Public Health Surveillance Program OfficeOffice of Surveillance, Epidemiology, and Laboratory Services

Barbara L. Massoudi, MPH, PhDBioSense Redesign Project Director,RTI International

BioSense 2.0Public Health Surveillance through Collaboration

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.

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 ObjectivesSyndromic Surveillance & BioSense

Early event detection Rapid event characterization (regardless of

how detected) Ongoing & timely monitoring over course of

event

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

Situation Awareness Value Examples

BioSense 1.0 Environment

Jurisdiction

Public-Access

Hospital

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)

Shared Spaces

BioSense 2.0: EnvironmentBioSense

2.0 Environmen

t

Jurisdiction

Public-Access

Hospital

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

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

Shared Space

data.biosen.seApache PHINMS

secure FTP

VPN Mirth

credentials, metadata

NwHIN (Direct Project, Connect, etc.

Linux virtual machine

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 2.0http://biosenseredesign.orginfo@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.