Outbreak Management Interoperability Working Group Webinar

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Outbreak Management Interoperability
Working Group Webinar

Presented June 17, 2009


Jeanne Tropper, MS, MPH
jwu0@cdc.gov
,

David Nitschke, PMP,
den4@cdc.gov
,

Gerald Jones
, gfj0@cdc.gov

Ulrica Andujar, MPH, CHES,
gte0@cdc.gov
, CDC contractor

Marty Cicchinelli, MS, PMP,
mlc7@cdc.gov

CDC contractor


National Center for Public Health Informatics



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Agenda


Background and Purpose


PHIN Conference Outbreak Management Interoperability (OMI)
Workshop Summary


Interoperability Progress on OMI Component Applications: Epi
InfoTM, OMS and CRA



Interoperability Progress on OMI Component Applications: Epi
InfoTM, OMS and CRA


Implications of H1N1 on OMI


Open Discussion


Next Steps

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What is OMI?


Original concept
:


desk top, interoperable tool set to better support the public health
(PH) practitioner during outbreaks


“Microsoft Office” concept for PH
initially
focused on CDC’s Epi
Info™ (EI), Outbreak Management System (OMS), and
Countermeasure and Response Administration (CRA) applications


Drivers
:


feedback from multiple venues including CSTE, PHIN Conference,
component system work groups


multiple disparate systems (including manual), siloed development
and use, lack of standard vocabulary and practice making data
sharing difficult, and so on


COTPER funded project for FY2009


2010 to
further define, scope, prototype and position for next
generation OMI

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Purpose of OMI Working Group


Bring together subject matter and technical experts
at the national, state and local level to:


Develop Vision and Scope for OMI Project


Determine priorities for OMI features


Gather requirements for OMI features for prototype; practical application in
the field


Workgroup first initiated at 2008 PHIN Conference;
most work since then has been at the component
application level


This meeting marks the re
-
initiation with initial focus
on


Updating progress at the component application level: Epi Info™, OMS,
and CRA


Reviewing previously requested OMI features to determine if they are still
appropriate


Considering the implications of H1N1 on initial approach


Determining next steps


meeting schedule, priorities, other

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OMI Activities to Date


June 2008



CSTE Conference Workshop: conducted OM
business processes requirements gathering and discussion


August 2008



PHIN Conference OMS, CRA and Epi Info
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Workgroup: collected first requirements for OM Interoperability
(OMI)


September 2008



NCPHI All
-
hands: established of OM
Program as part of reorganization


September 2008


present
: work on component applications;
internal discussions on OMI


February 2009



COTPER funding notice: OMI project
approval and ceiling


April


May 2009

-

H1N1 Outbreak: implications to OMI?


June 2009



Board of Scientific Counselors (BSC) presentation:
possible OMI strategy; re
-
initiation of OMI workgroup

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Summary of PHIN Conference OMI
Workgroup


Used 2005/2006 mumps scenario to illustrate use of
OMS, Epi Info
TM

and CRA in an outbreak


Illustrated how each application could be used in a fictional
progressive outbreak scenario


Distinguished how each system relates to one another and
their logical connectivity


Solicited partner input on future interoperability: short,
medium and long term


Demonstrated components of each application used
in a progressive outbreak


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CRA 1.9



Web
-
based with SOA



Highly scalable; supports multiple
users, clinics, sub
-
jurisdictions,
jurisdictions


HL7 messaging to IIS


Rapid data entry for mass tracking of
countermeasures


Regional & National Aggregate
reporting to CDC


CDC OM Program


Component Applications

Epi Info
TM

3.5.1


Forms generation with
standard vocabulary


Custom Data Entry


Entry Validation


Epi Map
TM

GIS


Analysis Visualization &
Reporting



Import and Export Tools


Stand
-
alone application



OMS 1.3


Entity Management


Forms Development Tools


Workload Management


Shareable vocabulary/question
set library


Integration with Epi Info
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AVR or SAS


Data synchronization


Version control


Import and Export tools


New HL7 messaging features


Stand
-
alone, Client Server, and
Citrix
-
enabled

OMI

New project

funded by

COTPER

2009
-
2010



OMS 1.3


Entity Management


Forms Development Tools


Workload Management


Shareable vocabulary/question
set library


Integration with Epi Info
TM

AVR or SAS


Data synchronization


Version control


Import and Export tools


New HL7 messaging features


Stand
-
alone, Client Server, and
Citrix
-
enabled

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2008 PHIN Conference


Use of OM Component
Applications in Progressive Outbreak

Month 5: linked to UK strain


vaccination campaign continuing

Month 4: additional persons with clinically compatible symptoms
investigated in three neighboring states; only 16% of total
cases were linked epidemiologically suggesting frequent
unapparent transmission


vaccination campaigns begin


Month 3: active surveillance initiated in seven geographical
areas, including three largest universities

Month 2: isolate from an unrelated patient cultured; identified
as mumps: multiple regions affected

Month 1: first reports of mumps
-
like illness at a university in a
Mid Western state

CRA


OMS

Epi
Info™

Outbreak Scenario

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2008 PHIN Conference Workgroup


OMI
Recommendations


Immediately useful to get questionnaires and data
from Epi Info
TM

to OMS and CRA



Eliminate duplicate data entry among

Epi Info
TM
, CRA, OMS, NBS, and IIS



Capture aggregate data in OMS



Use messaging and interoperability among systems



One system


“a one stop shop”


to do everything



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2008 PHIN Conference Workgroup


OMI Recommendations,
continued


Need to get OMS case data to surveillance systems
for transfer to CDC and state registries


Need a definition or standard for a minimum data set
for each disease entered


Need open platform coding


Need an application to take into the field unplugged,
plug it back in and synchronize the data


Need for a version of Epi Info
TM

to be deployed to a
PDA


Need to understand the entire process with pieces
talking to each other

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Epi Info™ Current Usage


Number of users unknown


estimated in the
hundreds of thousands


Used by 45+ states and their county health departments


Used by CDC CIOs for research projects; to create
applications for Global Health, Global Immunizations,
Division of Nutrition and Physical Activity, Influenza Division


Heavily relied upon by international public health
organizations such as WHO (World Health
Organization) and PAHO (Pan
-
American Health
Organization), especially for uses in Africa and South
America


Used by several countries as the foundation for their
national monitoring and evaluation systems
(including Egypt and El Salvador)

12/4/2013

11



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Epi Info™ Current Status


Current Version in production is 3.5.1


Epi Info
TM

Version 7 written with C#.Net
-

supports Access, SQL sever, and MySQL; in
pre
-
beta development at


http://www.codeplex.com/epiinfo



Meetings of the stakeholder, user, and
partner groups to be conducted:


Get input on future direction of EI


Facilitate open source development (NCPHI Open
Source Framework)

12/4/2013

12

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Epi Info™ Interoperability Features


Stand alone analysis feature


used by OMS, CRA,
other applications


Import / export in multiple formats


Prototyping underway on “light weight”
synchronization platform (Mesh4x) to:


Share data among different sources regardless of platform
or connectivity


Transmit data and maps over internet cloud or SMS
channels


Connect with fellow investigators’ data while in the field in
remote locations


Synchronize with SMS if internet connectivity unreliable or
intermittent

12/4/2013

13

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Mesh 4X The Prototype: Architecture

Edgeware, non
-
secure, lower
volume usage

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Generate Google Earth Map in

Epi Info
TM

Mesh4X Tool


In order to gain a perspective of the cases, the user can create a KML
file to display in Google Earth (map layers); to create the KML file, the
user launches the Epi Info™ Mesh4x tool and generates a local map
as follows:


Click the “Map Exchange” tab


Specify the data source (EpiInfo.mdb) and the outbreak data table


Click the “Create Map” button and this will generate the KML file



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Generate Google Earth Map,
continued


It takes about 30 seconds to make the KML file. To show the map,
open the Google Earth file generated by the Epi Info™ Mesh4x tool.


The resulting map below shows an example with 28 cases:


12 patients reported with illness (
Red pins
) between April 18
th

and 19
th


16 interviewers did not show any illness (
Yellow pins
)


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OMS Current Usage


Thirteen jurisdictions have received OMS Version 1.3


Two international partners have received OMS Version 1.3


One jurisdiction has requested to be an initial tester
for OMS Messaging


CDC’s NCEH has used OMS for a radiological
exercise


25 requests from state health departments /
jurisdictions for use of Version 1.2

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OMS 1.3 Current Status


Version 1.3 completes base system


Wizard
-
based setup and configuration


Developed OMS
-
HL7 Messaging sub
-
system


Messaging beta
-
testing in place at state level


Requested by states for use with H1N1



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OMS Interoperability Features


Conforms to PHIN Outbreak General Message
specifications.


OMS can send data to any 3
rd

party system capable
of consuming HL7 outbreak message.


In discussions with NEDSS Base System to be first
consumer of this message


OMS allows for data import (Excel format)


OMS allows for data export (variety of formats)


Data analysis: OMS data can be analyzed by Epi
Info
TM
, SAS, SPSS, Social Network or GIS Software

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OMS


HL7 Messaging


Conforms to PHIN Outbreak General Message
specifications.


Allows OMS to send data to any 3rd party system
capable of consuming HL7 outbreak message.


Developed OMS
-
HL7 Messaging sub
-
system


OMS
-
OMS Messaging


OMS
-
NEDSS Messaging


OMS
-
3rd Party Messaging


In discussions with NEDSS Base System to be first
consumer of this message.

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OMS


HL7 Messaging

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Messaging Queue Management

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CRA Current Usage


Used in vaccine doses administered exercises by
the 62 PHEP Grantees using seasonal influenza as
a proxy for pandemic influenza vaccine tracking via


Option 1


Data Exchange


Option 2


Web Based Aggregate



Option 3


Web Based Patient Detail


Used in state and local health department
emergency preparedness exercises for
countermeasure tracking


Used to support NCIRD, DGMQ, and NCEH efforts
for emergency preparedness activities for
countermeasure reporting and/or tracking of
pharmaceutical and non
-
pharmaceutical
interventions

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CRA Current Status


Version 1.8.2 in production




Version 1.9 in development to be released mid July


Complete support for data exchange with state IIS


Synchronization of data using Web Services


AVR capability utilizing Google Earth and Google Map
technologies

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CRA Visualization Capabilities


Uses Google
Maps/Google
Earth


Google Maps
Embedded
within CRA
(shown)


Generates KML
files with CRA
data for display
by Google Earth


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CRA Interoperability Features


HL7 Data Exchange with state IIS


Full support for Implementation Guide for Immunization


Data Transactions using version 2.3.1


Allows for bi
-
directional data exchange


Synchronization of data between CRA and state IIS


Supports both PHIN MS and web
-
based file upload


Aggregate Data Exchange


Supports Multiple Data Formats


Flat file (pipe
-
delimited) OR


Extensible Markup Language (XML) file OR


Health Level Seven (HL7) Version 2.5


Supports both PHIN MS and web
-
based file upload


Import/Export


CRA data can be analyzed using Epi Info
TM



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CRA Current Architecture

Laptops
State
CRA
County
CRA
CDC
CRA
CRA at
Points
-
of
-
Dispensing
State
IIS
sync
HL
7
Data
Exchange
Synchronization
using Web
Services
sync
sync
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Recommendations from 2008 PHIN Conference




Request



Progress



Application to take into the field unplugged, plug it

back in and synchronize the data.



Complete




OMS, CRA



Prototyped




Epi Info



Eliminate duplicate data entry among Epi Info, CRA,

OMS, NBS, and IIS.



Partial






Import/Export





Use messa

ging and interoperability among systems.



Partial






CRA to IIS; OMS to

NBS



Open platform coding.



Partial




Epi Info



Get questionnaires and data from Epi Info to OMS

and CRA.



Partial






Import/Export



Get OMS case data to surveillance systems for

transfer

to CDC and state registries.



Partial



Need for version of Epi Info

TM


to deploy to a PDA.



None



Definition or standard for a minimum data set for

each disease entered.



None



One system




a one stop shop




to do everything



None



Capture aggregate data in OM

S



None













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Epi Info
TM
, OMS, and CRA address
H1N1


Epi Info
TM


Hospitalized patients questionnaire


DGMQ cruise ship outbreak survey


OMS


Requested by states for use in outbreaks


CRA


Planned to support tracking vaccine doses
administered in fall 2009 during federal campaign


Requested by a number of states to be used for
antiviral tracking

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How do we best address OMI both
short term and long term?


Community of Practice (CoP)?


Demonstrations and trainings using what we have?


Messaging between applications?


Forms repository?


Composite application?


Grid
-
enabled application?


COTS application?

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Summary
-

OM Interoperability

Short Term

Today


Segregated use
with limited
interoperability


Import and export
features for data
sharing;


Limited
messaging
capability


Some shared
analysis tools


Some forms
development tools


All on different
Platforms


Some SOA
features


CRA ability to
send data to CDC


Deconstruct best
components from
each existing
application


Build web
-
enabled
composite
application
prototype (SOA)
with forms
service, GIS,
countermeasure
and response
administration
and linkage to
NBS for case
reporting


Use standard
vocabulary


Use same suite of
analysis tools


Joint training and
implementation

Mid Term

Long Term


Interoperable
platform that
becomes “best of
breed”, accessed
via Web or Grid
with open source
components


Data able to
remain locally but
accessed by CDC


Used by CDC and
field


Data shared freely
across state, local,
and regional
boundaries


Segregated use
with limited
interoperability


Import and export
features for data
sharing;


Limited
messaging
capability


Some shared
analysis tools


Some forms
development tools


All on different
Platforms


Some SOA
features


CRA ability to
send data to CDC


Deconstruct best
components from
each existing
application


Build web
-
enabled
composite
application
prototype (SOA)
with forms
service, GIS,
countermeasure
and response
administration
and linkage to
NBS for case
reporting


Use standard
vocabulary


Use same suite of
analysis tools


Joint training and
implementation


Segregated use
with limited
interoperability


Import and export
features for data
sharing;


Limited
messaging
capability


Some shared
analysis tools


Some forms
development tools


All on different
Platforms


Some SOA
features


CRA ability to
send data to CDC


Deconstruct best
components from
each existing
application


Build web
-
enabled
composite
application
prototype (SOA)
with forms
service, GIS,
countermeasure
and response
administration
and linkage to
NBS for case
reporting


Use standard
vocabulary


Use same suite of
analysis tools


Joint training and
implementation


CDC/field testing
and implementation
of SOA modular
composite
application


Allow messaging or
upload options for
partners not using
CDC application


Forms development,
contact tracing,
analysis tools, GIS,
countermeasure and
response
administration, case
reporting services


Data sharing
agreements in place
with all Project
Areas

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Possible Next Steps


Determine best frequency and dates for continued Workgroup
Meetings


Start OM Community of Practice


Collect new feature priorities


Rank new feature priorities


Develop draft Vision and Scope based on feature priorities


Gather new detailed requirements


Develop interface prototype


Demonstrate interface prototype


Develop application horizontal prototypes

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Questions?