Harmonized Biosurveillance Use Case

By

Resty Namata, Maria Metty & Priyaranjan Tokachichu

December 13, 2007

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.

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

BiosurveillanceUse 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

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

0 24 48 72 96 120 144 168

Incubation Period (Hours)

Disease Detection

Effective Treatment

Period

Gain of 2 days

Early Detection Traditional DiseaseDetection

Phase IIAcute Illness

Phase IInitial

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.

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

Modified BiosurveillanceUse 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

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

Costs

Costs

Costs

Costs

Costs

Impact

Patient Impact

Physician Impact

Physician Impact

Public Health Impact

Retail Stores Impact

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.

Dr. Lael GatewoodDr. Richard Pham Mr. Joseph Plasek

Special Thanks to:

Jayne GriffithSenior Epidemiologist Bioterrorism UnitMinnesota Department of Health651.201.5085Jayne.griffith@health.state.mn.us

M. Cleat SzczepaniakProgram Manager

National Retail Data Monitor and Pennsylvania RODS

412.648.6728

Thanks