2. Harmonized Biosurveillance Use Case By Resty Namata, Maria Metty & Priyaranjan Tokachichu December 13, 2007

3. Brief History From November 2002 to 31 July 2003 Severe Acute Respiratory Syndrome in Asia WHO estimates up-to 60 % of cases were healthcare workers 1979 - Sverdlovsk, Russia Accidental release of anthrax from bio-weapons plant. 6 people with flu-like symptoms not treated for anthrax. 21 people had died before lab results confirmed anthrax Following September 11, 2001 Anthrax release in United States Detected early because nation was on heightened alert.

4. Biosurveillance Use Case Requirements Attributes: Real-time Fulfilled by data transmission from HER Timeliness Define by Michael Wagner et al. as difference between time of event detection & time event occurred Ultimate Goal: Early detection Need to early detection of natural or man-made disease outbreak in order to mobilize resources and minimize morbidity and mortality Transmit real-time data from healthcare providers to Public health Agency within 24hr lag

5. Biosurveillance Use Case context diagram Public Healthcare Agency Hospital Laboratory Organization Ambulatory - Clinician Transmit /Receive essential ambulatory care Send /Receive acknowledgement Transmit /Receive essential lab results Transmit /Receive ED visits & Utilization Data is anonymized & aggregated before transmission from Electronic Medical Record Systems

6. Effective Treatment Period Gain of 2 days Early Detection Traditional Disease Detection Phase II Acute Illness Phase I Initial Symptoms * Use Case Data is collected after lab results and diagnosis Case for early detection Category A disease agents cause non-specific symptoms like fever, cough & fatigue People don’t seek medical care during effective treatment period. For example: Consumer Healthcare Products Association survey: 42% of people with “flu” symptoms purchased over-the-counter(OTC) medication prior seeking medical care.

7. Proposal  Collect sales data of over-the-counter healthcare product such as electrolytes, diarrhea, cough, thermometer and fever medications from retail stores and transmit it to public health agency * Available from National Retail Data Monitor System * It is low cost * It has been correlated with disease outbreak. * It is routinely collected for supply chain management

8. Modified Biosurveillance Use Case context diagram Public Healthcare Agency Hospital Laboratory Organization Clinician Send /Receive acknowledgement Transmit /Receive essential ambulatory care Transmit /Receive essential lab results Transmit /Receive ED visits & Utilization Retail Store Transmit Sales OTC sales data Data is anonymized &aggregated before transmission from Electronic Medical Record Systems

9. OTC-Sales Data Required Stakeholders Retails Stores that sell OTC healthcare products Pre-Conditions Procedures and agreements signed for data exchange Post-Conditions Data transmitted to an authorized Public Health agency Acknowledgement sent back to sender Universal Product Code Purchase Date Sales Total Product Description Category Store Identifiers Other Information

10. Costs

15. Impact

16. Patient Impact

17. Physician Impact

19. Public Health Impact

20. Retail Stores Impact

21. Recommendation We Recommend adding this data with reservations because: 1.It is difficult for public health to understand the data 2.OTC Data is noisy 3. Hard to identify a person who purchased a product. 4. Due to competitive agreements the store cannot be identified either.

22. Dr. Lael Gatewood Dr. Richard Pham Mr. Joseph Plasek Special Thanks to: Jayne Griffith Senior Epidemiologist Bioterrorism Unit Minnesota Department of Health 651.201.5085 Jayne.griffith@health.state.mn.us M. Cleat Szczepaniak Program Manager National Retail Data Monitor and Pennsylvania RODS 412.648.6728 Thanks