Opportunities for Strengthening Public Health Surveillance

Kathleen Gallagher D.Sc, MPH

PH Surveillance & Informatics Program Office OSELS, CDC

CSTE Pre-Conference Workshop, Pasadena CA June 9, 2013

Office of Surveillance, Epidemiology, and Laboratory Services

Public Health Surveillance & Informatics Program Office

Agenda

• CDC OSELS update• NNDSS (8:45-12:00)• BioSense (1:30-5:00

NNDSS Agenda

8:45am – 9:15am Actions taken in response to NNDSS Evaluation Phase I (Kathleen Gallagher, Jeffrey Kriseman)

9:15am – 9:45am Overview of the NNDSS Evaluation Phase II – (Perry Smith)

9:45am – 10:00am CDC Office of Infectious Disease perspective about surveillance issues and future (Tonya Martin)

10:00am – 10:15am Break 10:15am – 10:45am Results from the 2012 CSTE NEDSS

Assessment (Erin Holt, Kathryn Turner) 10:45am – 12:00pm Local, State, and Territorial

Perspectives/Discussion 12:00pm – 1:30pm Lunch on your own

External Evaluation of NNDSS

External Evaluators 1 former state epidemiologist, 2 informaticians

Purpose Identify issues/problems with current NNDSS

without the biases of persons ( within CDC ) invested in the system

Recommend solutions Scope

Phase I –focused on data and business processes within CDC

Phase II - identify issues/challenges/problems experienced by SLT health departments

Methods Conducted interviews with 81 staff from 14 CDC

divisions Reviewed documentation

4

Focus of External Evaluation of NNDSS

Healthcare

Providers,

inc. Labs

Local CDC/

OSELSNNDSS

CDC/OIDNational Centers

State

Health Depts.

Evaluation Phase 1

5

External Evaluation of NNDSS Findings

Organizational No consistent, national long-term oversight

governance Inconsistent leadership and poor organizational

support History of poor project management practices Inadequate capacity of internal staff to oversee

contracts

Technical Numerous data streams and transformations (that

occur at OSELS) prevent delivery of quality data to CDC programs

6

Data ProcessesCommon Data Store

ALLNNDSS

STD

PHINMSReceiver

CDC

NBSMaster Msg

HL7Msg

A1

B1

A2

B2

DMB

B3

MsgRepo

B4

NNDSSOperations

C1NETSS

Data(.DAT File)

ArboNet

E1

ArboNetProcess

E2

I1

PHINMSSender

PHINMSSender

· NBS_NND_11_INQ

· NBS_NND_11_OUTQ

· NND_Case_Note_inq

· NND_Case_Note_outq

SDNC2

· .DAT Files· .TXT File

\\cdc\project\NCPHI_DISSS_NEDSS

\fsp-centnetss\fepo-xdv-netss\link\mmwrprod· .\POLL76, .\POLL77, & .\

POLL78

Informatica

· .\SrcFiles\NETSS

· .\SrcFiles\NETSS_ArchiveCDS Copy Script

C3 C5

C4

NBS PostMapping

A4

A5

NETSS Post Mapping

C6

C7

Post Trigger

Payload Staging

F1

F2

InformaticaRepository

· MR_Message

· MR_Message_ErrorF3

· NBS_LDF_INQ

· NBS_LDF_OUTQ

A3

· \\aops-irm-sdn622\test_dps_queue\

DCA

PED FLU

CDC Alerting

TB CVR

D1

WHS(3x)

3x WarehouseProcessing

F4

F5

3x Metadata

CDS 3xProcess

Log

G13x DeliveryProcessing

3x Metadata

G5

G3

G2

G4

G6G7

ArboNetMapping

E4

E3

D2

I2

NNDSSViews

STDViews

H1

H2

· ANNOTATED

Annotation Post

Mapping

I3

I6

\\Cdc\project\NCPHI_DISSS_NEDSS\fsp-centnetss\fepo-xdv-

netss\link\mmwrprod· .\SrcFiles\ANNOTATED

· .\SrcFiles\ANNOTATED_Archive

I4

I5

ALLViews

H2

G8

7

Recommendations for Improvement

Implement long-term oversight of NNDSS FACA, subcommittee

Organizational Support Upper level management must be engaged (OID,

CGH,OSELS, OD) Lines of responsibility within OSELS need to be

addressed Improve Project Management

All levels of staff should be knowledgeable about good project management practices

All stakeholders must be actively involved Primary responsibility for checking data quality should

reside with the CDC programs CDC FTE’s must actively oversee all contract work8

Recommendations for improvement (cont’d)

Revise system design and current data processing procedures Further collaborative review by stakeholders Retire NETSS format Conduct full evaluation of the NEDSS base system (NBS) Revise Common Data Store (CDS) to use technology

smarter Avoid creating dependencies on single standards,

domains or vendors

9

10

Getting the Data Out to CDC Programs

Proposed Initial Design

Before Proposed

Ongoing Challenges

Organizational/operational barriers to success Staff capacity Hiring Budget MASO

Dependencies on contractors Expensive and may hamper our ability to get the most

innovative and cost-effective approaches

11

Conclusions

Technical issues exist but current technologies and computational practices can solve these Simplifying the approach can improve performance

and reduce costs Organization challenges will be more

difficult to overcome Will require high level organizational support and

stamina Collaborative support needed may be hampered by our

“image problems” Need to build internal capacity to reduce reliance on

contractors

Action Steps Taken To Date

Staff who need project management training have been identified and training has been or is being scheduled

Contracts for IT services have been critically reviewed/ new contracts have been awarded

Continue development of simplified data processing and provisioning strategy

Reorganization should help to improve efficiency and focus

Internal high level discussions at CDC have occurred about governance and support.

FACA is scheduled to “ stood up” by end of 2013

13

Ideal

• Strong local and state disease reporting systems that meet information needs– Shared and disease-specific – Local to state to national

• IT services enhance efficiency & minimize duplication– Platform(s) for multiple forms of surveillance– Consistent with emerging national information standards

• Healthcare and laboratory information systems• Information exchange• “Meaningful Use” program

• Exploit “cloud” computing environment– Support collaboration across jurisdictions and with CDC– Reduce data storage costs– Facilitate access to analysis tools

14

Vision for the Public Health PlatformPHP Advisory Group

FedRAMP Cloud Service Provider (CSP)

Potential Authorized Users

Potential Public Users

Potential MobileApps Development

Users

Client

Mobile Client

Application

Encryption

ApplicationProgramming

Interface (API)

Data source

Message

Cancer Data

OtherData

CMS Data

Flat Files

XML Files

HL7 2.x

CDA

Other Formats

PublicData

PHIN MS

VPN Mirth

sFTP

Direct

Connect

ObjectIdentification

Validation

Authorization

Vocabulary

Rules

Authentication

Other

TRANSPORTSERVICES

STANDARDIZATION & NORMALIZATION

SERVICES

API

API

Other

Data QualityDash Board

WEAT Other

MySQL

LEGEND

STORAGE & DATABASING

SERVICES

DATA ACCESS

SERVICES

POTENTIAL DATAANALYSIS &

EXPLORATIONSERVICES

Public Access

Secure AccessElastic Data

StorageWeb Service

SecureTransmission

Input data(2-way)

Data flow(2-way)

NotifiableDisease

Data

SyndromicSurveillance

Data

Vital Statistics

Data

MessageGuides

6/10/2013

Immunization Data

16

QUESTIONS?

Office of Surveillance, Epidemiology, and Laboratory Services

Public Health Surveillance & Informatics Program Office

NNDSS Message Guides Proposed Priority List

Priority Group 1

NETSS Core NBS Core Generic Case (v1,v2, HL7) Mumps Pertussis TB (v2, HL7) Varicella (v2, HL7) Hepatitis (HL7) STD (NETSS) Other NND’s ( to allow for retirement of all current NETSS feeds)

6/3/2013 18

National Public Health Surveillance and Biosurveillance Advisory Committee

Established to support CDC’s continued leadership in public health surveillance and biosurveillance. 

Advises the Director of CDC regarding the broad range of issues impacting public health surveillance and the human health component of biosurveillance. 

Chartered for 15 members.

National Public Health Surveillance and Biosurveillance Advisory Committee-

Timeline

November 6, 2012, MASO published through the federal register notice the request for nominations for candidate’s submission

Submission for nominees closed December 21, 2012.

January 2013, CDC Vetting Panel formed.  February 2013, CDC Vetting Panel process

complete. Next Steps:

Finalize proposed slate of potential candidates Submit proposed slate to CDC’s MASO for final round of

vetting   Submit slate to CDC Director and HHS Secretary for final

approval