Epi Info™, OMS, and CRA Interoperability

PHIN Conference Workgroup MeetingWednesday, August 27, 2008

Joint Presentation byJeanne Tropper, MS, MPH (CRA)

Amy Thompson, Trainer (Epi Info™)William Duck, MS, MPH (OMS)

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Overarching Objective

Build awareness, appreciation and understanding of how Epi Info™, OMS and

CRA can collectively support common work practices during public health response

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Learning Objectives

Present brief synopsis of the following systems: Epi Info™, Outbreak Management System (OMS) and Countermeasure and Response Administration (CRA)

Illustrate how each application would be used in a fictional progressive outbreak scenario

Distinguish how each system relates to one another and their logical connectivity

Solicit partner input on future interoperability: short, medium and long term

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2005/2006 Iowa Outbreak Scenario

December 2005: first reports to the Iowa Department of Public Health (IDPH) of mumps-like illness at a university in eastern Iowa

January 2006: isolate from an unrelated patient was cultured and identified as mumps indicating multiple regions affected

February 2006: active surveillance initiated in seven geographical areas, including campuses of the three largest universities in Iowa

March 2006: additional persons with clinically compatible symptoms were being investigated in three neighboring states (Illinois, Minnesota, Nebraska); only 16% of total cases were linked epidemiologically suggesting frequent unapparent transmission

April 2006: Source unknown but mumps strain (genotype G) same as 2005 UK epidemic

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When Would Each System be Used?

Outbreak Scenario Epi Info™

OMS CRA

Month 1: first reports of mumps-like illness at a university in Mid Western state

Month 2: isolate from an unrelated patient cultured; identified as mumps: multiple regions affected

Month 3: active surveillance initiated in seven geographical areas, including three largest universities

Month 4: additional persons with clinically compatible symptoms investigated in three neighboring states; only 16% of total cases were linked epidemiologically suggesting frequent unapparent transmission

Month 5: linked to UK strain

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Scenario Roles

Medical staff at student health center identify multiple mumps-like symptoms in college students; report to local county public health– Public health nurse develops initial questionnaire using Epi Info™ to begin

tracking students Index mumps case is identified; laboratory confirmed cases show

multiple regions affected– Public health nurse refines Epi Info™ questionnaire to focus on mumps– Epi Info™ analysis tools shows multiple regions affected

Disease investigation specialist at regional level initiates coordinated six county field investigation – OMS activated to manage complex relationships among persons,

organizations and events (contact tracing)– Questionnaire revision in field– Follow-up log

State health officials make a decision to vaccinate university students – CRA activated to support mass vaccination clinics at multiple college

campuses in three states established– Aggregate reporting to state and CDC activated

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Scenario Roles

Assumptions– Scenario is fictitious; systems were not deployed

during Iowa outbreak– States are familiar with and use the three tools– As the outbreak progresses additional tools are

required to manage increasing complexity– As each tool is activated, it continues to play a role

throughout the outbreak

System Demonstrations

Epi Info™

OMS

CRA

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Epi Info™ Demonstration

Brief backgroundDemonstrate initial questionnaire

development– Existing questionnaire used (if available) or– Modified for specific investigation– Questionnaire tailored to the flow of the data sheet– Data validation and skip-patterns programmed into

View to control data entry

Data merged at regional or state health department

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Epi Info™ Demonstration

Analyses and Maps show multi-county spread

Health department officials identify need for contact tracing/social networking analyses– Decision to use OMS– Data exported from Epi Info and imported into OMS

Epi Info report template (Epi Report) updated with current data to track and communicate infection frequency and spread

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Epi Info™ Future Opportunities

Seamless exchange of data between: – OMS and Epi Info– CRA and Epi Info

Continued ad-hoc analyses of OMS and CRA data - mapping and reporting results

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OMS Demonstration

Brief backgroundMumps outbreak now in 6 counties within

region, 12 lab-confirmed cases Epi Info™ Epi Map tool used to show

geospatial significance1 university, 3 high schools identified as

possible sites of infectionOver 300 potential close contacts identified

via OMS contact tracing)Field staff deployed to continue case

finding and contact investigation interviews

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OMS Demonstration

OMS deployed with field staff to perform the following activities– Continued case management of confirmed and

suspect cases including documenting further lab tests and vaccination history

– Use custom mumps case report form (from Epi Info?)

– Create relationships between multiple subject types – Initiate contact tracing investigation, create social

networking diagram– Manage outbreak activity workload through follow-

up log– Replicate and synchronize data collected from field

investigators back to regional level

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OMS Demonstration

Mass immunization events are now planned at the university and 2 high schools

OMS collected information on vaccination type, dosage, administration, and contraindications for all prophylaxis recipients

Additional 2000 vials of MMR vaccine need to be ordered to support prophylaxis efforts

Case/Contact demographics along with countermeasure tracking information is exported from OMS to CRA repository

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OMS Future Opportunities

Enhanced data exchange and messaging between OMS and NEDSS-based notifiable disease reporting systems

Web-enabled data entry Subject de-duplication via Master Patient

IndexImprove stand alone AVR capabilitySocial networking integration

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CRA Demonstration

Brief background State PH and CDC guidance indicates the following

interventions:– 5 days of isolation for all patients– Students and staff of campuses have had 2 doses of MMR or

are immune

Mass vaccination clinics set up in gymnasiums in multiple colleges and universities in three state region

Cascading rapid data entry approach chosen to support quick through put at “end of the line”1. Person demographics2. Screening 3. Vaccination given4. Data entered into CRA immediately

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Table Table

Patients ExitingPOD

Medical Counseling Area

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Mental Health Area

Meds Dispensing / Vaccination Area

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Medical Screening Area

CRAData Entry

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Gymnasium Set up and Flow

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CRA Demonstration

Rapid data entry of vaccineCapability to track multiple

countermeasures (medical, non-medical interventions)

Custom event set up– Aggregate counts for state and federal reporting– Adverse event tracking– Follow up – multiple dose schedule

Patient registration to support alternate POD operations and event specific upload (i.e., immunization registries information)

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CRA Future Opportunities

Bi-directional messaging – Immunization Information Systems– OMS, other disease surveillance systems

Upload of medication inventory information, i.e., quantity, type, lot #; – Vaccines– SNS– State stockpiles and inventory systems

Alternate means of data entry– Driver’s license scanning– Bar coding

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CRA

Highly scalable: supports multiple

users, clinics, sub-jurisdictions,

jurisdictions

Non case reporting

Rapid data entry for mass tracking

of countermeasures

Regional & National Aggregate

Reporting

Systems OverviewEpi Info

• Forms generation

• Custom Data Entry/Validation

• Integration with SAS

• Geographical Information

System

• Analysis Visualization &

Reporting 

OMS

• Entity Management

• Social Networking

• Workload Management

• Shareable

vocabulary/question set

library

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Open Discussion

How do you see these systems working together for you?

Can you share real world examples of how these systems may have been or could be helpful to your operations?

Would interoperability of these systems be helpful? Why?

How do we collaborate moving forward? Working group? Community of Practice – part of OM or separate?

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Future Interoperability

Short Term

“Siloed”, Segregated use with no interoperability

Mid Term

Coordinated use with messaging and data exchange

Long Term

Interoperable platform that becomes “best of breed”

Today

Coordinated use, build same forms, use same vocabulary and meaning, joint training and implementation

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Key Contacts

Epi Info™ David Nitschke Email: den4@cdc.gov

OMS William Duck Email: wdd8@cdc.gov Gerald Jones Email: gfj0@cdc.gov Araceli Rey Email: dyx8@cdc.gov

CRA Jeanne Tropper Email: jwu0@cdc.gov