Systemic Failure and Health Catastrophe: The Final Report from the Flint Water Advisory Task Force

"The Flint water crisis is a story of government failure, intransigence, unpreparedness, delay, inaction, and environmental injustice. The Michigan Department of Environmental Quality (MDEQ) failed in its fundamental responsibility to effectively enforce drinking water regulations.

The Michigan Department of Health and Human Services (MDHHS) failed to adequately and promptly act to protect public health. Both agencies, but principally the MDEQ, stubbornly worked to discredit and dismiss others’ attempts to bring the issues of unsafe water, lead contamination, and increased cases of Legionellosis (Legionnaires’ disease) to light."

Matthew M Davis, MD, MAPP, Chris Kolb, Lawrence Reynolds, MD, Eric Rothstein, CPA, Ken Sikkema, Executive Summary Statement, Flint Water Advisory Task Force Final Report, 2016, p. 5

From the Michigan Department of Environmental Quality, to the Michigan Department of Health and Human Services and all the way to the Governor’s office, there are more than enough culpable participants in the failure to protect the health of Flint’s children. According to pediatrician Mona Hanna-Attisha, MD, who first alerted government officials of concerns for her patients, the lead-contaminated water could impact as many as 8000 children.¹

The unimaginable happened. The repercussions are still unknown. But for persons engaged in disease surveillance, public health, health informatics and policy-making, the Final Report is a "must-read" to gain understanding of how separate individual and agency failures compounded to allow a catastrophic outcome. We recommend all practitioners review the report.

1. Abby Goodnough, Flint Weighs Scope of Harm to Children Caused by Lead in Water, nytimes.com, January 29, 2016

 

Public Health - EHR Vendors Collaboration Initiative

**Update: Pre-registration is NOW REQUIRED. See details below.**

Dear Public Health Colleagues:

The Office of the National Coordinator for Health IT (ONC), in collaboration with Centers for Disease Control & Prevention (CDC) has launched a Public Health (PH)–Electronic Health Records (EHR) Vendors Collaboration Initiative. The proposed participants in this initiative will include Public Health Practitioners and EHR Vendors from across the nation. The initial focus of this initiative will be on meeting Stage 1 and 2 Meaningful Use (MU) objectives for public health.

Initially, separate virtual meetings were held with public health and an EHR vendor workgroup to help frame and plan this initiative.  Based on inputs gathered from these interactions, joint meetings of the public health practitioners and EHR vendors from across the nation will be held on a recurrent basis starting on August 20^th, 2013, to work collaboratively towards achieving the desired goals and creating value for the public health and EHR vendor communities.

If you have suggestions for topics or issues to be addressed by this initiative, please send those to meaningfuluse@cdc.gov with a Subject Line of “Suggestion for PH-EHR Vendor Initiative” by COB August 16^th.   The suggestions received will help identify common issues and areas of focus for this initiative.

WebEx information Date and Time:

Tuesday, August 20, 2013 3:00 pm, Eastern Daylight Time (New York, GMT-04:00)

Tuesday, August 20, 2013 2:00 pm, Central Daylight Time (Chicago, GMT-05:00)

Tuesday, August 20, 2013 12:00 pm, Mountain Time (Arizona, GMT-07:00)

Tuesday, August 20, 2013 12:00 pm, Pacific Daylight Time (San Francisco, GMT-07:00)

Event number: 646 100 152

Event password: open&88

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To register for the online event
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1. Go to https://ahrqhit.webex.com/ahrqhit/onstage/g.php?d=646100152&t=a&EA=cuhrig%40rti.org&ET=cafa7b000967412beb9e5f9793f0a58e&ETR=2deb918cb86a8626ce8ae6715b9ed2aa&RT=MiMxMQ==&p
2. Click "Register".
3. On the registration form, enter your information and then click "Submit".

Once the host approves your registration, you will receive a confirmation email message with instructions on how to join the event.

Agenda

• Introduction – Jim Daniel
• Overview, Scope, Goals, and Status – Jim Daniel
• New Public Health Processes in Meaningful Use Stage 2 – Denise Webb
• Open Discussion - All
• Next Steps – All

BioSense User Community: Overview and Transition

ISDS has been hosting a series of BioSense 2.0 User Community Calls throughout 2012 and 2013, the most recent of which was held on July 16. These calls provide an opportunity to discuss BioSense 2.0, ask questions, and hear responses from RTI, BioSense Governance, CDC and ASTHO. ISDS is now transitioning into a monthly BioSense User Group Meeting, the first of which will be held on Tuesday, August 20, 3:00 PM - 4:00 PM EDT (registration is now open).

The User Group Meetings will follow a similar format to prior Community Calls. At the July 16th call we received responses to technical questions (submitted during meeting registration) that covered topics ranging from accessing BioSense to best practices for on-boarding. Mike Alletto at RTI led us through the questions and responses with additional input from Yvonne Konnor (BioSense Governance Representative), Alan Davis (CDC), and Scott Gordon and Lindsay Strack from ASTHO.

Yvonne also provided us with an update from BioSense Governance, including emphasizing a continuing focus on two-way communication between users, developers, and CDC to increase sustainability and transparency.

One of our interesting open discussion questions focused on using syndromic surveillance to look at information from a specific event such as a marathon, wildfire, or sporting event. We heard some good feedback from participants in Ohio, Florida, and Rhode Island with useful tips including creating a new, unique acronym to use specifically for monitoring the intended event. Other users noted that the increasing use of dropdown menus in EHRs may negatively affect the ability to create unique acronyms since there is no space for a free text chief complaint.

If you are part of the BioSense 2.0 community and are interested in asking questions, discussing your experiences, and hearing from others, we hope you’ll join us in August!

Future 2013 Meeting Dates: August 20th, September 17th, October 15th, November 19th, December 17th

Written by: Becky Zwickl, MPH, ISDS Public Health Analyst

New Publication: Steps to a Sustainable Public Health Surveillance Enterprise

Figure 1 in 'Steps to a Sustainable Public Health
Surveillance Enterprise,' illustrates the recommended
steps to a sustainable surveillance enterprise.

More than a decade into the 21^st century, the ability to effectively forecast, detect, and respond to disease outbreaks and other events of public health significance remains a major challenge. As an issue that affects population health, economic stability, and global security, the surveillance enterprise warrants the attention of decision makers at all levels. Public health practitioners responsible for surveillance functions are best positioned to identify the key factors associated with creating and maintaining effective and sustainable surveillance systems. This paper presents the recommendations of a Sustainable Surveillance Workgroup convened by ISDS to identify strategies for building, strengthening, and maintaining surveillance systems that are equipped to adequately promote and protect the public’s health.

Mirza N, Reynolds T, Coletta M, Suda K, Soyiri I, Markle A, Leopold H, Lenert L, Samoff E, Siniscalchi A, Streichert L. Steps to a Sustainable Public Health Surveillance Enterprise. Online Journal of Public Health Informatics. 2013;5(2). doi: http://dx.doi.org/10.5210%2Fojphi.v5i2.4703.

View article.

Nominations by Nov 30: New CDC Advisory Committee

The CDC is looking for nominees for a new committee, the National Public Health Surveillance Biosurveillance Advisory Committee (NPHSB AC). ISDS would like to share the following message with more information about this committee and how to submit nominations. We encourage the ISDS community to self-nominate or nominate others for this unique opportunity to play a role in influencing the pressing public health surveillance and biosurveillance issues of today. 

-----Start Message-----

Dear  Partners:

The Centers for Disease Control and Prevention (CDC) is forming a new committee, the National Public Health Surveillance and Biosurveillance Advisory Committee (NPHSB AC) with the recent release of a Federal Register Notice (FRN) http://www.gpo.gov/fdsys/pkg/FR-2012-10-03/html/2012-24423.htm.   As the Program Office charged with supporting the formation and work of the NPHSB AC, we are seeking your recommendations for members to serve on the NPHSB AC. 

Your perspective on public health surveillance and biosurveillance is important to CDC and would greatly enhance the work of the NPHSB AC.  The overall scope of the NPHSB AC is reflected in the FRN notice.  The primary focus of the NPHSB AC will address:

• How to take advantage of the expanding automation of health information
• How to better coordinate CDC’s multiple surveillance activities and their interface with state and local partners for both routine and urgent situations

It is desired that members of the NPHSB AC be recognized experts in one or more of the six Priority Areas outlined in the National Biosurveillance Strategy for Human Health http://intranet.cdc.gov/osels/phspo/bc/bc_pdf/NBSHH.pdf

which are:

• Electronic Health Information Exchange
• Electronic laboratory Information Exchange
• Unstructured Data
• Integrated Biosurveillance Information 
• Global Diseases Detection and Collaboration
• Biosurveillance Workforce of the Future

The FRN calling for member nominations was released on November 6th.  You can view and print this FRN at the following link: http://www.gpo.gov/fdsys/pkg/FR-2012-11-06/pdf/2012-27053.pdf.  Please follow the directions in the FRN and also take the additional step of validating the interest of your nominee(s) in serving prior to submitting their CV for consideration. Nominee submissions are due by November 30, 2012.  

Thanks in advance.

Sincerely,

Pamela Diaz, MD

Designated Federal Official, NPHSB AC

Deputy Director (Acting), Public Health Surveillance and Informatics Program Office

Syndromic Surveillance Job Posting - North Carolina DHHS

There is a job opening for a Public Health Epidemiologist in the North Caroline Department of Health and Human Service's Surveillance Unit of the Communicable Disease Branch. 

This position oversees the monitoring of the near real time public health surveillance systems data and continues efforts to improve early event detection public health surveillance systems for the state of North Carolina. The primary purpose of this position is to detect bioterrorism and other events of public health significance by monitoring real-time surveillance systems data. Responsibilities include providing surveillance systems training and technical assistance. This position also serves as a consultant to the epidemiologists in the Communicable Disease Branch, local public health staff, and hospital epidemiologists with early event surveillance. The epidemiologist in this position is also responsible for contracts development and monitoring with the partners recruited to build early event detection systems.

Desired knowledge, skills and ability include working knowledge of epidemiology, in particular in the areas of public health and infectious disease, epidemiological surveillance data collection, and analysis and interpretation methods. In addition, applicants should have working knowledge of information technology systems as they apply to disease surveillance, excellent written and oral communication skills, and the ability to effectively coordinate and supervise activities of contractors. 

If interested, you are encouraged to go to the job posting to learn more about this position and how to submit your application online. You may find the job posting here: http://tinyurl.com/9eef5r5. 

Contact information for this job posting is below: 

Division of Public
Human Resources Office
Shari Emery
5605 Six Forks Road  
Raleigh, NC 27609
Phone: 919-707-5450

CDC Discusses Vision for Public Health Surveillance

The Centers for Disease Control and Prevention (CDC) released a new MMWR Supplement today, Friday, July 27, 2012, entitled "CDC's Vision for Public Health Surveillance in the 21st Century". This supplement includes several reports that were developed as by-products of the 2009 CDC/ATSDR meeting convened to assess public health surveillance in the U.S. and around the world. These deliberations drew together around 100 CDC/ATSDR scientists and managers to discuss the state of public health surveillance practice and to recommend a strategy to advance the future of public health surveillance. 


As a part of the process to assess public heath surveillance, the CDC/ATSDR leadership conducted a survey that revealed the following top six issues that must be addressed by the public health community to advance public health surveillance in the 21st century: 

• Lexicon, definitions, and conceptual framework for public health surveillance;
• Global health surveillance;
• Roles of information sciences and technological advances in public health surveillance;
• Public health surveillance work force of the future;
• Accessing and using data for public health surveillance: legal, policy, ethical, regulatory, and practical concerns related to data sharing; and
• Analytical challenges for emerging public health surveillance.

These areas of concern were discussed at the 2009 meeting by six workgroups charged with the task of describing and identifying ways to address the challenges and opportunities of each of the topic areas. The outcomes of these deliberations are captured in the reports contained in the current MMWR supplement. 

To review these reports and learn more about the CDC's Vision for Public Health Surveillance in the 21st Century, view the July 27, 2012 MMWR Supplement page or download the pdf document of the current issue. 

ASPR's 2012 Public Health Challenge

ISDS would like to encourage its community to take part in a challenge to create a web application that uses data from Twitter to automatically generate a list of trending illnesses based on location. Developed by the Office of the Assistant Secretary for Preparedness and Response, the "Now Trending Challenge" is looking for technology-minded participants from various backgrounds to step up to this challenge and opportunity to win $21,000. 

For more information about the "Now Trending Challenge" and how to participate, read the announcement below and visit the challenge website at www.nowtrendingchallenge.com.

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ASPR's 2012 Public Health Challenge: Now Trending -#Health In My Community

We’re looking for:

·                     Computer Phenoms

·                     Technology Students

·                     At-home Coders

·                     Problem Solvers

The Challenge:

At a recent Forum hosted by the Office of the Assistant Secretary for Preparedness and Response, state and local health practitioners expressed their desire to more easily access social media data. The Now Trending Challenge was created to help fill this need.

The Now Trending Challenge asks participants to create a web-based application using open-source Twitter data that will automatically deliver a list of the top-five trending illnesses from a specified geographic region in a twenty-four hour period. This data would be sent to state and local health practitioners to use in a variety of ways including building a baseline of trend data, engaging the public on trending health topics, serving as an indicator of potential health issues emerging in the population, or cross-referencing other data sources.

The winning submission will receive a grand prize of $21,000, as well as a $1000 travel stipend to attend an event announcing the winner.  In addition to the monetary prize, winners will have the chance to present their tool at a Fusion Forum and will ultimately benefit from national visibility and recognition as the tool is used by state and local health practitioners throughout the nation.

For further information, including complete rules and regulations, and to register your intent to participate, please visit www.nowtrendingchallenge.com.

Stay informed!

For frequent updates and more information follow:

Twitter: @ASPRFusion

Hashtag: #NowTrending2012

Questions to now.trendingchallenge@hhs.gov.

Virginia DOH Job Opening

	Working Title	Enhanced Surveillance Coordinator, #08910 (EP)
	Role Title The non-classified role title can be used for those job titles not listed under current classified role titles.	Prog Admin Specialist II - 19212
	Hiring Range	negotiable to $84,062
	Job Type	Full-Time
	Job Type Detail Definition	Full-Time Salaried - Non-Faculty- FTS-1
	Is this position funded in whole or in part by the American Recovery & Reinvestment Act (Stimulus Package)? Definition	No
	Agency	Dept of Health (601)
	Agency Website Replace www.yourwebsite.gov with your agency's website. This will show as a link to applicants.	Click Here for Agency Website
	Location	Richmond (City) - 760
	Sublocation
	District	VDH - Office of Epidemiology - 601 - 602
	Position Number	08910
	Job Posting Number	0054688
	Type of Recruitment Definition	General Public - G
	Pay Band Information about state pay bands	05
	Job Description	This is a readvertisement: Applications received in December 2011 remain under review so applicants need not reapply. Manages VDH's Enhanced Surveillance projects to detect and monitor emerging events and unusual diseases, especially those that might result from bioterrorist activities or constitute a public health emergency. Directs initiatives and provides epidemiologic oversight for enhanced surveillance programs statewide, including syndromic surveillance, special event surveillance, and influenza surveillance. Ensures the timeliness, accuracy and utility of existing enhanced surveillance programs, establishes policies and procedures for enhanced surveillance activities, and supervises enhanced surveillance epidemiology staff. Researches innovations to improve enhanced surveillance and prioritizes new initiatives. Implements data collection, data analysis, data management and data dissemination strategies to support surveillance. Guides the design, development, implementation, maintenance and enhancement of data systems to support epidemiology activities, including ESSENCE, EARS, and OMS. Implements procedures for the surveillance use of data from ESSENCE, EARS, and BioSense. Coordinates the transmissions, testing, acceptance and implementation of "Meaningful Use" compliant electronic data submissions of syndromic surveillance data. Develops grant applications, manages budgets and prepares progress reports. Serves as a liaison to the Offices of Emergency Preparedness and Response (EP&R) and Information Management and Health Information Technology (OIMHIT), to health care providers and to national enhanced surveillance workgroups. Serves as a Bioterrorism Response support team member.
	Minimum Qualifications	Knowledge of syndromic surveillance strategies, public health surveillance methods, principles of epidemiology, communicable diseases, and of laws, regulations, and policies on disease reporting and control. Strong skills in enhanced surveillance (including syndromic surveillance), data collection and management, statistical analysis, data interpretation and presentation, quality assurance of epidemiologic data and oral and written communication. Ability to apply epidemiologic principles; plan and implement new initiatives; train and supervise staff; manage statewide programs; conduct training; manage grant activities; develop goals and evaluate progress; develop/manage databases; analyze and interpret statistical information; use statistical software programs (e.g., SAS), spreadsheet applications (e.g., Excel), databases (e.g., Access and SQL) and presentation software (e.g., LogiXML, SAS, Excel and PowerPoint). Degree with major coursework in epidemiology, statistics or related field and/or equivalent experience and training.
	Preferred Qualifications	Advanced degree in epidemiology, statistics or related fields; and experience planning enhanced surveillance activities, performing epidemiologic emergency response activities, and working with data systems (e.g., ESSENCE and OMS) preferred.
	Special Requirements	Applicants must successfully complete a national criminal background investigation. As a Bioterrorism support team member, must be available 24 hours a day, seven days a week for emergency response. Valid Driver's license and some travel required.
	Special Instructions to Applicants	Applicants needing sponsorship need not apply. A completed application, including all previous employment, salary history, and education must be submitted on-line at www.vdh.virginia.gov for consideration. No faxed, mailed, or e-mailed applications accepted. Electronic applications will be accepted until 5:00 p.m. on the closing date. Initial review will be conducted on applications received by March 5, 2012. This is a restricted position which is solely funded by CDC Public Health Preparedness grant funds for the current budget period ending 8/9/2012. The availability of funding is scheduled for review in May 2012 and annually thereafter. Employment is contingent on the continued availability of grant or non-general funds.
	Contact Information
	Name	Pat Tucker
	Phone	804-864-8142
	Job Close Date Jobs close at 5pm EST.	Open Until Filled
	Quicklink for Posting	jobs.agencies.virginia.gov/applicants/Central?quickFind=144029

Curious about Cloud Computing?

Many public health professionals have cloud computing on their radar. Some people view cloud computing as a potential solution for public health surveillance, some view the cloud as a potential threat to health information privacy, while others are simply just curious to know more. 


In response to the growing curiosity about this new technology and its future role in public health surveillance, ISDS recently hosted a webinar entitled "Public Health Surveillance in the Internet Cloud: The BioSense 2.0 Experience" to shed some light on the topic. Presenters Jeff Barr, Amazon Web Services, and Mike Alletto, CDC BioSense 2.0 Redesign Team, introduced some basic information on cloud computing and discussed the government cloud services of the BioSense 2.0 environment.


If you missed this presentation and are curious to learn more, visit the webinar page to watch a recording of the webinar or download the presentation slides. 


You may also visit the ISDS cloud computing resource page for more useful information on the cloud and public health.