1. A Briefing for the American Health Information Community on Biosurveillance A Briefing for the American Health Information Community on Biosurveillance Bringing public health surveillance, monitoring, and response into the electronic age Materials Developed in Consultation With: Thomas R. Frieden, M.D., M.P.H., & Farzad Mostashari, M.D., M.S.P.H., New York City Department of Health and Mental Hygiene John Loonsk, M.D., Office of the National Coordinator for Health Information Technology, HHS Leah Devlin, D.D.S., M.P.H., & Steve Cline, D.D.S., North Carolina Department of Health Edward Sondik, Ph.D., National Center for Health Statistics, HHS George Hardy, M.D., M.P.H. & Mary Shaffran, M.P.A., Association of State and Territorial Health Officials Laura Conn, M.PH., Centers for Disease Control and Prevention, HHS This briefing has been developed under the auspices of Health Systems Research, Inc. under a contract with the Office of the National Coordinator, HHS November 29, 2005

2. 1 Scope and Boundaries of the Issue Transformative potential of health IT for Public Health Transformative potential of health IT for Public Health Prevention-focused personal health recordsPrevention-focused personal health records Prevention-focused clinical decision support toolsPrevention-focused clinical decision support tools Population-wide chronic disease managementPopulation-wide chronic disease management Population-level quality monitoringPopulation-level quality monitoring Public health surveillancePublic health surveillance

3. 2 Possible Breakthroughs Potential IT breakthroughs for Public Health: Strengthen existing public health IT systems Strengthen existing public health IT systems Promote the delivery of standardized health care data to public health for biosurveillance purposes Promote the delivery of standardized health care data to public health for biosurveillance purposes Build a nation-wide system that collects information from different jurisdictions and/or clinical facilities and enables both local and central analysis, alerts, and actions Build a nation-wide system that collects information from different jurisdictions and/or clinical facilities and enables both local and central analysis, alerts, and actions

4. 3 Specific Biosurveillance Use-Case Transmit essential ambulatory care and emergency department visit, utilization, and lab result data from electronically enabled health care delivery and public health systems in standardized and anonymized format to authorized Public Health Agencies with less than one day lag time

5. 4 Harmonized Use-Case January 18, 2006 January 18, 2006 NHIN Contractors submit use-cases March 19, 2006 March 19, 2006 AHIC releases harmonized use-case June 29, 2006 June 29, 2006 HITSP releases draft standards for use-case Oct 31, 2006 Oct 31, 2006 Data Sub Group releases minimum data set

6. 5 AHIC Priority Issues (10/31/06) Lack of central dissemination process for public health HIT standards Privacy/ Security Concerns Storage, retrieval, and management concerns of large amounts of data Lack of EHR case reporting, adverse events, and electronic lab reporting (ELR) integration Lack of interoperable bi-directional communication Lack of EHR decision support to prompt Immunization reminder Prevention guidelines

7. 6 ScopeScope “ “actions that are required to identify specific clinical care information used in the context of care and share these data with public health organizations to support Biosurveillance needs including initial event detection, situational awareness, outbreak management and response support” Does not include how data are used by PH agencies (including alerts back to providers)

8. 7 Scenario Flow

9. 8 Ambulatory EHRs NAMCS 2005 Survey: NAMCS 2005 Survey: 24% physicians reported using EHRs 24% physicians reported using EHRs Uncertainty in definition, includes full or partialUncertainty in definition, includes full or partial 3% annual increase3% annual increase Higher rates with larger practices, HMOsHigher rates with larger practices, HMOs Lower rates in NortheastLower rates in Northeast Features: Features: Demographics reporting- 21%Demographics reporting- 21% Physician notes- 18%Physician notes- 18% Lab results- 17%Lab results- 17% Public health reporting- 5%Public health reporting- 5%

10. 9 PHDSC Use-Case Focus on Ambulatory EHR- PH linkage Focus on Ambulatory EHR- PH linkage Includes public health investigation and response Includes public health investigation and response Requirements Analysis Methodology Requirements Analysis Methodology Generated by end-users, used by information system developersGenerated by end-users, used by information system developers GoalsGoals ActorsActors Benefits to stakeholdersBenefits to stakeholders Use-case description (scenario)Use-case description (scenario) FunctionsFunctions Data SourcesData Sources Description of data flow and workflowDescription of data flow and workflow List of data elementsList of data elements Standards neededStandards needed Process Issues encounteredProcess Issues encountered

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