# Presentation: 024853

## American Health 

**A****merican ****H****ealth **
**I****nformation ****C****ommunity**
**Biosurveillance Data Steering Group**
**Final Report**
**October 20, 2006**

## Adoption of the Minimum Data Set

- RECOMMENDATION 1.0:
- The Secretary of the Department of Health and Human Services
- should adopt the Minimum Data Set to guide data collection in
- biosurveillance programs that involve the simultaneous sharing
- of clinical data from health care providers to authorized local,
- state and federal public health agencies.  (Details of the
- Minimum Data Set are provided in Appendix A)
- 	**	**
**	**

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## Working Towards Implementation

- Recommendation 1.1:
- By September 2007, the U.S. Department of Health
- and Human Services, in collaboration with state and
- local governmental public health agencies, should
- work with clinical care partners to implement the
- short term Minimum Data Set and enable
- simultaneous data access to local, state and federal
- public health entities for biosurveillance purposes.

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## Evaluation of Implementation Models

- Recommendation 1.2:
- By March 2007, the U.S. Department of Health and
- Human Services, in collaboration with state and local
- governmental public health agencies, and clinical
- care partners, should evaluate implementation
- models, costs, and determine availability of resources
- and establish a plan to effect a short term Minimum
- Data Set implementation

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## Evaluation of Implementation Models

- Recommendation 2.0:
- Public health agencies and partners who implement
- the short term Minimum Data Set should filter out
- some components of the following data elements as
- appropriate:  date of birth, age, zip code,
- diagnosis/injury code,  and laboratory test/procedure
- codes (Details of filtering are included in Appendix A).

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## Monitoring the  MDS

- Recommendations 3.0:
- CDC should, no less than annually, involve local,
- state and federal public health agencies and clinical
- care partners, in an MDS monitoring process for
- biosurveillance usefulness and make appropriate
- modifications as evidence develops to support such
- modifications.

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## Biosurveillance Data Steering Group (BDSG) Members

** ****Co-chairs:****	****	****	****Affiliation**
- Arthur Davidson		Denver Public Health Department
- Martin LaVenture		Minnesota Department of Health
**  ****Members:**
- Edward Barthell		American College of Emergency Physicians
- Steven Hinrichs		Nebraska Public Health Laboratory
- Daniel B. Jernigan		Centers for Disease Control and Prevention
- Eileen Koski			Quest Diagnostics Incorporated
- Dick Melton			Utah Department of Health
- Mark Rothstein		University of Louisville School of Medicine
- Perry Smith			New York State Department of Health
- Lynn Steele			Centers for Disease Control and Prevention
- William Stephens		Southwest Center for Advanced Public Health Practice
**Office of the National Coordinator:**
- Kelly Cronin
- Laura Conn
- Scott Holter
- Judy Sparrow

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## BIOSURVEILLANCE DATA STEERING GROUP CHARGES

**Broad Charge:   **
- Make recommendations to the Community so that within one year, essential ambulatory care and emergency department visits, 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.
**Specific Charge:   **
- The specific charge of the BDSG will be to identify the requirements for data from ambulatory care, emergency departments, and laboratories necessary for multi-jurisdictional biosurveillance programs. These requirements will build upon previous work completed by the AHIC Biosurveillance Work Group and the Health Information Technology Standards Panel Biosurveillance Technical Committee (HITSP-TC). Recommendations that specify these requirements will also refine and supplement the work of the HITSP-TC.

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## What data should be captured?

**BSV RECOMMENDATION 1.1:  ****(cross-cutting recommendation)**
- 	The Biosurveillance Data Steering Group will identify the data elements and the appropriate filtering of data from ambulatory care settings, emergency departments and laboratories; as well as hospital utilization data needed to enable the key public health functions as outlined above.  HITSP-TC should identify the technical specifications for these initial data requirements by 9/30/06.  CDC and others should provide HITSP-TC with the public health expertise and funds needed to perform this task.

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**Notes:**
Sometime we will have to explain the concept of filtering

## Biosurveillance Data Steering Group Process

- Formation June 2006
- 11 Members
- Two representatives from Biosurveillance HITSP-TC
- Held 6 public meetings
- To identify Minimum Data Set (MDS) elements:
- Specified three relevant functional areas
- Conducted Gap Analysis (*Ad Hoc *Group)
- Based on 5 of the DHS National Planning scenarios
- Cross referenced MDS to relevant functional areas
- Received and reviewed expert testimony
- Feasibility assessments
- Determine filtering *(in progress)*
- Selected definitions and preconditions to set the context

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## Biosurveillance Data Steering Group (BDSG) Inputs & Outputs

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## Summary of Biosurveillance Steering Committee Minimum Data Set Recommendations Process, Input and Deliverables.

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## Minimum Data Set – Categories

| MDS Category | No.  | Examples: |
| --- | --- | --- |
| Base Facility Elements | 5 | Facility: Identifier, Name, Location, # of beds, and # of Licensed beds |
| Daily Facility Summary Report | 18 | Admissions, Discharges, and Deaths in last 24 hours, Facility Status, Staffing  |
| Patient Data Elements | 10 | DOB, Age, Gender, Zip Code, State, and Event Date/Time |
| Clinical Data Elements | 10 | Diagnosis/injury code, Chief Complaint, Temperature,  |
| Laboratory & Infectious Disease Test Orders | 3 | Order Number, Test/Procedure Name and Test/Procedure Code |
| Laboratory & Infectious Disease Results | 12 | Performing Lab, Specimen Source, Results and Test Interpretation |

- Total data elements = 58

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## Functional Areas1 for short term focus

- Early Event Detection (EED)
- Secondary use of clinical data
- Reportable disease case reporting
- Situational awareness
- Outbreak Management (OM)
- Case investigation and management
- Integration with early detection and countermeasure administration
- Linking laboratory test results with clinical case data
- Countermeasure & Response Administration (CRA)
- Support apportionment and allocation for limited supplies

- 1The Public Health Information Network (PHIN) Preparedness Initiative
- John W. Loonsk, MD et al. JAMIA October 12, 2005

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## Filtering & Feasibility - definitions

**Filtering:**	To select data; filters use patterns (masks) to either select or deselect data; within the reporting facility, all data are compared to the filter.  Only those data matching the filter criteria will either be transmitted  or withheld, respectively.
**Feasibility**:	Could the data element be transmitted electronically by 25% of reporting facilities with currently available resources in the: short term (< 1 year), longer term (1 to 2 years) or not feasible (>2 years)?

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## Filtering & Feasibility – testimony questions

- To what extent are the listed minimum data set (MDS) elements available electronically now within your organization, membership, entity or jurisdiction? What future plans or steps would be necessary to make those data elements available?  What standard vocabularies are in place to enable machine interpretable health exchange (e.g., Level 4 interoperability) with other systems? Please describe the status of those standards in your organization both currently and for the future (including implementation timelines).
- What changes would be required in your organization, membership, entity or jurisdiction in order to collect the proposed MDS elements in electronic format?  What are anticipated costs (both human/workflow and infrastructure) associated with those changes toward MDS element collection?  Please include reference to the following in your response:
- end user workflow
- interfaces
- mapping and filtering of elements
- commercial-off-the-shelf (COTS) products
- daily reports

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## Biosurveillance Data Steering Group

- Appendix

## Ad Hoc Process

- Gap Analysis Process:
- Walk through each of the selected DHS Planning scenarios
- Applied the MDS elements from broad category to actual elements required for scenario
_*Example*_*: Are lab results needed for biological disease outbreak – if YES, then which elements are needed and how are they identified for surveillance purposes?*
- At the end of each Scenario performed a Gap Analysis
- Group then gave their rationale for taking off and adding elements

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**Notes:**
Combine the process with the National planning scenarios...

## Ad Hoc (Gap Analysis Group) members

- BDSG facilitators
- Ed Barthell		American College of Emergency Physicians
- Laura Conn		Office of the National Coordinator
- Members
- Jodi Garrett		Nebraska Medical Center Clinical Laboratories
- Tony Sambol	Nebraska Public Health Laboratory
- Jim McClay		Nebraska Medical Center Emergency Dept.
- Janet J Hamilton	Florida Department of Health
- Allen S. Craig	Tennessee Department of Health
- Michael Davisson	Washington Public Health Laboratory
- George Hripcsak	New York City Department of Health
- Dina Hannah	ARUP Laboratories
- Deborah Holt	Laboratory Corporation of America
- Joe Lombardo	Johns Hopkins - Applied Physics Laboratory

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## DHS - National Planning Scenarios

| Planning Scenario | Name | Example |
| --- | --- | --- |
| 3 | Biological Disease Outbreak | Pandemic Influenza |
| 7 | Chemical Attack | Nerve Agent
 |
| 10 | Natural Disaster | Major Hurricane |
| 11 | Radiological Attack | Radiological Dispersal Devices
 |
| 13 | Biological Attack | Food Contamination
 |

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## Glossary of terms

- 	**Acronym**	**Definition or Organization**
- ACEP	American College of Emergency Room Physicians
- ACLA	American Clinical Laboratory Association
- AHIC		American Health Information Community
- APC		Advanced Practice Centers - NACCHO
- APHL	Association of Public Health Laboratories
- ASTHO	Association of State and Territorial Health Officials
- BDSG	AHIC - Biosurveillance Data Steering Group
- BSV		AHIC - Biosurveillance Workgroup
- CC		Chief Complaint
- CDC		Centers for Disease Control and Prevention
- CRA		Countermeasure and Response Administration

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## Glossary of terms cont.

**	****Acronym**	**Definition or Organization**
- CSTE	Council of State and Territorial Epidemiologist
- DHS		Department of Homeland Security
- Dx		Diagnosis
- EED		Early Event Detection
- HAVBED	Hospital Bed Availability (HAVBED) Project
- HAVE	Hospital Availability Exchange
- HITSP-TC	Healthcare Information Technology Standards 		Panel - 	Technical Committee
- LOINC	Logical Observation Identifier Names and Codes
- MDS		Minimum Data Set
- NACCHO	National Association of County Health Officials
- OM		Outbreak Management
- PHIN		Public Health Information Network
- SNOMED-CT	Systematized Nomenclature of Medicine Clinical 		Terms

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