Opportunities for Strengthening Public Health
Surveillance
Kathleen Gallagher D.Sc, MPH
PH Surveillance & Informatics Program Office
OSELS, CDC
CSTE Pre-Conference Workshop, Pasadena CA
June 9, 2013
Office of Surveillance, Epidemiology, and Laboratory Services
Public Health Surveillance & Informatics Program Office
Agenda
• CDC OSELS update
• NNDSS (8:45-12:00)
• BioSense (1:30-5:00
NNDSS Agenda

8:45am – 9:15am Actions taken in response to NNDSS Evaluation
Phase I (Kathleen Gallagher, Jeffrey Kriseman)

9:15am – 9:45am Overview of the NNDSS Evaluation Phase II –
(Perry Smith)
9:45am – 10:00am CDC Office of Infectious Disease perspective
about surveillance issues and future (Tonya Martin)
10:00am – 10:15am Break
10:15am – 10:45am Results from the 2012 CSTE NEDSS
Assessment (Erin Holt, Kathryn Turner)
10:45am – 12:00pm Local, State, and Territorial
Perspectives/Discussion





12:00pm – 1:30pm Lunch on your own
External Evaluation of NNDSS

External Evaluators


Purpose



1 former state epidemiologist, 2 informaticians
Identify issues/problems with current NNDSS without the
biases of persons ( within CDC ) invested in the system
Recommend solutions
Scope


Phase I –focused on data and business processes within CDC
Phase II - identify issues/challenges/problems experienced by
SLT health departments

Methods


Conducted interviews with 81 staff from 14 CDC divisions
Reviewed documentation
4
Focus of External Evaluation of NNDSS
Evaluation Phase 1
Health
Depts.
Healthcare
Providers,
inc. Labs
Local
CDC/OID
National
Centers
CDC/OSELS
NNDSS
State
5
External Evaluation of NNDSS Findings

Organizational





No consistent, national long-term oversight governance
Inconsistent leadership and poor organizational support
History of poor project management practices
Inadequate capacity of internal staff to oversee contracts
Technical

Numerous data streams and transformations (that occur at
OSELS) prevent delivery of quality data to CDC programs
6
Data Processes
Common Data Store
A1
PHINMS
Sender
NBS
Master Msg
Msg
Repo
PHINMS
Receiver
A2
A3
· NBS_NND_11_INQ
· NBS_LDF_INQ
· NBS_LDF_OUTQ
Post Trigger
· MR_Message
F2
F3
3x Warehouse
Processing
F4
· MR_Message_Error
3x
Metadata
A4
CDC Alerting
· NBS_NND_11_OUTQ
NBS Post
Mapping
· NND_Case_Note_outq
B1
PHINMS
Sender
DCA
F5
· NND_Case_Note_inq
B2
G2
F1
HL7
Msg
G3
G4
ArboNet
TB CVR
E2
B3
G5
A5
E3
ArboNet
Process
WHS
ArboNet
Mapping
E1
CDS 3x
NNDSS
Views
3x Delivery
Processing
3x
Metadata
Process
Log
E4
DMB
G1
(3x)
D1
PED
FLU
G6
G7
H1
G8
ALL
NNDSS
STD
Payload
Staging
B4
D2
H2
STD
Views
CDC
C7
I6
· .DAT Files
· .TXT File
SDN
C2
C6
\\cdc\project
\NCPHI_DISSS_NEDSS
\fsp-centnetss
\fepo-xdv-netss\link\mmwrprod
· .\POLL76, .\POLL77, & .\
POLL78
I1
Informatica
Repository
C1
· \\aops-irm-sdn622\
test_dps_queue\
ALL
Views
Annotation
Post
Mapping
NETSS Post
Mapping
NETSS
Data
(.DAT File)
H2
C3
\\Cdc\project\
NCPHI_DISSS_NEDSS\
fsp-centnetss\fepo-xdvnetss\link\mmwrprod
I5
Informatica
CDS
Copy
Script
· .\SrcFiles\NETSS
· .\SrcFiles\ANNOTATED
· .\SrcFiles\NETSS_Archive
· .\SrcFiles\
ANNOTATED_Archive
C4
C5
I3
I4
· ANNOTATED
I2
NNDSS
Operations
7
Recommendations for Improvement

Implement long-term oversight of NNDSS
 FACA, subcommittee

Organizational Support
 Upper level management must be engaged (OID, CGH,OSELS,
OD)
 Lines of responsibility within OSELS need to be addressed

Improve Project Management
 All levels of staff should be knowledgeable about good project
management practices
 All stakeholders must be actively involved
 Primary responsibility for checking data quality should reside
with the CDC programs
 CDC FTE’s must actively oversee all contract work
8
Recommendations for improvement (cont’d)

Revise system design and current data processing
procedures





Further collaborative review by stakeholders
Retire NETSS format
Conduct full evaluation of the NEDSS base system (NBS)
Revise Common Data Store (CDS) to use technology smarter
Avoid creating dependencies on single standards, domains or
vendors
9
Programs
Proposed Initial Design
Before
Proposed
10
Ongoing Challenges

Organizational/operational barriers to success





Staff capacity
Hiring
Budget
MASO
Dependencies on contractors

Expensive and may hamper our ability to get the most innovative
and cost-effective approaches
11
Conclusions

Technical issues exist but current technologies and
computational practices can solve these
 Simplifying the approach can improve performance and reduce
costs

Organization challenges will be more difficult to
overcome
 Will require high level organizational support and stamina
 Collaborative support needed may be hampered by our “image
problems”
 Need to build internal capacity to reduce reliance on contractors
Action Steps Taken To Date



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Staff who need project management training have
been identified and training has been or is being
scheduled
Contracts for IT services have been critically
reviewed/ new contracts have been awarded
Continue development of simplified data processing
and provisioning strategy
Reorganization should help to improve efficiency
and focus
Internal high level discussions at CDC have occurred
about governance and support.
FACA is scheduled to “ stood up” by end of 2013
13
Ideal
• Strong local and state disease reporting systems that meet
information needs
– Shared and disease-specific
– Local to state to national
• IT services enhance efficiency & minimize duplication
– Platform(s) for multiple forms of surveillance
– Consistent with emerging national information standards
• Healthcare and laboratory information systems
• Information exchange
• “Meaningful Use” program
• Exploit “cloud” computing environment
– Support collaboration across jurisdictions and with CDC
– Reduce data storage costs
– Facilitate access to analysis tools
14
Vision for the Public Health Platform
6/10/2013
PHP Advisory Group
FedRAMP
Cloud Service
Provider (CSP)
Immunization
Data
STANDARDIZATION
& NORMALIZATION
SERVICES
PHIN
MS
Object
Identification
DATA
ACCESS
SERVICES
VPN
Mirth
Syndromic
Surveillance
Data
MySQL
Potential Authorized Users
WEAT
Vocabulary
Authorization
API
Potential Mobile
Apps Development
Rules
CDA
Direct
Authentication
Other
Other
Formats
Other
Data Quality
Dash Board
Message
Guides
sFTP
Notifiable
Disease
Data
POTENTIAL DATA
ANALYSIS &
EXPLORATION
SERVICES
Validation
XML Files
HL7 2.x
Cancer
Data
STORAGE &
DATABASING
SERVICES
Flat Files
CMS
Data
Vital
Statistics
Data
TRANSPORT
SERVICES
Other
Potential Public Users
Connect
API
Public
Data
Other
Data
LEGEND
Data source
Message
Data flow
(2-way)
Input data
(2-way)
Secure
Transmission
Application
Encryption
Web
Service
Elastic Data
Storage
Application
Programming
Interface
(API)
Secure
Access
Client
Public
Access
Mobile
Client
Users
16
QUESTIONS?
Office of Surveillance, Epidemiology, and Laboratory Services
Public Health Surveillance & Informatics Program Office
NNDSS Message Guides
Proposed Priority List

Priority Group 1







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
NETSS Core
NBS Core
Generic Case (v1,v2, HL7)
Mumps
Pertussis
TB (v2, HL7)
Varicella (v2, HL7)
Hepatitis (HL7)
STD (NETSS)
Other NND’s ( to allow for retirement of all current NETSS feeds)
National Public Health Surveillance and
Biosurveillance Advisory Committee



Established to support CDC’s continued leadership
in public health surveillance and biosurveillance.
Advises the Director of CDC regarding the broad
range of issues impacting public health surveillance
and the human health component of
biosurveillance.
Chartered for 15 members.
National Public Health Surveillance and
Biosurveillance Advisory Committee- Timeline





November 6, 2012, MASO published through the federal
register notice the request for nominations for
candidate’s submission
Submission for nominees closed December 21, 2012.
January 2013, CDC Vetting Panel formed.
February 2013, CDC Vetting Panel process complete.
Next Steps:
 Finalize proposed slate of potential candidates
 Submit proposed slate to CDC’s MASO for final round of vetting
 Submit slate to CDC Director and HHS Secretary for final
approval