opportunities for strengthening public health surveillance
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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 WarehouseProcessingF4
F5
3x Metadata
CDS 3xProcess
Log
G1 3x 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 DesignBefore Propose
d
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
UsersClient
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