State of the Science: Preparedness Informatics

1. State of the Science:Preparedness Informatics John W. Loonsk, M.D. Associate Director for Informatics Centers for Disease Control and Prevention

2. Informatics - the Science • Medical Informatics - the rapidly developing scientific field that deals with resources, devices and formalized methods for optimizing the storage, retrieval and management of biomedical information for problem solving and decision making. - Edward Shortliffe • Public Health Informatics – “Improving the way public health is practiced by taking advantage of what technology affords…” • The Science of Informatics – We are not interested that your hard drive needs backing up or you can’t log into e-mail

3. Why Now? A Unique Moment in Time for Public Health Information Technology • Clinical care - becoming computerized – best opportunity ever to get clinical data • Improved ability to share data because of standards – now engaged at the federal level • Informatics – have seen ways that IT can help public health do more • Technologymore available – connectivity, software, development and resources

4. Why Now? A Unique Moment in Time for Public Health Information Technology • Anthrax attacks – there are compelling and urgent needs • Recognition of public health’s role – a unique part of homeland defense • West Nile – threat isn’t only terrorism • SARS – must depend on international colleagues

5. State of the Science: National Center for Public Health Informatics • Information systems and informatics are becoming an assumed part of what public health is • In transition from: • Information systems can help and you should use these standards if you build them. to • You need to have systems that do specific things and they must be regularly used to achieve optimal public health outcomes. • Having these systems consistently in place (and in clinical care) = new public health benefits

6. IT Needs of a Major PH Event

8. State of the Science: Interoperable Systems Systems that can directly exchange information and services • Shared data standards • Shared technical standards • Shared information architecture Federal Health Architecture, NHII & Consolidated Health Informatics

9. A Integration B HL7 <?xml version="1.0"?> <caseWorkup> <caseResult> <observation></observationResult> <caseResult> <labData> <labTest></labTest> </labData> </caseWorkup> State of the Science: Interoperable Systems

10. Public Health Lab Hospital or Health Plan CDC and Other Federal Organizations Investigation Team Health Department Ambulatory Care R X Pharmaceutical Stockpile Early Detection Sources Vaccination Center Law Enforcement and First Responders Public Public Health Information Network Coordinated Organizations and Systems

11. PHIN Coordinated Functions • Event detection and monitoring– support of disease and threat surveillance, national health status indicators • Analysis– facilitating real-time evaluation of live data feeds, turning data into information for people at all levels of public health and clinical care • Information resources and knowledge management - reference information, distance learning, decision support • Alerting and communications– transmission of emergency alerts, routine professional discussions, collaborative activities • Response– management support of isolation, prophylaxis, vaccination, etc.

12. State of the Science: Early Event Detection Health care data are available to public health, in real time, for early event detection, localization, quantification, and monitoring • Clinical care diagnoses, lab results, procedures • Other health related data (e.g. test orders, prescriptions, early health seeking behaviors) offer promise also

13. State of the Science: Early Event Detection CaseReport Name: Jane Age 46 Sex Female Weight____ Height_____ Temp_____ BP_______ Secondary Reporting of Health Care Data • Near real-time data analysis • No clinical reporting burden • Critical for next steps of secondary detection, investigation, quantification, localization, and outbreak management Diagnoses and Procedures from Clinical Care Sites • Investigative Early Detection Data Sources • Over the counter drug sales • School / work absenteeism • Other data Early Detection Data Traditional Case Reporting • Most reporting steps are still paper-based and manual • Many, if not most, reportable disease cases are not reported • Can take as long as 26 days for a bioterrorism related disease to be reported to the CDC • Inconsistent coverage of major cities and no timely cross-jurisdictional coverage Public Health Case Reports

14. West Nile Virus NYC - 1999 3 Epi investigation started 2 Unreported Number of cases cases 1 Reported cases 0 8-Aug 15-Aug 22-Aug Date of Admission State of the Science: Early Event Detection Clinical care data supportive of many information needs – even after an event has been identified NYC DOHMH – Marci Layton

15. State of the Science: Early Event Detection Detection algorithms can identify and monitor outbreaks and events • Complement the well trained clinician – don’t replace them • Can detect subtle events in data early – may not be visible at any single site • Use algorithm across multiple data sources to increase sensitivity and specificity BioSense Demonstration Data

16. Reported data – no names or medical record numbers Appropriate Public Health Investigation State of the Science: Early Event Detection A bi-directional network for getting detection data can enhance privacy protection • Patient names and medical record numbers can be kept out of reporting • Privacy can be protected • Appropriate public health investigation (query), can be supported through linking

17. SARS cases in Singapore Bogatti SP. Reprinted in MMWR 5-9-03 State of the Science: Outbreak Management Systems for managing outbreaks • Outbreaks are frequently about relationships • Lab results to possible cases • Person to person • Vector to person • Location to person

18. State of the Science: Outbreak Management Systems for managing outbreaks • Outbreaks are frequently about relationships • Lab results to possible cases • Person to person • Vector to person • Location to person • Computer does the contact tracing / data linking • Public health professionals do the analysis and planning

19. State of the Science: Information Dissemination Information accessed when and where it is needed for supporting public health outcomes • Consistent content descriptors for content indexing (metadata and vocabulary) allow for better searching and multipurposing • Separating content (text) from the presentation (i.e. web page) allows for use on web, in PDA’s in internal documents and in decision support systems

20. State of the Science: Information Dissemination Information delivered to those who need it in the way that they want it • Using consistent directories of those who participate in public health with standard roles • Systems that can deliver information with consideration for roles, geographic location, level of urgency and method of delivery (pager, e-mail, call, etc.)

21. State of the Science: Counter Measure and Response Administration Support delivery of prophylaxis, vaccination and management of isolation and treatment • Optimization and management of response is very data intensive • Computer systems are necessary to monitor the effectiveness and completeness of response

22. Public Health Information Network • Early Event Detection • BioSense • Outbreak Management Outbreak Management System • Surveillance • NEDSS • Secure Communications • Epi-X • Analysis & Interpretation • BioIntelligence • analytic technology • Information Dissemination & KM • CDC Website • Health alerting • PH Response • Countermeasure administration • Lab, vaccine, • prophylaxis Federal Health Architecture, NHII & Consolidated Health Informatics