Informatics

Mobile technology provides opportunities to monitor and improve health in areas of the world where resources are scarce. Poor infrastructure and the lack of access to medical services for millions have led to increased usage of mobile technology for health related purposes in recent years. As adoption has increased, so has its acceptance as a viable technology for health data collection. The ability to provide timely, accurate, and informed responses to emerging outbreaks of disease and other health threats makes mobile technology highly suitable for use in surveillance data collection activities and within the arena of global health informatics overall. The American Public Health Association defines global health informatics as the application of information and communication technologies to improve health in low-resource settings, which include the following: linking disparate sources of data together through natural language processing, use of mobile health technologies for disease surveillance, use of telemedicine to manage chronic disease, use of digital libraries to increase knowledge and awareness of public health events. 

Objective 

To present the prevailing global public health informatics landscape in developing countries highlighting current mobile system requirements and usage for disease surveillance and revealing gaps in the technology.

The American Recovery and Reinvestment Act (ARRA) initiated a broad range of national implementation activities. In order to support the critical activities of meaningful use (MU), ONC established the S&I Framework. In the beginning of 2011 the Laboratory Reporting Interface (LRI) Public Health (PH) Work Group (WG) was formed as a subworking group of the S&I Framework LRI activity. This LRI PH WG, besides providing PH required data elements to the LRI, assessed a need for assessment of the broad landscape of public health laboratory data exchange transactions. As a result, this WG recommended to participants and leadership of the ONC S&I that a new initiative, the ONC S&I PHR activity should be established. In July 2011 a team of public health practitioners, (co-authors of this presentation) started working on a charter and use cases for the group.

Objective

The objective of this presentation is to evaluate progress on harmonization of public health electronic data exchange through the Public Health Reporting (PH-R) Standards and Interoperability (S&I) Framework activity.

Under the Electronic Health Record Incentive Program Rule, hospitals are eligible to receive incentive payments from the Centers of Medicare and Medicaid Services provided they meet certain requirements including Meaningful Use (MU). Demonstrating MU requires meeting a core and menu set of objectives including the capability to submit electronic syndromic surveillance, Electronic Lab Reporting (ELR), and immunization data in accordance with state law and practice. NH is building a NH Heath Information Exchange to serve all NH's MU needs including those of public health. This represents a huge opportunity for public health to collect more data to enhance disease detection and control, improve safety, and reduce health disparities, but also presents an integration challenge.

Objective

To describe steps used to build the required infrastructure to meet Public Health MU reporting requirements for electronic syndromic surveillance, ELR, and immunization data in NH Division of Public Health Services.

In response to the terrorist attack of September 11, 2001, the NH Department of Health and Human Services (NH DHHS) engaged state and external partners in the design of an early warning surveillance system to support bioterrorism and emergency preparedness. Initially, NH DHHS began collecting four syndrome counts from thirteen hospital Emergency Departments (ED) by fax. Automation began in 2002, when an over the counter (OTC) syndromic surveillance pilot system was implemented by Scientific Technologies Corporation (STC). In 2003-2004 this system, the Syndromic Tracking and Encounter Management System (STEMS), was expanded to include school absentee and occupational health reports. Over time, an internal Death Data application was automated to query vital record deaths, and in 2005 a real-time ED surveillance pilot, the Automated Hospital ED Data System (AHEDD), was developed by STC to replace manual ED surveillance. Over the past decade NH continued to expand the original concept with innovative approaches to identify undetected or under reported disease outbreaks.

Objective

To illustrate development of syndromic surveillance in NH, share innovation experience with the public health community, and contribute to the syndromic surveillance body of knowledge in the new public health Information Technology landscape.

Cross-jurisdictional sharing of public health syndrome data is useful for many reasons, among them to provide a larger regional or national view of activity and to determine if unusual activity observed in one jurisdiction is atypical. Considerable barriers to sharing of public health data exist, including maintaining control of potentially sensitive data and having informatics systems available to take and view data. The Distribute project [1,2] has successfully enabled cross-jurisdictional sharing of ILI syndrome data through a community of practice approach to facilitate control and trust, and a distributed informatics solution. The Gossamer system [3] incorporates methods used in several UW projects including Distribute. Gossamer has been designed in a modular fashion to be hosted using virtual or physical machines, including inside cloud environments. Two modules of the Gossamer system are designed for aggregate data sharing, and provide a subset of the Distribute functionality. The Distribute and Gossamer systems have been used for ad-hoc sharing in three different contexts; sharing of common ILI data for research into syndrome standardization, sharing syndromic data for specific events (2010 Olympics) and for pilot regional sharing of respiratory lab results. Two additional projects are underway to share specific syndromes of recent interest: alcohol related and heat related ED visits.

Objective

To demonstrate how rapid adhoc sharing of surveillance data can be achieved through informatics methods developed for the Distribute project.

Two significant barriers to greater use of syndromic surveillance techniques are computational time and software complexity. Computational time refers to the time for many methods (for example, scan statistics and AMOEBA statistics) to create reliable results. Software complexity refers to the difficulty of setting up and configuring suites of software to collect data, analyze it, and visualize the results. Both of these barriers can be partially surmounted by the use of cloud computing resources.

Objective

To describe how use of cloud computing resources can improve the timely provision of disease surveillance analyses.

We previously experimented with tracking influenza in ER chief complaint data using existing syndromic surveillance tools. We identified several deficiencies in these tools: poor natural language processing, inefficient user interfaces, frequent (thus costly) false alarms, and one-size-fits-all approaches to syndromes. Furthermore, we were surprised that some epidemiologists we spoke with had relatively little faith in existing surveillance tools, and so we set out to build one that would address their concerns: DADAR (Data Analysis, Detection, And Response).

Objective

To develop an adaptable platform for periodically loading semi-structured medical text, extracting syndromic information using advanced natural language processing, detecting outbreaks in the data (including the ability to tune sensitivity vs. specificity on a syndrome-by-syndrome basis so as to reduce the rate of false alarms), generating timely cartographic surveillance reports, and providing tools to quickly validate or rule out syndromic alerts.

In response to major epidemic and pandemic outbreaks, WHO-AFRO and its Member States have adopted the Integrated Disease Surveillance and Response (IDSR) strategy to address International Health Regulations (2005) as well as individual Member State’s national disease control objectives. Significant progress has been made scaling-up capacity for disease surveillance and response using the IDSR guidelines, including implementation of IHR, the WHO African Region has experienced many challenges in designing, developing and implementing electronic surveillance systems. Over the past decade or more, many local and international stakeholders have independently pursued solutions for electronic surveillance and reporting in African countries. This has resulted in multiple systems of varying effectiveness and minimum interoperability due, in part, to limited agreement among stakeholders on data collecting and reporting standards. This complicated situation prevents most African countries from reaping the full benefits of having electronic systems to help detect, report, and respond to endemic, emerging and priority disease threats.

Objective

We report on the development of the African Surveillance Informatics Governing Board (ASIGB) as a conceptual strategy for strengthening eSurveillance in the African Region.