsk --it is important to reiterate that locals have primary
    responsibility for response and will continue to have that but there
    are demonstrated needs at all levels for this type of data

-   ASTHO has published an issue brief on privacy that will be shared
    and discussed at the WG call.

-   Important to make sure health providers and public health are aware
    of what this program will support and how it is intended to help
    public health.

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| *       |      |    |        |                               |     |
| *ACTION |      |    |        |                               |     |
| ITEMS   |      |    |        |                               |     |
| --      |      |    |        |                               |     |
| OPEN**  |      |    |        |                               |     |
+=========+======+====+========+===============================+=====+
| Source  | Date | Pr | Lead   | Short Description and Actions | Due |
|         | O    | io | /Owner | to Complete                   | D   |
|         | pene | ri |        |                               | ate |
|         | d-ID | ty |        |                               |     |
|         |      |    |        |                               |     |
|         |      | (  |        |                               |     |
|         |      | H, |        |                               |     |
|         |      | M, |        |                               |     |
|         |      | L) |        |                               |     |
+---------+------+----+--------+-------------------------------+-----+
| 4/21/06 | 4    | H  | Laura  | Broad and shallow approach -- |     |
| BSV     | /21/ |    | Conn / | what is right subset of data  |     |
| S       | 06-1 |    | Shu    | for this approach? What kinds |     |
| ubgroup |      |    | Mc     | of data should we be thinking |     |
| Meeting |      |    | Garvey | about?                        |     |
|         |      |    |        |                               |     |
|         |      |    |        | -   Capacity data             |     |
|         |      |    |        |                               |     |
|         |      |    |        | -   Chief complaint data      |     |
+---------+------+----+--------+-------------------------------+-----+
| 4/21/06 | 4    | H  | Kelly  | Filtering of data within each |     |
| BSV     | /21/ |    | Cronin | type of data within the MDS   |     |
| S       | 06-2 |    |        | -- Kelly to work with         |     |
| ubgroup |      |    |        | co-chairs to determine group  |     |
| Meeting |      |    |        | of subject matter experts to  |     |
|         |      |    |        | convene and discuss the       |     |
|         |      |    |        | filtering approach.           |     |
+---------+------+----+--------+-------------------------------+-----+
|         |      |    |        |                               |     |
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