Emerging Health Threats and
Health Information Systems:
Getting Public Health and Clinical
Medicine to Real Time Response
John W. Loonsk, M.D.
Associate Director for Informatics
Centers for Disease Control and Prevention
TM
Emerging Health Threats and Health
Information Systems: Getting Public
Health and Clinical Medicine to Real Time
Response
• John Lumpkin – NCVHS and clinical care
standards activities
• Richard Platt – Using health plan data for
public health
• John Loonsk – The Public Health Information
Network and background on public health /
clinical care connection
TM
“The New Normal”
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Public Health
Lab
Law Enforcement and
First Responders
Hospital or
Health Plan
Health
Department
Preparedness
Information Architecture
Investigation
Team
Vaccination
Center
Data Exchange and
Information Management
CDC and
Other
Federal
Organizations
Ambulatory
Care
Early Detection
Sources
RX
Pharmaceutical
Stockpile
Public
Health
Information
Network
Public
TM
What is PHIN?
Multi-organizational business and technical
architecture
− Technical standards
− Data standards
− Specifications to do work
Is also a process
− Commitment to the use of standards
− Commitment to support other organizations
public health systems needs
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PHIN Coordinated Functions
• 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
recommendations, prophylaxis, vaccination, etc.
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Public Health Information Network - Process
1.
Document functional requirements to support public
health activities (starting with preparedness)
2.
Identify relevant industry standards - technical and data
3.
Develop specifications based on the standards that are
concrete enough to do work
4.
Fund through the functions, standards and
specifications
5.
Make systems available to support these functions and
that use these standards - now
6.
Develop software elements and artifacts to be used in
other systems that implement the standards
7.
Support certification of the functions and specifications
TM
Public Health Information Network
Early Event Detection
BioSense
Outbreak Management
Outbreak
Management System
Surveillance
NEDSS
Secure Communications
Epi-X
Analysis & Interpretation
BioIntelligence
analytic technology
Federal Health
Architecture, NHII
& Consolidated
Health Informatics
Information Dissemination &
KM
CDC Website
Health alerting
PH Response
Countermeasure
administration
Lab, vaccine,
prophylaxis
TM
Public Health Information Network
Early Event Detection
BioSense
Outbreak Management
Outbreak
Management System,
lab result reporting
Surveillance
NEDSS
Secure Communications
Epi-X
Analysis & Interpretation
BioIntelligence
analytic technology
Federal Health
Architecture, NHII
& Consolidated
Health Informatics
Information Dissemination &
KM
CDC Website
Health alerting
PH Response
Countermeasure
administration; isolation,
vaccine, prophylaxis
TM
BioSense - Setting
One of the new national bioterrorism initiatives:
BioShield -rapid development of new vaccines and
therapeutics
BioWatch - deployment of environmental air
samplers in key locations
BioSense - early event detection through accessing
and analyzing pre-existing diagnostic and prediagnostic health data
BioSense is a major part of the DHHS / DHS 2005
biosurveillance initiative.
TM
All Hazards Detection and Response Data
Outbreak
or Attack
Hours
Days
Weeks
Health seeking behaviors
Ambulatory care visits
Tertiary Care, morbidity and mortality (traditional)
Traditional case reporting
Initial detection
Subsequent detection, quantification, localization
Outbreak management, contact tracing, case
confirmation
Countermeasure administration, isolation,
prophylaxis, Rx
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“Traditional” Public Health Reporting
Local Health
Department
Case Report
Name: Jane
Age 46
Sex Female
Weight____
Height_____
Temp_____
BP_______
Public Health
Case Reports
• Most reporting steps are still
paper- based and manual
• Most reportable disease
cases are not reported
• Can take as long as 26 days
for a bioterrorism related
disease to be reported
• Inconsistent coverage of
major cities and no timely
cross-jurisdictional coverage
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BioSense - Secondary Use of Health Data
• Near real-time data analysis
• No clinical reporting burden
• Analytic tools allow for
identification of subtle trends
not visible to individual MD’s
Clinical
Diagnoses and
Lab Results
BioSense
• Critical for next steps of
secondary detection,
investigation, quantification,
localization, and outbreak
management
Other Early
Detection Data
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Early Detection Plans
• Establish test beds with adequate
community based health data
• Advance infrastructure for, and
provisioning of, substantiated data
sources
• Implement standards for data exchange
at all levels of public health
• Advance consistent application of
approaches that ensure confidentiality
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Early Detection Research
• Evaluation of early health seeking
behavior data sources
• Algorithm and visualization evaluation
• Population-based presentation profiles
of health events / outbreaks
• Multi-data source integration for
increased sensitivity and specificity
TM
Public Health Information Network
Early Event Detection
BioSense
Outbreak Management
Outbreak
Management System,
lab result reporting
Surveillance
NEDSS
Secure Communications
Epi-X
Analysis & Interpretation
BioIntelligence
analytic technology
Federal Health
Architecture, NHII
& Consolidated
Health Informatics
Information Dissemination &
KM
CDC Website
Health alerting
PH Response
Countermeasure
administration; isolation,
vaccine, prophylaxis
TM
Outbreak Management
Managing outbreaks includes:
− Exchanging possible case data at the individual
level among involved organizations
− Linking contacts, exposures, lab results, etc.
SARS cases in Singapore
Bogatti SP. Reprinted in MMWR 5-9-03
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Outbreak Management Activities
• Foster data standards for
exchange and automated
linkage
• Modeling of disease conveyance
• Structured data management
tools and techniques
• Methods for automating the
association data at the individual
level
TM
Public Health Information Network
Early Event Detection
BioSense
Outbreak Management
Outbreak
Management System,
lab result reporting
Surveillance
NEDSS
Secure Communications
Epi-X
Analysis & Interpretation
BioIntelligence
analytic technology
Federal Health
Architecture, NHII
& Consolidated
Health Informatics
Information Dissemination &
KM
CDC Website
Health alerting
PH Response
Countermeasure
administration; isolation,
vaccine, prophylaxis
TM
Countermeasure and Response
Administration
• Systems and infrastructure to rapidly
administer prophylaxis, vaccination and
isolation
• Research optimization of clinic structure
and administration systems support
• Support societal findings relative to
behaviors in different levels of
emergencies
TM
Public Health Information Network
Early Event Detection
BioSense
Outbreak Management
Outbreak
Management System,
lab result reporting
Surveillance
NEDSS
Secure Communications
Epi-X
Analysis & Interpretation
BioIntelligence
analytic technology
Federal Health
Architecture, NHII
& Consolidated
Health Informatics
Information Dissemination &
KM
CDC Website
Health alerting
PH Response
Countermeasure
administration; isolation,
vaccine, prophylaxis
TM
Communications and Knowledge Management
• Targeted just in time and just in case
information delivery for emergent and
routine public health outcomes
• Knowledge storage, coding and
management
• Portal and content optimization for
information access and delivery
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