BioSense 2.0
Public Health Surveillance through Collaboration
Barbara L. Massoudi, MPH, PhD
BioSense Redesign Project Director,
RTI International
Any views or opinions expressed here do not necessarily represent the views of the CDC, HHS, or any other entity of the United States
government. Furthermore, the use of any product names, trade names, images, or commercial sources is for identification purposes only, and
does not imply endorsement or government sanction by the U.S. Department of Health and Human Services.
Office of Surveillance, Epidemiology, and Laboratory Services
Public Health Surveillance Program Office
History of BioSense

2002
 Mandated in the Public Health Security and Bioterrorism (BT)
Preparedness and Response Act of 2002
 Nationwide “integrated system” for early detection and assessment of
potential BT-related illness

2003
 Funding provided by Congress to CDC
 Development of BioSense infrastructure started, initial focus on:
• VA and DoD
• Direct reporting to CDC of detailed clinical data by civilian hospitals (initiated
in 2004)

2006
 Began soliciting more limited data from health departments that had
already established automated systems for ED-based syndromic
surveillance
• By 2007, 8 state/local HDs connected
Epidemiologic Objectives
Syndromic Surveillance & BioSense



Early event detection
Rapid event characterization (regardless of how
detected)
Ongoing & timely monitoring over course of event
Situation Awareness Value Examples

2011
 Japan Earthquake/Tsunami
 Cluster of Visits for Heat-Related Illness in Texas

2010
 Dengue surveillance - Florida
 Gulf Oil Spill
 Maryland anti-infective pharmaceutical surveillance

2009
 H1N1 event and Distribute
BioSense 1.0 Environment
Jurisdiction
Hospital
Public-Access
Recommendations from Prior Evaluations
(GAO, US Senate, ASTHO, CSTE, BioSense Evaluation Project)

Strengthen state and local public health engagement
 Enhance state/local HD syndromic surveillance capacity
 Increase participation of state/local HD syndromic surveillance
systems (improve coverage)
 Share data with HDs from hospitals reporting directly to CDC
 Share governance





Leverage investments in EHRs
GAO, 2008: Adopt an “open, distributed computing
model”
Improve utility of the data and data sources
Preparedness role: Greater “all hazards” emphasis
Expand uses for broader spectrum of PH concerns
BioSense 2.0: Approach


Shift from a need-to-know to a need-to-share and co-create
“User-Centered” design
 Partners engaged in every step of the redesign
 Low barrier to participation for HDs and their providers
• HDs fully control “their data” at the level of granularity they are authorized
• Support expansions in SS prompted by Meaningful Use (MUse)
 More options for data sharing
• HDs are able to share data directly with other jurisdictions and CDC

Alignment with ONC and MUse
 Agreed upon core SS data elements (CDC/ISDS/ONC collaboration)

Enhanced partnerships
 States (ELC): MUse SS adoption, building capacity, joining BioSense 2.0
 Collaborations with associations (ASTHO, CSTE, NACCHO) and ISDS

Simple and unobtrusive technology option
 Cloud technology; distributed, easy to adopt, cost-effective, and secure
The Cloud: A Scalable Solution
BioSense 2.0: Timeline

June-October 2011: Governance, Cloud, and Recruitment
 Established an interim S&L governance structure
 Identified and procured Amazon as the Cloud vendor
 Recruitment in coordination with ASTHO, NACCHO, CDC, and ISDS (67 jurisdictions)

November 2011: Open for Business
 S&L HDs can initiate or expand their syndromic surveillance systems under the MUse
program for their own jurisdiction
 Stakeholders can begin collaborating among themselves and CDC in the new
environment governed by data use agreements

By April 2012: Retire BioSense 1.0
 Followed EPLC process (internal to OSELS and the CDC enterprise)
BioSense 2.0: Environment
BioSense 2.0
Environment
Shared
Spaces
Jurisdiction
Hospital
Public-Access
BioSense 2.0: Environment

Four primary services
 Catcher’s Mitt
• Provides for securely receiving (multiple channels), storing, and
processing high volumes of data for jurisdictions at no cost to them
 Data Conversion
• Can receive all data forms and formats, including HL7 or CDA, and
convert them to any format an individual health department uses
 Analytics
• Compatible environment for the users’ requested analytic tools, such
as: SAS and R statistical packages, ESSENCE, etc
 Collaboration
• Allows for ad hoc or continual data sharing among jurisdictions based
on data use agreements initiated by the jurisdiction and signed with
ASTHO
Application Home Page
Shared Space
A “View” consists of a map, timeline and
metadata
• Save View for viewing later or sharing
• Data can be filtered by demo, sources
• Statistical anomaly detection tools
• A view can be annotated with notes that are
saved for future use and for sharing
• The View can be shared within a jurisdiction
or other BioSense users (who have similar
permissions)
• Export View as: .csv, .html, .png, .ppt, .pdf
• Self-defined alerts, based on frequency,
statistics, etc. sent to email or phone
data.biosen.se
Linux virtual machine
Apache
PHINMS
VPN Mirth
secure FTP
NwHIN (Direct Project,
Connect, etc.
credentials,
metadata
BioSense 2.0: Recruitment

Recruitment is lead by CSTE and coordinated
with ASTHO, NACCHO and ISDS
 First Tier
• Jurisdictions that have explicitly communicated their interest
• 26: 16 States, 3 Counties, and 7 Cities
 Second Tier
• Jurisdictions with either mature capacity or high value with
moderate interest
• 35: 29 States (including DC), 5 Counties, and 1 City
 Third Tier
• Jurisdictions who haven’t expressed interest at this time
• 6: 6 States [LA, CA, NJ, TX, AL, and RI]
BioSense 2.0: Technical Assistance

Assist jurisdictions in joining the environment is part of
the redesign contract
 Direct program and application TA
 Challenge Grants administered by the redesign contract and
coordinated with the associations
• FY 2012: 10 jurisdictions at $20K each
 Technology and science innovation prizes administered by the
redesign contract and coordinated with ISDS and academic
partners
Thank You!
BioSense 2.0
http://biosenseredesign.org
info@biosen.se
Any views or opinions expressed here do not necessarily represent the views of the CDC, HHS, or any other entity of the United States
government. Furthermore, the use of any product names, trade names, images, or commercial sources is for identification purposes only, and
does not imply endorsement or government sanction by the U.S. Department of Health and Human Services.