# Presentation: 109298

## BioSense: Integrating Local, Regional, Nationwide Biosurveillance Capabilities

- ISDS Annual Conference, Baltimore
- October 19, 2006
- Lynn Steele, Director
- Division of Emergency Preparedness & Response
- National Center for Public Health Informatics
- CDC

## CDC’s Health Protection Goals

**Healthy People in Every Stage of Life**:
- 	All people, and especially those at greater risk of health disparities, will achieve their optimal lifespan with the best possible quality of health in every stage of life.
**Healthy People in Healthy Places**:
- 	The places where people live, work, learn, and play will protect and promote their health and safety, especially those at greater risk of health disparities.
**People Prepared for Emerging Health Threats**:
- 	People in all communities will be protected from infectious, occupational environmental, and terrorist threats.
**Healthy People in a Healthy World**:
- 	People around the world will live safer, healthier, and longer lives through health promotion, health protection, and health diplomacy.

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**Notes:**
Source: CDC website

## BioSense Aligned with Four of CDC’s Nine Preparedness Goals

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| Pre –Event | Event | Post-Event |  |
| --- | --- | --- | --- |
| Prevent
Increase the use and development of interventions known to prevent human illness from chemical, biological, radiological agents, and naturally occurring health threats.
Detect
Decrease the time needed to classify health events as terrorism or naturally occurring in partnership with other agencies.

Decrease the time needed to detect and report chemical, biological, radiological agents in tissue, food or environmental samples that cause threats to the public’s health.

Improve the timeliness and accuracy of communications regarding threats to the public’s health.  | Investigate
Decrease the time to identify causes, risk factors, and appropriate interventions for those affected by threats to the public’s health.
 |  | Recover
Decrease the time needed to restore health services and environmental safety to pre-event levels.

Improve the long-term follow-up provided to those affected by threats to the public’s health. |
|  | Control
Decrease the time  needed to provide countermeasures and health guidance to those affected by threats to the public’s health. |  | Improve
Decrease the time needed to implement recommendations from after-action reports following threats to the public’s health. |

**Notes:**
Source: CDC website

## The BioSense Mission

- The purpose of the BioSense program is to improve the nation's capabilities for real-time biosurveillance and situational awareness
- Provide immediate, constant, and comparable information needed to inform local, state, and national public health, to support preparedness efforts; and
- Assess health data about current patients as needed from hospitals nationwide to identify disease clusters (i.e. outbreak) or unusual health indicators (i.e. bioterrorism attack).

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**Notes:**
Source: Biosurveillance_v7_final_06 20. 06.doc

## The BioSense Vision

- Provide local, state, and nationwide health situational awareness
- For suspect illness
- Cases of disease
- Before, during, and after a health event
- Help confirm or refute the existence of an event
- Monitor disease outbreak
- Size
- Location
- Rate of spread

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**Notes:**
Source: Science mtg 27June2006.ppt

## The 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

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**Notes:**
Source: Science mtg 27June2006.ppt

## Defining the Intent

- Early Event Detection:
- Confirmation of an outbreak or other public health emergency at as early a stage as possible through review of supporting clinical data.  (Does NOT imply only initial event detection). May assist in detecting the very first upswing of the epidemic curve.
- Health Situational Awareness
- Literally, the ability to know what’s going on; accomplished by monitoring extent of disease or disease indicators over time and geographically, especially in an emergency context.  Emphasis is placed on monitoring after the initial upswing of the epidemic curve.

**Discussion:   EED and HSA are synonymous**

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**Notes:**
Source: CDC_BioSense_RTHD_User_GuideV1.1 - version 2.06 changes.doc

## Clinical Care Data of Interest:ED, Outpatient, Inpatient Care Settings 

**Foundational**: demographics *(minus obvious identifiers),* chief complaint, discharge diagnoses, disposition, hospital utilization
**Clinical (ED)**: vitals, triage notes, working diagnosis, discharge summary
**Laboratory**: orders, microbiology results
**Pharmacy**: medication orders
**Radiology**: orders, interpretation results

## Implementation Targets and Status: National Healthcare Data Sources

*Working toward, 2006:*

| Data Source | Rationale |
| --- | --- |
| Orders & results from 3 major commercial clinical laboratories | Represent 20% of all US lab testing; 60% of independent testing; critical to many PH efforts |
| Real-time data from VA | 150 hospitals and ~1000 ambulatory care clinics; share data with many state and local PH communities |
| Real-time data from DoD | 45 US hospitals and ~800 ambulatory; share data   |
| Poison Control Centers call data | All 62 poison control centers; display and compare with other community health data  |

**Notes:**
Use this slide to provide a high level view of the project solution set.  This may be in narrative or “bulleted” form or it may be in the form of an architectural diagram or component diagram.

You can use this slide to indicate key functions or technologies as well.	

## Implementation Targets:Hospitals / Healthcare Systems

|  | 2006 | 2009 |
| --- | --- | --- |
| Level A
- Foundational (ADT) data, existing systems | 250 | 3,000 |
| Level B
- Foundational plus ED Clinical, Micro Lab | 35 | 500 |
| Level C
- Above plus Pharmacy, Radiology, Other Labs and Clinical Data | 65 | ? |
| TOTAL    | 350 | 3,500  |

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**Notes:**
Source: Science mtg 27June2006.ppt

## BioSense Hospitals Target Cities

**Atlanta**
-    Austin
**Baltimore**
**Boston**
-    Buffalo / Rochester
- Charlotte
**Chicago**
- Cincinnati
- Cleveland
**Columbus**
- Dallas – Ft. Worth
**Denver**
-    Detroit
**El Paso**

- Houston
- Indianapolis
-    Jacksonville
- Kansas City
**Las Vegas**
- Los Angeles
- Louisville
- Memphis
- Miami
**Milwaukee**
- Minneapolis
-    New Orleans
-    New York
-    Newark
-    Norfolk

- Orlando
**Philadelphia**
- Phoenix
-    Pittsburgh
- Portland
-    Salt Lake City
- San Antonio
**San Diego**
-    San Francisco
-    San Jose
- Seattle
- St. Louis
-    Tampa
**Washington D.C.**

***Last updated 1Oct06***

**Notes:**
Please list the resources assigned to your project, their project role, and % time committed to this project.  Contractor resource may be indicated as well.

## Long-term Performance Measure For CDC Biosurveillance Capacity2006 OMB PART Measure

- By 2010, CDC’s biosurveillance activities (including BioSense) will _reduce the time_ needed from a triggering surveillance event to initiate event-specific standard... procedures for [investigating] all infectious, occupational or environmental (whether man-made or naturally occurring) threats of national importance.

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**Notes:**
Source: Biosurveillance_v7_final_06 20. 06.doc (PART)

## Primary Tensions

- Early warning system,  primary terrorism detection
- VS
- System to enable PH access to real-time existing healthcare information, for any situation that arises

- Developing a single national system, one architecture, cross-jurisdictional info
- VS
- Local responsibility, under jurisdiction of States, necessary for local relationship-building

## What We’ve Heard 

- Ensure more involvement in discussion of BioSense mission / vision, next steps for development
- Evaluation is critical (system use in emergencies, data types, data quality / validity)
- Foster additional opportunities for communication with BioSense staff, information about program
- Improve system functionality

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## Input into BioSense Development 

- Enhance, enable information “push out”
- Data monitoring and Notification protocols
- Enable visibility of events/anomalies for all levels of Public Health
- Local /state Public Health need access to “granular” data on patients for best interpretation
- Cross-jurisdictional data access and views
- Flexibility in data visualization, defining syndromes and case definitions

**Application Input**
**Work Group**

**Response Protocols **
**Work Group**** **

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## Key BioSense Concepts

- Sacrosanct
- Simultaneous access to health data by all levels of PH
- National data sources KEY – what CDC can offer that no one else can
- Continue analytics development, but 1st support ability to investigate suspicions
- Reach back to local hospitals remains responsibility of S/L public health
- CDC to develop expertise for interpretation of data (PH informatics!)
- Still evolving
- Extent of clinical data (AHIC Minimum Data Set)
- Implementation model (DIY?)

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- For more information:
- _[www.cdc.gov](http://www.cdc.gov/BioSense)__[ / BioSense](http://www.cdc.gov/BioSense)_
- BioSenseHelp@cdc.gov
- Lynn Steele
- _[LSteele@cdc.gov](mailto:LSteele@cdc.gov)_
- 404 639 7600