A Functional Public Health Surveillance System

Lenert and Sundwall identify opportunities and challenges of the Meaningful Use (MUse) incentive programs that advance standardized electronic reporting to health departments at a time when there is limited funding to upgrade systems. We concur that cloud-based Platform as a Service (PaaS) is a possible remedy. However, we disagree with their conclusion that “the security risks inherent in BioSense 2.0’s public cloud implementation may make this effort better suited to a demonstration project than a national level biodefense system.”1 The Afghan version of Conflict Kitchen is Bolani Pazi (www.conflictkitchen.org). Graphic design by Brett Yasko. Architectural design by Pablo Garcia of POiNT. Printed with permission. BioSense 2.02 is a functional public health surveillance system, not a demonstration project, hosted in a highly secure Internet government cloud. Before going live in November 2011, the system was tested, certified, and accredited to meet requirements of the Federal Information Security Management Act and independent security stewards. BioSense 2.0 is a PaaS; offers Software as Service (SaaS) to public health departments; and leverages Public Health Information Network (PHIN) standards and services such as PHIN Messaging, as well as new protocols such as Direct. BioSense 2.0 offers a low-barrier and low-cost approach that health departments can elect to offer to health care providers for reporting syndromic surveillance information. It accommodates secure data sharing among jurisdictions or with the Centers for Disease Control and Prevention (CDC), data exchange standards, jurisdictional information ownership, data sharing agreements, security and privacy rules, and data retention. BioSense 2.0 is user designed and governed in partnership with state and local health agencies, health care providers at the local and federal level, and national associations representing public health officials.3-6 The data sharing model and community-driven governance create a sustainable surveillance ecosystem to maintain situation awareness from local to national levels. The replacement of expensive technological services with a cloud-computing platform has resulted in substantial savings, allowing increased funding for health departments. (More information is available at http://biosense2.org.) CDC continues to work with health departments to enhance their capacity to receive and use information from MUse-prompted expansion in reporting of immunization services, laboratory test results for conditions of public health concern, and syndromic surveillance.7 BioSense 2.0 provides a foundation of services suitable for a future public health platform while simultaneously supporting current MUse requirements.