BioSense: Achieving National Simultaneous Data Access
Initiated in 2003/2004, BioSense is a Centers for Disease Control and Prevention (CDC) national surveillance program designed to provide sentinel monitoring for bioterrorism and epidemic outbreaks.1 Both developed and hosted by the CDC’s National Center for Public Health Informatics (NCPHI), it is a Web-based system designed to provide near real-time coordination of health surveillance information between federal, state and local public health organizations. In the prototype system, data was provided by the Department of Defense (DoD) and Veterans Affairs (VA). It now includes data collected by local and state health departments, hospital emergency departments, national clinical laboratories, and Health Information Exchanges (HIE).
BioSense information is transferred to the CDC as HL-7 formatted messages using the CDC’s PHIN Messaging System (PHINMS)2 and is used by the CDC’s BioIntelligence Center to provide early detection of biological events, frequently referred to as ‘situational awareness.’ It is also used as a tool to either confirm or refute the existence of an event, as well as observing an intervention’s response. It attempts to minimize response time by reusing already existing healthcare and health-related data.
Once received by CDC, data is processed using a variety of algorithms to flag potential events. The results of this processing are simultaneously provided to all jurisdictions in a variety of views to allow users to isolate significant factors. The handling of this data is continuing to evolve, with CDC encouraged to move toward both an open source and an open access paradigm incorporating agile development methodologies, with particular emphasis on providing maximum transparency of the process to all stake holders.3
The BioSense program has not been without controversy. It has undergone several redesigns, with one of the more recent ones, taking place in 2007, working to apply advances in informatics to improve collaboration between local, state and federal entities. However, in many instances, state and local health personnel tend to rely on their own locally developed syndromic monitoring systems, as opposed to making use of BioSense. When queried, a diverse list of reasons were given, but a key factor appears to be CDC’s lack of inclusion of state and local personnel in the design process. This resulted in a mismatch of needs and, perhaps more importantly, lack of ownership of the final system by the potential state and local users.5
1. CDC BioSense Background: www.cdc.gov/biosense/subtopic/background/index.html
2. BioSense Technical PDF: atreja.info/papers/BioSensetechnical.pdf
3. Kass-Hout, T.A. BioSense Program: Going Forward: ISDS8 Conference. (2009)
4. GAO: Redesign of BioSense is Flawed. Health Data Management (2008)
5. Buehler, J.W. et al. Situational Uses of Syndromic Surveillance. Biosecurity and Bioterrorism 7, 165-177 (2009).
— John R. Joyce, Ph.D., VA State Consolidated LabServices Division