pm803 21slides

The National Electronic Disease Surveillance System (NEDSS): 

The National Electronic Disease Surveillance System (NEDSS) Lawrence P. Hanrahan PhD MS Principal Investigator Wisconsin Division of Public Health Population Health Sciences 802 Madison, WI. November 13, 2002

Objectives: 

Objectives Understand Informatics Understand Wisconsin’s Implementation of NEDSS & HAN Know NEDSS Design Elements Opportunity to envision

What is Informatics?: 

What is Informatics? The Application, Management and Use of Information and Computer Science and Technology to a field (practice), research, and learning

Levels of Biomedical Informatics: 

Levels of Biomedical Informatics Bioinformatics - Molecular, Cellular (e.g. gene sequences) Imaging Informatics - Tissues, Organs (e.g. radiology) Clinical Informatics - Patients (e.g. Computerized Physician Order Entry) Public Health Informatics - Populations (e.g. Disease Surveillance Systems)

Public Health Informatics: 

Public Health Informatics Systematic Application of Information and Computer Science and Technology to Public Health Practice, Research, and Learning

Public Health Informatics: 

Public Health Informatics Knowledge Application from: Information Science, Computer Science Management, organizational theory, Psychology, Communications, Political Science, Law Public Health: e.g. Epidemiology, Microbiology, Toxicology, Biostatistics

Public Health Informatics - Foundations: 

Public Health Informatics - Foundations Information Science - Analysis of Structure, Properties, Organization, Storage & Retrieval of Information: DB Design & Architecture, Library Science, Project Management, Change Management, Business Process Reengineering

Public Health Informatics - Foundations: 

Public Health Informatics - Foundations Computer Science - Automatic Data Processing Machines, Hardware and Software Design, Algorithm Development, Computational Complexity, Networking & Telecommunications, Pattern Recognition, Artificial Intelligence

Slide9: 

Public Health Informatics: Automation vs Reengineering Replace Paper with PC Based Surveillance Data Entry Systems vs Eliminate Surveillance Data Entry - Poll Information from Existing Clinical Information Systems & Electronically Transmit, Real Time Analysis & Automated Intervention

Slide10: 

Public Health Informatics Principles - Apply Science and Technology to: Promote Population Health Prevent Disease and Injury Prevent at all vulnerable points in causal pathways Governmental Context - with Private Sector Partnerships

Slide11: 

Our Implementation of NEDSS (and HAN): ‘The Wisconsin Idea’ IT Governance - Stakeholders DHFS-DPH - Public Health UW-WISCNET - Network UW-DoIT - Internet, Learning Technology State Laboratory of Hygiene Local Public Health Departments Hospitals, Clinics, ERs, Labs, Security

Slide12: 

WISCONSIN HEALTH ALERT NETWORK GOALS: Improve Internet (T1) Connectivity - All Local Health Departments Create Distance Learning Infrastructure Create Web / Multi-platform Alert Messaging System Assess Organizational Capacity

Slide13: 

What is the National Electronic Disease Surveillance System (NEDSS)? The Web Enabled Public Health System National Data Standards / Architecture for Public Health Eliminate Program / Data Silos Add in Systems (Modules) Secure

Slide14: 

HAN-Basic Infrastructure NEDSS- Epi-X Capabilities Public Health Response Bioterrorism - All Foci Emerging Infections All Other Health Threats Assuring Public Health PREPAREDNESS

Limitations of Current Public Health Surveillance Systems: 

Limitations of Current Public Health Surveillance Systems Multiplicity of categorical systems Data incomplete, not timely Burden on respondents in health care sector increasingly unacceptable Systems do not utilize state of the art information technology

NEDSS, broadly: 

NEDSS, broadly Capture and analyze data in real time, using data that are already electronic Organize surveillance by relevant data sources, not diseases Do standards-based development in a defined architecture, using commercial products Integrate public health and health care data, as appropriate Emphasize adoption and implementation of standards Gartner Group – “…right approach to a tough, classic problem in application integration.”

How can NEDSS meet Public Health Surveillance Needs?: 

How can NEDSS meet Public Health Surveillance Needs? NEDSS uses actual or de facto national standards for architecture; NOT specific to infectious disease Substantial emphasis on need for broad functionality at second NEDSS stakeholders’ meeting, April 2001 Current discussions with vital registrars, NCHS to harmonize new birth and death records re-engineering with NEDSS standards FY2001 intra-mural $’s to support NEDSS pilot projects beyond infectious diseases blood lead levels: NCEH, NIOSH; GIS and toxic substances data: ATSDR, NCEH, EPO SENSOR RFP; Environmental Tracking

Slide18: 

NEDSS - 8 Design Elements Web data entry / management Process HL7 / XML Integrated data repository data exchange (integration broker) transportable business logic data reporting / visualization LDAP directory of public health personnel security system / policies

Slide19: 

Implement an integrated data repository able to be patient centered, non-categorical support “thick” client and web applications (ODBC, JDBC and ANSI SQL)

Slide20: 

Implement a security system and appropriate security policies (Internet-based, with a firewall and certificates or tokens) Security

Slide21: 

Conduct and support web browser-based data entry and data management. Internet presentable, but not necessary Multi-tiered including an application server to run web “forms” from others State Health Department Local Health Department Or Clinical Site Security

Slide22: 

Accept, route and process electronic HL7 messages containing laboratory and clinical content (LOINC, SNOMED). Electronic Laboratory Messages HL7 Security State Health Department Local Health Department Or Clinical Site

Slide23: 

Develop active data translation and exchange (integration broker) functionality (XML, DTD’s HTTPS). CDC and Other Health Depts. XML Data Exchange Electronic Laboratory Messages HL7 Security State Health Department Local Health Department Or Clinical Site

Slide24: 

Develop data reporting and visualization capability (messaging and import/export ODBC, JDBC, ANSI SQL). CDC and Other Health Depts. XML Data Exchange Electronic Laboratory Messages HL7 Reporting, GIS and Analysis Security State Health Department Local Health Department Or Clinical Site

Slide25: 

Implement a shareable directory of public health personnel (LDAP). Shareable Directory of PH Personnel CDC and Other Health Depts. XML Data Exchange Electronic Laboratory Messages HL7 Security State Health Department Local Health Department Or Clinical Site Reporting, GIS and Analysis

Slide26: 

Develop transportable business logic capability (COM, CORBA, EJB). CDC and Other Health Depts. XML Data Exchange Electronic Laboratory Messages HL7 Security State Health Department Local Health Department Or Clinical Site Shareable Directory of PH Personnel Reporting, GIS and Analysis

Slide27: 

NEDSS Base System & Program Area Modules Functional Model NEDSS BASE System National Notifiable Diseases Core Demographics Lyme Disease PAM (scope to be determined) Tuberculosis PAM Meningitis & Bacteremia PAM Hepatitis PAM Additional PAMs ... STD PAM Enterprise Services National Immunization Program PAM Application Support HIV PAM CDC-developed software and user support for those who choose to use it A platform for building integrated surveillance systems through element development and sharing

Current Status of NEDSS: 

Current Status of NEDSS 50 states, 6 cities, and 1 territory funded for NEDSS: 43 started with Assessment & Planning phase in 2000 September 2001: 35 states and 1 city receiving funds for development of NEDSS compatible systems 16 implementing NEDSS compatible state developed system 20 deploying NEDSS Base System (NBS) January 2002: Public Health and Social Services Emergency Fund provides major funding for state and local public health capacity, including guidance from HHS on surveillance and IT capacity

Slide29: 

NEDSS Base System and Element Development, FY 2001 Previous Assessment and Planning – all states

Slide30: 

WI NEDSS - Funding Web data entry / management Process HL7 / XML Integrated data repository data exchange (integration broker) transportable business logic data reporting / visualization LDAP directory of public health personnel security system / policies Base System Installation

WI NEDSS - Developments: 

WI NEDSS - Developments HAN / NEDSS Portal - System Integration Complies with NEDSS Architectural standards Built from the “inside out” - Security Designed as a portal, user customizable Shared administration Streamlined user contributed content Multiple access/notification mechanisms

Slide32: 

WI NEDSS Developments Wisconsin Base System Development Envrionment / Reusable Logic Electronic Laboratory Reporting - SLH, Milwaukee Public Health New Born Hearing Screening PAM West Nile Virus Surveillance PAM MCH PAM Coroner / Medical Examiner PAM Environmental Tracking PAM - Cancer CDC Base System - Communicable Disease

Slide33: 

Gateway to NEDSS Surveillance Programs

PAM: West Nile Virus: 

PAM: West Nile Virus

Slide35: 

SAS Integration Visualization

Slide36: 

Your Turn - Reengineering Suppose Sufficient Resources Were Allocated to do Job Right. What are Key System Attributes for: Public Health Workers? Clinicians / Health Care Community? The General Public at Large?

References: 

References Claire Broome NEDSS 101 - 5/2002 Stakeholders Meeting Robert Pinner NEDSS Grantees Meeting Welcome & Introduction, ibid. www.cdc.gov www.cdc.gov/nedss/index.htm