BioSense

The practice of public health surveillance is evolving as electronic health records (EHRs) and automated laboratory information systems are increasing adopted, as new approaches for health information exchange are employed, and as new health information standards affect the entire cascade of surveillance information flow. These trends have been accelerated by the Federal program to promote the Meaningful Use of electronic health records, which includes explicit population health objectives. The growing use of Internet “cloud” technology provides new opportunities for improving information sharing and for reducing surveillance costs. Potential benefits include not only faster and more complete surveillance but also new opportunities for providing population health information back to clinicians. For public health surveys, new Internet-based sampling and survey methods hold the promise of complementing existing telephonebased surveys, which have been plagued by declining response rates despite the addition of cell-phone sampling. While new technologies hold promise for improving surveillance practice, there are multiple challenges, including constraints on public health budgets and the workforce. This panel will explore how PHSIPO is addressing these opportunities and challenges.

Objective

To provide updates on current activities and future directions for the National Notifiable Diseases Surveillance System (NNDSS), BioSense 2.0, and the Behavioral Risk Factor Surveillance System (BRFSS) and on the role of PHSIPO as the “home” at CDC for addressing cross-cutting issues in surveillance and informatics practice

In November of 2011 BioSense 2.0 went live to provide tools for public health departments to process, store, and analyze meaningful use syndromic surveillance data. In February of 2012 ESSENCE was adapted to support meaningful use syndromic surveillance data and was installed on the Amazon GovCloud. Tarrant County Public Health Department agreed to pilot the ESSENCE system and evaluate its performance compared to a local version ESSENCE they currently used. The project determined the technical feasibility of utilizing the Internet cloud to perform detailed public health analysis, necessary changes needed to support meaningful use syndromic surveillance data, and any public health benefits that could be gained from the technology or data.

Objective:

This project represents collaboration among CDC’s BioSense Program, Tarrant County Public Health and the ESSENCE Team at the Johns Hopkins University APL. For over six months the Tarrant County Public Health Department has been sending data through the BioSense 2.0 application to a pilot version of ESSENCE on the Amazon GovCloud. This project has demonstrated the ability for local hospitals to send meaningful use syndromic surveillance data to the Internet cloud and provide public health officials tools to analyze the data both using BioSense 2.0 and ESSENCE. The presentation will describe the tools and techniques used to accomplish this, an evaluation of how the system has performed, and lessons learned for future health departments attempting similar projects.

 

BioSense 2.0, a redesigned national syndromic surveillance system, provides users with timely regional and national data classified into disease syndromes, with views of health outcomes and trends for use in situational awareness. As of July 2014, there are 60 jurisdictions nationwide feeding data into BioSense 2.0. In New Jersey, the state’s syndromic surveillance system, EpiCenter, receives registration data from 75 of NJ’s 80 acute care and satellite emergency departments. EpiCenter is a system developed by Health Monitoring Systems, Inc. (HMS) that incorporates statistical management and analytical techniques to process health-related data in real time. To participate in BioSense 2.0, New Jersey worked with HMS to connect existing data to BioSense. In May, 2013, HMS established a single data feed of New Jersey’s facility data to BioSense 2.0. This transfer from HMS servers occurs twice daily via SFTP. The average daily visit volume in the transfer is around 10,000 records. This data validation project was initiated by the New Jersey Department of Health (NJDOH) in 2013 to assure that the registration records are delivered successfully to BioSense 2.0.

Objective

To assess and validate New Jersey’s ED registration data feed from EpiCenter to BioSense 2.0.

Timely access to Emergency Department (ED) Chief Complaint (CC) data, before the definitive diagnosis is established, allows for early outbreak detection and prompt response by public health officials.BioSense 2.0 is a cloud-based application that securely collects, tracks, and shares ED data from participating hospitals around the country. Denver Health (DH) is one of several Colorado hospitals contributing ED Chief Complaint data to BioSense 2.0. In August 2013, ED clinicians reported an increase in patients presenting with excited delirium, possibly related to synthetic marijuana (SM). We used this event to test the use of CC field of ED data for detection of a novel public health event (i.e., serious adverse events related to synthetic marijuana use) not currently categorized in the BioSense syndromic surveillance library.

Objective

The aims of this presentation is to use ED chief complaint data, to test BioSense 2.0 for detection of a novel public health event (i.e., serious adverse events related to synthetic marijuana use) not currently categorized in the BioSense syndromic surveillance library.

The May arrival of two cases of Middle East Respiratory Syndrome (MERS) in the US offered CDC’s BioSense SyS Program an opportunity to give CDC’s Emergency Operations Center (EOC) and state-and-local jurisdictions an enhanced national picture of MERS surveillance. BioSense jurisdictions can directly query raw data stored in what is known as “the locker.” However, CDC cannot access these data and critical functions, like creating ad-hoc syndrome definitions within the application are currently not possible. These were obstacles to providing the EOC with MERS information. BioSense staff developed a plan to 1) rapidly generate query definitions regardless of the locally preferred SyS tool and, 2) generate aggregate reports to support the national MERS response.

Objective

Demonstrate that information from disparate syndromic surveillance (SyS) systems can be acquired and combined to contribute to national-level situational awareness of emergent threats.

The benefits of inter-jurisdictional data sharing have been touted as a hallmark of BioSense 2.0, a cloud-based computing platform for syndromic surveillance. A key feature of the BioSense 2.0 platform is the ability to share data across jurisdictions with a standardized interface. Jurisdictions can easily share their data with others by selecting data sharing partners from a list of participating jurisdictions. Technically the process is simple, however there are several other considerations (discussed herein) to be taken into account before and after deciding to share data with the larger BioSense community. This green paper is a continuation of several discussions stemming from a workshop hosted by the International Society of Disease Surveillance (ISDS) in collaboration with the Association of State and Territorial Health Officials (ASTHO), with the support of the U.S. Centers for Disease Control and Prevention (CDC). This initial workshop brought together epidemiologists from city, county and state public health departments primarily located in the US Health and Human Services Region 5. The workshop documented (Appendix 1) a variety of known benefits to data sharing, including:

• Cross-border case-finding

• Identifying patterns or trends (local, state, regional, federal)

• Emergency preparedness planning and partner notification

• Estimating an end to an event, based on declining trends in neighboring areas

• Mutual aid

• Ensuring national situational awareness for federal partners

• Hypothesis generation and testing

• Retrospective analysis to improve public health practice Members of this workshop composed an open letter to the BioSense Governance Group (Appendix 2) reporting on the top priorities and suggestions for functionality and documentation that would support data sharing among regional partners. Several members of the workshop coordinated a roundtable discussion at the ISDS 2013 annual conference (Appendix 3).

The annual ISDS conference attracts members across disciplines including practical epidemiologists, statisticians, researchers, informaticians and academic scholars. The objective of the roundtable was to open the conversation to the wider surveillance community and find potential solutions to the three primary barriers to data sharing originally identified by the workshop: legal/ethical concerns; unknown quality of the shared data; and the need for more granular (user role-based) sharing.

Objective

The purpose of this paper is to summarize the general and breakout group discussions facilitated by the roundtable members. This paper does not make any specific policy recommendations, however, we intend for the feedback captured in this document to lead to improvements in the BioSense 2.0 platform and application. The goal is to increase meaningful inter-jurisdictional data sharing by identifying existing barriers and user-generated solutions.