PHINnews logo and header

Summer 2008 

Volume 2 Issue 4 

In this issue 

.. In and around PHIN 

.. OpenELIS: How a small lab 
community created a world-
wide database 

.. InformationLinks 
Community of Practice: 
Advancing Health 
Information Exchanges 

.. eHealth Initiative: 
Partnership, collaboration, 
and public health 

.. Expanding BioSense utility 
and situational awareness 
through new partnerships 

Image: PHIN Conference logo and link to site 
Click here for conference info!

 

 

 

 

 

 

 

From the Directors desk 

With the publication of this fourth issue of PHINews, we 
are excited that the 2008 PHIN Conference is right 
around the corner. August 24-28 at the Westin Hotel in 
Atlanta, the Centers for Disease Control and Prevention 
(CDC) and the Association of State and Territorial Health 
Officials (ASTHO) plan to bring you an exciting agenda 
packed with opportunities to hear innovative approaches 
to public health informatics. 

 

This years theme, Public Health Informatics: 
Collaboration at the Crossroads, reflects our renewed 
emphasis on working together with all of our partners to 
tackle issues. It also represents the understanding that no one 
group can achieve a nationwide network; we must work together. 

 

Here are just a few of the items in store for the PHIN community at this years 
conference: 

 

.. Open conversation: This year, the entire conference will have an open-
conversation feel to it, allowing you to collaborate with your peers and work 
directly with CDC leadership. 

.. Keynote speaker: Representatives from the Office of the National 
Coordinator, CDC, ASTHO, and NACCHO will open the plenary session on 
Monday. Etienne Wenger, who coined the term Community of Practice (CoP) 
and is considered to be the father of the CoP model, will speak at the 
Tuesday plenary session. 

.. CoP: There will be a PHIN CoP kickoff at the Tuesday morning plenary 
session, as well as numerous opportunities throughout the conference to 
learn, join, and help build the future of PHIN. 

 

I hope you enjoy this issue of PHINews. Were publishing a special daily edition of 
PHINews at the conference to keep you up to date with the latest conference 
news and events, so stay tuned for a daily dose of PHINews. We look forward to 
seeing you there! 

 

Lynn Gibbs Scharf 

Director, 

 
Division of Alliance Management and Consultation (DAMC) 
National Center for Public Health Informatics (NCPHI) 

 

 

 

Photo: Lynn Gibbs Scharf 

Lynn Gibbs Scharf 

 


 

 

 

 

n the PHIN site 

O 
www.cdc.gov/phin 

 

Grantee IT Solutions Inventory

 

PHIN Vocabulary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In and around PHIN 

by Phyllis McGuire 

 

 

 

 

 

 

 

 

 

 

 

 

PHIN Headquarters, Atlanta, GA 

 

.. NCPHI and the National Center 
for Health Marketing (NCHM) 
hosted an expert panel 
meeting on May 14, 2008, to 
solicit input on refining and 
expanding CDC and public 
health participation in 
Consumer Health Informatics 
(CHI). Results will be reported 
in the Journal of Preventive 
Medicine and a white paper. 
Contact Jason Bonander for 
more information. 

 

.. NCPHI and NCHM also collaborated on the Epidemic Information 
Exchange (Epi-X) Notification Proficiency Testing. On April 3, 2008, 
over 5,000 Epi-X users logged in to Epi-X and were routed to an 
OMB-approved survey. Over 60% of users completed the survey. 
Contact Alan Davis in NCPHI for more information. 

.. In related news, Epi-X was used to inform the public health 
community about the initial Minnesota cases of a neurological illness 
that was identified as a new disorder. The illness affected workers at 
several U.S. swine slaughterhouses and received widespread media 
coverage after the Epi-X posting. For more information, contact 
Marsha Vanderford. 

 

.. On May 7, 2008, DAMC hosted the monthly NCPHI Partner Discussion. 
Topics included Inside the Maryland HAN Portal, presented by Arthur 
G. Thacher, MPH, Chief Information Officer with the Maryland 
Department of Health and Mental Hygiene. Also, Jim Grant, PHIN 
Program Director with the Wisconsin Dept of Health and Family 
Services, presented the Wisconsin Electronic Disease Surveillance 
System (WEDSS). Please contact Jessie Legros for more information. 

 
.. DAMC hosted a presentation at the CDCs Roybal Campus Distance 
Learning Center titled, Running a Successful Open Source Project, 
on May 5, 2008. The speaker was Jim Jagielski, Chairman of the 
Board of Directors for Apache Software Foundation. Mr. Jagielski 
discussed the key factors that helped Apache become one of the 
largest, longest-lived open source development communities in 
history. Please contact Nicole Fehrenbach for more information. 

 

 

 

 

 

Photo of NCPHI Headquarters


 

 

 

 

 

On the PHIN 
Collaborative Forum 

Main Page

The main page of the forum. If 
youre not a member, e-mail a 
request to phin@cdc.gov. 

Requirements

Ongoing discussion of the PHIN 
Requirements V. 2.0 

Messaging

Forum devoted exclusively to 
PHIN messaging and the 
messaging implementation 
guides. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In and Around (continued) 

 

 

.. The third and final BioSense Roundtable meeting was held on April 
23, 2008, in Atlanta, GA. Attendees included representatives from 
state and local public health departments (Nebraska, Georgia, North 
Carolina, and New York City, New York) and academia (Emory 
University, Washington University in St. Louis, Missouri) as well as 
CDCs NCPHI, Division of Emergency Preparedness and Response 
(DEPR), DAMC, and the Coordinating Center for Health Information 
and Service (CCHIS). The group heard presentations from Dr. Les 
Lenert about the future state of biosurveillance and Lynn Gibbs-
Scharf about building the biosurveillance community. Please contact 
Lynn Gibbs-Scharf for more information. 

 

.. On April 22, 2008, Deborah B. Gwaltney, Knowledge Application Team 
Leader, Federal Highway Administration (FHWA), presented What if 
We Build It, and No One Comes? Ms. Gwaltneys presentation shared 
FHWAs experiences with CoPs and the new opportunities Web 2.0 
offers for building successful virtual communities. Attendees learned 
what organizational support FHWA provides to establish and nurture 
communities, including the use of facilitators to sustain communities 
over time without FHWA taking control. For more information, contact 
Lynn Gibbs-Scharf. 

 

.. The Department of Health and Human Services (DHHS) of Long 
Beach, CA, recently used CDCs Countermeasure and Response 
Administration (CRA) application to track administration of HPV 
vaccines in a local clinic. For more information, contact Jeanne 
Tropper) 

 

.. The National Electronic Disease Surveillance System (NEDSS) team 
conducted its first training of NEDSS Brokering Tool (NBT) and Orion 
Rhapsody outside Atlanta. The NEDSS team held the training in 
Jackson, MS, April 711, 2008. Ten state employees representing the 
disease surveillance, syndromic epi group, and other areas with the 
state and local public health department attended the training. For 
more information, contact Arunkumar Srinivasan. 

.. On November 16, 2007, RADM Craig Vanderwagen, the Health and 
Human Services (HHS) Assistant Secretary for Preparedness and 
Response, and Dr. Julie Gerberding, CDC Director, agreed that CDC 
would assume lead federal agency authority and responsibility to 
carry out the two HSPD-21 urgent bio-surveillance requirements 
(including all the related specified and implied tasks). On December 
14, 2007, CDC convened a biosurveillance summit with key internal 
CDC stakeholders to discuss current threat detection, monitoring, and 
response knowledge management capabilities and to determine a 
strategy for achieving HSPD-21, as well as the global bio-surveillance 
requirements of the 21st Century. 

 

 


 

 

 

 

 

 

 

Remember these dates 

.. 2008 PHIN 
Conference, Atlanta, 
GA, August 2428 

.. Partner calls are on 
the first Wednesday of 
each month. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In and Around (continued) 

 

 

.. The Johns Hopkins University School of Medicines Division of Health 
Sciences Informatics (DHSI), in conjunction with the Bloomberg 
School of Public Health, have announced their 2007-2008 Seminar 
Series. These seminars occur approximately three times per month 
on Fridays at the Bloomberg School of Public Health and cover a wide 
variety of topics in public health and health informatics. For more 
information and a complete listing of future speakers in this series 
and webcast instructions, please visit the DHSI website. To be added 
to the mailing list for this seminar series, please email Kersti Winny. 

 

.. The Michigan Center for Public Health Preparedness provides distance 
learning opportunities including online training courses, archived 
webcasts, and live webcasts of new courses. In March, 2008, they 
hosted a Public Health Grand Rounds: Public Health in China via 
webcast. Anyone interested in other events and learning opportunities 
provided by the Michigan Center for Public Health Preparedness 
should contact Holly Szafarek or visit their website. Future distance 
learning opportunities will be posted on the PHIN website as well. 

 

.. From the NACCHO Public Health Informatics List: 

o HITSP Free Webinar Series Starting June 2008: The 
Healthcare Information Technology Standards Panel (HITSP) will 
host a series of 90-minute webinars sharing different topics on 
health information technology and interoperability. The webinars 
are targeted to consumers, government representatives, policy 
makers, healthcare providers, standards developers, vendors, and 
any other interested stakeholders. For more information, visit 
www.HITSP.org or email hitsp@ansi.org. 

 

o The National Alliance for Health Information Technology 
(NAHIT) releases HIT Definitions Report: On May 20, 2008, 
the National Alliance for Health Information Technology (Alliance) 
released its final report, Defining Key Health Information 
Technology Terms. This report reflects consensus work completed 
over the last several months on definitions for five important 
health information technology (IT) terms: electronic medical 
record (EMR), electronic health record (EHR), personal health 
record (PHR), HIE, and regional health information organization 
(RHIO). For more information on the definitions and to view the 
full report, visit the NAHIT website. 

 

o Free webinar series: Starting May 2008, the National 
Association of Public Health Information Technology (NAPHIT) will 
host a webinar series for professionals in public health information 
technology and informatics. For more information on upcoming 
webinars, visit www.naphit.org. 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In and Around (continued) 

 

.. Scott Danos retired on May 31, 2008, after 30 years of service with 
CDC as the Senior Advisor to the Director, Division of Integrated 
Surveillance Systems & Services (DISSS), NCPHI. Scott joined CDC 
as a Public Health Advisor in May 1978. His first assignment was with 
the Venereal Disease Program 
in Los Angeles. 

 
In 2004, Scott transferred out 
of the STD program to the 
organizational unit that was 
soon to become NCPHI, where 
he assumed the role of NEDSS 
Project Team Lead. In 2005, 
Scott transitioned to overall 
NEDSS Project Director. 

 

Scott will travel with his wife, 
Beanie, to see adult sons living in the Netherlands and Southern 
California. He also hopes to work on a photography hobby, both 
above and below water. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Photo: Scott Danos 

Scott Danos 

 

Photo by Scott Wilson


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OpenELIS: How a small lab community 
created a world-wide database 

by Jay Jones

A successful open source software 
project is impossible without 
collaboration. What began as an 
Association of Public Health 
Laboratories (APHL)-funded project 
among several state public health 
laboratories morphed into two state 
labs that produced open source 
software that is now fully 
implemented in Vietnam and 
continues to grow nationally. 

 

For this article, I interviewed Gary 
Jones, Information Systems (IS) 
Manager, Minnesota's Public Health 
Laboratory; Dari Shirazi, Information Technology (IT) Director, University 
of Iowa Hygienic Laboratory; and Michelle Meigs, APHL Senior Laboratory 
Informatics Program Manager. In my conversations with each of them, 
three terms were mentioned by all when describing Open Source 
Enterprise Laboratory Information System (OpenELIS)a Laboratory 
Information Management System (LIMS): community, collaboration, and 
open source. 

 

Given that community, 
collaboration, and 
open source are the 
new focus areas of 
PHIN, PHINews 
investigated how 
OpenELISa software 
project with limited 
funding, time 
constraints, and 
dispersed global 
teamswas built and 
successfully 
implemented around 
the world. 

 

Community: How it 
began 

OpenELIS is the result of a project that formed around 2001. At that 
time, APHL worked with the Public Health Informatics Institute (PHII), an 
informatics think tank, and received initial funding by the Robert Wood 
Johnson Foundation (RWJF). 

 

What is OpenELIS? 

 

A LIMS is database software that labs use to manage the 
data they collect and analyze. For a single lab or a group 
of labs, homegrown or lab-developed LIMS software 
works in the short term and for their specific needs, but 
in order to manage and share data with disparate 
systems in other labs, the software must have common 
attributes, such as a standard vocabulary for labeling 
specimens (i.e., interoperability). 

 

OpenELIS is a LIMS database that uses standard 
vocabulary and data sets that were agreed upon by the 
community that developed it. It is also built on open 
source technology, which means that members of the 
community can use the source code to build versions (or 
branches) of the software to meet their own unique 
needs. As this occurs, the softwares capabilities continue 
to grow and evolve with each enhancement. 

Photo:University of Iowa Hygienic Laboaratoy team

University of Iowa Hygienic Laboratory 
team. 

Photo by Pat Blake 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OpenELIS (continued) 

 

According to Gary Jones, part of APHLs strategic plan was to get an 
effective and efficient LIMS into every public health laboratory. In order 
to do that, APHL needed to start by determining if there were common 
requirements from all public health labs, and so the collaboration among 
APHL, PHII, and some of the public health labs across the country 
began. 

 

During the next few years, and under the direction of PHII, a six-state 
workgroup (i.e., Kansas, Iowa, Virginia, Minnesota, New York, and 
Alaska) met to review, identify, and document the requirements, and 
ultimately published the document on APHLs website: Requirements 
Document for Public Health Laboratory Information Management 
Systems. 

 

After the publication of the final requirements document, there were 
three states remaining from the initial six-state workgroupMinnesota, 
Iowa, and Kansas (Kansas later had to withdraw from the group after 
their IT Director retired)that wanted to implement the plan for an open 
source LIMS system. Dari Shirazi states:PHII went back to the RWJF and 
said that they would like to extend the project and do a logical design, 
which is basically a more detailed view of the requirements, showing how 
the plan can incorporate business processes. 

 
Collaboration: Sharing resources for a common goal 
From the beginning of the project, the workgroup worked collaboratively 
with each other and with APHL, PHII, and CDC. We knew we had what 
we needed to build 
the database: the 
team, the 
resources, the 
need, and the 
expertise. We 
(Minnesota and 
Iowa) also knew, 
from day one, that 
we wanted an 
open-source 
environment to 
reduce the amount 
of time spent 
supporting a large 
LIMS says Dari. 
The community 
realized that one member could not do everything, but together we could 
build OpenELIS. 

 

Anatomy of an open-source project 

 

We had some goals for the project itself: We wanted 
open source based on things that laboratorians do 
every day. When you develop a method for a testing 
process, you share that method with other people so 
they can duplicate your work. Open Source is nothing 
more than that: You share the code so that others can 
see what youre doing and allow them to improve that 
process. We do that all the time in the lab. The 
method is openly shared. We knew from day one that 
we wanted to combine our resources. 

 

 

Gary Jones

IT Manager, Minnesota Department of Health 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OpenELIS (continued) 

 

For the last two years, Minnesota and Iowa have continued the OpenELIS 
project. At about the same time, APHL had been working globally, 
partnering with CDC on laboratory information system projects in African 
countries and Vietnam. When Vietnam was getting ready to implement a 
LIMS, APHL proposed to CDC that they examine OpenELIS. After review 
and evaluation, the decision was made to implement the OpenELIS 
system in Vietnam. Vietnam then became an OpenELIS collaboration 
partner, making the once small, domestic project an international open 
collaboration success story. 

 

During our initial design, we hadnt considered global needs, so we 
developed our database based on domestic requirementsname and 
address, and things like that. With Vietnam, we had to make some 
changes, so a consulting firm was hired through CDC-Vietnam and APHL 
to work on the Vietnam localization and customization and to provide in-
country support. A consulting firm from Ho Chi Minh City provided the 
language translation and other system customizations to meet Vietnams 
requirements. They continue to work closely with Reshma Kakkar of 
CDC-Vietnam and representatives from the pilot laboratories using 
OpenELIS in Hanoi and Ho Chi Minh City. 

 

Michelle Meigs adds that the Vietnam lab, which employs its own 
developers who work along side CDC-Vietnam staff and the Vietnam 
Ministry of Health, is now adding the functionality that will make 
OpenELIS a true international application. Gary Joness team provides 
consultation on design and functionality for the Vietnam implementation, 
since the version Vietnam uses is the same base code as the one in 
Minnesota. 

 

Open Source: Sharing the keys to development 

The ultimate goal of OpenELIS is to create 
and implement a universal, interoperable 
LIMS, replace disparate systems, and to 
have a system that will be modified and 
improved by the community of labs. 
Minnesota and Iowa each employ software 
engineers who collaborate with one another 
and make design improvements as a group. Once fully implemented, the 
system will manage clinical, environmental, newborn, and animal data. It 
will be an enterprise-wide system, one that probably could not have 
happened without the early and ongoing community collaboration. In a 
very real sense, the OpenELIS team has given the Vietnam developers 
the keys to drive their own version of OpenELIS, allowing them to steer 
software development in a way that best fits their needs as they extend 
the capabilities of OpenELIS for the community. 

 

 

 

Image: One hand giving keys to another out-folded hand
 

 

 

 

OpenELIS timeline 

 

2002: APHL and PHII, 
spurred by the Anthrax 
attacks, receive funding 
from RWJF to evaluate and 
determine the feasibility of 
interoperable public health 
laboratory information 
management systems. 

 

2003: Participating state 
labs, PHII, 
APHL, and CDC review and 
publish requirements 
document. 

 

2004: Iowa and Minnesota 
begin collaborative, open 
source development of 
OpenELIS. 

 

2006-2007: Vietnam public 
health lab collaborates with 
APHL, CDC, Iowa, and 
Minnesota to build and 
implement a new branch of 
OpenELIS. 

 

2008-2010: Minnesota and 
Iowa release OpenELIS to 
production. 

 

 

 

 

 

 

 

 

 

 

 

 

 

OpenELIS (continued) 

 

 

In fact, the Vietnam version of OpenELIS is now in production, Minnesota 
is in the process of rolling out, 
and Iowa plans to go into 
production within the next year 
and half. All involved believe it to 
be successful because of the 
collaborative, open source 
environment. Although unilateral 
decisions are made faster, the 
community decisions led to a 
more robust, interoperable 
solution. Dari says that by next 
years PHIN conference, they will 
be able to present OpenELIS and 
allow the PHIN community to 
evaluate it and kick the tires. 

 

 

 

For more information 

.. OpenELIS website (in development) 

.. APHL 

.. Requirements Document for Public Health Laboratory Information 
Management Systems. 

.. For more information on OpenELIS, please contact Michelle Meigs at 
APHL: 240-485-2771, michelle.meigs@aphl.org 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Photo: Vietnam Lab Technician using OpenELIS.

Serology laboratory technician at the 
National Institute for Infectious and 
Tropical Diseases in Hanoi, Vietnam, 
uses OpenELIS to manage results. 

 

Photo by Michelle Meigs


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

InformationLinks Community of Practice: 
Advancing Health Information Exchanges 

 

by Keena Hamilton 

Overview 

The InformationLinks Community of Practice (InfoLinks CoP) officially 
launched in February 2008 and is designed to facilitate knowledge 
sharing and collaborative problem solving between public health 
professionals who have expertise and/or active involvement with the 
development of Health Information Exchanges (HIEs) in the United 
States. InfoLinks CoP is funded by CDCs NCPHI, the Robert Wood 
Johnson Foundation (RWJF), and also receives support from the Public 
Health Informatics Institute (PHII). InfoLinks CoP members share a 
commitment to promote HIEs within public health systems, and the 
community serves as a venue where they can openly discuss issues, 
share their personal HIE story or lessons learned, and exchange ideas on 
various aspects of HIE. 

 

History of InformationLinks 
The InfoLinks CoP that exists today builds 
upon a two-year program originally funded by 
the RWJF. RWJF has a 35-year history of 
addressing some of the most pressing health 
and health care problems facing Americans 
and works with diverse groups of 
organizations to identify solutions. RWJF 
funded the original InformationLinks program 
from 2005-2007 to explore ways information 
technology could be used to improve 
healthcare and, more specifically, to 
encourage state and local health departments 
to participate in HIEs. 

 

As explained in the Regional Health Information Organization article 
featured in the Spring 2008 issue of PHINews, HIEs allow for the rapid 
exchange of clinical and administrative healthcare data across disparate 
systems and organizational boundaries. On its website, the Agency for 
Healthcare Research and Quality states that the sharing of such data 
could improve health care processes with respect to safety, quality, cost, 
and other indicators. 

 

Through InformationLinks, RWJF awarded twenty-one grants of up to 
$100,000 to state and local health departments and public health 
institutes for 12-month projects focusing on HIEs. During the course of 
the program, the grantees partnered with health care providers in their 
local areas to examine how public health agencies could leverage HIEs to 
share data with providers and understand how sharing that information 
could improve both clinical care and public health. The participants 
reviewed various aspects of how to make HIEs work and meet the needs 
of both private care providers and public health. Some of the grantees 
and projects included the following: 

 

Image: People walking through inter-connect grid.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

InformationLinks (continued) 

 

.. Indiana State Department of Health: Developed a model health 
exchange network that identifies the components, resources, and 
personnel needed in the state and local community to establish an 
information exchange. 

.. Louisiana Public Health Institute: Created an HIE to develop 
shared disease control protocols between public health and health 
care to support rapid and coordinated diagnosis, treatment, and 
prevention of HIV, STDs, TB, and Hepatitis C. 

.. State of Rhode Island Department of Health: Assisted with the 
adoption of electronic data standards for use in the HIE and converted 
lab and child health data to facilitate data flow between the 
department and the HIE. 

While some progress was 
made, many found that in 
order to truly make HIEs work 
with local partners, public 
health agencies needed to first 
clearly understand their own 
business processes and 
requirements. RWFJ decided 
to address this by funding 
Common Grounds, an 
initiative to describe what 
business processes state 
health departments have in common that can be leveraged to develop 
systems based on common needs. 

 

Once the RWJF InformationLinks program ended, participants felt that 
one of the most valuable, yet unexpected, results of the project was the 
relationship and candor the grantees established with one another. A 
sense of community developed among the grantees as they openly 
discussed issues and shared ideas. The CDC, RWJF, and PHII saw this 
new community as an opportunity for professionals to learn and 
collaboratively develop solutions to further promote the use of HIEs 
within public health. The CDC, RWJF, and PHII agreed to support and 
move InformationLinks forward as a CoP to continue the dialog on public 
health information exchange, with a primary focus on documenting the 
historic knowledge. 

 

Partnering for healthy communities 
Today, the InfoLinks CoP builds upon the original RWJF project and 
brings together public health professionals from across the nation; this 
includes a wide variety of organizations, such as state, local, federal, or 
non-profit agencies who have hands-on experience with HIEs, including 
15 participants from the original RWJF InformationLinks project. 

 

 

Open conversations and 
genuine dialogue can reveal 
those ah-ha moments and 
unwritten rules that build up 
to solutions or spark further 
innovation. 

 

Janise Richards 

NCPHI Senior Advisor 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

InformationLinks (continued) 

 

According to Janise Richards, PhD, MPH, MS, the Facilitator for the 
InfoLinks CoP and Senior Advisor within NCPHI, a key objective for the 
newly established InfoLinks CoP is to create an environment (both in-
person and online) where community members can share their personal 
HIE stories and insights, openly discuss issues, and collaboratively 
develop innovative solutions to current barriers. 

 

Collectively, the members bring dozens of years of expertise and 
involvement with national HIEs to the community, commented Janise. 
The problem is, sometimes people dont know what they know or that 
what they know may be valuable to someone else until they start talking. 

Open conversations and genuine dialog can reveal those ah-ha moments 
and unwritten rules that build up to solutions or spark further 
innovation. The InformationLinks CoP was formed to facilitate these 
conversations between people on the frontlines of HIEs so that the tacit 
knowledge, knowledge that only comes from doing, can be documented, 
analyzed, and shared more broadly with the public health community. 

 

During this early 
stage, Janise plans to 
encourage 
participation and 
engage community 
members in HIE 
discourse by 
organizing webinars, 
teleconferences, face-
to-face meetings or 
site visits, and develop 
an online web portal. 
The portal serves as a 
community hub and 
online knowledge 
repository. Users can 
share their personal 
stories, read and 
discuss recent issues 
raised by InfoLinks 
CoP members, and view announcements and calls to action detailing 
upcoming events and various ways to get involved in current HIE 
projects. They can also contribute to an organized collection of HIE-
related information, such as industry news, funding opportunities, and 
related organizations and initiatives. Future plans include building 
collaborative workspaces to support InfoLinks community projects and 
adding interactive content such as audio/video recordings of community 
members that capture their HIE stories and perspectives. 

 

 

 

Image: InfoLinks web portal 

InfoLinks web portal 


InformationLinks (continued) 
According to Janise, it takes a village to raise an HIE, and while HIEs are 
in their infancy in the United States, the InfoLinks CoP provides an 
opportunity for individuals passionate about this kind of work to get 
involved in the discussions. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

By facilitating in-person meetings and building an online community, 
Janise believes those interested in HIEs will find a variety of ways to 
participate in InfoLinks CoP that fit both their personal learning styles and 
their busy schedules. These activities and interactions will help build a 
sense a community, energize participants, and create an open 
environment where those grappling with HIE issues can pose questions, 
voice their concerns, learn from those more experienced, and 
collaboratively develop solutions to improve HIE use in America. 

 

To learn more about InfoLinks CoP and how you can get involved, join us 
at our upcoming community meeting at this years PHIN conference. 
Community meetings provide a great opportunity to meet and connect 
with new and interesting people from around the nation who share the 
same passion and interest in advancing HIEs. 

 

For more information 

.. InformationLinks CoP web portal 

.. Agency for Healthcare Research Quality HIE Information 

.. Robert Woods Johnson Foundation 

.. Public Health Informatics Institute 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

eHealth Initiative: Partnership, collaboration, 
and public health 

by Jessie Legros and Melissa Bundy

What is the eHealth Initiative (eHI)? What does the organization hope to 
accomplish, and where does public health fit in the initiative? PHINews 
interviewed Janet Marchibroda, the CEO of eHI, to explore the history 
and future of eHI and the role of public health. 

eHI mission 

According to its website, the mission of eHI is to drive improvements in 
the quality, safety, and efficiency of healthcare through information and 
information technology. 

eHI was formed seven years ago to raise 
awareness of the importance of Health 
Information Technology (HIT) in addressing 
health and healthcare challenges across 
mainstream healthcare. Janet Marchibroda 
states: There wasnt a combined voice that 
represented all the actors in healthcare, 
referring to clinicians, consumers, employers, 
health plans, hospitals, health IT vendors, 
public health, and states and communities. 

What need does eHI fill that no other 
organization does? 

We talk to policy makers. Whether on the Hill 
or at the state and local level, [the policy makers] know that we 
represent a common voice that reflects multiple stakeholders across the 
system. She goes on to say that on so many healthcare issues, there is 
no agreement on how to move things forward. For a whole host of issues, 
including how health IT supports quality or healthcare reform, we bring 
people together and try to find common ground. Were not always able to 
get theregiven diverse interestsbut when we do, its very powerful. 

The following eHI Blueprint demonstrates how eHI successfully 
established common ground among multiple stakeholders. Over 200 
organizations, including public health, came together to gain consensus 
on a shared vision for improving health and healthcare through HIT. The 
eHI Blueprint principles, strategies, and actions that emerged from that 
meeting fall into five categories: 

.. Engaging consumers 

.. Transforming care delivery 

.. Improving population health 

.. Aligning financial and other incentives 

.. Managing privacy, security, and confidentiality 

 

Janet Marchibroda 

 

Photo courtesy of 
ehealthinitiative.org/


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

eHealth Initiative (continued) 

 

 

What is eHIs work on an ongoing basis? 

.. Monitoring, evaluating, and influencing policy when common ground 
is found (public and private sector) 

.. Finding synergy in strategy and tactics 

.. Creating a place for learning using a cooperative model 

.. Developing learning laboratories utilizing funds from philanthropic 
organizations, the private sector, and the federal government. The 
value of IT solutions is put to the test and then shared through the 
public domain. 

 

What are some barriers to 
achieving the mission of 
improving healthcare 
through HIT? 

.. Interoperability 
standardsImproving 
healthcare through HIT 
requires the establishment 
and adoption of 
interoperability standards 
that enable data exchange across the multi-stakeholder environment. 

.. Funding and financial incentivesThe current system pays 
healthcare providers according to quantity rather than quality. This 
system does not support a model for coordinated, high quality, and 
preventive care. 

.. Privacy and confidentialityManaging patient privacy and 
confidentiality while enabling the exchange of electronic data to 
support improvements in health and healthcare is essential. 

.. Changes in workflowImprovement through HIT would also require 
management of the change in workflow needed at the patient care 
level to ensure adoption of new technologies. 

What issues or areas of HIT have made progress but still need 
work? 

eHI started its work by tackling interoperability standards, believing that 
electronic health records (EHRs) would have little value without 
standards because of the disparate sources of information that make up 
a persons health record. Without a way to effectively and consistently 
exchange data electronically between these sources, EHRs would largely 
be empty vessels with no way to receive the data they are designed to 
house. 

The collaborative model of 
public health [in this 
country] where national, 
state, and local efforts are 
linked and intentionally 
aligned is also the key to 
success around getting HIT 
adoption. 

 

Janet Marchibroda, 

CEO of eHI, 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

eHealth Initiative (continued) 

When momentum was developed around interoperability standards, eHI 
moved to the next challenge. We arent where we need to be on 
adoption, and it isnt because people working on standards arent working 
hard, Marchibroda added. It has more to do with the fact that we need 
to make a better business case for standards, and we dont have one. 

While eHI might have left the standards fight too early, Janet says that 
shes really excited about the American Health Information Community 
(AHIC) 2.0 process. AHIC 2.0, the nationwide focal point for health 
information interoperability, is transitioning from a government advisory 
group to a public-private organization. This shift will maintain and 
accelerate nationwide initiatives aimed at using HIT to improve the 
quality and efficiency of health care. 

How is the work of eHI related to public health on a local, state, 
or federal level? And how will public health fit into improving the 
quality, safety, and efficiency of HIT? 

 

Public health has been a critical component of eHI from the very 
beginning, Marchibroda explains. Very early on, eHI worked closely with 
CDC on a private/public collaboration to determine how existing 
electronic clinical systems could be leveraged for public health disease 
surveillance. Marchibroda draws a parallel between the missions of eHI 
and CDC, saying: They are considerably related, because eHI is trying 
to improve quality, efficiency, and access to healthcare. She adds that 
she sees public health as collaborators and partners of eHI. 

The collaborative model of public health [in this country] where national, 
state, and local efforts are linked and intentionally aligned is also the key 
to success around getting HIT adoption. I believe we can use the same 
model to create a foundational infrastructure for electronic [health] 
information. She continues: Getting to our vision requires national 
standards and national changes in how we pay for healthcare, with 
implementation at the local level, where healthcare is delivered every 
day. 

CDC has been a pioneer in standards and in informatics. CDC went 
before others, and [eHI] has much to learn from CDC. 

For more information: 

.. eHealth Initiative 

.. eHealth Initiative Blueprint 

.. AHIC 2.0 

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Expanding BioSense utility and situational 
awareness through new partnerships 

 

by Lourdes Martinez-Cox and Claudia Vousden

 

The BioSense application began collecting and displaying data in 2004. 
Data sources included community hospitals and hospital systems and 
federal agencies such as the Department of Veterans Affairs (VA) and 
Department of Defense (DoD). Today, BioSense collects national 
laboratory and pharmaceutical data, connects to state syndromic 
systems, and contains an Influenza Module that displays both BioSense 
and Influenza Division data. The BioSense program has recently awarded 
cooperative agreements to three HIEs. Clinically rich data from the 
partnering HIEs will increase national coverage and make BioSense a 
more robust system. 

 

However, lessons learned from increased outreach efforts with state and 
local partners have poised BioSense to take a new strategic direction. In 
response to partner guidance and the vision of Dr. Les Lenert, the 
Director of NCPHI, BioSense will 
begin to move away from direct 
connections with hospitals and 
move toward sources with 
access to clinical data covering 
large geographic areas. One 
example of a BioSense data 
source with statewide coverage 
is North Carolinas Disease Event 
Tracking and Epidemiologic 
Collection Tool (NC DETECT). 

 

NC DETECT and BioSense 

 

NC DETECT is a web-based public health surveillance system in the North 
Carolina PHIN that is developed and managed through collaboration 
between the Department of Emergency Medicine at the University of 
North Carolina at Chapel Hill (UNC DEM) and the North Carolina Division 
of Public Health (NC DPH). The system uses the CDCs Cumulative Sums 
(CUSUM) algorithms from the Early Aberration Reporting System (EARS) 
to monitor data sources for suspicious patterns. NC DETECT supports 
statewide capacity for early event detection, public health situational 
analysis, case finding, contact tracing, and timely surveillance related to 
injuries, chronic diseases, environmental exposures, and other public 
health concerns. 

 

 

 

 

 

 

 

If Im following an 
outbreak, I want others to 
know what Ive done so 
they do not duplicate my 
steps. 

 

Dr. Anna Waller, 

NC DETECT Principal Investigator at UNC 
DEM 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Expanding BioSense (continued) 

 

At least once a day, NC DETECT receives data from 109 of the states 
112 hospital emergency departments, the statewide poison control 
center, and the statewide EMS data collection system. In addition, a pilot 
test is underway using data from select urgent care centers, a regional 
wildlife center, and three laboratories of the North Carolina State College 
of Veterinary Medicine. According to Dr. Anna Waller, NC DETECT 
Principal Investigator at UNC DEM, BioSense is an extension of our 
work, referring to the NC DETECT data visualized within the BioSense 
application. The application also employs automated quality checks for 
their data. A data quality manager for the program has the expansive 
task of monitoring the states data. 

 

NC DETECT serves over 200 registered users, and most are in public 
health agencies at the local, regional, and state levels. NC DPH owns the 
data, and all users must have approval from NC DPH before gaining 
access to the system. As a statewide system, NC DETECT serves users in 
multiple jurisdictions with varying responsibilities. Depending on the 
assigned user role and data source, users may access county and/or 
hospital views of the data and an array of tabular, graphical, and map-
based reports. Users whose job responsibilities include outbreak 
investigation and response have access to more detailed, patient line 
listing information. 

 

Combing systems for richer data 

 

As end-user needs continue to evolve, developers rely heavily on user 
feedback to guide enhancements and development of new features. 
Collaboration is critical to our program success. We use iterative 
development with the focus on good relationship building and 
partnerships, says Dr. Waller. 

Image: Hospital Emergency Departments Reporting to NCDETECT
 

 

 

PHINews Staff 

 

Editor: 

Lynn Gibbs-Scharf

 

Managing editor: 

Laura Franzke

 

Staff writer/editor 

Jay Jones

 

Staff writers: 

Keena Hamilton

Jessie Legros

Phyllis McGuire

Claudia Vousden

 

Contributing writers 

Melissa Bundy 

Lourdes Martinez-Cox 

Staff photographer: 

Scott Wilson

 

Publisher: 

NCPHIs Division of Alliance 
Management and 
Consultation (DAMC) 

 

 

 

 

 

 

For more information, contact 
phin@cdc.gov

Expanding BioSense (continued) 

 

For example, such feedback, combined with the need for situational 
awareness and interest in improving communication among users, drove 
the development of the Annotation Report and the Custom Event Report 
in 2007. The annotation reports allow an NC DETECT user to document 
the steps in an investigation for other users to view. According to Dr. 
Lana Deyneka, epidemiologist for NC DPH, If Im following an outbreak, 
I want others to know what Ive done so they do not duplicate my steps. 
The annotation reports are visible only to authorized NC DETECT users 
and do not contain patients individual identifiers. The Custom Event 
Report allows quick deployment of search criteria to monitor existing 
events of public health significance. Dr. Deyneka said, It pulls 
information just using keywords and generates a new report. This new 
report can be created and deployed in the system in less than two 
hours. She described it as very accurate when compared with medical 
record information. 

 

PHINews also asked Dr. Deyneka how BioSense fits in with NC DETECT, 
and she had this to say: The NC DETECT system does not receive VA or 
DoD data, which is only available to us through BioSense. So, BioSense 
allows NC public health epidemiologists to have the complete Emergency 
Department data from all hospitals in the state, including Veterans Affairs 
(VA) and Department of Defense (DoD) hospital systems. Dr. Deyneka 
commented on the BioSense Influenza Module stating, It is a great 
feature. We use it because it combines many sources on one page, 
making it easier to view. Deyneka added, BioSense support is very 
important for our state NC DETECT system. 

 

NC DETECT provides wide reaching and comprehensive coverage for the 
state of North Carolina within BioSense. Dr. Waller shared that, with the 
various NC DETECT data sources, it was a boon for data availability in 
North Carolina. In a similar way, systems like NC DETECT will enhance 
data availability within BioSense, further enhancing national 
preparedness via partnership and outreach efforts with state and local 
partners. 

 

For more information 

 

.. NC DETECT: e-mail ncdetect@listserve.med.unc.edu. 

.. BioSense: email biosensehelp@cdc.gov. 

 

 

 

 

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