# Presentation: 189557

## Use of GIS in BioSense:a national public healthsurveillance system

- August 9, 2006ESRI International User Conference, San DiegoLeslie Z. SokolowNational Center for Public Health Informatics – CDC

## What is BioSense?

- BioSense is a national program intended to improve the nation’s capabilities for conducting near real-time biosurveillance and health situational awareness through access to existing data from healthcare organizations

## What is BioSense?

- BioSense began in 2003, providing public health access to
- VA and DoD ambulatory care data  - diagnoses and procedure codes
- Large commercial laboratory - lab order data
- Over-the-counter pharmacy sales (now discontinued)
- BioSense data have been used successfully to
- Monitor/track seasonal outbreaks of influenza, WNV and RSV
- Assist local public health to identify/investigate data anomalies
- Only system of its type to receive and analyze nationwide data
- Data is organized by 11 standard health syndromes and 79 sub-syndromes

## BioSense Approach

- Real-time delivery of healthcare data to BioSense from:
- Hospitals
- Laboratories
- Ambulatory care settings
- Other health data sources
- Electronic “views,” analytics, and reports for:
- National public health, CDC
- State and local public health
- Contributing healthcare organizations

## Who uses BioSense?

- State and local health departments have access to jurisdictional data views
- Only state BioSense administrators can authorize access to their state views
- Hospitals and VA clinics also have access to their facilities
- Additional national monitoring in CDC BioIntelligence Center (BIC)
- Only users that have cross-jurisdictional viewing
- Daily monitoring results in enhancements to application

**Notes:**
The purpose of BioSense is to provide early event detection and situational awareness critical for bioterrorism surveillance and routine public health event management. BioSense utilizes near-real time reporting of health data, performing analysis and data visualization techniques on national diagnostic and pre-diagnostic electronic data sources and providing the results to state and local public health departments for use in detecting and characterizing potential outbreaks and events of public health importance. 

## BioSense: The System

- National “safety net” for early detection and situational awareness
- Infrastructure and data acquisition for near real-time reporting
- A platform for the implementation and evaluation of different analytic approaches
- Connection to the CDC BioIntelligence Center to support early detection analysis at local, state and national levels

## What is Health Situational Awareness?

- Ability to know what’s going on during a public health event, especially in an emergency context
- Is there really something going on?
- Where is it?
- How big is it?
- Is it spreading?
- Is our response working?
- Is the event over?

## What is Health Situational Awareness?

- Accomplished by monitoring the extent of disease or disease indicators
- Over time
- Over geography
- Emphasis is placed on monitoring after the initial upswing of the epidemic curve
- Health situational awareness needs exist at the local, State, and Federal levels

## What is Early Event Detection?

- Ability to detect a potential public health event before it is known

## BioSense Data Sources

- DoD and VA outpatient clinics
- Diagnoses (ICD-9s) and procedures (CPTs)
- Since 2003
- Laboratory Corporation of America
- Lab test orders
- Since 2004
- Selected hospitals nationwide
- Chief complaint, working diagnoses and discharge diagnoses
- Since 2006
- 10 cities = 32 hospitals
- 350 more hospitals by end of 2006

## Geographic coverage for VA data

## Geographic coverage for DoD data

## Geographic Coverage for LabCorp data

## Geographic Coverage for Hospital data

## Why Geography Matters in BioSense

- BioSense provides across-the-nation coverage
- Data streams cross traditional jurisdictions
- Ideal for GIS-enhanced analysis
- Smallest geographic unit is ZIP code
- Patient residence
- Provider & lab locale
- ZIP code-level data can be aggregated
- Temporally
- Day – 5-days – week – month – more
- Geographically
- ZIP3 – metro areas – state – adjacent states – nationally
- Hospital facility – – hospital group – more

## Why Geography Matters in BioSense

- BioSense utilizes geospatial statistics to identify anomalies
- SaTScan
- Identifies statistically significant clusters by syndrome over time (rolling 7 days) and space
- Additional geospatial analysis available on an ad hoc basis
- SAS
- SAS EG
- MS Excel
- ArcGIS

## How GIS is used in BioSense

## How GIS is used in BioSense

## How GIS is used in BioSense: 

- Syndrome-Specific Maps

## How GIS is used in BioSense

## How GIS is used in BioSense

## How GIS is used in BioSense: Nationwide Hospital Map

## How GIS is used in BioSense:Hospital-level Anomalies

## Special Uses: West Nile Virus Surveillance

## Special Uses: Seasonal Flu Surveillance

## What’s new in the future?

- Laboratory test results
- Lab tests positive for specific agents
- Radiology results
- Pharmacy orders
- Maps to include county and health district options
- Added features for hospital data
- Customizable syndromes, events, tables & graphs
- Spatial-temporal analysis (SaTScan)
- Influenza
- Signal fusion and dashboard

## What’s new in the future?

- Increased geographic coverage
- 2006
- Orders & results from 3 major clinical laboratories
- Hospitals in 31 additional cities
- Increase types of data from initial hospitals
- Data from associated ambulatory care sites
- Enable real-time data from VA and DoD
- Data from all 62 Poison Control Centers
- Pharmacy / prescriptions data (pilot)
- 2007 & beyond
- Additional volunteer hospitals; other national data sources

## Future BioSense Hospital Coverage (2007)

## Acknowledgements

- Thanks to invaluable assistance from my fellow BioSense colleagues
- Roseanne English
- Lisa Hines
- Colleen Bradley
- Jerome Tokars
- Lynn Steele
- Haobo Ma