Posted By Sharon Watkins, PhD, CSTE President and Pennsylvania State Epidemiologist,
Wednesday, January 15, 2020
Updated: Wednesday, January 15, 2020
Happy New Year to all CSTE members and non-member applied epidemiologists in our community! We have reached the midway point of my tenure as CSTE president, and I’d like to update readers on my Presidential Priorities for the term and offer a progress report on the status of this work. Each year, the CSTE President sets forth a list of Presidential Priorities.
These are key areas impacting the field of applied epidemiology that the organization, Executive Director and Executive Board work to advance during the year. Presidential Priorities change from year to year, and I immediately began working to articulate and implement my priorities in Fall 2019. Working closely with CSTE staff, I identified two Presidential Priorities that align closely with goals in CSTE’s 2018-2020 Strategic Plan.
The identified priorities are:
• Priority B3, Under Strategic Pillar B (Develop, Expand & Diversify the Epidemiology Workforce) – Develop & Foster Leadership
• Priority A2, Under Strategic Pillar A (Establish Leading Edge Public Health Applied Epidemiology) – Co-Develop Infectious & Non-Infectious Disease Surveillance Initiatives
I am pleased to report that work is well underway in the CSTE National Office to implement both priorities. To develop and foster the next generation of epidemiology leaders, I proposed the development of a forum/platform to train mid-level leaders, some of whom are former CSTE fellows, and provide them opportunities for additional mentorship, exposure to advocacy and public policy, and partnership across states, disciplines and outside organizations. The idea is similar to APHL’s Emerging Leader Program.
In response to this priority, the CSTE Workforce Team is currently working to develop an interactive mid-level leadership training opportunity to be launched in 2020. Additional focus upon this priority will offer early career epidemiologists more exposure to the national picture in our field, and I look forward to the new trainings becoming reality.
The second Presidential Priority focuses on the co-development of Infectious Disease and non- Infectious Disease surveillance initiatives, and this is also the basis for the 2020 Presidential Priorities Award via abstract submission. Like years past, applied epidemiologists across the U.S. will have the opportunity to submit their abstract for the Presidential Priorities Award, so long as the abstract exemplifies partnership and participation between ID and non-ID entities on an outbreak or surveillance initiative. Projects demonstrating a use of data that supports cross-disciplinary partnership and a harmonized response with the best use of available tools will better compete for the award.
CSTE’s ongoing Data: Elemental to Health campaign is an example of a cross-disciplinary project that has been successful in the last year, as the effort yielded $50 million in new federal funding to modernize CDC’s data infrastructure. Ongoing national responses to the opioid crisis and the EVALI outbreak are also recent examples of ways that ID and non-ID epidemiologists are partnering on surveillance initiatives that require a harmonized approach.
We have received a number of abstracts already for the 2020 Presidential Priorities award, and I look forward reviewing these projects and determining the potential for a breakout session that will take place at the 2020 Annual Conference to discuss the award-winning project. Overall, it has been a privilege to serve as your president in 2019 and now 2020. I look forward to further implementing these priorities and to all CSTE will achieve in the future.
Dr. Sharon Watkins is CSTE’s Executive Board President for the 2019-2020 term and the Pennsylvania State Epidemiologist.
Posted By Celia Hagan, MPH, Vice President, CRD Associates,
Saturday, December 21, 2019
Updated: Saturday, December 21, 2019
It has been an exciting year since the launch of the Data: Elemental to Health campaign in February! CSTE has been working non-stop to advocate for funding to improve public health data systems. After the successful inclusion of new funding in the House appropriations bill, the entire process came to a halt when Congress could not agree to a spending package by September 30 resulting in two continuing resolutions.
But good things come to those who wait/never stop advocating for data modernization! Late Friday night, the President signed the FY20 spending bill into law solidifying $50 million in new money for CDC’s efforts to modernize public health data systems! This is a huge win for public health and the new funds will help pave the way towards a 21st century public health data superhighway. A big thanks to all of you that participated in our digital days of action to urge your elected officials to support data modernization. It goes to show that every voice counts!
Here are some highlights of CSTE’s activity over the past year for the Data: Elemental to Health campaign:
·Janet Hamilton, CSTE’s Director of Science and Policy, testified about public health data needs before the House Labor, Health and Human Services, Education, and Related Agencies Appropriations Subcommittee;
·Dr. Sharon Watkins, CSTE’s President and State Epidemiologist for the Pennsylvania Department of Health, testified about public health data needs in front of the House Science, Space, and Technology Committee;
·Four authorizing bills, two in the House and two in the Senate, were introduced to support public health data modernization:
oH.R. 2479 Section 45001 of the Leading Infrastructure for Tomorrow’s (LIFT) America Act;
oH.R. 5321 Public Health Infrastructure Modernization Act of 2019;
oS. 1793 Saving Lives Through Better Data Act;
oS. 1985 Section 405 of the Lower Health Care Costs Act;
·CSTE submitted written statements for two Congressional hearings on e-cigarettes.
There is more good news! Funding for CDC as a whole increased this year. FY20 includes a total of $8 billion for CDC which is $636 million above FY19 and $1.4 billion above the President’s Budget Request. A breakdown of areas of interest are listed below:
·$230 million to address tobacco and e-cigs; an increase of $20 million
·$622 million to Emerging and Zoonotic Infectious Diseases; an increase of $2 million
o$170 million to the Antibiotic Resistance Initiative; an increase of $2 million
oFlat funding for vector-borne diseases at $38.6 million
o$14 million for Lyme disease; an increase of $2 million
o$188.7 million for the Emerging Infectious Disease line; an increase of $31.8 million
oFlat funding for AMD at $30 million
·$555.4 million to Public Health Scientific Services; an increase of $59 million
o$50 million in NEW funding for public health data modernization!
o$9 million for all other surveillance, epidemiology, and informatics
oPublic Health Workforce is flat funded at $51 million
·For the first time in 20 years there is $12.5 million in new funding to support firearm injury and mortality prevention research in the National Center for Injury Prevention and Control
·$852.2 million for public health preparedness and response; a decrease of $5.7 million
oFlat funding for the Public Health Emergency Preparedness Cooperative Agreement at $675 million
·$85 million for the Infectious Disease Rapid Response Reserve Fund; an increase of $35 million.
At the end of the day, CSTE’s priorities fared extremely well in the year-end spending bill! Thanks to CSTE’s strong advocacy and presence on Capitol Hill, many of CSTE’s priorities saw increases in funding. Our advocacy successes this year are a good example of your membership fees at work! Without the commitment and strength of CSTE’s members, all of our wins would not be possible. Thank you for your dedication and support.
Additional information about funding levels for your specific priorities can be found in the spending bill, and in the accompanying report that provides more detailed information.
Celia Hagan, MPH is vice president at Cavarocchi Ruscio Dennis Associates, LLC, which represents CSTE’s interests on Capitol Hill in Washington, DC
Posted By Celia Hagan, MPH, Vice President, CRD Associates ,
Tuesday, December 17, 2019
Updated: Monday, December 16, 2019
This time of year, many people get sick. It’s cold outside, you’re cooped up indoors, and holiday stress is in full swing. Your symptoms may start with a cough and a sore throat. Could it be a cold? Then your muscles start to ache and the fatigue, headaches, and chills set in—it’s the flu.
Although flu viruses circulate in the U.S. year round, a peak of activity in the fall and winter months defines the flu season. Consider: while we know flu season will come each year, the season itself is unpredictable – when and where it will start, what virus strain will be circulating, how severe will the season be, and how well will the vaccine strains match. This unpredictability necessitates robust public health surveillance. The respiratory virus changes quickly making it challenging to develop a fully effective vaccine to prevent and mitigate illness. Tracking the virus is a multinational effort that relies on year-round public health surveillance and data collection.
It’s this complicated, yet coordinated scientific process of seasonal flu vaccine development that drew interest from the U.S. House of Representative’s Science, Space, and Technology Committee, which held a Fighting Flu, Saving Lives: Vaccine Science and Innovation hearing on November 20. Today, a universal flu vaccine—a one-and-done dose that would provide lifetime immunity—does not exist, hence the need to get annual flu vaccines each fall. The Committee was interested in understanding the full cycle from basic research to vaccine development, production, distribution and public health surveillance. The House Science, Space, and Technology Committee used this year’s flu season to highlight the scientific and innovation challenges around vaccine development and also focused on efforts to discover alternative influenza vaccine manufacturing processes from the current egg-based process.
CSTE’s President Dr. Sharon Watkins, State Epidemiologist for the Pennsylvania Department of Health, was invited to testify to share the public health perspective and express the need for better public health data. She highlighted that collecting and exchanging public health data is critical to detect and respond to flu outbreaks, gain an understanding of potential changes in the virus, and deliver life-saving vaccines. In her testimony, Dr. Watkins emphasized the need for interoperable data systems to share data, such as birth and death records and immunization registries and the need to be seamlessly connected to hospital emergency departments. Highlighting CSTE’s recent report, Driving Public Health in the Fast Lane: The Urgent Need for a 21st Century Data Superhighway, Dr. Watkins also spoke of the challenges public health faces when it has to rely on paper-based, manual data exchange methods. In the midst of the vaping epidemic that is occurring concurrently with flu season, it is important for public health professionals to distinguish between the two. As part of her written testimony, a four-page sample of a 350-page faxed medical record for an e-cigarette case showed that it is largely illegible and takes a public health professional significant amounts of time to input into the health department’s system. Dr. Watkins’ testimony helped to emphasize the need to improve public health data systems that has been an ongoing effort of CSTE’s through the Data: Elemental to Health Campaign.
Pictured: CSTE President and PA State Epidemiologist Sharon Watkins, PhD and Dr. Anthony S. Fauci, MD, Director, National Institute of Allergy and Infectious Disease, NIH, on November 20 during a hearing of the U.S. House Science, Space and Technology Committee.
Dr. Watkins testified alongside Dr. Tony Fauci the Director of the National Institute of Allergy and Infectious Disease at the National Institutes of Health, Dr. Dan Jernigan the Director of the Influenza Division in the National Center for Immunization and Respiratory Diseases (NCIRD) at the Centers for Disease Control and Prevention (CDC), and Dr. Robin Robinson, former head of the Biomedical Advanced Research and Development Authority (BARDA) and current Vice President of Scientific Affairs at RenovaCare. Dr. Fauci discussed NIH’s research efforts to discover a universal flu vaccine through its collaborations with academia, philanthropic organizations, and biotechnology and pharmaceutical companies. Dr. Jernigan emphasized that the flu vaccine is the single best way to protect yourself, and that CDC is working with other federal partners to use cutting edge science to improve the effectiveness of seasonal flu vaccines. He also discussed the importance of public health surveillance data to help inform policy recommendations and better vaccines. Dr. Robinson discussed his former role as head of BARDA, preparedness efforts to build national stockpiles of pre-pandemic flu vaccines, and BARDA’s activities to improve vaccine manufacturing.
The panel was well received by the House Science, Space, and Technology Committee, and the presiding Chair of the Committee emphasized that the flu vaccine is safe and the best way to stay healthy during flu season.
To protect yourself and your loved ones from flu, which can have severe complications requiring hospitalization and sometimes result in death, the CDC recommends getting an annual flu vaccine.
Celia Hagan, MPH is vice president at Cavarocchi Ruscio Dennis Associates, LLC, which represents CSTE’s interests on Capitol Hill in Washington, DC.
Posted By Jeffrey Engel, MD,
Friday, December 6, 2019
Updated: Friday, December 6, 2019
In August, CSTE activated its Concept of Operations (ConOps) Plan for emergency response for the first time. The activation was in reaction to the emerging epidemic of vaping associated lung injury in the United States. That week, there were reports of outbreaks from Illinois and Wisconsin in Epi-X, CDC’s emergency communication system, and a few days later I received a call from Minnesota State Epidemiologist, Ruth Lynfield, that her state was experiencing a similar outbreak. She was concerned about the lack of a national response given the three-state experience and anecdotal reports coming in from other states, such as Utah, California, and Massachusetts.
I quickly learned that the CDC already had three Centers involved: Injury, Environmental Health, and Chronic Disease (Office of Smoking and Health) all under the Deputy Director of Non-Infectious Diseases, and that they were managing the outbreak through a multi-state Epi Aid sending CDC Epidemic Intelligence Officers (EIS) to affected states for technical assistance. These Centers had little experience with national public health emergency responses and by August 20, well into the outbreak with hundreds of cases emerging (according to media reports) there was no central epidemiological response organized to begin surveillance, and collect and analyze case data from affected states; nor methods of lab testing of human samples and vaping fluids; nor investigations through usual mechanisms of establishing standardized case definitions, medical chart abstraction forms, and patient questionnaires. Thus, on August 21, CSTE activated its ConOps (the first organization or agency to do so) to assist states and the federal government with a national epidemiological emergency response.
I’ll stop the chronologic story telling here (as most are aware of the ongoing vaping-associated lung illness outbreak) and shift focus of this article to the ConOps process and impact on the CSTE National Office. Response to public health emergencies involves, in one way or another, activation of an incident management system. The system’s intent is to better manage and align people in an organization, ensure accurate and timely communications among stakeholders, and execute a plan that leads to a response, and eventual de-escalation back to normal operations. When CSTE activated, some staff had new job titles, reporting channels, and new responsibilities (within their skillsets), and once a new work flow was established, a daily rhythm was set. All CSTE departments were involved including program, communications, finance, information technology, and human resources.
CSTE was in Incident Command mode for nearly five weeks when we held an after-action review to discuss lessons learned and de-escalation. Importantly, we learned lessons around the activation levels articulated in our original ConOps plan, differing staff and supervisory roles, and mechanisms by which the national office staff remains updated on the emergency response and in turn provides CSTE members with regular updates. As of the writing of this blog, CSTE remains in ConOps activation and the vaping associated lung injury national outbreak continues with about 200 new cases reported per week. The CSTE-led Epi Task Force leads federal and state partners in the epidemiological response through regular calls, technical assistance, and critical communications. At this time of this writing, It appears we will scale down to a Level 1 or complete deactivation in the near future, as CDC stabilizes their new surveillance system for disease notification, analysis, and response. Overall, I am pleased CSTE has been able to execute this emergency response to the EVALI outbreak and have already discussed modifications to the ConOps plan for future emergency and/or outbreak responses.
Dr. Jeffrey Engel has been CSTE’s Executive Director since 2012. Prior, Dr. Engel was the State Health Official (2009-2012) and State Epidemiologist (2002-2009) in North Carolina and served on the CSTE Executive Board as the ID Steering Committee Chair from 2008-2009.
Posted By Rima Khabbaz, MD, Director, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID),
Wednesday, September 18, 2019
Updated: Wednesday, September 18, 2019
As the multi-year effort of rolling out whole genome sequencing (WGS) for PulseNet successfully completes its transition, I am pleased to report that thanks to the herculean efforts of our laboratory and epidemiology partners, the entire country is now able to sequence all foodborne disease pathogens. Public health departments across the country are starting to use the powerful tools of advanced molecular detection (AMD) to detect and investigate outbreaks and better understand antibiotic-resistant bacteria so we can stop their spread.
For more than 20 years, PulseNet has helped detect, investigate, and stop outbreaks and improve our food safety system nationwide, reducing the overall burden of enteric disease in the United States. In 2019, we have seen the culmination of an exceptional effort to transform foodborne disease surveillance in the era of next-generation sequencing. We hope our state epidemiology partners from Florida to Washington appreciate how their diligence in this effort will strengthen all infectious disease surveillance for years to come.
We will look to you as leaders to not only use this technology to track and prevent other diseases, but also to help us at CDC learn about the many ways this tool can be harnessed to drive future innovation and prevention research. You well know that this has been a long, arduous process and would not have been accomplished without the contributions of our federal, state, and local partners. I would like to express sincere gratitude on behalf of our agency for your dedication and commitment to this forward-thinking transition of our public health system.
As we did 23 years ago at the dawn of PulseNet, we will work collaboratively to optimize this technology and further improve our efficiencies. As with any major technological transition, technical or logistical challenges may emerge – we hear you at CDC and are committed to working with you to make this transition as smooth as possible. We think this technology will empower public health decision-making at the local, state, and federal levels, and we anticipate its increasing use internationally.
I am fortunate to be the director of a center at CDC that strives to push forward public health science, but without partnership with groups like CSTE, we’d be hard pressed to accomplish anything close to what we have done over the last few years for enteric disease prevention. I’d like to reflect on the many interactions with our state and local health department partners who have attended a number of CDC-sponsored trainings and meetings over the course of this transition. We have been most struck by the large number of bright, young public health scientists drawn to the field with laboratory, epidemiology, and environmental health training who were excited about the challenges and the potential innovations at hand. Just as it has from the beginning, PulseNet will continue to find more ways to drive the prevention of foodborne and other enteric illnesses, make our food supply safer, and keep all of us healthier.
Rima F. Khabbaz, MD, is director of the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) at the Centers for Disease Control and Prevention (CDC). NCEZID’s experts work around the clock to protect people from a multitude of health threats and advance the agency’s cross-cutting infectious disease priorities, including the integration of advanced molecular detection (AMD) technologies into public health. For more information about PulseNet and the transition to whole genome sequencing, please visit NCEZID’s PulseNet Lab transition to WGS page.
Posted By Emily Holubowich, CSTE Washington, DC Liaison,
Friday, July 19, 2019
Updated: Friday, July 19, 2019
In early 2019, the Council of State and Territorial Epidemiologists (CSTE), Association of Public Health Laboratories, Healthcare Information and Management Systems Society (HIMMS), and National Association for Public Health Statistics and Information Systems (NAPHSIS) joined together to spearhead a bold and transformative campaign – Data: Elemental to Health – to secure $1 billion over the next decade to modernize the public health surveillance enterprise at the Centers for Disease Control and Prevention (CDC) and through it, state, territorial, local, and tribal (STLT) health departments. This funding would also support efforts to modernize the public health workforce by training, recruiting (e.g., student loan repayment and fellowships), and retaining skilled data scientists. Data systems require adept staff to use them, maintain them, interpret the data, and develop and deploy actionable public health interventions to save lives.
No doubt you are familiar with the proverb, “if you want to go fast, go alone. If you want to go far, go together.” Indeed, partnerships are the cornerstone of the Data: Elemental to Health campaign. Today, there are 90 entities representing patients and consumers, public health professionals, health care providers, and IT that are advancing our priorities to build a public health data “superhighway” of the 21st century. Our partners extend beyond these organizations. You have been a centerpiece of this campaign, as well. For the first time ever, CSTE helped coordinate a Day of Digital Action in June using HIMSS’s grassroots advocacy platform that allowed CSTE’s members and others to send emails to federal lawmakers about the importance of public health data, and the need to modernize IT systems. This Day of Digital Action yielded more than 1,200 messages from every state to members of Congress.
In just six months, together we’ve gone both far and fast.
As a result of our collective efforts leading the Data: Elemental to Health campaign, we’ve delivered the following results:
Legislation passed in the House that, if enacted, would appropriate $100 million in fiscal year (FY) 2020 for CDC to modernize the public health surveillance enterprise and workforce at the federal and STLT levels.
Legislation introduced in the House – the LIFT America Act – that would authorize $100 million per year for public health data modernization activities over each of the next five years.
Two bills introduced in the Senate – The Saving Lives through Better Data Act and the Lower Health Care Costs Act – both of which are bipartisan, that would also authorize data modernization initiatives.
With four bills in two chambers, lawmakers have made clear their support for public health data modernization in both words and deeds. Unfortunately, making these promises a reality hinges entirely on Congress and the White House’s ability to stave off devastating cuts – 10 percent across the board – that are scheduled hit defense and domestic programs, including public health in fiscal 2020. Without a bipartisan budget deal to #RaiseTheCaps, lawmakers will have no choice but to cut funding for public health, despite their best intentions. Congressional leaders are intent upon raising the spending caps and avoiding scheduled cuts. White House officials continue to participate in conversations with congressional leaders, but seem less enthusiastic about a deal, or at least, a deal that would increase funding for domestic priorities like public health (recall that the president’s fiscal 2020 budget request proposed deep cuts to public health).
In sum, our progress to date is exciting, but a broader budget deal will need to fall into place for our efforts to bear fruit. We will continue to urge Congress to #RaiseTheCaps, so we can secure much needed funding to improve the nation’s public health infrastructure.
Emily J. Holubowich, MPP is the Senior Vice President, Cavarocchi Ruscio Dennis Associates, LLC. Emily joined CRD Associates in 2009 and has nearly 20 years of experience in health and fiscal policy, government relations, strategic communications, and coalition management. She has represented CSTE’s interests on Capitol Hill since 2013.
Posted By Emily Holubowich, CSTE Washington, DC Liaison,
Friday, April 26, 2019
Updated: Thursday, April 25, 2019
Global health security depends on 24/7 population-wide, fast, complete and accurate detection and reporting of diseases and conditions of high public health consequence. Every day—often unbeknownst to most Americans—public health surveillance is saving lives by detecting and facilitating the response to health threats, including E. coli contaminated lettuce, measles, antibiotic resistance, lead poisoning, influenza, health care-associated infections, opioid overdoses, Zika, and more.
Unfortunately, the nation’s public health data systems are antiquated, rely on obsolete surveillance methods, and are in dire need of security upgrades. Lack of interoperability, reporting consistency, and data standards leads to errors in quality, timeliness,and communication. Sluggish, manual processes—paper records, spreadsheets, faxes and phone calls—still in widespread use, have consequences, most notably, delayed detection and response to public health threats of all types: chronic, emerging, and urgent.
To protect our nation’s health security we need more, better, faster, and secure data. For the first time ever, the Council of State and Territorial Epidemiologists (CSTE), Association of Public Health Laboratories, National Association for Public Health Statistics and Information Systems (NAPHSIS), and Healthcare Information & Management Systems Society (HIMSS) have joined together to spearhead a campaign to secure $1 billion over the next decade—$100 million in fiscal year 2020—to modernize the public health surveillance enterprise at the Centers for Disease Control and Prevention (CDC) and through it, the state, local, tribal, and territorial health departments. This funding would also support efforts to modernize the public health workforce by training, recruiting (e.g., student loan repayment and fellowships), and retaining skilled data scientists. Data systems require adept staff to use them, maintain them, interpret the data, and develop and deploy actionable public health interventions to save lives.
Pictured: CSTE Executive Board members and staff visiting Capitol Hill in March to promote the new advocacy initiative, Data: Elemental to Health
Our “Data: Elemental to Health” campaign is gaining traction in Washington, DC and beyond since its launch in February:
·More than 80 institutions representing health care providers, patients and consumers, public health professionals, and IT developers have endorsed our funding request to Congress. You can read a copy of our letter to appropriators HERE.
·CSTE’s leadership travelled to Capitol Hill in March to discuss our proposal with officials in Congress, the Department of Health and Human Services (HHS), and the Office of Management and Budget;
·Senator Richard Blumenthal (D-CT)—recognizing the need to modernize the data infrastructure—sent a letter to appropriators endorsing our funding request;
·CSTE’s Director of Science and Policy Janet Hamilton was invited to testify before the House appropriations subcommittee with jurisdiction over public health funding about the dire need to build a public health data superhighway of the 21st Century. You can watch her testimony HERE and access her written statement for the record HERE.
We will soon know if our campaign has made an impact when the House appropriations subcommittee unveils its public health funding bill on/around April 30 and the full committee considers it on May 8.
You can help us between now and then by sharing this blog, our campaign flyer and letter, Janet’s testimony, and this Association of State and Territorial Health Officials (ASTHO) video about the campaign with your colleagues at the department of health, your governor, and to the extent you are comfortable, with your federal elected officials. This funding, if appropriated, will represent the most significant, strategic, transformative investment in data systems at the federal, state, and local levels ever, and we want as many people as possible to know about it.
Emily J. Holubowich, MPP is the Senior Vice President, Cavarocchi Ruscio Dennis Associates, LLC. Emily joined CRD Associates in 2009 and has nearly 20 years of experience in health and fiscal policy, government relations, strategic communications, and coalition management. She has represented CSTE’s interests on Capitol Hill since 2013.
Posted By Charisse LaVell,
Tuesday, April 16, 2019
Updated: Monday, April 15, 2019
I have known about the Healthcare Information and Management Systems Society (HIMSS) Annual Global Conference and Exhibition for many years, and I finally got the chance to attend HIMSS19 in Orlando, FL as a representative of CSTE. I was briefed beforehand on the enormity of the conference, yet I was completely unsure how my experience would unfold. HIMSS is a global non-profit whose mission is to improve health through information and technology. The annual HIMSS conference draws upwards of 45,000 attendees, with over 1300 exhibitors and more than 300 education sessions. I was blown away by the diversity and caliber of vendors and their uniquely designed booths that filled the exhibit hall at the Orange County Convention Center.
CSTE was invited by the Centers for Disease Control and Prevention (CDC) to participate in the HIMSS Interoperability Showcase to demonstrate how the Reportable Conditions Knowledge Management System (RCKMS) supports electronic case reporting between healthcare providers and public health. The Interoperability Showcase is a major exhibit at HIMSS and is comprised of several guided, real-time demonstrations presented by diverse companies that work through partnerships using innovative techniques to address current health problems. CSTE joined the Association of Public Health Laboratories (APHL), CDC, several state health departments including Tennessee, Michigan, Utah, and Washington, Epic, Netsmart, FormFast, CareEvolution, National Consortium of Telehealth Resources Centers, and American Well to present our use case: The Opioid Crisis: The Person and The Population. For this use case, we worked together to demonstrate how emerging technologies and standards are applied to enhance public health reporting and surveillance for the opioid overdose epidemic.
Pictured: Partners demonstrating The Opioid Crisis: The Person and The Population use case at the 2019 HIMSS Global Conference’s Interoperability Showcase. From left to right, Laura Conn (CDC), Jim Fitzpatrick (Epic), Sai Valluripalli (APHL) and Charisse LaVell (CSTE).
In our showcase, we simulated a patient, who is a resident of Washington, that presented to a Tennessee emergency department with an apparent opioid overdose. The opioid overdose diagnosis entered into the electronic health record (EHR) triggered the subsequent process of reporting to public health. The emergency department’s EHR system, represented by Epic, generated and sent the electronic initial case report (eICR) to the APHL AIMS secure cloud-based platform. This process invoked the RCKMS decision support service to determine whether this potential case is reportable to public health. Based on the reporting logic for both Washington Department of Health and Tennessee Department of Health, RCKMS determined that this case of opioid overdose is reportable to Washington and Tennessee. RCKMS outputted the determination with other pertinent routing information to the APHL AIMS platform for inclusion in a reportability response (RR). AIMS then routed the RR back to the Epic EHR system. Concurrently, the eICR and RR were routed to both the Washington Department of Health and the Tennessee Department of Health. Washington’s health information exchange (HIE) and Tennessee’s surveillance system consumed the eICR and the RR, while Epic received and processed the RR.
Pictured: CSTE staff member Charisse LaVell leads the crowd through a demonstration of the Reportable Conditions Knowledge Management System (RCKMS) at the 2019 HIMSS Global Conference in Orlando, FL.
As the opioid overdose epidemic has gained more visibility as a public health crisis, CSTE’s participation in this year’s HIMSS conference was invaluable in broadening attendees’ awareness of the importance of public health reporting for opioid overdoses and how RCKMS supports surveillance and electronic case reporting. Throughout the conference, I was able to share the work of RCKMS with clinical and public health professionals. Having the opportunity to represent CSTE by presenting at my first HIMSS conference was an unforgettable experience.
Charisse LaVell is a Program Analyst supporting the RCKMS project. For more information about RCKMS, contact Charisse at firstname.lastname@example.org.
Posted By CSTE Conference,
Monday, April 1, 2019
Updated: Thursday, April 4, 2019
We are pleased to announce an exciting and diverse lineup of speakers for the 2019 CSTE Annual Conference, June 2-6, 2019 in Raleigh, North Carolina. Our 2019 speakers include Jonathan M. Mann Memorial Lecturer Anne Schuchat, Principal Deputy Director at the Centers for Disease Control and Prevention (CDC). This year’s Plenary sessions include topics around the theme of the 2019 Conference, "First in Flight: Recognizing Risk Takers & Risk Factors." Our Plenary sessions include “Flying into the Winds of Political Change” (Monday, June 3), “A Bird's Eye View of Our Environment” (Tuesday, June 4), and “Navigating the Opioid Crisis: Local Success” (Wednesday, June 5). Our 2019 speakers will share perspectives on applied public health epidemiology, with a focus on best practices and recent successes. Please take a moment to view all of the 2019 speakers below.
Jonathan M. Mann Memorial Lecture
Anne Schuchat - Principal Deputy Director Centers for Disease Control and Prevention Rear Admiral (Ret.), U.S. Public Health Service
Monday Plenary - Flying into the Winds of Political Change
Rachel Levine - Secretary of Health for the Commonwealth of Pennsylvania and Professor of Pediatrics and Psychiatry at the Penn State College of Medicine
Tuesday Plenary - A Bird’s Eye View of our Environment
Trish M. Perl - Professor of Medicine and the Chief of Infectious Diseases at the University of Texas Southwestern Medical School and Medical Center
Gregory C. Gray - Professor at Duke University with three affiliations: The Division of Infectious Diseases in Duke University’s School of Medicine, Duke Global Health Institute, and Duke Nicholas School of the Environment
Wednesday Plenary - Navigating the Opioid Crisis: Local Success
Van Ingram - Executive Director for the Kentucky Office of Drug Control Policy
Pam Pontones - Deputy State Health Commissioner State Epidemiologist
Continuing Education for Attendees
This year, CSTE has partnered with CDC to provide continuing education to Annual Conference attendees. We anticipate offering 12.5 hours/credits of free CE for doctors, nurses, health educators, veterinarians, general practitioners, and those certified in public health. Approval is pending.
Houston is the first of seven Digital Bridge pilot sites to implement eCR in production for reportable diseases. Houston Methodist utilized their electronic health record (EHR) system vendor, Epic who is also a Digital Bridge participant, with the Health Department’s Houston Electronic Disease Surveillance System, provided by their vendor, Maven. Other locations participating in the Digital Bridge eCR pilot are in California, Kansas, Massachusetts, Michigan, New York, and Utah.
CSTE has been building RCKMS with HLN Consulting and Northrop Grumman with funding from CDC since 2014. The tool provides comprehensive information on public health reporting requirements. RCKMS is comprised of three parts that ensure accurate, timely, and complete coverage of reportable conditions reporting criteria:
The authoring interface allows public health agencies to input, edit, and manage their jurisdiction-specific reporting criteria.
The knowledge repository stores these criteria for use in adjudicating eCR data sent by health care electronic health record systems containing clinical encounter information.
The decision support system uses the criteria in the knowledge repository to determine whether data sent in the eCR constitutes a reportable condition and which jurisdiction(s) the data should be sent. The decision support system also notifies the reporting organization about the reportability of the clinical encounter.
RCKMS is part of the larger technical solution for eCR, and the launch of this real-time, automated process promises to improve the timeliness, accuracy and completeness of data, allowing public health to quickly intervene and prevent the spread of disease. RCKMS has been deployed on the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) platform, the combination resulting in an all-inclusive decision support intermediary for use by public health and reporters to improve data exchange.
The pilot implementation focuses on five conditions: chlamydia, gonorrhea, pertussis, salmonellosis, and Zika virus infection. Public health agencies currently receive provider case reports predominantly through time-intensive manual processes that involve paper (e.g., faxes), phone calls, or data entry into a web portal. These manual processes are time consuming, burdensome to reporters and public health, and inconsistent. To ensure accurate reporting, providers must know what, when, how, and to whom to report their clinical data. In addition, public health agencies must ensure all reporting mandate information is up to date and available to those required to report. RCKMS benefits both reporters and public health agencies by providing a centralized location for public health reporting requirements.
While Houston Methodist, Houston Health Department, and Epic may be the first partners to embark on bridging the gap in case report data exchange between health care and public health, public health agencies, health care partners, and EHR vendors across the country are excited about implementing eCR. Overall, I would encourage CSTE members to stay current on electronic case reporting activities, and especially RCKMS because it will soon be part of business as usual for public health.
The Reportable Condition Knowledge Management System (RCKMS) is an authoritative, real-time portal to enhance disease surveillance. RCKMS provides comprehensive information on public health reporting requirements to public health reporters, such as clinicians and laboratories. More information can be found on the CSTE Surveillance and Informatics Steering Committee page, Digital Bridge website, and CDC website.
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