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PHIN NEDSS and the Base System An Overview Over the Counter


PHIN NEDSS and the Base System An Overview Over the Counter

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									Public Health Information
  an update from CDC
           Claire Broome, M.D.
              March 17, 2004
 Public Health Data Standards Consortium
                PHIN Coordinated
   Detection and monitoring – support of disease and
    threat surveillance, national health status indicators
   Analysis – facilitating real-time evaluation of live data
    feeds, turning data into information for people at all levels
    of public health
   Information resources and knowledge management -
    reference information, distance learning, decision support
   Alerting and communications – transmission of
    emergency alerts, routine professional discussions,
    collaborative activities
   Response – management support of recommendations,
    prophylaxis, vaccination, etc.
    What is PHIN?
Gartner project on PHIN implementation – PHIN
 is a multi-organizational business and technical
   Technical standards

   Data standards

   Specifications to do work

Is also a process
     Commitment to the use of standards

     Commitment to participating in development
      and implementation of specifications
                    Public Health Information
      Early Event Detection
     Outbreak Management
      Management System
                   NEDSS                     Federal Health
   Secure Communications                    Architecture, NHII
                                             & Consolidated
   Analysis & Interpretation
            BioIntelligence                 Health Informatics
        analytic technology
Information Dissemination &
              CDC Website
             Health alerting
              PH Response
Lab, vaccine administration,
       Topics for presentation
   Biosense
   PHIN surveillance (NEDSS)
   Example of PHIN “tool” --
    PHIN Messaging System
         BioSense - Principles
   Early event detection is critical for Bioterrorism
    management and response
   The most useful tools will be dual use; Bioterrorism
    capable and regularly exercised for “routine” public
    health activities
   Multiple data sources should be co-ordinated to facilitate
    signal evaluation and reduce user burden
   Both diagnostic and pre-diagnostic (syndromic) data
    exist in electronic form in many yet untapped health-
    related data stores
        What is Biosense?
   Near real-time data access
   Analysis capabilities at local, state
    and national levels
   Shareable outbreak detection
    algorithms and analytic capabilities
   National coverage
             National and
                            BioSense System I
                   Data                                   City / State
              Sources                                     Recipients

      National labs
test requests & results

     DoD and VA
 sentinel clinical data
                             Analysis and Visualization
  Clinical lab orders

      Nurse Call
      Line Data

Lab Response Network
 (including BioWatch)

    drug sales
           National and
                       BioSense System II
          Regional Data
                          (proposed)                  City / State

      National labs
test requests & results

     DoD and VA
 sentinel clinical data
                             Analysis and Alerts
   Regional clinical

      Nurse Call
      Line Data            Electronic Investigation
Lab Response Network
 (including BioWatch)
    drug sales                                           State and Metropolitan
                                                           Surveillance and
       (others)                                           Response Systems
             Next Steps
   BioSense system infrastructure is in use at CDC
   System I release for state and city use this month
   Should belong to the users and those interested in early
    detection analytic evaluation as a platform
   Actively seeking additional:
       outbreak analytic approaches
       Display approaches for multiple data sources
       Interested groups->
     PHIN surveillance
    component (NEDSS)
   Browser-based data entry over
   Person-centric
   Case investigation capabilities
   ELR messages can be received
   Security that meets HIPAA standards
             NEDSS funding
 50 states, 6 cities, and 1 territory funded for NEDSS:
  43 started with Assessment & Planning phase in
  September 2000
 FY2003 NEDSS grants: 31 propose NEDSS Base
  System; 26 NEDSS compatible approach
 September 2002: Public Health and Social Services
  Emergency Fund provides >$1 billion for state and
  local public health preparedness capacity
    guidance from CDC and HRSA to use PHIN
     standards for IT investments
    Guidance explicitly includes NEDSS as part of
 September 2003 : second year Preparedness funding
     HRSA grants $498 million ; CDC $870 million
    NEDSS Base System
    NEDSS compatible system for state and local use
    developed by an experienced web software developer
    (Computer Sciences Corporation)

 Also useful as a specific implementation of NEDSS e.g.
    standard messages, database model

 Version 1.0 includes 93 notifiable diseases, and modules
    for vaccine preventable diseases, hepatitis, bacterial
    meningitis and pneumonia

 Now at Version 1.1.1; includes expanded data entry
    capacity, reporting capacity, locally defined fields

 Added additional contractor, SAIC, to accelerate Program
    Area Module Development
                  NEDSS Site Status as of 12/23/2010

                                                                   New York City


                                                                 Washington D.C.

              Los Angeles

31 Total NBS Sites          NBS In Use – 2
                            NBS Deployment Underway - 10
NBS = NEDSS Base System
(CDC-developed)             NBS Deployment Planned - 19
                            NBS Collaborative Development - 1
                            NEDSS – Compatible State/Jurisdiction Development - 26
    Public Health Information
    Network Messaging System
Software for industry standards based inter-
  institutional message transport available from CDC
      ebXML “handshake”, PKI encryption and security
      Payload agnostic (HL-7, text file, etc)
      Bi-directional data exchange
PHIN-MS in use by state and local partners for point to
  point messaging
Several commercial systems planning to incorporate
Technical assistance available for public health
   Second PHIN conference Atlanta,
    May 24-27, 2004
   CDC policy that all IT investments with
    cooperative agreement funds use PHIN
   PHIN Alerting and Secure Communications
   PHIN Vocabulary Provisioning services
   Integration of outbreak management,
    response, and surveillance systems
Background Information
    Conclusions from Gartner
    Group review of PHIN
 An independent review of the PHIN Version 1
  has been completed
 PH partners interviewed agree to the vision and
  overall direction of the PHIN
 The PHIN standards and specifications are a
  strong start and are appropriate for use in PH,
  as annotated in this report
      Gartner’s incremental steps
      towards PHIN compatibility...
   application development teams should focus first on the
    data, data model and the use of CMVs (i.e., create
    data that can be easily aggregated at the national level
    using XML schema).
   next focus on the messaging formats, transport &
    security standards to easily and securely share this data
    with its PH partners and CDC.
   then, directory services that will allow authorized and
    controlled access
   Tools that can be provided by CDC (e.g., compliant
    software modules, tools for messaging, etc. built on
    PHIN standards) should be made available to the states
    and their partners, for use as interested
Implementation, continued
   PHIN should allow for multiple solutions for those
    components that are more technically challenging or
    immature in the market (e.g., HL7 v3.0, ebXML).
    However, the goal of a “live” network must be
   Attach the PHIN standards to the cooperative
    agreements as was done with the Preparedness
   Security is required at all levels of state PH
    infrastructure; independent verification & validation
    (IV&V) services assist the states with security
       BioSense - Principles
   Where available, early event detection data based on
    the diagnostic skills of clinical personnel should be
    emphasized and certainly integrated
   Data stores are aggregated locally, regionally,
    nationally, and in cross organizational databases that
    can be actively leveraged for public health purposes
   Real-time data acquisition and analysis technologies
    are still not broadly implemented
   Needs for analytic capabilities at the local, state, and
    national levels
      BioSense Principles
   Consequence management is a major issue
   As much as possible let public health users
    control alerting and notifications
   Systems should minimize reporting burden -
    manual reporting of data has limited roles
      prospectively around major events

      retrospectively after major occurrences

   Support comparative analysis and
    interpretation by public health professionals
      BioSense Principles

   Data should be securely managed for public health use
    with jurisdictional access controls
   Be sensitive to patient confidentiality – reported data will
    not include patient names or medical record numbers – but
    strive for linkage
   Support public health investigation through supplemental
    electronic queries for information – bidirectional
    infrastructure; reporting and query
   Build on national standards and investments
      Public Health Information Network (PHIN – required
         for BT cooperative agreement spending) (fully
        aligned with national and industry standards - CHI,
        NCVHS, Federal Health Architecture…)
      BioSense Principles
   Early event detection needs to connect to the people
    and systems for public health response
   Systems and evaluation should consider the
    continuum for:
     1.   Initial detection
     2.   Subsequent case identification
     3.   Quantification of event magnitude to help
          shape public health response
     4.   Data exchange and integration with outbreak
          management and response systems

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