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Additional Data For Harmonized Use Case for Biosurveillance
HINF 5430 Final Project
By
Maria Metty, Priyaranjan Tokachichu &Resty Namata
December 13, 2007
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√ Brief History of Outbreak
√ Harmonized Use Case for Biosurveillance
√ Proposal
√ Costs and Financial Benefits
√ Impact
√ Recommendation
√ Questions
Agenda
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Harmonized Use Case for Biosurveillance
Brief History1979 - Accidental release of anthrax from bio-weapons plant inSverdlovsk, Russia
• 6 people with flu-like symptoms not treated & 21 people had died before lab results confirmed anthrax
After September 11, 2001• Anthrax release in United States
November 2002 to 31 July 2003•Severe Acute Respiratory Syndrome in Asia•WHO estimates up-to 60 % of cases were Healthcare workers
What is Biosurveillance Use Case• Specifications given by American Health Information Community for
implementing a Biosurveillance system.
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Use Case Requirements
Real-timeFulfilled by data transmission from HER
Timeliness Define by Michael Wagner et al. as difference between time of event detection & time event occurred
Goal: Early detection Need early detection of natural or man-made disease outbreak in order to mobilize resources and minimize morbidity and mortality
Transmit real-time data from electronically enabled healthcare providers to Public health Agency within 24hr lag time.
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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
Importance of early detection
• Category A disease agents cause non-specific symptoms like fever, cough, fatigue• People don’t seek medical care during effective treatment period.• 42% of people with “flu” symptoms purchased over-the-counter (OTC)• medication prior seeking medical care.• Use Case Data is collected after lab results and diagnosis
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Proposal
• It has been correlated with disease outbreak.• It is routinely collected for supply chain management• Available from National Retail Data Monitor System It is low cost
Collect daily sales data of over-the-counter (OTC) healthcare product such as electrolytes, diarrhea, cough, thermometer and fever medications from retail stores and transmit it to public health agency within 24-hour time lag
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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 Pharmacy Store
Transmit Sales OTC sales data
Current scenario
Amended scenario
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Scope
Includes: Data electronically collected during a routine OTC product
sale of pediatric electrolytes, “flu” remedies, chest rubs, diarrhea remedies, thermometer, adult & child anti-fever.
Excludes: Sales data of other OTC healthcare products for symptoms not caused by infectious agents e.g allergy Customer identification information.
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OTC-Sales Data
Stakeholders• Retails Stores that sell OTC healthcare products• Customers who purchase 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
√ Standard Product identifier √ Purchase Date
√ Sales Total √ Product Description
√ Category √ Store Identifiers
√ Other Information
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Costs
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Costs
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Costs
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Costs
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Costs
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Impact
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Patient Impact
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Physician Impact
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Physician Impact
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Public Health Impact
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Retail Stores Impact
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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. Impossible to identify a person who purchased a product.
4. Due to competitive agreements the store cannot be identified either.
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1. Dr. Lael Gatewood2. Dr. Richard Pham 3. Mr. Joseph Plasek
1. Jayne GriffithSenior Epidemiologist Bioterrorism UnitMinnesota Department of [email protected]
2. M. Cleat SzczepaniakProgram Manager of National Retail Data Monitor and Pennsylvania RODS
412.648.6728
Special Thanks to:
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Questions?