Integration

In 2015, ISDH responded to an HIV outbreak among persons using injection drugs in Scott County [1]. Information to manage the public health response to this event and aftermath included data from multiple sources (e.g., HIV testing, surveillance, contact tracing, medical care, and HIV prevention activities). During the outbreak, access to timely and accurate data for program monitoring and reporting was difficult for health department staff. Each dataset was managed separately and tailored to the relevant HIV program area’s needs. Our challenge was to create a platform that allowed separate systems to communicate with each other and design a DP that offered a consolidated view of data. ISDH initiated efforts to integrate these HIV data sources to better track HIV prevention, diagnosis, and care metrics statewide, support decision-making and policies, and facilitate a more rapid response to future HIV-related investigations. The Centers for Disease Control and Prevention (CDC) through its Info-Aid program provided technical assistance to support ISDH’s data integration process and develop a DP that could aggregate these data and improve reporting of crucial statewide metrics. After an initial assessment phase, an in-depth analysis of requirements resulted in several design principles and lessons learned that later translated into standardization of data formats and design of the data integration process.

Objective: The objective was to design and develop a dashboard prototype (DP) that integrates HIV data from disparate sources to improve monitoring and reporting of HIV care continuum metrics in Indiana. The tool aimed to support Indiana State Department of Health (ISDH) to monitor key HIV performance indicators, more fully understand populations served, more quickly identify and respond to crucial needs, and assist in planning and decision-making.

In Reunion Island, the non-specific surveillance was developed since 2006 and was based on the activity of only one hospital emergency department and on mortality. To respond to the threat of influenza A(H1N1) pandemic emergence, this surveillance system was significantly enhanced. All hospital emergency departments of the island have been included as well as the emergency medical service regulation center. In 2010, a new surveillance was implemented from National Health Insurance data.

Objective

To demonstrate that the different surveillance systems allow to establish complementary indicators.

Most outbreaks are small and localized in nature, although it is larger outbreaks that result in the most public attention. So a solution to manage an outbreak has to be able to accommodate a response to small outbreaks in a single jurisdiction scalable up to outbreaks that involve thousands of cases across multiple jurisdictions and to handle different types of situations with different questions and response required. To make this happen, information and resources need to be shared more consistently and efficiently to help facilitate the communication that occurs at all levels and to support day-to-day operations in order to ensure consistent use.

Objective

1.To provide a flexible solution to perform an outbreak investigation by improving communications during an incident.

2.To provide all users with a common set of data for decision support.

3.To provide standard forms for a consistent approach and to improve data quality.

Life science and biotechnology advances have provided transforming capabilities that could be leveraged for integrative global biosurveillance. Global infectious disease surveillance holds great promise as a tool to mitigate the endemic and pandemic infectious disease impacts, and remains an area of broad international interest. All nations have significant needs for addressing infectious diseases that impact human health and agriculture, and concerns for bioenergy research and environmental protection. In January 2011, Los Alamos National Laboratory, Department of State, and the Defense Threat Reduction Agency co-hosted the "Global Biosurveillance Enabling Science and Technology" Conference. Guided by the National Strategy for Countering Biological Threats, and joined by major government stakeholders, the primary objective was to bring together the international technical community to discuss the scientific basis and technical approaches to an effective and sustainable InGBSV system and develop a research agenda enabling a long-term, sustainable capability. The overall objective of the conference was to develop a technology road map for InGBSV, with three underlying components: 1) Identify opportunities for integrating existing biosurveillance systems, the near-term technological advancements that can support such integration, and the priority of future research and development areas; 2) Identify the required technical infrastructure to support InGBSV, such as methodologies and standards for technology evaluation, validation and transition; 3) Identify opportunities, and the challenges that must be overcome, for partnerships and collaborations.

Objective

To review observations and conclusions from a recent Global Biosurveillance conference, provide an assessment of the scientific and technical capabilities and gaps to achieve an effective and sustainable integrative global biosurveillance (InGBSV) system, and recommend research and development priorities enabling InGBSV.

With increasing availability of syndromic meaningful use data, new approaches to disease surveillance utilizing linkages to other data systems are possible. Expanded communicable disease information may be valuable during outbreaks or other public health emergencies. San Diego County is experiencing a significant and protracted hepatitis A outbreak. The disease has been transmitted person-to-person through close contact or through a fecally-contaminated environment, and has been primarily affecting homeless people and injection and non-injection illicit drug users. As of August 31, 2017, there were nearly 400 cases with 15 deaths. Approximately, 70% of the cases were hospitalized. This is one of the nation’s largest hepatitis A outbreaks since the introduction of the hepatitis A vaccine in 1995. Additional cases are expected over the next twelve months. The population affected by this outbreak presents some challenges for outbreak response. It is often a difficult population to reach. In addition, many have multiple comorbidities and often have health care seeking behaviors that differ from the general population. Using the medical record number (MRN) to link hepatitis A disease cases from the communicable disease registry to syndromic HL7 messages for emergency department visits and hospitalizations enabled the identification of additional hospital encounters the cases may have had before, during, or following their hepatitis A disease incident. This allowed an exploration of the ways in which this unique population interacted with the health care system in the context of a communicable disease outbreak. This presentation will highlight the steps to link information across surveillance systems, the results, the challenges, and the benefits of linked information to public health departments.

Objective:

To describe how the County of San Diego linked information from a communicable disease registry and syndromic surveillance system to further describe cases associated with a large hepatitis A outbreak. Specifically, to detail the linkage process which resulted in a longitudinal understanding of individuals’ hospital visits before, during, and after the reported hepatitis A incident.

In 2015, the Indiana State Department of Health (ISDH) responded to a large HIV outbreak among persons who inject drugs (PWID) in Scott County. Information to manage the public health response to this event and its aftermath included data from multiple sources such as surveillance, HIV testing, contact tracing, medical care, and HIV prevention activities. Each dataset was managed separately and had been tailored to the relevant HIV program area’s needs, which is a typical practice for health departments. Currently, integrating these disparate data sources is managed manually, which makes this dataset susceptible to inconsistent and redundant data. During the outbreak investigation, access to data to monitor and report progress was difficult to obtain in a timely and accurate manner for local and state health department staff. ISDH initiated efforts to integrate these disparate HIV data sources to better track HIV prevention metrics statewide, to support decision making and policies, and to facilitate a more rapid response to future HIV-related investigations. The Centers for Disease Control and Prevention (CDC) through its Info-Aid mechanism is providing technical assistance to support assessment of the ISDH data integration process. The project is expected to lead to the development of a dashboard prototype that will aggregate and improve critical data reporting to monitor the status of HIV prevention in Scott County.

Objective:

To assess the integration process of HIV data from disparate sources for reporting HIV prevention metrics in Scott County, Indiana.