1. Issues and Challenges for Integrated Surveillance Systems Daniel M. Sosin, MD, MPH Division of Public Health Surveillance and Informatics Epidemiology Program Office

2. Information is the “Business” of Public Health Surveillance Research Intervention evaluation Program evaluation

3. Uses of Public Health Surveillance Estimate magnitude of a problem Determine characteristics of a problem Portray natural history of a condition Detect clusters and epidemics Track health behaviors and practices Stimulate research Evaluate prevention and control measures Facilitate program implementation

4. Surveillance Information Sources Vital records Clinical records Laboratories Administrative/Billing records Personal surveys Environmental surveys Public safety records

5. Need for Integration Multiple categorical systems Incomplete data Untimely Burdensome

6. Surveillance Integration at CDC National Electronic Disease Surveillance System (NEDSS)  Architecture  Standards  Security Health Alert Network (HAN)  Infrastructure

7. NEDSS Base System Commercial software development Web-based data entry Electronic messaging Integrated Data Repository Platform for content modules Commercial analytic tools (SAS, ESRI GIS)

8. NEDSS: Current Status Funding: 50 states, 6 cities, 1 territory  43 started with Assessment and Planning  35 states, 1 city funded for development  20 states to deploy the Base System HL7 messaging pilot projects (laboratories, emergency departments, cancer registries) Convening public health partners in standards development and privacy protection

9. Issues and Challenges

10. Investment IT development and deployment Training and culture change Engaged leadership

11. Accommodation Multiplicity of program needs Multiplicity of data sources Collaboration across many disciplines and fields

12. Clinical Database CDC and Other Health Depts. XML Data Exchange Electronic Laboratory Messages HL7 Security Integrated State / Local Data Repository State Health Department Local Health Department Or Clinical Site Shareable Directory of PH Personnel Reporting, GIS and Analysis B L

13. Privacy Opportunity and responsibility HIPAA  Administrative simplification  Electronic data interchange  Health information privacy  Improving health care delivery

14. Privacy: HIPAA New safeguards Covers individually-identifiable health information Does not constrain public health authority http://www.hhs.gov/ocr/hipaa http://www.cdc.gov/cic

15. Summary: Issues/Challenges Investment Accommodation Complexity Privacy

16. Get Informed – Get Involved http://www.cdc.gov/cic http://www.phppo.cdc.gov/han http://www.hhs.gov/ocr/hipaa