National Center for Public Health Informatics

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The Evolution of Public Health Surveillance to a
GRID Model
National Center for Public Health Informatics
Dr. Leslie Lenert, Director, National Center for
Public Health Informatics
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CDC CCHIS - NCPHI
Centers for Disease Control and Prevention (CDC)
Coordinating Center for Health Information and
Service (CCHIS)
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National Center for Health Statistics
National Center for Public Health Informatics
(NCPHI)
National Center for Health Marketing
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CDC MISSION Health Protection, Health Equity,
and Health System Transformation NCPHI MISSION
To protect publics health, promote health
equity, and transform the health system through
advancement of the science of biomedical
informatics and application of its principles to
public health practice.
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Strategic Themes Moving Forward
Science Services
Future
Development Operations
Partnership Collaboration
Present
Systems Applications
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Select Programs Vision for the Future
Sustain
Initiate
Improve
Expand
Program Management Operations
CDC Unified Process
CDC Enterprise Architecture
CDC Enterprise GIS Program
CDC Enterprise GIS Program
CDC Vocabulary Community of Practice
NEDSS Platform
Countermeasure and Response Administration
Outbreak Management System
Epi Info
BioSense

CDC Information Resources Governance
NCPHI Organizational Excellence Planning
Measurement, Evaluation Improvement
Research Science
Present
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Health Protection Framework

• HAN
• PHIN Alerting
• OMS
• CRA (CIT/CAT)

• PHIN Vocabulary
• PHIN Messaging
• Surveillance systems (NEDSS)

• DEOC Call Down Lis
• Simulation software

• PHIN Directory
• Data Warehousing
• Enterprise Geospatial Data Warehouse
• Biosense

• Monitoring (BIC)

• SiteScape (i.e. GIS Knowledge Base)
• Epi-X

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Health Protection Framework Foundation
Actions
Data
Plans
Information
HEALTH THREAT
Decisions
Knowledge
EDUCATION
POLICY
EVALUATION
RESEARCH
APPLICATIONS SERVICES
STANDARDS
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Current Approach
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Service Oriented Architectures for Public Health
Collaborative, Efficient, Agile
PHIN Open Source Services
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Modular Approach Demonstrated
Collaborative, Efficient, Agile
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Modular Approach Demonstrated
Collaborative, Efficient, Agile
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Goal State
Collaborative, Efficient, Agile
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Moving Forward

• Open Source Initiative at CDC/NCPHI
• Opportunistically Open Source
• Use widely accepted proprietary systems where it
  makes sense
• Use proprietary systems for rapid experimentation
• Prefer exclusively Open Source applications for
  projects where costs are a primary consideration
• Community of Practice based
• NCPHIs PHIN Conference used to create and
  sustain communities of practice who
  collaboratively work to design, develop, and
  expand Open solutions for public health
• CDC role
• Lead development for some applicationssupport
  leaders in others
• Support communities of practice with Web 2.0
  technologies
• Collaborative effort with other funders such as
  the Markel Foundation
• Version control, release and testing of modules
• Federal security certification

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NCPHI Biosense HIE Initiative

• Five year program to develop real world
  capabilities for integration for real time data
  acquisition from HIE for public health usage
• HIEs required to perform the following tasks
• Transmit data from AHIC Bioterrorism use case
  simultaneously to regional and state public
  health authorities and the CDC
• Bidirectional communications
• Case management (optional)
• Data integrated with present Biosense application
  for surveillance and situational awareness
• Annual costs 8-10 million per year
• Leverage if all qualified HIEs could have been
  funded, the program would achieve 20 coverage of
  US populations
• Expansion
• Promote public health participation in HIEs
  (working with RWJ)
• Accelerate development by providing tool kits
  that lower costs
• Attracting data strategy that accelerates NHIN
  development

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Accessing Data in a Network
Walmart
Kaiser Permanente
Tenant Healthcare
Department of Veterans Affairs
RHIO 1
RHIO 2
CDC Biosense Application
RHIO 4
RHIO 3
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Attracting Data in Network
Walmart
Kaiser Permanente
Tenant Healthcare
Department of Veterans Affairs
RHIO 1
RHIO 2
CDC BiosenseNEDSS, OMS applications
RHIO 4
RHIO 3
Hospitals w/ Biosense II Integrator
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Design Principles PH-NHII Integration

• There will be only one public health oriented
  software package that HIEs and healthcare
  providers will be willing to install and support
  in an NHII environment
• Maintenance costs and resource availability
  preclude multiple systems
• The software system must be able to
• Case reporting of notifiable diseases
• Voluntary reporting of adverse events, errors,
  and complications
• Situational awareness for emergency response and
  outbreak management
• Software Systems for PH should provide a return
  on investment to adopters

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Public Health Integration with Provider Community
PHIN Services
Provider
PH Standardized Vocabulary
Message
Data Marts
Vocabulary Services
PH Case Reporting Criteria
Case Report Criteria
State and Local NND Reporting
PH Data Collection Forms
Message Validation
CDC Programs
PH Case Report Msg.
Public Health Interface
Public Health Interface
NND Condition Classification
PH Case Information Request
Knowledge Management
Case Filter Information Request Processing
Diff Dx
BioSense
PH Observation Report Msg.
Syndromic Detection
OMS
Patient Records
Case/Alert Information Exchange
Outbreak Detection
HAN
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Critical Element Decision Support for Case
Finding and Management
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Foundation A Public Health Ontology
OBX-3
OBX-17
SPM-4
OBX-8
OBX-7
OBX-5
Links to HL7 2.X for Compatibility
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Case Detection
Algorithm applied between the data and its Set of
relationships
Different types of relationships to other
concepts
DATA - Attributes or instances of the object
Object
Concepts in the Ontology
Relationships to other objects
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Integration of Public Healthwith Clinical
Decision Support
DOH sends alert to community re Legionella cases
in Parkchester community in the Bronx
Practice Alert in EHR this center only if patient
presents with cough matched to order set to
help provider with dx and tx of possible
Legionella infection
Cough
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Summary and Conclusions

• NPCHIs approach to surveillance is based on
  collaboration with State and Local Public Health
• System development will take a pragmatic Open
  Source approach
• Communities of practice around PHIN
• Goal state is a public health grid environment
  with web enabled public health services
• Advance surveillance through NHIN participation
  and acceleration adoption
• Single open public health application for NHIN
  integration for healthcare providers
• Decision support techniques/methods critical to
  ultimate success of public health NHIN systems
  for surveillance

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Questions
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BioSense
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CRA Countermeasure Inventory Tool
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PHIN Vocabulary and Distribution System
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CDC Team (SiteScape)