Transcript PHIN, NEDSS and the Base System: An Overview

Public Health Information
Network:
an update from CDC
Claire Broome, M.D.
March 17, 2004
Public Health Data Standards Consortium
PHIN Coordinated
Functions





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
architecture
 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
Network
Early Event Detection
BioSense
Outbreak Management
Outbreak
Management System
Surveillance
NEDSS
Secure Communications
Epi-X
Analysis & Interpretation
BioIntelligence
analytic technology
Information Dissemination &
KM
CDC Website
Health alerting
PH Response
Lab, vaccine administration,
etc.
Federal Health
Architecture, NHII
& Consolidated
Health Informatics
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 healthrelated 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
Regional
Data
Sources
BioSense System I
City / State
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)
Over-the-counter
drug sales
BioSense
System
II
National and
Regional Data
Sources
(proposed)
City / State
Recipients
National labs
test requests & results
DoD and VA
sentinel clinical data
Analysis and Alerts
Regional clinical
networks
Nurse Call
Line Data
Electronic Investigation
Lab Response Network
(including BioWatch)
Over-the-counter
drug sales
(others)
State and Metropolitan
Surveillance and
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-> [email protected]
PHIN surveillance
component (NEDSS)





Browser-based data entry over
Internet
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
surveillance
 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 7/17/2015
Chicago
New York City
Philadelphia
Washington D.C.
Los Angeles
31 Total NBS Sites
Houston
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
(PHIN-MS)
Software for industry standards based interinstitutional 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
partners





Second PHIN conference Atlanta,
May 24-27, 2004
CDC policy that all IT investments with
cooperative agreement funds use PHIN
standards
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
implementation
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
maintained.

Attach the PHIN standards to the cooperative
agreements as was done with the Preparedness
awards

Security is required at all levels of state PH
infrastructure; independent verification & validation
(IV&V) services assist the states with security
compliance
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.
2.
3.
4.
Initial detection
Subsequent case identification
Quantification of event magnitude to help
shape public health response
Data exchange and integration with outbreak
management and response systems