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BioSense 2.0 Current Status, Challenges and Opportunities CSTE Pre-Conference Workshop June 9, 2013 Kathleen Gallagher, D. Sc., MPH Director Division of Notifiable Diseases and Healthcare Information Public Health Surveillance and Informatics Program Office Office of Surveillance, Epidemiology, and Laboratory Services Public Health Surveillance and Informatics Program Office (PHSIPO, Proposed) Office of Surveillance, Epidemiology, & Laboratory Services (OSELS)

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Discussion Points Future funding and budget Current status and activities DUAs Onboarding Evaluation activities Updating C&A Review of new products ICD9-ICD10 transition Current Priorities Challenges and Opportunities Questions?

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BioSense Cooperative Agreement Funding (dollars in millions) FY 2013 Estimated FY 2014 Request FY 2015 Request Number of Awards 3534 Average Award $0.196$0.200 Range of Awards $0.100$0.275$0.100$0.300 Number of New Awards 000 Number of Continuing Awards3534 Total Grant Award$6.871$7.084

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Timeline for Funding Year 2 of BioSense Cooperative Agreement March 15, 2013 - RFA published May 3, 2013 - Applications due in Grants.gov June 14, 2013 - Funding recommendations to PGO August 19, 2013 - NGA sent to grantees September 1, 2013- Start date for all awards

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Status and Current Activities

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BioSense 2.0 DUA Status (June 15, 2012) Signed DUA New to BioSense, N=13 Arkansas Arizona Illinois Kansas Louisiana Montana New Jersey Tennessee Virginia Washington West Virginia San Diego County, CA Washington, D.C. Signed DUA BioSense 1.0 and 2.0, N=4* Indiana North Carolina Ohio Tarrant County, TX Alabama Alaska California Colorado Connecticut Florida Georgia Kentucky Massachusetts Maine Michigan Minnesota Missouri North Dakota Nebraska New Hampshire New York Pennsylvania Rhode Island South Carolina Utah Vermont Wisconsin Wyoming Boston, MA Los Angeles County, CA Montgomery County, MD New York City, NY Sacramento County, CA DUA Under Review, N=29 Local Public Health Engaged in Recruitment (ongoing outreach to S&L) Declined for this Year, N=2 *Out of 8 DUAs in BioSense 1.0. The other 3 states are anticipated to sign soon (MI, MO, GA). Cook County is participating under the IL DUA. There was no data loss from 1.0 to 2.0, as all data is captured in the CDC locker.

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BioSense 2.0 Signed Data Use Agreements May 29, 2013 N=44 Alabama Alaska Arizona Arkansas Florida Illinois Indiana Kansas Louisiana Maine Maryland Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina Ohio Pennsylvania Rhode Island Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Boston, MA Denver, CO El Dorado Co., CA Houston, TX Marion Co., IN New York City, NY Sacramento Co., CA San Diego, CA Tarrant Co., TX Washington, D.C.

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BioSense 2.0 Data by State May 29, 2013 N=28 Alabama (2 of 101) Alaska (1 of 20) Arizona (8 of 70) California (13 of341) Colorado (5 of 83) Illinois (50 of 193) Indiana (107 of120) Kansas (28 of 131) Louisiana (38 of 113) Maine (26 of 37) Maryland (1 of 48) Massachusetts (11 of 73) Missouri (77 of 119) Montana (3 of 58) Nevada (15 of 33) New Mexico (9 of 37) New York (1 of 199) North Carolina (119 of 119) Ohio (176 of 189) Pennsylvania (119 of 171) Rhode Island (7 of 10) Texas (72 of 439) Utah (38 of 46) Virginia (7 of 96) Washington (19 of 95) Washington, DC (4 of 8) West Virginia (5 of52) Wisconsin (46 of 126)

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Updating C&A Originally approved by CDC November 2011 Needs to be updated to incorporate all changes to the BioSense 2.0 environment Needs to comply with FedRamp requirements re: cloud environments ( waiting for guidance on how to do this) Current environment continues to operate as is while updated submission is being prepared and reviewed Opportunity for incorporating other changes to the environment

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Process for Review of New Products, Priorities and Functions Established weekly internal feature review Requests from all stakeholders Establish process for reviewing requests from BioSense governance (or others?) Newly formed PHSIPO IT governance and review process Product Review Technical design and architecture Data exchange and integration Security/ Privacy Cost/ Licensing Functionality (analytic capacity, data coding)

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Current Priorities ( next 1-2 years) Onboard ED data from all participating jurisdictions Onboard national lab and pharmaceutical sales data and enable these data to be shared with participating state and local PH jurisdictions Expand sharing of data in BioSense environment between state and local health jurisdictions Develop robust and objective process for evaluating ( and adding ) analytical and visualization products for use in the BioSense environment Increase the utility for CDC of data from BioSense 2.0 to describe and monitor all hazards situational awareness at the national level

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Evaluation Activities Evaluation with key external stakeholders (RTI) will assess the performance, use, utility, usability, and costs of the system as well as the onboarding experience. The evaluation is intended to guide the Governance Group, CDC, state, local, and territorial (STLT) stakeholders and the RTI BioSense Redesign team in their deliberations and decisions about the development of BioSense 2.0. CDC Internal Evaluation to ensure the whole of the BioSense program will meet its goals and demonstrate its value to public health, an internal evaluation is warranted to explore current issues and identify key activities that will realize the program's objectives.

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BioSense 2.0 Challenges Capacity ( internal and external) Analytic ( Big data, switch from SAS to R) Community of Practice Coordination Multi-dimensional project with many moving parts with many intersections and interfaces Technical, legal, policy, security, programmatic considerations Communication Promoting utility to cynics Managing expectations of advocates Onboarding Data This is a rate-limiting step Operationalizing the sharing of data across jurisdictions/owners

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BioSense 2.0 Opportunities Expand data use to include non-infectious conditions (e.g, MI, injury) Explore other sources of data ( weather, EMS, social media) MUse Stage 3 for outpatient & inpatient facilities Expand coverage and representativeness of participants Expand Community of Practice Including other federal partners?

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For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov Thank you

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ASTHO and CDC Building BioSense 2.0 June 2011 June 2012 Governance ASTHO established an interim S&L governance structure Meeting every other week since early winter Establishing BioSense 2.0 Cloud ASTHO identified Amazon Web Services as the Cloud vendor of choice Worked with BioSense redesign team to set up cloud environment BioSense 1.0 retired April 2012 BioSense 2.0 Open for Business S&L HDs can initiate or expand their syndromic surveillance systems under the MUse program for their own jurisdiction CSTE started recruitment in coordination with ASTHO, NACCHO, CDC, and ISDS (67 jurisdictions) Stakeholders begin collaborating among themselves and CDC in new environment governed by data use agreements established with ASTHO CDC BioSense 2.0 Funding Opportunity proposals due June 26

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ASTHO and CDC Building BioSense 2.0 Next steps June 2012: Establish permanent governance structure July 2012: Award BioSense 2.0 cooperative agreement $7 million for up to 35 sites December 2012: Demonstrate examples of data sharing October 2013: 32 DUAs signed June 2014: Redesign complete

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OSELS Current Priority Initiatives Increase use of electronic health records as part of an integrated system for public health surveillance Improve public health data access, analysis, interpretation, and communication Develop an efficient, sustainable and integrated network of public health laboratories Prepare the public health workforce to meet 21 st Century challenges