Data Integration

Under leadership of the Secretary of Veterans Affairs (VA), Office of Operations, Security and Preparedness has established the Veterans Affairs Integrated Operations Center, with the goal of enhancing integration and analysis of data, and information from VA’s preparedness partners, both internal and external, for timely decision support.

Objective

The objective of this study is to describe Veterans Affairs Integrated Operations Center-enabled collaborations to enhance the synergy of relevant data/information from Veterans Affairs (VA) and non-VA partners for improved early warning, and situational awareness of infectious disease threats.

The Office of the Medical Examiner (OME) is a statewide system for investigation of sudden and unexpected death in Utah. OME, in the Utah Department of Health (UDOH), certified over 2000 of the 13,920 deaths in Utah in 2008.

Information from OME death investigations is currently stored in three separate UDOH data silos that have limited interoperability. These three electronic data systems include death certificates, medical examiner investigations, and laboratory results. Without interoperability, OME staff is required to enter the same data into multiple systems. In addition, the process of requesting laboratory analysis and receiving results is paper based, significantly slowing final cause of death determination in a majority of cases.

Epidemiological studies and surveillance activities are hindered by the lack of systems integration in UDOH and often require retrospective data linkage. As an example, in 2005, CDC and the UDOH reported that deaths in Utah caused by drug poisoning from non-illicit drugs had increased fivefold from 1991 to 2003.1 This significant finding relied on retrospective linkage of death certificates, medical examiner records, and toxicology results to describe the problem.

In 2008, funding from a bioterrorism grant from the US Department of Homeland Security was secured to support development of a unique, integrated system for medical examiner and death certificate data.

Objectives

The objectives of the Utah Medical Examiner Database (UMED) project are:

• To provide a single point of entry for medical examiner pathologists and staff to manage investigation information.
• To develop an operational system that links death certificate, medical examiner, and laboratory data in real time as a resource for epidemiology and public health surveillance.

Group A Streptococcal (GAS) pharyngitis, the most common bacterial cause of acute pharyngitis, causes more than half a billion cases annually worldwide. Treatment with antibiotics provides symptomatic benefit and reduces complications, missed work days and transmission. Physical examination alone is an unreliable way to distinguish GAS from other causes of pharyngitis, so the 4-point Centor score, based on history and physical, is used to classify GAS risk. Still, patients with pharyngitis are often misclassified, leading to inappropriate antibiotic treatment of those with viral disease and to under-treatment of those with bone fide GAS. One key problem, even when clinical guidelines are followed, is that diagnostic accuracy for GAS pharyngitis is affected by earlier probability of disease, which in turn is related to exposure. Point-of-care clinicians rarely have access to valuable biosurveillance-derived contextualizing information when making clinical management decisions.

Objective

The objective of this study was to measure the value of integrating real-time contemporaneous local disease incidence (biosurveillance) data with a clinical score, to more accurately identify patients with GAS pharyngitis.

The Centers for Disease Control and Prevention (CDC) launched the BioSense program in 2003 to establish an integrated system of nationwide public health surveillance for the early detection and assessment of potential bioterrorism-related illness. Over the ensuing years, the original aims of BioSense were broadened to meet evolving public health surveillance needs and priorities.

In 2009, CDC embarked on a redesign of the BioSense system that would retain the original purpose of early event (or threat) detection and characterization, but enhance the capacity for situation awareness, event response, and routine public health practice. The BioSense redesign will be accomplished through continuous involvement of state and local users, and technical experts in the planning, design, development, and testing phases of the new BioSense system.

Objective

The objective of this poster presentation is to provide information on the efforts and results of the user requirements gathering process, pursued in the redesign of the BioSense system employing a User-Centered Design (UCD) approach. A UCD system development approach studies the people that the system will serve, and involves them through the planning, design, and development processes.

Objective

The National Biosurveillance Integration System (NBIS) is a consortium of federal agencies, whose joint objective is to enhance the identification, location, characterization, and tracking of biological events potentially impacting homeland security. Together, the consortium members benefit from a joint awareness of potentially significant biological events that are unfolding or imminent, based on information shared among the group. This presentation describes the framework, activities and benefits for NBIS participants, and invites participation by other agencies.

The 2009 H1N1 novel flu pandemic demonstrates how a rapidly spreading, contagious illness can affect the world’s population in multiple ways including health, economics, education, transportation, and national security. Pandemic disease and the threat of bio-terrorism are prompting the need for a system that integrates disparate data, makes optimal use of the breadth of available health-related analysis and predictive models, and provides timely guidance to decision makers at multiple levels of responsibility.

Objective

Traditional real time surveillance systems such as RODS and ESSENCE have focused on the task of threat detection; however, experience with the use of these systems in pandemic and disaster response settings suggests that a more common application is threat characterization and response management. This paper describes EpiSentry: a novel second generation real-time surveillance software system under development at Lockheed Martin that uses simulation to aid in threat characterization, response management and to provide decision support for disease outbreaks or bio-terror events.

Federal laws and national directives have focused attention on the development of more robust biosurveillance systems intended to detect events of public health interest in a timelier manner. Presidential Decision Directive 21 calls for integrated biosurveillance data, enhanced clinician awareness, and an epidemiologic surveillance system with sufficient flexibility to tailor analyses to new syndromes and emerging diseases. In 2007, a statewide syndromic surveillance system (ESSENCE) was implemented and hospitals were recruited to participate. Experience with ESSENCE in the context of the ED data analysis, visualization, and reporting prompted the exploration of integrating new data sources into ESSENCE and new analyses specific to these new data. The purpose of the ESSENCE system is now to provide an intuitive environment for state and local epidemiologists to conduct routine descriptive epidemiologic analysis, to monitor morbidity and mortality trends over time and space and across multiple data sources, thereby providing information that can assist with making decisions on how to improve population health.

Objective

Use of the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) in Florida has evolved from early event detection based on emergency department (ED) chief complaints to routine descriptive epidemiologic analysis, data visualization, and reporting across four different data sources, using and building on tools originally developed for syndromic surveillance.

Given the clear relationship between spatial contexts and health, the Indiana Center of Excellence in Public Health Informatics (ICEPHI) aims to serve both the needs of public health researchers and practitioners by contextualizing the health information of large populations. Specifically, ICEPHI will integrate one of the nation’s largest health information exchanges, the Indiana Network for Patient Care, with well-established community information systems that collect, geocode, organize, and present integrated data on communities in Indiana and surrounding states, including data on public safety, welfare, education, economics, and demographics.

Objective

This presentation describes a collaborative approach for realizing the public health potential of a geospatially enabled statewide health information exchange.