This integration project could be a lifesaver

A better integrated CDC could help officials address new threats to public health

If you think you face integration challenges in 2007, consider the situation at the Centers for Disease Control and Prevention in Atlanta, U.S. Better integration between its information systems could help officials address new threats to public health that range from the increasing number of antimicrobial-resistant infections in hospitals to influenza outbreaks and terrorist attacks.

In the war on disease, information technology is a mission-critical weapon. Today, however, much of the CDC's information still remains tucked away in silos.

The CDC is a sprawling agency with many different subcenters, each of which gathers information for different purposes. Few of the CDC's systems were originally designed to be interoperable, nor were the data structures designed with cross-functional integration in mind. Furthermore, much of the data the CDC relies upon comes from state and local officials who have their own systems.

The CDC's National Center for Public Health Informatics (NCPHI) has been working for four years to create a framework for consolidating its disparate systems and making them interoperable. By gathering data faster and aggregating data from various sources for better analysis, the CDC hopes its Public Health Information Network initiative can identify trends faster and enable states and health care professionals to respond more quickly.

Whereas poorly executed integration projects cost businesses money, the success or failure of the CDC's efforts will be measured in human life. For example, an early-warning system, part of the CDC's BioSense initiative, could provide critical information during an influenza pandemic. It might help health officials fight the spread of an outbreak that could take millions of lives.

The scope of the integration challenge is huge, however. The CDC has information systems that track food-borne illnesses, adverse drug interactions, hospital infections and influenza, to name just a few health concerns. Even within one area of focus, there can be a mix of disparate systems that must be pieced together to create a full picture. For example, there are seven different IT components just for flu surveillance. The CDC must assemble information from subcenters that track how many people were affected, whether they had flu shots, who had adverse reactions to flu shots and how vaccines are disseminated.

Before it can do that, however, the CDC needs to know exactly what resources are available. "There are systems I don't even know about," acknowledges NCPHI medical officer Dr. Thomas Saval. Right now, his organization is trying to get a handle on what systems are out there so it can decide whether to migrate those to newer systems or upgrade them to support current CDC standards.

While today there are more information repositories for public health than Saval can count, the good news is that the NCPHI has a plan to harmonize and consolidate them. That includes standard data vocabularies, as well as messaging, security and directory systems and other components that must be uniform for cross-functional use.

The CDC also has several national health initiatives under way and is beefing up its IT infrastructure to handle the collected data. The new systems are designed for organization-wide use and meet the agency's new standards.

For example, the Early Event Detection system, which began ramping up in 2006, receives near-real-time data feeds from some hospitals and other sources and collects a broad spectrum of data. The system is designed to spot early indicators of a public health problem. For example, in the early stages of an influenza outbreak, a sudden increase in sales of acetaminophen might alert officials to the threat even before patients start showing up at hospitals. The challenge lies in connecting hospitals, clinics and other reporting sources. To date, the system has about 350 participating hospitals, but that's a fraction of the more than 6,000 facilities in the U.S.

Other projects under way include the Vaccine Adverse Events Reporting System, the Epidemic Information Exchange and the National Electronic Disease Surveillance System. The NEDSS addresses another CDC challenge: getting states to provide data electronically in a timely and consistent fashion. State health departments can install NEDSS software, which is accessible to any health official with Internet access and a browser.

However, even if the CDC can get all of its information systems on the same page, it will need to persuade states and health care providers to participate. Ultimately, Saval says, the CDC plans to move toward a service-oriented architecture and is hoping that the states will go along. If they do, information systems in local and state health departments could be much more tightly integrated with CDC systems.

With SOA projects still in the early stages, that level of integration may not come to pass for some time at the CDC -- and it may never happen at the state and local level. But with the threat of a potentially deadly avian flu pandemic looming, any changes that ensure faster analysis and response can't come soon enough.

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