# Presentation: 347924

## BioSense Implementation: Communication with State and Local Public Health OfficialsNovember 3, 2004

- Colleen Bradley
- David Walker
- Nancy Grady
- Henry Rolka
- John Loonsk
- Leslie Sokolow
- Matthew Miller
- Centers for Disease Control and Prevention

**Notes:**
Good afternoon! 
My name is Colleen Bradley and I am a public health analyst with the BioSense project at CDC. I will be discussing BioSense implementation and the role of communication with state and local public health officials.

## Overview

- System access and user approval
- Training
- User support
- BioIntelligence Center and data monitoring support
- Future directions
- Conclusions

**Notes:**
Today I will be presenting information regarding system access and user approval, BioSense training, methods by which we provide user support, and the BioIntelligence Center and its role with regards to data monitoring and aberration investigation support. 
I will also touch upon some future system enhancements relating to training and user communications, as well as some conclusions based upon our experiences thus far.

## BioSense

- System designed for early event surveillance
- Potential for expanded public health utility
- BioSense priority
- Serve the needs of the public health community
- Timely, consistent, and productive communication
- Training
- User support

**Notes:**
BioSense is an early event detection system that can be applied to both bioterrorism surveillance and more general public health applications. 
Aside from the system intricacies and complex analytical algorithms that are vital to the system’s performance, we believe firmly that serving the needs of the public health community nationwide is a major priority. 
Public health is about people, and we strive to maintain this perspective.
Timely, consistent, and productive communication with state and local system users, as well as ongoing training and user support, are absolutely essential as we continually work to develop and enhance the system. 

## BioSense Access

- BioSense available for external use in April 2004
- BioSense administrators
- Identified by public health
- Point of contact for states and metropolitan areas
- Approve system access for monitors within their jurisdictions

**Notes:**
When BioSense was first rolled out to users in April of 2004, the first step of the process was identifying appropriate BioSense administrators within each state and metropolitan area who would be responsible for approving other monitors within each jurisdiction. 
The public health community identified appropriate individuals for the role of BioSense administrator for the states and major metropolitan areas.
BioSense administrators are the point of contact for each state and metropolitan area regarding data aberrations observed in BioSense.
They are also responsible for approving monitors within their jurisdictions for access to the application.

## Secure Data Network

- Approved users obtain access via the CDC Secure Data Network (SDN)
- Application for digital certificate
- Approval process
- Maintain information regarding users

**Notes:**
All users obtain access to BioSense via the Secure Data Network.
Users must apply for a digital certificate and request BioSense access as an activity on that certificate.
Once approved by the appropriate BioSense administrator, CDC grants access.
State level users are granted access to view BioSense data for their state as well as any metropolitan areas within their state, while local level users may be granted access only to metropolitan level data. 
Local users whose jurisdiction does not fall within a BioSense metropolitan area may be granted access to state data if approved by the state administrator. 
Such users also have the option of requesting the creation of a customized metropolitan area region.
Approved users’ information is maintained for communication and training purposes.

## User Status

- BioSense Administrators
- 48 states
- 30 major metropolitan areas
- Approved over 250 users through SDN
- Number of users more than doubled since June 1, 2004

**Notes:**
Currently, BioSense administrators have been identified for 48 states and 30 major metropolitan areas. 
Over 250 users have been approved for access to BioSense through the Secure Data Network.
Since June 1, the number of state and local BioSense users has more than doubled.

## Training Schedule

- Bi-monthly webinars
- Advance notification by email
- Training schedule available in the application
- Navigate to “Contact Us” link at bottom of BioSense home page

**Notes:**
Once we obtained BioSense administrators and approved users, our next step was to provide in-depth training regarding the many system functionalities, analytics, and data visualizations.
All users are notified by email one month in advance of upcoming training opportunities. 
In addition, a schedule of training sessions is available within the application by navigating to the “Contact Us” link at the bottom of the BioSense Home page.

## Training Topics

- General overview of the system
- Means to begin monitoring data
- Forum for addressing questions
- Information on new functionalities and data sources

**Notes:**
Training sessions occur on a bi-monthly basis and utilize an interactive telephone bridge and web-based presentation.
In addition, tailored training sessions for a smaller group of state or local users are available upon request.
The webinars provide a general overview of the BioSense system and its functionalities, the tools users need to begin monitoring data, a forum for addressing questions, and information regarding new system functionalities and data sources.
Users are encouraged to ask questions during the training sessions, and often useful dialogue and feedback is generated.

## Users Trained

- 10 sessions since June 2004
- 221 BioSense users completed training

**Notes:**
Since June 2004, 221 BioSense users participated in one of 10 training sessions.

## Online Resources

- Internet materials
- http://www.cdc.gov/phin/Webinars/BioSense.htm
- Recorded training session
- Informational webinars
- FAQs document
- BioSense Help section
- General system functionalities
- Updated regularly

**Notes:**
In addition to the training webinars, we have posted other materials on the Internet.
Since state and local public health officials may be unable to attend scheduled trainings due to busy schedules, a recorded training session was posted on the PHIN website for viewing at users’ convenience.
Also posted at this web address are two additional informational webinars, as well as a frequently asked questions and answers document.
Within the BioSense application itself, the Help section provides extensive background documentation regarding general system functionalities, the data sources, analytical algorithms, and how to customize the system view using various data selection and display options. 
The Help section is updated regularly to provide current information regarding new system functionalities.
Often, answers to user generated questions are incorporated into the BioSense Help.
Users may access the Help section by selecting the link at the top frame of the application.

## User Support

- Questions and feedback
- BioSense Help email
- BioSenseHelp@cdc.gov
- Technical help desk
- 1-800-532-9929
- Prompt responses to hundreds of inquiries and requests for further information

**Notes:**
We are committed to providing user support regarding the BioSense system.
User support plays two major roles; the first is the provision of requested information and assistance, and the second is the opportunity to obtain user feedback for incorporation into system development and enhancement. 
We have two main methods of providing user support.
The first is the BioSense Help email address, and the second is the Technical help desk phone line.
Questions are routed to the appropriate BioSense project team member for response.
Through these mechanisms, we have ensured prompt and informative responses to hundreds of inquiries and requests for further information.

## User Feedback Applied

- Enhanced “user friendliness”
- Improved labeling of data visualizations
- Increased capability to navigate between pages
- Included ICD-9 code descriptions
- Re-evaluation of OTC syndrome mapping
- Customized BioSense jurisdictions
- G-8 Summit regions (Brunswick and Savannah, GA)
- Pierce County, WA
- Kansas City, KS/MO

**Notes:**
As I mentioned before, user feedback is invaluable as we strive to meet user needs in system development and enhancement.
Internal and external use of the system has generated many ideas regarding ways to make BioSense more user friendly.
Examples include better labeling of data visualizations, increased capability to navigate between pages, and providing descriptions of ICD-9 codes associated with individual patient visits. 
Users also provided feedback regarding the Over the Counter data syndrome mapping, and we are in the process of re-evaluating this mapping to reduce redundancy.
We have also created customized BioSense jurisdictions in response to local user requests.
Such customized regions enable local users to view results from the analytical algorithms for their region, in addition to the data visualizations within the Health Indicator pages.
During the G-8 summit in June, 2004, the Brunswick and Savannah, Georgia regions were created to better enable surveillance during that important convention.
In addition, users from Pierce County, WA, part of the Seattle-Tacoma metropolitan area within BioSense, requested the creation of a Pierce County region within BioSense.
We have recently created a new metropolitan area region for Kansas City and are in the process of enrolling BioSense administrators and users.

## Data Requests

- Historical flu season data
- State BioSense administrator request
- Use in establishing baseline patterns in the respiratory syndrome
- Tracking flu season patterns for 2004-2005
- Lessons to be learned for dual use applications

**Notes:**
In addition to responding to questions and incorporating user feedback, we are developing the capability to provide jurisdictional data for use in various public health applications.
One example of this data provisioning involved a state BioSense administrator requesting historical flu season clinical data for use in establishing baseline patterns in the respiratory syndrome and tracking flu season patterns for 2004-2005.
This is a great example of a dual use for the system, and we are looking forward to learning the results from this application of BioSense data.

## BioIntelligence Center

- CDC BioIntelligence Center
- Initiated June 2004
- Daily national data monitoring and tracking
- State and local monitoring support
- Data aberration investigations
- System troubleshooting and enhancement

**Notes:**
CDC initiated the BioIntelligence Center in June 2004 to conduct internal monitoring and investigation of national data on a daily basis, as well as to support state and local system monitoring and data anomaly investigations.
Daily monitoring includes data aberration investigation and tracking.
In addition, daily usage allows for system troubleshooting and generates ideas for system enhancements.

## Monitoring Support

- Interaction with state and local public health officials
- Communication with BioSense Administrators
- Data aberrations
- One-on-one monitoring training
- Major events
- Political conventions
- Presidential debates

**Notes:**
The BioIntelligence Center has provided state and local public health officials with support for major events, such as political conventions and presidential debates, as well as one-on-one evaluation of data to enable users to better understand monitoring methods and data aberrations.
Communication with BioSense administrators regarding data aberrations of potential concern has been a two-way learning process as CDC and state and local users work to characterize the data seen in BioSense.
User-requested BioIntelligence Center daily reports provide a summary of data activity within BioSense and explanations of any data aberrations of concern within the user’s jurisdiction. 
BioIntelligence Center monitors are available for questions and feedback regarding these reports.

## Sample Monitor Report

- _BIOSENSE SURVEILLANCE ANALYSIS: ABCville MRA, WED, OCT 6_
- BioSense surveillance data available through MON 10/4
- 3 diagnoses of VIRAL MENINGITIS, X Army Health Center, ABCville (ZC xxxxx)
- All cases involve 33-year old women, 2 days apart (9/27, 9/29 and 10/1)
- Suspect same patient returning to her doctor every few days
- Continue to monitor
- No other visible syndromic aberrations

**Notes:**
This is an example of a BioSense monitoring report that may be provided to a state or local user upon request.
The report has been de-identified.
Such reports indicate the region and report date within the title and subsequently provide information about the degree of data completeness within the jurisdiction for the date on which monitoring is occurring. 
Monitors examine the available data and determine if particular situations may require further monitoring or investigation.
Examples of such situations may be elevations in non-promotional over the counter sales, several unusual diagnoses within a region, or increases in syndromic activity for a particular zip code or set of adjacent zip codes.
In this example, the monitor examined the data regarding what appeared to be three cases of viral meningitis at a particular Department of Defense military treatment facility over a short time period.
The monitor determined that this was probably one case returning to the clinic for treatment, as opposed to three distinct cases.
Reports such as these help state and local users to delve into data aberrations or unusual clusters of diagnoses.
Since monitors at the BioIntelligence Center review data for a set of jurisdictions on a daily basis, they are familiar with data activity for that particular area of the country.
Monitors are available for assisting state and local users with monitoring data for their jurisdictions.

## BioSense Monitors Working Group

- Objectives
- Foster working relationships
- Solicit user feedback
- Provide in-depth information and training
- Share monitoring practices
- Identify additional state and local data sources
- Discuss multiple uses
- All BioSense users encouraged to join
- Expect to initialize by end of 2004

**Notes:**
We would like to expand upon our current communications and training.
We are currently developing the framework for a BioSense monitors working group that we believe will foster working relationships and communications between CDC and state and local users, as well as enhance the process of obtaining user feedback for system development.
The working group will allow for the provision of further training and in-depth information regarding data sources, analytics, and other aspects of the system.
Discussion and training regarding monitoring practices will be helpful for both CDC and state and local users who may approach the system differently.
The working group may also help us identify state and local data sources for incorporation into BioSense, as well as multiple uses for the system to expand its applications.
All BioSense users will be invited to join this group.
We expect to have this group initialized by the end of this year.

## Future Directions

- Creation of “customized” metropolitan areas
- Development of data provisioning capabilities
- Training procedures for investigating data anomalies
- Regional on-site training
- Enhanced communication regarding data aberrations detected in BioSense

**Notes:**
In the near future, we will need to develop additional training, enhanced communications, and continue to shape system development according to user needs.
The creation of additional user-requested “customized” metropolitan or county areas will assist local public health officials with surveillance for their jurisdictions.
Development of data provisioning procedures and capabilities will enable state and local users to apply and analyze BioSense data to better suit their needs.
Training regarding procedures for investigating data anomalies is a need that has been identified by users and may be incorporated into the BioSense monitors working group I mentioned earlier.
In addition, users have indicated that in-depth, on-site regional training would be beneficial, and this is a potential future development as well.
Enhanced communication of potential events detected in BioSense to state and local users will need to be developed in the case of a large, multi-jurisdictional event.

## Conclusions

- Importance of communication
- Essential to obtain user feedback
- Continue to develop system to meet user needs
- Necessary to provide ongoing training
- Vital to be responsive to user questions, concerns, and needs
- Important to provide monitoring support through the BioIntelligence Center

**Notes:**
In conclusion, we maintain the importance of communication with state and local public health officials and incorporation of user feedback in BioSense system development.
This enables us to develop a system that meets user needs.
We understand the importance of ongoing training and responsiveness to user questions and needs as we continue to enroll new users.
The BioIntelligence Center has provided monitoring support for important national events, as well as provided one-on-one assistance to state and local officials with regards to monitoring practices and how to explore data aberrations.
This will continue to be important as new requests for monitoring support arise.
In the future, we look forward to fostering stronger working relationships with state and local users through mechanisms such as the BioSense Monitors Working Group.
We believe that as BioSense continues to develop, its use will better equip public health for the surveillance challenges, both bioterrorism-related and otherwise, of the 21st century.

## Further Information

- BioSense Information
- _[BioSenseHelp@cdc.gov](mailto:BioSenseHelp@cdc.gov)_
- 1-800-532-9929
- _[http://www.cdc.gov/phin/Webinars/BioSense.htm](http://www.cdc.gov/phin/Webinars/BioSense.htm)_
- Colleen Bradley, MSPH
- (404)498-3201
- _[CBradley1@cdc.gov](mailto:CBradley1@cdc.gov)_

**Notes:**
Please contact me directly or via the BioSenseHelp email address at any time if you have questions regarding BioSense or if you are interested in obtaining access to the system.
The technical help phone line is available if you have questions regarding the Secure Data Network or require application-related technical assistance.
There is a recorded BioSense training session, two additional informational webinars, and a frequently asked questions and answers document posted at the address on the screen.
THANK YOU FOR YOUR TIME AND ATTENTION!
I look forward to answering any questions you may have.