BioSense Update May 2013

BioSense 2.0Current Status, Challenges and Opportunities

CSTE Pre-Conference WorkshopJune 9, 2013

Kathleen Gallagher, D. Sc., MPHDirectorDivision of Notifiable Diseases and Healthcare Information Public Health Surveillance and Informatics Program Office Office of Surveillance, Epidemiology, and Laboratory ServicesPublic Health Surveillance and Informatics Program Office (PHSIPO, Proposed)Office of Surveillance, Epidemiology, & Laboratory Services (OSELS)1Discussion PointsFuture funding and budget Current status and activitiesDUAs OnboardingEvaluation activitiesUpdating C&AReview of new productsICD9-ICD10 transitionCurrent Priorities Challenges and Opportunities Questions?

3BioSense Cooperative Agreement Funding(dollars in millions)FY 2013EstimatedFY 2014RequestFY 2015RequestNumber of Awards353434Average Award$0.196$0.200$0.200Range of Awards$0.100$0.275$0.100$0.300$0.100$0.300Number of New Awards000Number of Continuing Awards353434Total Grant Award$6.871$7.084$7.084Timeline for Funding Year 2 of BioSense Cooperative AgreementMarch 15, 2013 - RFA publishedMay 3, 2013 - Applications due in Grants.govJune 14, 2013 - Funding recommendations to PGOAugust 19, 2013 - NGA sent to granteesSeptember 1, 2013- Start date for all awards Status and Current ActivitiesBioSense 2.0 DUA Status (June 15, 2012)

Signed DUANew to BioSense, N=13 ArkansasArizonaIllinoisKansasLouisianaMontanaNew JerseyTennesseeVirginiaWashingtonWest VirginiaSan Diego County, CAWashington, D.C.Signed DUABioSense 1.0 and 2.0, N=4*IndianaNorth CarolinaOhioTarrant County, TXAlabamaAlaskaCaliforniaColoradoConnecticutFloridaGeorgiaKentuckyMassachusettsMaineMichiganMinnesotaMissouriNorth DakotaNebraskaNew HampshireNew YorkPennsylvaniaRhode IslandSouth CarolinaUtahVermontWisconsinWyoming

Boston, MALos Angeles County, CAMontgomery County, MDNew York City, NYSacramento County, CA

DUA Under Review, N=29Local Public HealthEngaged 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.10 States and an ever-changing number of local jurisdictions are engaged in ongoing recruitment. 7BioSense 2.0 Signed Data Use Agreements

May 29, 2013N=44

AlabamaAlaskaArizonaArkansasFloridaIllinoisIndianaKansasLouisianaMaineMarylandMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew Hampshire New JerseyNew MexicoNew YorkNorth CarolinaOhioPennsylvaniaRhode IslandTennesseeTexasUtahVermontVirginia WashingtonWest VirginiaWisconsinBoston, MADenver, COEl Dorado Co., CA Houston, TXMarion Co., INNew York City, NYSacramento Co., CASan Diego, CATarrant Co., TXWashington, D.C.Several States and an ever-changing number of local jurisdictions are engaged in ongoing recruitment. 8BioSense 2.0 Data by State

May 29, 2013N=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)

Several States and an ever-changing number of local jurisdictions are engaged in ongoing recruitment. 9Updating C&AOriginally approved by CDC November 2011Needs to be updated to incorporate all changes to the BioSense 2.0 environmentNeeds 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 reviewedOpportunity for incorporating other changes to the environmentProcess for Review of New Products, Priorities and FunctionsEstablished weekly internal feature reviewRequests from all stakeholdersEstablish process for reviewing requests from BioSense governance (or others?)Newly formed PHSIPO IT governance and review process Product ReviewTechnical design and architectureData exchange and integrationSecurity/ PrivacyCost/ LicensingFunctionality (analytic capacity, data coding)

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

Evaluation ActivitiesEvaluation 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 Evaluationto 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.

BioSense 2.0 ChallengesCapacity ( internal and external)Analytic ( Big data, switch from SAS to R)Community of PracticeCoordination Multi-dimensional project with many moving parts with many intersections and interfacesTechnical, legal, policy, security, programmatic considerationsCommunicationPromoting utility to cynicsManaging expectations of advocatesOnboarding DataThis is a rate-limiting stepOperationalizing the sharing of data across jurisdictions/owners

BioSense 2.0 OpportunitiesExpand 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 facilitiesExpand coverage and representativeness of participants Expand Community of PracticeIncluding other federal partners?

Thank youFor more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.govASTHO and CDC Building BioSense 2.0June 2011 June 2012GovernanceASTHO established an interim S&L governance structureMeeting every other week since early winterEstablishing BioSense 2.0 CloudASTHO identified Amazon Web Services as the Cloud vendor of choiceWorked with BioSense redesign team to set up cloud environmentBioSense 1.0 retired April 2012BioSense 2.0 Open for BusinessS&L HDs can initiate or expand their syndromic surveillance systems under the MUse program for their own jurisdictionCSTE 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 ASTHOCDC BioSense 2.0 Funding Opportunity proposals due June 26We are working closely with the associations. The environment is being built as we speak and youll also see a demonstration of the interface that will be the primary interface for the shared space of the BioSense 2.0.

ASTHO has put together an interim governance that will be reporting into the TEP until the final governance is in place.

We are open for business in November. Any HD is welcome to join the new environment. Instructions will be underway through the associations and through our redesign website at biosenseredesign.org.

Migrating current feeds is a parallel process with the goal to retire the current infrastructure at CDC by April-May next year. For the direct reporting feeds, we are in the process of reaching out to HDs and the providers who send us this data bypassing the HD and renegotiate the agreements to ensure HDs receives this data and get their approval.

17ASTHO and CDC Building BioSense 2.0Next stepsJune 2012: Establish permanent governance structureJuly 2012: Award BioSense 2.0 cooperative agreement$7 million for up to 35 sitesDecember 2012: Demonstrate examples of data sharingOctober 2013: 32 DUAs signedJune 2014: Redesign complete

OSELS Current Priority InitiativesIncrease use of electronic health records as part of an integrated system for public health surveillanceImprove public health data access, analysis, interpretation, and communicationDevelop an efficient, sustainable and integrated network of public health laboratoriesPrepare the public health workforce to meet 21st Century challenges