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

 

Fridays from the Archives: Understanding EMS Data Sources

Friday, November 1, 2013: Understanding EMS Data Sources

With Meaningful Use an increasingly important focus of state- and local- public health agencies, the usual suspects of data sources (i.e., hospital-based) seem to be central to most surveillance conversations. However, other data sources, such as those from EMS (Emergency Medical Services) not only offer unique insight, but may also complement streams of emergency department and hospital inpatient data.

In May of 2010 ISDS hosted a presentation, Understanding the Spectrum of Emergency Medical Services (EMS) Data Sources and their Variation by Community, that delves in deep to the specifics of EMS data flow, structure, and use.

For instance, did you know that the approaches to recording EMS calls differs widely? Some dispatch centers use an unstructured process, others use a locally developed structured process, while still others use an international standard for structured data. 

Once the information is in the system, the presenters describe a number of unique ways in which EMS data can help address the growing problem of ambulance diversions in the United States. In particular, they describe the development of a model that can aid EMS and hospitals in better managing the health of the community by predicting diversions and potentially avoiding them altogether. Additionally, presenters describe some drawbacks of EMS data, such as the obstacles in obtaining subsequent hospital outcome data and the limitations of use when the data is aggregated.

Thank you to Todd Stout, Abey Kuruvilla and Christopher Olola for an interesting and informative presentation. A video recording of the full presentation and copies of the slides are available in the ISDS Webinar Archive at: http://www.syndromic.org/component/content/article/31/250

This blog post is the second installment of the series, "Fridays from the Archives". The first post can be accessed here.

Written by Becky Zwickl, MPH, ISDS Public Health Analyst (bzwickl@syndromic.org)

*NEW* ONC Training Course on Interoperability & Public Health

The Office of the National Coordinator for Health IT (ONC) recently announced a new 6-part training course on Interoperability and Public Health. 

The course contains lessons on the following topics:

• Introduction to Interoperability and Public Health
• Ongoing Submission to Public Health Agencies
• Submission of Electronic Data to Immunization Registries
• Submission of Syndromic Surveillance Data to Public Health Agencies
• Submission of Electronic Lab Results to Public Health Agencies
• Submission of Electronic Cancer to Public Health Agencies

For more information visit the course website.

ISDS Works to Improve Inter-Jurisdictional Data Sharing

Sharing public health data and practices among public health authorities enhances local and regional situational awareness and epidemiological capacities. Although technology is a critical medium for data sharing, positive working relationships and trust must come first.

To promote inter-jurisdictional syndromic surveillance data sharing and facilitate skill development among practitioners, a *Regional Data Sharing Workshop* was developed and piloted by ISDS. A non-formal education approach, which stresses self-directed learning and peer-to-peer problem solving, was used to design and plan Workshop activities. The effect of the Workshop on data sharing and participant skills was assessed using quantitative and qualitative methods.

Thirteen surveillance professionals from seven state and local public health agencies, mainly from the U.S. Department of Health and Human Service (HHS) Region 5, planned and participated in the 2-day Workshop. The participants selected data sharing for heat-related illness surveillance using BioSense 2.0 as a use case to focus Workshop activities and discussions.

Assessment findings indicated that Workshop participation increased syndromic surveillance data sharing among Region 5 jurisdictions and, furthermore, built new knowledge and skills that advanced surveillance competencies and performance. Survey data showed that 13 new data sharing partnerships are underway or planned as a result of the Workshop. Comparisons of participant responses on a syndromic surveillance skills inventory before and after workshop participation indicated positive gains in skills for:

• Data processing;
• Data analysis and interpretation;
• Communicating syndromic surveillance information;
• Data quality assurance; and
• Establishing data sharing partnerships.

The Regional Data Sharing Workshop is an effective and efficient means for promoting syndromic surveillance data sharing and skill development. With the opportunity to collaborate and discuss data sharing in-person for a specific, regionally relevant purpose, participants strengthened inter-jurisdictional relationships, leading to more data sharing and improved skills that benefit syndromic surveillance work. These results present a strong case for repeating similar workshops in other HHS regions in order to build regional data sharing and to improve public health practice nationwide.

Discover IMED 2013 - Vienna, Austria

ISDS would like to share with its surveillance community an exciting opportunity for learning, collaborating, and sharing work for those working in the field of infectious disease.

What: The International Meeting on Emerging Diseases and Surveillance (IMED) 2013 will convene leading scientists, clinicians and policy makers in Vienna, Austria in February of 2013 to present new knowledge and breakthroughs and discuss how to discover, detect, understand, prevent and respond to outbreaks of emerging pathogens. Organized by the International Society for Infectious Diseases (ISID), this meeting has become a fixture for those whose work deals with threats from infectious agents.

IMED draws together human and veterinary health specialists and serves as a true One Health forum where those working in diverse specialties and regions can meet, discuss, present and challenge one another with findings and new ideas. Relevant and compelling topics such as social media and data mining, novel laboratory methods, rapid point-of-care diagnostics, public health, risk communication and political and societal responses to outbreaks will all be featured at IMED 2013.

Who: The target audience of IMED 2013 is ProMED-mail subscribers, physicians, veterinarians and other health care workers, public health leaders, pharmaceutical and biotechnology industry, journalists and other interested persons.

When: February 15 - 18, 2013

Where: Hilton Hotel, Vienna, Austria

Important Date:

• December 1, 2012 - Abstract Submission Deadline

Learn more: Visit the IMED 2013 website for more information and meeting updates.

BioSense 2.0 FOA - Update!

The Centers for Disease Control and Prevention announced important amendments to the BioSense 2.0 funding opportunity, "BioSense 2.0: Building State, Local, Tribal, and Territorial Surveillance Capacity to Enhance Regional and National All-Hazards Public Health Situation Awareness"on June 14, 2012. Thanks to newly available funds, the funding capacity of the FOA has increased. Please find a detailed description of the changes below.


The amendment involved three main issues: 
1. Increased funding - approximate current fiscal year funding: $7,000,000
2. Increased number of grantees - approximate number of awards: up to 35
3. Changed anticipated award date - September 1, 2012


These changes have not had any effect on the application deadline date which remains June 26, 2012 at 5:00 PM EDT. 


Learn more about this funding opportunity by downloading the updated appellation package found here: http://apply07.grants.gov/apply/opportunities/packages/oppCDC-RFA-OE12-1202-cfda93.283-cidOSELS-NR.pdf

The instructions for applying for this grant opportunity have also changed.  You can download the new instructions here: http://apply07.grants.gov/apply/opportunities/instructions/oppCDC-RFA-OE12-1202-cfda93.283-cidOSELS-NR-instructions.doc

2012 ISDS Conference Highlight: Abstract Submission

2012 ISDS Conference

Expanding Collaborations to Chart a New Course in

Public Health Surveillance

Sheraton San Diego Hotel and Marina

1380 Harbor Island Drive | San Diego, California 92101

The ISDS Annual Conference is the premier event dedicated to the advancement of the science and practice of biosurveillance. This year’s theme, Expanding Collaborations to Chart a New Course in Public Health Surveillance, will highlight the importance of working together across agencies, sectors, and disciplines to improve surveillance methods and population health outcomes. The conference will be held at the Sheraton San Diego Hotel and Marina in San Diego, CA, December 4-5, 2012, with Pre-Conference Workshops on December 3rd.

 

Submission Types

Traditionally, the ISDS Conference has accepted abstracts for two types of presentations: oral and poster. This year, ISDS is introducing three new presentation types:

1.     Panel *New for 2012*

2.     Roundtable *New for 2012*

3.     System Showcase Demonstrations *New for 2012*

 

Track Descriptions

I.        Analytical Method

a.       Analytical Methods: Applied

b.      Analytical Methods: Research & Development

This theme is focused on important and novel advances in the field of surveillance methodologies and analytical approaches. Abstracts in the Applied sub-track should describe methods or processes routinely used in a production-type environment. Abstracts in the Research and Development sub-track should describe methods and processes still under development or tested within a research or pilot setting.

II.     Informatics

a.       Informatics: Applied

b.      Informatics: Research & Development

Abstracts in the Applied sub-track should describe methods or processes routinely used in a production-type environment. Abstracts in the Research and Development sub-track should describe methods and processes still under development or tested within a research or pilot setting.

III.  Policy (at local, state, federal, international levels)

This theme is focused on sharing successes, challenges or approaches leveraged in the use or development of policy that affects biosurveillance operations and activities.

IV.  Public/Population health surveillance

a.      Public/Population Health Surveillance: Practice

b.      Public/Population Health Surveillance: Research

c.      Public/Population Health Surveillance: Evaluation

This theme is focused on improving the daily processes of timely public/population health surveillance, including detection, signal validation, event characterization, investigation, and response. Abstracts in the Practice sub-track should describe practices routinely used in a production environment and/or deployed in field by public health departments or other agencies. Abstracts in the Research sub-track should describe research related to surveillance, health systems, etc. Abstracts in the Evaluation sub-track should describe evaluations of public/population health surveillance systems, workflows, protocols, etc.

For more information about the changes and to submit an abstract visit http://www.syndromic.org/abstract-submission/2012. The abstract submission deadline is September 6, 2012.

2012 Conference Registration is also OPEN. For more information and to register: http://www.syndromic.org/annual-conference/2012/registration.

*Use #2012ISDSC in all conference-related tweets!

A Message from the BioSense Redesign Team

The following is a message from the BioSense Redesign team with a March update on the Redesign Project.

It’s Time to Retire, On-Board, and Award!

They say time flies when you’re having fun… well, it’s been four months since BioSense 2.0 opened for business! And as of Friday, March 30^th, we will retire BioSense 1.0. This milestone is the direct result of collaborative efforts between our stakeholders and the Redesign Team.  Your feedback and ongoing involvement with the redesign have made twenty first century surveillance a reality. And, if you haven’t already, please take a moment to register for access to BioSense 2.0.  There are two ways to establish a BioSense 2.0 account. Please visit the Community Forum to learn how you can gain access to the new environment.

For additional information or assistance with on-boarding, please take a moment to view our technical assistance (TA) resources in the “on-boarding information” section of the Library. Current TA resources provide pertinent recruitment and on-boarding information for BioSense 2.0. We anticipate the TA focus will shift once we move out of the recruitment phase and include sharing promising and best practices for using the BioSense 2.0 application for enhanced public health surveillance. 

Finally, in the next few weeks, the Redesign Team will announce the recipients of the BioSense 2.0 Challenge Grants. A total of 14 letters of intent were received and 12 organizations were invited to apply. The applications are currently under review and award decisions will be announced no later than March 30, 2012. The BioSense 2.0 Challenge Grant Opportunity was created to help sites and public health jurisdictions address challenges and overcome barriers to establishing or enhancing syndromic surveillance capabilities within the BioSense 2.0 community.  As part of CDC’s ongoing commitment to innovation and creativity, we are working to identify new funding opportunities for the public health community.  So stayed tuned for upcoming submission guidelines!

Have questions about BioSense 2.0 or on-boarding?  View our new FAQs or simply visit the BioSense Redesign Collaboration Site where you can read our most recent community forum posts or e-mail info@biosen.se.

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. 

Now Available: Introduction to the National Emergency Medical Services Information System (NEMSIS) Webinar Recording and Slides

If you missed the January 31st webinar entitled "Introduction to the National Emergency Medical Services Information System (NEMSIS) and Its Potential Uses in Syndromic Surveillance", you may now download a pdf of the presentation slides or view a recording of the webinar below. You may also visit the webinar page in the ISDS webinar archives to learn more about the presenters and the information that was discussed.

ISDS would like to thank the presenters Dr. Clay Mann, Gamunu Wijetunge, and Bernice Boursiquot for their wonderful and informative presentation. If you would like to learn more about NEMSIS, create your own customizable report of EMS data, or get updated on the latest NEMSIS news visit www.NEMSIS.org.

ISDS Member Publication

ISDS member, Dr. Scott McNabb, and ISDS Board member, Dr. John Brownstein, were among the contributing authors of the article "Infectious disease surveillance and modelling across geographic frontiers and scientific specialties" that was recently published in the The Lancet Infectious Diseases. This article discusses the sharing of epidemic intelligence across global frontiers using new technologies and modelling that crosses scientific specialties for improved infectious disease surveillance for mass gatherings.

Read a summary of this article below and the full text in The Lancet to learn more.

Infectious disease surveillance and modelling across geographic frontiers and scientific specialties

Dr Kamran Khan MD a b n , Scott JN McNabb PhD c, Prof Ziad A Memish MD d e n, Rose Eckhardt MA b, Wei Hu BSc b, David Kossowsky BA b, Jennifer Sears BSc b, Julien Arino PhD f, Anders Johansson PhD g h, Maurizio Barbeschi PhD i n, Brian McCloskey MDj n, Bonnie Henry MD k n, Martin Cetron MD l, John S Brownstein PhD m n

Summary: 

Infectious disease surveillance for mass gatherings (MGs) can be directed locally and globally; however, epidemic intelligence from these two levels is not well integrated. Modelling activities related to MGs have historically focused on crowd behaviours around MG focal points and their relation to the safety of attendees. The integration of developments in internet-based global infectious disease surveillance, transportation modelling of populations travelling to and from MGs, mobile phone technology for surveillance during MGs, metapopulation epidemic modelling, and crowd behaviour modelling is important for progress in MG health. Integration of surveillance across geographic frontiers and modelling across scientific specialties could produce the first real-time risk monitoring and assessment platform that could strengthen awareness of global infectious disease threats before, during, and immediately after MGs. An integrated platform of this kind could help identify infectious disease threats of international concern at the earliest stages possible; provide insights into which diseases are most likely to spread into the MG; help with anticipatory surveillance at the MG; enable mathematical modelling to predict the spread of infectious diseases to and from MGs; simulate the effect of public health interventions aimed at different local and global levels; serve as a foundation for scientific research and innovation in MG health; and strengthen engagement between the scientific community and stakeholders at local, national, and global levels.
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As member service, ISDS likes to share information about its members with the ISDS community. ISDS staff depends on the help of others to notify us of member news. If you are an ISDS member and would like ISDS to share something, please send the information to Amanda at aschulte@syndromic.org.

Published Joint Statistical Meetings Proceedings Papers

View two recently published 2011 JSM Proceedings papers about the Distribute project. 

Analytic Evaluation of a Standardization Effort for the DISTRIBUTE Emergency Department Surveillance Project

• Howard Burkom, Donald Olson, Atar Baer, Marc Paladini, Debra Revere, Anne McIntyre

Generation of Prediction Intervals to Assess Data Quality in the Distribute System Using Quantile Regression

• Ian Painter, Julie Eaton, Don Olson, Debra Revere, Bill Lober