11May / 2023

Successful COVID-19 exposure notification system shuts down in most states

Photo of an iPhone showing a notification that says, "Exposure Notifications Off."

By Melanie Padgett Powers

As the COVID-19 Public Health Emergency expired on May 11, 2023, the COVID-19 Exposure Notifications System (ENS) in the majority of states also shut down. For the past three years, APHL has played a critical role in the US ENS.

The COVID-19 ENS made it possible for users to receive smartphone alerts when they — or more accurately, their phone — had been in the vicinity of someone who soon after reported a positive COVID-19 test through the ENS.

APHL, in collaboration with Google, Apple and Microsoft, and with program funding and guidance from partners at the Centers for Disease Control and Prevention, has provided support for the ENS by hosting national servers since August 2020.

“The availability of these servers eliminated a significant burden for state public health authorities and enabled exposure notifications to occur across state lines, despite each state having a unique solution,” explained Emma Sudduth, APHL consultant and program manager for the national server operations.

At one point, 28 states were using the ENS and relying on the servers hosted by APHL. Over time, as pandemic restrictions loosened and vaccine uptake increased, some states’ public health authorities discontinued their exposure notification solutions. Most of the remaining states shut down ENS on May 11 as Apple, Google and APHL discontinued their support for key components of the system.

The ENS saved countless lives across the country, as people were alerted to exposures, allowing them to get tested quickly and take precautions to reduce the ongoing spread of COVID-19. Research in Washington state in June 2021 showed that the state’s exposure notifications tool, known as WA Notify, had saved an estimated 30–120 lives and likely prevented about 6,000 COVID-19 cases during the first four months of its use.

By 2023, WA Notify had approximately 235,000 participants share a positive test result, which generated more than 2.5 million anonymous exposure notifications.

“We’re tremendously proud of what WA Notify was able to accomplish in a relatively short amount of time, and eager to find ways to utilize this life-saving technology again in the future,” said Bryant Thomas Karras, MD, chief medical informatics officer at Washington State Department of Health. “Much of WA Notify’s success can be attributed to innovative collaboration among public, private and academic partners,” which included APHL, Apple, Google, Microsoft and the University of Washington.

Unprecedented private-public health partnership

It became clear early on in the pandemic that most states did not have the time, funding or capacity to create their own ENS. Even if they did, it would have resulted in several different types of exposure notifications tools across the country.

To solve this problem, Google and Apple partnered to create a turnkey solution called Exposure Notifications Express (ENX). ENX made it easier for public health agencies to launch a state ENS by eliminating the need to build their own tool. These private technology companies looked to APHL, as a trusted public health partner, to host the servers.

“APHL has a long history of supporting states in data exchange and the hosting of solutions,” said Scott Becker, APHL CEO. “Our participation in the ENS gave the US public health community a capable and accountable partner for hosting key components of this groundbreaking technology.”

APHL stepped up to provide the necessary national key server, which holds the ENS data for the entire country. With APHL taking responsibility for storing and securing the data, states did not have to host and maintain their own servers. The Bluetooth-enabled notifications and the digital language known as “exposure notification keys” protected privacy.

Furthermore, a national centralized server allowed exposure notifications to work between users who had tools published by different states, ensuring notification regardless of state boundaries.

“The national infrastructure supported by APHL was essential to the deployment and maintenance of exposure notification systems,” Karras said. “By securely hosting the [national servers] APHL removed the burden on individual public health authorities to build and host their own servers, and importantly, enabled communication, i.e., interoperability, between exposure notification tools deployed in the U.S. Interoperability ensured that individuals using the systems could seamlessly notify others when traveling across states.”

Lessons for the future

Throughout the nearly three years of ENS, lessons were learned and applied to improve the system over time. This resulted in more states providing an exposure notification solution and more users in those states adopting it, which led to higher levels of notifications.

The knowledge and experience gained with the use of the ENS means that, in the future, public health won’t have to start at baseline to build a system from scratch. In addition, the ability to learn from different states about their experiences with ENS could be leveraged for future public health solutions.

The private-public health partnership — with Google and Apple working together with APHL, along with the public health community and state health departments — was the first of its kind and shows the value of such measures. The ENS saved lives, prevented cases and slowed disease spread. The public health community will continue to explore how such innovations can be used in the future to improve public health.

“Washington State Department of Health recognizes the great value of public-private-academic partnerships and collaboration with other states to develop interoperable systems,” Karras said. “This collaboration allowed us to accomplish something that would not have been possible without working together. We are committed to strengthening these partnerships that have made exposure notification systems so successful.”

At APHL, Sudduth said, “The collaboration between private technology companies and public health in this endeavor made a far stronger solution. Learning from this experience and growing these established relationships will strengthen public health.”

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08Sep / 2020

COVID-19 exposure notifications expand among public health community

The emergence of COVID-19 required swift action to develop systems and processes that support public health agencies and their pandemic response efforts. This year APHL has worked to create new connections, develop new message formats, standardize language and host a variety of solutions to aid in the COVID-19 response. This blog post is the third in a series that outlines and explains these efforts.

APHL recently announced a new effort to bring COVID-19 exposure notifications to the public health community. Through this collaboration with Apple, Google and Microsoft, APHL has enabled state and territorial public health agencies to provide COVID-19 exposure notifications to residents who choose to receive information regarding COVID-19 exposures in their area.

Today we are excited to announce another step toward expanding exposure notifications in the United States. To reduce the effort needed by public health agencies to bring exposure notification to their jurisdiction, APHL has made available a multi-tenant verification server running on Google Cloud.

Reducing boundaries between jurisdictions

Since July, several states have launched apps using Apple and Google’s Exposure Notifications System (ENS) to augment contact tracing efforts for the disease. Two states have launched an app using ENS with a national key server, hosted by APHL. The national key server allows exposure notifications to work between users who have applications published by different states, which enables the system to work across the US. It assures users can determine when they may have been exposed to someone who has tested positive for COVID-19 from other states.

As a part of ENS, a verification server is necessary to ensure a user has received a positive test result before uploading their temporary exposure keys to the national key server. Before, each public health agency needed to stand up their own verification server and decide on a verification approach. Having one verification server reduces the additional time and complexity to deploy ENS.

The new multi-tenant verification server provides each state and territory secure access to generate single-use verification codes. These verification codes could be provided to the user by a contact tracer or case investigator—over the phone or via SMS (text message)—after they have verified a positive test result. This server does not store personally identifiable information, but can send verification codes via SMS to make it easier for users to enter the verification code in their app.

The multi-tenant verification server reduces the burden on busy public health agencies and enables more rapid adoption of exposure notification. APHL, as a trusted public health partner, is a key conduit in delivering this solution to the public health community to help stop the spread of COVID-19.

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26Aug / 2020

Connecting the COVID-19 dots with technology

People in a public transportation hub, checking their phones

The emergence of COVID-19 required swift action to develop systems and processes that support public health agencies and their pandemic response efforts. In the last seven months, APHL has worked to create new connections, develop new message formats, standardize language and host a variety of solutions to aid in the COVID-19 response. This blog post is the second in a series that outlines and explains these efforts.

In order for public health officials to successfully respond to an emerging threat, they need to have a direct line to the public to understand the situation, monitor the spread of disease and provide potentially life-saving guidance to a variety of audiences. In the case of COVID-19, the ability for health departments to monitor those at-risk and advise appropriate isolation measures and medical needs has been critical. Health informatics technology solutions are providing health departments with real-time data, ensuring they can respond quickly to changing threats.

Meet Sara Alert^TM

A real-time COVID-19 monitoring and reporting tool, Sara Alert was developed by MITRE Corporation in collaboration with APHL and other national public health organizations. Available in the public domain and free of charge to public health agencies, Sara Alert is designed to contain the spread of disease through automated and remote monitoring and rapid response. Here’s how it works:

For Monitoring Exposed Individuals

- Sara Alert enables public health officials to enroll individuals who are ill or at risk of developing COVID-19 (e.g., individuals from affected areas or contacts of known cases).
- Enrolled individuals enter their (and other members of their household) symptoms daily through their preferred platform (i.e., web browser via mobile or desktop, text-based, voice), providing public health officials real-time insights.
- The information is stored in a secure database and displayed on monitoring line lists so that public health officials can quickly and efficiently identify individuals requiring care coordination or follow up for non-response.

For Monitoring Ill Individuals

- Sara Alert enables public health officials to enroll individuals who have developed a disease, like COVID-19, who need to be monitored to determine when it is safe to discontinue isolation.
- Once enrolled, individuals enter their symptoms daily through their preferred platform (i.e., web browser via mobile or desktop, text-based, voice), providing public health officials real-time insights.
- The information is stored in a secure database and displayed on monitoring line lists so that public health officials can quickly and efficiently identify individuals who may discontinue isolation.

Sara Alert modernizes the public health monitoring and response system by providing increased efficiency in tracking both active and potential cases, leading to earlier containment of the virus and reduction of burden on public health resources. As an open source tool, Sara Alert is available for public and private use and is easily integrated into other healthcare tools.

Sara Alert is hosted on the APHL Informatics Messaging Services (AIMS) platform, a secure, cloud-based environment that provides shared services to aid in the transport, validation, translation and routing of electronic data.

A deluge of data

In addition to hosting Sara Alert, APHL has built and maintains a data lake on AIMS to help paint a comprehensive picture of the nation’s testing landscape and needs.

In the simplest terms, a “data lake” is a repository—it hosts raw data of diverse formats from various sources with no real organizational structure. These data can be accessibly stored and repurposed to meet multiple data needs, such as reporting and visualization of disease trends.

APHL originally developed its data lake as a resource for monitoring cases of antibiotic resistance and was designed with the security and functionality needed to work as part of AIMS. But two weeks before going live, the extent of the COVID-19 pandemic became apparent and priorities for the data lake shifted.

Knowing states had valuable data and APHL had technology to scale, the US Centers for Disease Control and Prevention (CDC) asked APHL to reconfigure its data lake to focus on COVID-19. In a matter of weeks, the data late was modified to capture positive, negative and inconclusive COVID-19 testing data.

Today, APHL’s data lake holds nearly all the nation’s COVID-19 testing data sent from public health departments who are reporting their states’ testing data county by county. These data are analyzed and visualized for surveillance and provide a real-time snapshot of the testing landscape nationwide.

Ready for what’s next

Public health officials and epidemiologists remain on high alert for a COVID-19 resurgence, both in the weeks ahead and into the next flu season. Since both the Sara Alert platform and COVID-19 data lake are configurable for other conditions, they give scientists an invaluable head start for monitoring in the event of new pandemics and large-scale outbreaks. The advancements and refinements made with monitoring tools and technologies now will help the public health community respond even faster to track and contain an outbreak in the future.

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17Jul / 2020

Bringing COVID-19 exposure notification to the public health community

People interacting in a park while looking at their cellphones.

Starting in 2006 with the Public Health Laboratory Interoperability Project (PHLIP)—one of the first systems that allowed public health entities to exchange standardized data—APHL has worked to make connections between public health laboratories and agencies more efficient. Those efforts took a dramatic step forward with the APHL Informatics Messaging Services (AIMS) platform, which has evolved from a one-way router of critical health information to a secure, cloud-based platform that transports, translates, validates and hosts data for federal, state and local public health agencies.

The emergence of COVID-19 required swift action to develop systems and processes that support public health agencies and their pandemic response efforts. In the last seven months, APHL has worked to create new connections, develop new message formats, standardize language and host a variety of solutions to aid in the COVID response. This blog post, regarding exposure notification, is the first in a series that outlines and explains these efforts.

How Does Exposure Notification Work?

To limit the spread of COVID-19, information must travel faster than the virus can. The scope and transmission rate of COVID-19 makes this a monumental challenge for public health agencies. Exposure notification technology, however, is a potential game changer. By providing rapid alerts to individuals who may have been in close proximity to someone who has COVID-19, exposure notifications allow the spread of information to stay one step ahead.

Working in conjunction with Apple, Google and Microsoft, APHL is taking a major step to support public health agencies that want to provide focused, privacy-preserving and user-controlled exposure notifications at scale using the Apple | Google Exposure Notifications System. APHL’s presence on the project gives the US public health community a capable and accountable partner for hosting key components of this groundbreaking technology.

The Apple | Google Exposure Notifications System (A|G ENS)

To augment traditional COVID-19 contact tracing efforts around the world, Apple and Google co-developed the A|G ENS, which consists of an Exposure Notification Application Protocol Interface (API) that is available on both the iOS and Android operating systems. Apps developed by public health agencies can then use the Exposure Notification API to help determine if a user may have been exposed to another user who subsequently tested positive for COVID-19. This is accomplished through the use of privacy-preserving randomly generated numbers also known as keys, which in turn generate temporary IDs that are transmitted between devices using Bluetooth Low Energy signals. Apps using this system are not permitted to collect or use location data from the device, and user identities are not revealed to other users, Apple, Google or APHL.

Rather than each state and territorial public health agency bearing the burden of building and hosting its own key servers, a national server can securely host the keys of those affected users, eliminate duplication and enable notifications across state borders. APHL is also championing the effort to build and host a national key server on behalf of the public health community. This will allow users to continually benefit from exposure notifications as they travel across state lines, and help state and territorial agencies deploy their apps quickly.

“APHL’s participation is key to the success of these efforts,” said Washington State Secretary of Health John Wiesman. “Without a national key server, each state that chooses to implement such an application would be responsible for its own data sets. APHL’s centralized and secure national server will be accessible to every state public health agency.”

Microsoft is supporting the partnership by working with APHL to host the national key server, based on the open source reference design created by Google Cloud. Through Microsoft’s Azure cloud platform, Microsoft will provide cloud services that will allow APHL to host the key server and securely enable interstate operability for the apps that public health agencies deploy.

Only users who choose to download an app developed by their public health agency and voluntarily opt in can receive exposure notifications. If users are alerted to a possible exposure, the app will also provide information about what to do next.

“We’re honored to partner with Apple, Google and Microsoft to make this groundbreaking technology accessible to state and territorial public health agencies,” Bill Whitmar, president of APHL and director of the Missouri State Public Health Laboratory, said. “Apps using this technology will rapidly inform users of a potential exposure to COVID-19 and provide them information they can use to protect themselves and their families.”

APHL develops technological innovations that support public health agencies at the federal, state and local level. For more information on how your agency can benefit from a partnership with APHL, contact informatics@aphl.org.

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23Apr / 2020

Moving data at the speed of a virus

by Rachel Shepherd, specialist, Informatics, APHL

The public health system serves as the backbone to our nation’s health and safety; there is nothing more collectively critical than making sure we are prepared to respond to threats. When a public health crisis like COVID-19 strikes, laboratories need to get mechanisms in place fast to test for a new pathogen. But there’s another, equally important side to that story. Without the technical infrastructure to send and receive data, and without agreed-upon language to communicate information, there could be no comprehensive response or strategy. In other words, you can build a car to get from Point A to Point B, but you won’t get very far if there are no roads. This is a story about roads.

In 2008, APHL built the APHL Informatics Messaging Services (AIMS) Platform, a messaging service for public health laboratories and agencies to transmit their influenza results to the US Centers for Disease Control and Prevention (CDC) for surveillance. Over time, AIMS went from having a handful of laboratories signed on to establishing connections with every state in the country, making, for the first time in history, near real-time national flu surveillance possible.

Today, most of the nation’s public health network—more than 200 public health laboratories and agencies, clinical and commercial labs, hospitals and medical providers, and federal agencies—uses AIMS to exchange critical health data, sending more than 25 million messages per month. AIMS now serves as a “super highway” on which testing data for several major public health initiatives flow, providing the means for national surveillance. While its functionality continues to expand, at its core AIMS ensures that important data travel fast into the right hands so that it can be actionable when it matters most.

When cases of COVID-19 began cropping up in the US, public health laboratories began getting testing up and running successfully. The public heard about assays not working, testing backlogs, overwhelmed staff, and reagent shortages. What the public didn’t hear about were the crises averted. Amidst all of the pandemic chaos, there has been at least one major positive: we already had a national data messaging platform that connects all of public health. No infrastructure had to be built; it’s been in place and growing since 2008.

When public health entities connect to AIMS, they enable faster transmission of a higher volume of data for surveillance or trend analysis. When information is exchanged through AIMS, what used to take days now takes minutes, and time saved—whether in a pandemic or in the routing and sharing of test orders and results—translates to lives saved. Doctors can make better informed decisions about patient-care when they have timely access to test results, and epidemiologists can analyze data to identify emergent threats before they become crises.

In addition to transporting data, AIMS also has portal services that automatically transform and translate data to different message formats and standards; in other words, users are able to communicate through AIMS, even if they are speaking different languages. AIMS converts messages and makes them readable to the receiver. Because of the sensitive nature of the data that flows through AIMS, AIMS takes security seriously and meets some of the most stringent security standards in the country.

AIMS also allows multiple users to take advantage of shared resources—for instance, laboratories can maintain one route on AIMS for all of their trading partners rather than having to establish and maintain an individual route with each. This is a major benefit to AIMS users. Typically, each laboratory would have to set up a connection with every entity with whom they exchange data—clinical laboratories, hospitals, public health agencies. When laboratories or agencies are on AIMS, they can condense all of their routes into a single connection and significantly reduce time and effort that would otherwise have to be dedicated to each.

In just over a month’s time, APHL worked with every single public health laboratory and agency to make sure they were able to electronically send their COVID-19 requests and results to CDC. They also worked on developing COVID-specific vocabulary and coding for testing so that when laboratories started conducting testing, they were all using the same terminology from the start. This means that all results sent to CDC were standardized—no effort or time had to be spent deciphering and comparing reports across laboratories to try and synthesize.

APHL’s job is to build and leverage technical solutions that will ease the burden on laboratories, not only for this response effort and a future of unknown threats, but to improve and simplify data exchange for public health at large on a day-to-day basis. When CDC launched its Data Modernization Initiative, it placed the urgent need for meaningful data to be sent and received faster; public health depends on information and results to be communicated quickly for surveillance, intervention and treatment. Time is critical. With the response to COVID-19, there is now a national recognition and comprehensive effort to modernize tools, technology, strategy and perceptions around data.

COVID-19 may very well prove to be a once-in-a-lifetime public health emergency. It may not. All we know is that we don’t know, and that our collective health and safety depends on having an efficient exchange mechanism in place to surveil, protect and be prepared.

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13Apr / 2020

APHL, partners garner $550M for data modernization initiative

Like many aspects of public health, the effective, efficient movement of public health data has been chronically underfunded. Faced with this perpetual issue—combined with a sharp increase in data production from new laboratory techniques that have added great volumes of data to an overburdened system—APHL joined with the Council of State and Territorial Epidemiologists, the National Association of Public Health Statistics and Information Services, and the Health Information and Management Systems Society in 2019 to engage in the first serious effort to secure federal funding for improved handling of public health data.

APHL contributed to the production of materials that quickly and easily explained the problem and urged Congress to provide $1 billion over the next ten years, at a rate of $100 million per year. With these materials in hand, APHL met with interested partners on Capitol Hill to press the case for funding. It also organized a Hill briefing for Congressional staff where subject matter experts, such as APHL member Dr. Joanne Bartkus, presented on the challenges with existing data handling processes. Dr. Anne Schuchat, Principal Deputy Director of the US Centers for Disease Control and Prevention (CDC), highlighted these same challenges in virtually every hearing where she testified on public health emergencies.

These educational activities culminated when Congresswoman Rosa DeLauro took up data modernization as one of her key initiatives in the Labor-HHS appropriations bill. Congresswoman DeLauro successfully included the first installment of $100 million for CDC to pursue the data modernization initiative in the Labor-HHS appropriations bill for fiscal year (FY) 2020. This is an unparalleled achievement in the first year of any significant effort, and one made even more remarkable considering that data management is not a particularly trendy or exciting topic.

Though the Senate never produced a Labor-HHS bill for FY 2020, but indicated that it would not accept the House amount of $100 million for data modernization, APHL persevered, continuing to work closely with Senate staff to advance the funding of the data modernization initiative. Ultimately, Congresswoman DeLauro was able to include $50 million in the final version of the bill. The COVID-19 response allowed for an additional $500 million to be directed to data modernization, and it appears that the balance of the $1 billion ($450 million) could be included in the next emergency supplemental funding bill.

APHL continues to pursue additional annual federal funding for the data management initiative, beginning with fiscal year 2021, and production of the required CDC report to Congress detailing how these federal funds will be expended in 2020 and the spend plan for the subsequent nine years.

While APHL looks forward to more nimble response to public health emergencies, such as COVID-19, due to improved public health data management, the association remains energized by the benefits to result from the $550 million already allocated to the data modernization initiative.

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27Mar / 2020

APHL and partners: COVID aid package provides much needed funding for data modernization

FOR IMMEDIATE RELEASE
March 27, 2020

Washington, D.C. – Together, the Association of Public Health Laboratories (APHL), Association of State and Territorial Health Officials (ASTHO), Council of State and Territorial Epidemiologists (CSTE), Healthcare Information & Management Systems Society (HIMSS), National Association of County and City Health Officials (NACCHO), and National Association for Public Health Statistics and Information Systems (NAPHSIS) issued the following statement in response to the Coronavirus Aid, Relief, and Economic Security (CARES) Act:

We applaud members of Congress for providing $500 million for the Data Modernization Initiative at the Centers for Disease Control and Prevention (CDC) that will transform public health data systems and save lives.

The nation faces an unprecedented challenge to address the COVID-19 pandemic. Now, more than ever, it is critical to have a strong public health surveillance system that detects and facilitates immediate responses and containment of emerging health threats. The CDC—together with state, local, territorial, and tribal health departments—have taken important steps to improve the nation’s public health data infrastructure, but due to funding shortages, this has often been in a piecemeal approach.

The COVID-19 pandemic has exposed gaps in our nation’s outdated public health data systems and a workforce struggling to keep up. The United States currently relies on error-prone, sluggish and burdensome manual and paper-based data exchange methods such as faxing and phone calls to share critical public health data, especially with the health care sector. Simply put, the virus is moving faster than the data and when data move more slowly than diseases, the American people suffer. We are watching as our leaders struggle to make critical decisions without complete data.

An integrated, high-speed, networked health system—from laboratories to health care facilities to public health authorities—with fast and reliable data is necessary in order to protect Americans from COVID-19 and future health threats. Modernization is not just network upgrades; it is a commitment to building and sustaining a world-class data workforce and data systems that are ready for the next public health emergency. The funding provided in the CARES Act is an enterprise-level commitment to build a public health data superhighway of the 21^st Century to speed the transmission of accurate, complete data.

We look forward to working with Congress to ensure sustained annual funding for CDC’s Data Modernization Initiative and with CDC in formulating its multi-year implementation plan.

Contact: Erin Morton at 202.484.1100 or emorton@dc-crd.com

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25Sep / 2019

Supporting rapid exchange of public health data is urgent, crucial and laden with challenges

By Jody DeVoll, advisor, communications, APHL

In an era when digital communications move at blazing speeds, public health laboratories still have to resort to fax, email or phone to exchange data with some partners. Yet, this is only one of the obstacles to rapid exchange of critical public health laboratory data needed for public health surveillance, emergency response and patient care.

The volume of public health laboratory data presents an obstacle in and of itself. Infectious diseases, environmental toxins, foodborne illnesses, radiological exposure, hazardous chemicals, high consequence pathogens, antibiotic resistance: public health laboratories test them all. Add to this exponential increases in volume from the expansion of advanced molecular technologies like next-generation and whole genome sequencing, and the result is terabytes of data that public health laboratories must manage, interpret, store and share.

In addition, dozens of different, stand-alone systems make programming and maintenance of laboratory reporting systems labor-intensive and costly. For example, the US Centers for Disease Control and Prevention (CDC) maintains over 100 surveillance programs, each with its own reporting system. Dari Shirazi, APHL’s health information technology manager, explains how these many systems affect public health laboratory operations: “It’s as though you have a houseful of furniture to arrange in dozens and dozens of different houses and, periodically, you receive shipments of additional furniture that also has to be arranged.”

Of course, CDC is not public health laboratories’ only data exchange partner. Other federal partners, state and local health agencies, hospitals and others also require laboratory data, and they too want it parsed and transmitted through their proprietary systems.

With all these demands, data scientists at public health laboratories face a mountain of work, yet their numbers are few. The number of graduates in public health informatics has not kept pace with demands for workers from public and private sector institutions. As a result, graduates can choose from an array of positions, and they often choose private sector jobs which tend to be higher paying and longer-term than lower-salaried, time-limited positions at a public health laboratory.

Huge data volumes, a multitude of reporting systems and a shortage of public health data scientists make data exchange a laborious, costly and frustrating enterprise for public health laboratories. However, the implications extend beyond laboratories to the populations the data is intended to protect, in other words, us. According to Peter Kyriacopoulos, APHL’s senior policy director, “We are fast approaching the confluence of events on the management of public health data that threatens the very relevance of governmental public health. The volume of data generated by new laboratory technologies adds to the burden of over 100 inefficient data reporting systems that each have been designed to move specific information to a point at CDC, which constrains the utility of that information.

Fortunately, there are signs of change. Four national health organizations — APHL, the Healthcare Information and Management Systems Society (HIMSS), the Council of State and Territorial Epidemiologists (CSTE) and the National Association for Public Health Statistics and Information Systems (NAPHSIS) – launched the Data: Elemental to Health campaign calling for a $1 billion investment in congressional funding over the next decade to modernize public health data/IT systems and develop a skilled workforce of data/IT specialists. Under the plan, state, local, tribal and territorial health departments would receive direct funding for these purposes through the CDC.

Over the last six months, the campaign has convened stakeholders, made the case for improved data systems to congressional and administration staff, appeared before the House Appropriations Subcommittee, hosted Hill briefings and organized a Day of Digital Action. Already there are results:

The House appropriations bill includes $100 million in fiscal 2020 for public health data systems and workforce modernization
The House LIFT America Act authorizes $100 million per year for five years to develop public health data systems and train staff
The Senate Saving Lives Through Better Data Act authorizes $100 million per year for five years for systems and people
The Senate Lower Health Care Costs Act authorizes “such sums as may be necessary” over five years to modernize data systems.

How would legislation initiated through the campaign support public health laboratories? First and foremost, it would help them to strengthen their LIMS. Shirazi explains, “A LIMS is a living, breathing thing that has to grow with lab needs. These needs change every year as the lab takes on new and novel types of testing.” Building LIMS capacity would enable laboratories to expand capability for data capacity, exchange and analytics; eliminate manual entry of test results; and provide secure, instantaneous communication of results to health partners. In addition, legislation initiated through the campaign would underwrite laboratory systems for exchange of electronic health records, National Notifiable Disease Surveillance System data, vital health records (e.g., notices of births and deaths) and other public health surveillance data.

Looking forward, the US would do well to complement the advances initiated under the Data: Elemental to Health campaign with a data transfer solution that consolidates all public health data systems into one. Kyriacopoulos notes that: “the creation of a single reporting site, that multiple data providers and users can report to and receive information from, would be a significant improvement that would allow for the efficient and comprehensive use of this data throughout the federal/state/local public health system.”

Photo credit: James Marvin Phelps

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12Feb / 2019

New lab informatics courses introduce basics to non-specialists

Two online laboratory informatics courses now on the CDC TRAIN site help laboratory staff to understand how their jobs relate to their laboratory’s informatics system. Developed by APHL and the Centers for Disease Control and Prevention (CDC) in collaboration with the APHL Informatics Committee and members of the target audience, the courses follow a TB specimen as it advances through testing and reporting to inform decisions by clinical care providers and public health agencies.

Historically the term “informatics” evoked fear among laboratory staff who avoided the unfamiliar discipline. Responsibility for the function often devolved to one person who became the de facto informatician more by accident than by intent. When the new skill set proved highly marketable, this individual often departed for new opportunities, leaving the laboratory with no one who could distinguish between LOINC and SNOMED codes, much less maintain the Laboratory Information Management System.

But times have changed. With electronic data now integral to work at both private and public sector laboratories, all staff require a basic knowledge of informatics. With an understanding of how the data they touch flows in and out of their facility, staff can improve the quality and speed of laboratory operations and, ultimately, patient treatment and disease control.

The two online courses, Life of a Specimen and Life of a Result, trace the testing and reporting process in plain language, explaining who comes into contact with the specimen at each point, when errors are most likely to occur and how to avoid them, and how a specimen becomes a result and is reported to stakeholders. Both courses offer P.A.C.E.® credits. Visit CDC TRAIN to register.

Specifically:

Life of a Specimen introduces staff roles in laboratory informatics, data relationships, data quality and standards, and the generation and flow of information as a specimen progresses through the pre-analytic, analytic and post-analytic phases.
Life of a Result examines how data and information move through and outside the laboratory to impact clinical care and public health decision making. It covers the recipients of laboratory data, data and results storage, and communication of data and results to stakeholders.

The two courses would be a valuable addition to staff onboarding programs at laboratories of all types. Keith Higginbotham, IT systems manager at the Alabama Department of Public Health, laments that such training was not available earlier in his career:

“I wish I’d had access to this training when I was first starting out. It condenses a year’s worth of knowledge into a few hours, giving lab staff from all backgrounds a real head start. Those in leadership can become stronger advocates for their labs by better understanding their informatics needs and capabilities.”

A third course, which takes the student on a deeper journey into Laboratory Information Management Systems (LIMS), is in production and slated for release in 2019.

The post New lab informatics courses introduce basics to non-specialists appeared first on APHL Lab Blog.

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08Feb / 2019

Lab Culture Ep. 17: Exploring bioinformatics: From fellow to full time in Virginia

Kevin Libuit went from the APHL-CDC Bioinformatics Fellowship to a contractor to working full-time as a bioinformatician at the Virginia state lab (VA Division of Consolidated Laboratory Services (DCLS)). First he talks about when he discovered bioinformatics as a field and how the fellowship propelled his career. Then Kevin takes the mic and interviews Dr. Denise Toney, director of Virginia DCLS, about the value and growing need for bioinformaticians in public health labs.

Kevin G. Libuit, M.S.
Bioinformatics Lead Scientist, Division of Consolidated Laboratory Services (DCLS), Virginia Department of General Services

Denise Toney, PhD
Director, Division of Consolidated Laboratory Services (DCLS), Virginia Department of General Services

Links:

APHL-CDC Fellowships

APHL-CDC Bioinformatics Fellowships

Virginia Division of Consolidated Laboratory Services (DCLS)

APHL Off the Bench (new Facebook group!)

The post Lab Culture Ep. 17: Exploring bioinformatics: From fellow to full time in Virginia appeared first on APHL Lab Blog.

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Category Archives: informatics

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Connecting the COVID-19 dots with technology

Bringing COVID-19 exposure notification to the public health community

Moving data at the speed of a virus

APHL, partners garner $550M for data modernization initiative

APHL and partners: COVID aid package provides much needed funding for data modernization

Supporting rapid exchange of public health data is urgent, crucial and laden with challenges

New lab informatics courses introduce basics to non-specialists

Lab Culture Ep. 17: Exploring bioinformatics: From fellow to full time in Virginia

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