Change in Plans
Because BioSense failed to catch on (only 441 of the nation’s more than 5,600 hospitals are currently participating), its effectiveness as a nationwide flu-detection system was limited. But instead of giving up on BioSense, the CDC has adopted a new approach to make the system work.

After investing an estimated $100 million on hospital recruitment and technology for BioSense in 2005 and 2006, the CDC decided last year to work with state and local public health care systems, rather than competing with them. The agency will continue to use BioSense in its limited geographic form, while simultaneously pursuing other initiatives to gather early pandemic data.

The new approach is designed to foster a cooperative, information-sharing initiative with state health departments. “We want to get surveillance without the states having to move their data into a national repository,” the CDC’s Dr. Lenert explains. The states that participate in the new initiative would keep their patients’ data, but would share the aggregate analysis.

“We would like to find a way to federate existing state databases so that we can share the analysis of that data,” he adds. “But it involves more than just sharing the results: We have to be able to look across state borders to recognize patterns.” 

To that end, the CDC has begun enlisting state health departments to send their data into BioSense to try to create this national system. To seed the growth of this new initiative, the CDC will soon begin providing grants to state and regional health care agencies to develop systems that accomplish these goals of patient data sharing and pattern analysis. Dr. Lenert notes that Indiana and North Carolina have already agreed to participate, adding, “They are forwarding to us anonymized individual-level case data.”

The jury is still out on precisely what the new initiative will look like and how it will work, according to Dr. Lenert. “We are piloting different strategies for this in order to fund the best approach,” he says. “We will provide five years of grants, with $8.5 million in funding to start for this year. We know we can’t do the whole country at one time.”

Simultaneously, the CDC is focusing efforts on a variety of different systems that could be deployed when an early outbreak of a flu pandemic was identified. For example, the federal agency enlisted CIBER, a systems integrator, to build an alerting system to electronically notify state and regional public health care officials and agencies when and where an outbreak is taking place. Previously, the CDC had to contact state health officials by e-mail or telephone.

The CDC Alerting Service (CDCAS) is part of the agency’s four-year effort to develop the Public Health Information Network (PHIN), a set of functional and technical standards that lay out minimum IT capabilities and interoperability requirements for local and state health agencies.

“Working with CIBER, we’ve developed both an alerting service and a directory service on which we can build all our programs and specific applications in order to get all the benefits of a service-oriented architecture,” says Robb Chapman, the CDC IT program director who oversees the CIBER implementation. “This was all spawned by the events of 2001. A lot of people point to 9/11, but even more than that, it was the anthrax scare—along with concerns about things like bird flu—that made it clear we needed to improve the way public health agencies work together.”

Officials from five states helped craft CDCAS’ cascade reporting protocol, so the CDC can use the PHIN to rapidly alert officials across jurisdictional boundaries without stepping on political toes, according to Richard Draut, account manager for CIBER’s federal health practice.

The PHIN system is currently running in Michigan and Indiana, and public health agencies in New York and Minnesota are in the latter stages of adoption, according to Chapman. CDC officials expect to have the majority of states on board within two years, he says.