Lab Matters Winter 2017 | Page 20


An Informatics Response to a Public Health Emergency

by Melanie Kourbage , PhD , MA , APHL consultant ; Gretl Glick , MPH , APHL consultant ; and Laura Carlton , MPH , senior specialist , Informatics

Public health informatics is an important , if often unacknowledged component of emergency outbreak response . Through the use of integrated information management systems and standardized electronic data exchange , informaticians assure that epidemiologists have high quality , relevant data to review in a timely fashion and in a usable format . The US Centers for Disease Control and Prevention ( CDC )’ s rapid response to the emerging Zika threat in 2016 provides a relevant example of a highly coordinated public health response . Working together , APHL , CDC and the Council of State and Territorial Epidemiologists ( CSTE ) were able to quickly develop and implement enhanced electronic messaging from key public health agencies ( PHAs ) to CDC ’ s Arboviral Diseases Branch .

The ability to send case notifications from their integrated surveillance system reduces duplicate data entry , allowing those resources to be used for surveillance and response .
Working Together on the Ground …
Data collection and analysis of potential Zika cases began as soon as the first case was discovered in Puerto Rico in late December 2015 , concurrently with the more well-publicized public health outbreak response . Subject matter experts ( SMEs ) from all three agencies worked together to develop and test a message mapping guide ( MMG ) for arboviral diseases , with teams including experts in system integration , vocabulary and messaging , epidemiology and project management , as well as stakeholders from state and local PHAs . Further development updates were made to the Message Quality Framework ( MQF ), the system used to validate messages prepared by PHAs , and to prepare CDC systems to receive , process , and provision the arboviral messages . Select PHAs piloted the Arboviral v1.3 MMG , participated in end-to-end testing and completed onboarding activities to move into production by the end of
2016 . The ability to send case notifications from their integrated surveillance system reduces duplicate data entry , allowing those resources to be used for surveillance and response .
… And In the Cloud
APHL SMEs and the CDC NEDSS Base System team provided expertise through every development stage of the updated Arboviral v1.3 MMG , and extensive technical assistance ( TA ) to help PHAs implement HL7 messaging . The APHL TA team worked with New York and Florida as pilot states — both remotely and on site — to expedite the implementation process . APHL terminologists helped PHAs accurately map the Arboviral v1.3 MMG to state surveillance system data and update their systems to generate a valid arboviral HL7 message .
Additionally , APHL technical architects helped guide PHAs through transport set up , validation , user acceptance testing and onboarding activities . For PHAs with limited resources that were trying to simultaneously coordinate an outbreak response and execute a highly complex implementation project , this extra support was essential to implementing the updated Arboviral v1.3 MMG in an expedited and timely fashion . The CDC NEDSS Base System team provided similar support to states using NEDSS Base Systems , including Tennessee and Texas . As of December 2016 , four PHAs ( New York , Florida , Tennessee and Texas ) are in production and submitting Arboviral v1.3 HL7 case notifications , with all state PHAs to be sending case notifications by summer 2017 .
The aggressive timeline is only possible because APHL , CDC and CSTE have been actively working to modernize the National Notifiable Diseases Surveillance System ( NNDSS ) as part of the NNDSS Modernization Initiative ( NMI ). The ultimate goal of NMI is to replace the National Electronic Telecommunications Surveillance System and associated reporting systems with a single data feed of HL7 2.5.1 case notification messages from PHAs to CDC . These messages will provide meaningful , more timely information to CDC to support critical decisions about threats to the nation ’ s public health .
Arboviral MMG Development in 2016
Despite the redirection of NMI resources to arboviral messaging , the NMI team is implementing HL7 case notification messages for other diseases and was able to onboard the first two pilot agencies , Michigan and Oregon , with Generic v2.0 and Hepatitis case notifications by January 2017 . Moreover , CDC opened onboarding for Generic v2.0 and Hepatitis to all PHAs beginning in mid-January 2017 . The finalized MMGs , as well as the NMI Implementation and Technical Assistance Guidebook are available through the NMI Technical Assistance and Training Resource Center at https :// www . cdc . gov / nmi / ta-trc / index . html . Interested PHAs can also request technical assistance by emailing edx @ cdc . gov .
LAB MATTERS Winter 2017
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