Emerging Health Threats and Health
Information Systems: Getting Public Health
and Clinical Medicine to Real Time
Response
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
John W. Loonsk, M.D.
Associate Director for Informatics
Centers for Disease Control and Prevention
TM
TM
“The New Normal”
Public Health
Lab
Law Enforcement and
First Responders
Hospital or
Health Plan
Investigation
Team
Health
Department
Vaccination
Center
Preparedness
Information Architecture
Data Exchange and
Information Management
CDC and
Other
Federal
Organizations
Ambulatory
Care
Early Detection
Sources
RX
Pharmaceutical
Stockpile
Public
Health
Information
Network
Public
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PHIN Coordinated Functions
What is PHIN?
• Detection and monitoring – support of disease and
threat surveillance, national health status indicators
Multi- organizational business and technical
architecture
• Analysis – facilitating real-time evaluation of live data
feeds, turning data into information for people at all
levels of public health and clinical care
− Technical standards
− Data standards
− Specifications to do work
• Information resources and knowledge management reference information, distance learning, decision
support
Is also a process
• Alerting and communications – transmission of
emergency alerts, routine professional discussions,
collaborative activities
− Commitment to the use of standards
− Commitment to support other organizations public
health systems needs
• Response – management support of recommendations,
prophylaxis, vaccination, etc.
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Public Health Information Network
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
Early Event Detection
BioSense
Outbreak Management
Outbreak
Management System
Surveillance
NEDSS
Federal Health
Architecture, NHII
& Consolidated
Health Informatics
Secure Communications
Epi-X
Analysis & Interpretation
BioIntelligence
analytic technology
Information Dissemination &
KM
CDC Website
Health alerting
PH Response
Countermeasure
administration
Lab, vaccine,
prophylaxis
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Public Health Information Network
BioSense - Setting
Early Event Detection
BioSense
Outbreak Management
Outbreak
Management System, lab
result reporting
One of the new national bioterrorism initiatives:
BioShield -rapid development of new vaccines and
therapeutics
Surveillance
NEDSS
Federal Health
Architecture, NHII
& Consolidated
Health Informatics
Secure Communications
Epi-X
Analysis & Interpretation
BioIntelligence
analytic technology
Information Dissemination &
KM
CDC Website
Health alerting
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.
PH Response
Countermeasure
administration; isolation,
vaccine, prophylaxis
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All Hazards Detection and Response Data
“Traditional” Public Health Reporting
Outbreak
or Attack
Hours
Days
Weeks
Local Health
Department
Health seeking behaviors
• Most reporting steps are still
paper- based and manual
• Most reportable disease cases
are not reported
Ambulatory care visits
Tertiary Care, morbidity and mortality (traditional)
Case Report
Traditional case reporting
Name: Jane
Age 46
Sex Female
Weight____
Height_____
Temp_____
BP_______
Initial detection
Public Health
Case Reports
Subsequent detection, quantification, localization
Outbreak management, contact tracing, case
confirmation
• Can take as long as 26 days
for a bioterrorism related
disease to be reported
• Inconsistent coverage of major
cities and no timely crossjurisdictional coverage
Countermeasure administration, isolation,
prophylaxis, Rx
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BioSense - Secondary Use of Health Data
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
• Near real-time data analysis
• No clinical reporting burden
Clinical
Diagnoses and
Lab Results
• Analytic tools allow for
identification of subtle trends
not visible to individual MD’s
BioSense
• Critical for next steps of
secondary detection,
investigation, quantification,
localization, and outbreak
management
Other Early
Detection Data
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Public Health Information Network
Early Detection Research
Early Event Detection
BioSense
Outbreak Management
Outbreak
Management System, lab
result reporting
• Evaluation of early health seeking
behavior data sources
• Algorithm and visualization evaluation
Surveillance
NEDSS
Secure Communications
Epi-X
• Population-based presentation profiles of
health events / outbreaks
Analysis & Interpretation
BioIntelligence
analytic technology
Federal Health
Architecture, NHII
& Consolidated
Health Informatics
Information Dissemination &
KM
CDC Website
Health alerting
• Multi-data source integration for
increased sensitivity and specificity
PH Response
Countermeasure
administration; isolation,
vaccine, prophylaxis
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Outbreak Management
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Outbreak Management Activities
Managing outbreaks includes:
− Exchanging possible case data at the individual level
among involved organizations
• Foster data standards for
exchange and automated linkage
− Linking contacts, exposures, lab results, etc.
• Modeling of disease conveyance
• Structured data management tools
and techniques
• Methods for automating the
association data at the individual
level
SARS cases in Singapore
Bogatti SP. Reprinted in MMWR 5-9-03
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Public Health Information Network
Countermeasure and Response
Administration
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
• 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
PH Response
Countermeasure
administration; isolation,
vaccine, prophylaxis
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Public Health Information Network
Communications and Knowledge Management
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
• 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
Information Dissemination &
KM
CDC Website
Health alerting
PH Response
Countermeasure
administration; isolation,
vaccine, prophylaxis
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