Information Sharing and Collaboration

APPLICATIONS TO INTEGRATED BIOSURVEILLANCE
WORKSHOP SUMMARY

Deepali M. Patel and Steve Olson, Rapporteurs

Planning Committee on Information-Sharing Models and
Guidelines for Collaboration: Applications to an Integrated One
Health Biosurveillance Strategy

A Workshop

Board on Health Sciences Policy

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
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Information Sharing and Collaboration APPLICATIONS TO INTEGRATED BIOSURVEILLANCE WORKSHOP SUMMARY Deepali M. Patel and Steve Olson, Rapporteurs Planning Committee on Information-Sharing Models and Guidelines for Collaboration: Applications to an Integrated One Health Biosurveillance Strategy A Workshop Board on Health Sciences Policy

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This study was supported by Contract No. HSHQDC-08-C-00111 between the National Academy of Sciences and the Department of Homeland Security. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-22403-1 International Standard Book Number-10: 0-309-22403-9 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624- 6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2012 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2012. Information sharing and collaboration: Applications to integrated biosurveillance: Workshop summary. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE ON INFORMATION-SHARING MODELS AND GUIDELINES FOR COLLABORATION: APPLICATIONS TO AN INTEGRATED ONE HEALTH BIOSURVEILLANCE STRATEGY—A WORKSHOP1 SCOTT A. MUGNO (Co-chair), Vice President, Safety and Maintenance, FedEx Ground, Moon Township, PA WILLIAM F. RAUB (Co-chair), Retired, Senior Advisor to the Secretary, Department of Health and Human Services, Rockville, MD JAMES W. BUEHLER, Director, Public Health Surveillance Program Office, Office of Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA JOSEPH KIELMAN, Chief Scientist, Infrastructure Protection and Disaster Management Division, and Program Manager, Office of University Programs, Department of Homeland Security Science and Technology Directorate, Washington, DC RICHARD C. LARSON, Mitsui Professor of Engineering Systems, and Director, Center for Engineering Systems Fundamentals, Massachusetts Institute of Technology, Cambridge, MA MARK E. TEACHMAN, Director, Interagency Coordination, National Center for Animal Health Emergency Management, Department of Agriculture, Riverdale, MD MICHAEL M. WAGNER, Associate Professor of Biomedical Informatics and Intelligent Systems, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA Study Staff CATHARYN T. LIVERMAN, Senior Program Officer DEEPALI M. PATEL, Program Officer LARA STRAWBRIDGE, Research Associate JUDY ESTEP, Program Associate PAMELLA ATAYI, Senior Program Assistant MEGAN PEREZ, Senior Program Assistant VICTORIA BOWMAN, Financial Associate 1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its pub- lished report as sound as possible and to ensure that the report meets in- stitutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confi- dential to protect the integrity of the process. We wish to thank the fol- lowing individuals for their review of this report: James Buehler, Director, Public Health Surveillance Program Office, Centers for Disease Control and Prevention, Department of Health and Human Services Joseph Gibson, Director of Epidemiology, The Marion County Public Health Department Amy Kircher, Associate Director, National Center for Food Protection and Defense, University of Minnesota Scott A. Mugno, Vice President, Safety and Maintenance, FedEx Ground Although the reviewers listed above have provided many construc- tive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was over- seen by Claire V. Broome, Adjunct Professor, Division of Global Health, Rollins School of Public Health, Emory University. Appointed by the Institute of Medicine, she was responsible for making certain that an independent examination of this report was carried out in accordance vii

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viii REVIEWERS with institutional procedures and that all review comments were careful- ly considered. Responsibility for the final content of this report rests en- tirely with the authors and the institution.

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Contents ACRONYMS xi 1 INTRODUCTION AND OVERVIEW 1 Status of National Biosurveillance Integration, 3 Overview of the Workshop, 5 Organization of This Summary, 6 Acknowledgments, 7 2 EXPERIENCES OF FEDERAL AGENCIES 9 Responding to Epidemics at the Centers for Disease Control and Prevention, 9 Coordinating Animal Health Actions Across the Human-Animal Interface, 13 Integrating Complex National Missions: Lessons from the National Counterterrorism Center’s Directorate of Strategic Operational Planning, 16 Viewpoint of the National Security Staff, 20 3 STATE AND LOCAL EXPERIENCES 23 Biological Preparedness and Response in New York City, 23 Seeking Access to Surveillance Data in Marion County, Indiana, 27 Information Sharing for Biosurveillance in North Carolina, 31 4 OUTSIDE PERSPECTIVES 35 Keeping Pace with Data Collections in a Rapidly Changing Environment, 35 Information Sharing: The Israeli Experience, 37 ix

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x CONTENTS 5 DISCUSSION OF A SCENARIO 41 First Move, 42 Second Move, 45 Third Move, 49 Fourth Move, 51 Fifth Move, 55 6 CONCEPT OF OPERATIONS 57 A Focus on Performance Improvement, 57 Operational and Organizational Impacts, 61 Operational Realities, 63 A Regional Solution, 65 Discussion, 66 REFERENCES 69 APPENDIXES A Workshop Agenda 71 B Speaker Biographies 79 C Planning Committee Biographies 93 D Standing Committee on Health Threats Resilience 99

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Acronyms AFHSC Armed Forces Health Surveillance Center APHIS Animal and Plant Health Inspection Service BATR biological assessment threat response BCU Biosurveillance Coordination Unit (renamed in 2009 as Biosurveillance Coordination Activity) CDC Centers for Disease Control and Prevention CONOPS concept of operations DHS Department of Homeland Security DOD Department of Defense DSOP Directorate of Strategic Operational Planning EOC emergency operation center FBI Federal Bureau of Investigation FDA Food and Drug Administration FSIS Food Safety Inspection Service GAO Government Accountability Office HHS Department of Health and Human Services HSPD Homeland Security Presidential Directive IDF Israeli Defense Forces IOM Institute of Medicine xi

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xii ACRONYMS MACFIO Multiple Agency Coordination Foodborne Illness Outbreak NBAS National Biosurveillance Advisory Subcommittee NBIC National Biosurveillance Integration Center NBIS National Biosurveillance Integration System NC-DETECT North Carolina Disease Event Tracking and Epidemiologic Collection Tool NC DHHS North Carolina Department of Health and Human Services NCTC National Counterterrorism Center NSS National Security Staff OIG Office of Inspector General OODA observe, orient, decide, and act STEC Shiga toxin-producing Escherichia coli USDA Department of Agriculture