Digital Disease Detection
The ability to rapidly recognize and respond to both global and local health threats is a critical public health priority. The digital world provides an unprecedented opportunity to develop novel tools that provide solutions capable of mitigating public health emergencies. Digital Disease Detection has been made possible by the growing influence of internet technology, which has significantly changed the landscape of public health surveillance and epidemic intelligence gathering. EHA’s contribution to the field of Digital Disease Detection helps identify both global and local health threats.
FOOD SAFETY MODERNIZATION ACT (FSMA)
Eagle Health Analytics is honored to be selected as a prime contractor providing subject matter expertise to the Food and Drug Administration (FDA) leadership for both novel technology development and policy support during FDA’s implementation of the Food Safety Modernization Act (FSMA). This initiative was announced on April 30, 2019, by acting FDA Commissioner, Dr. Ned Sharpless, and Deputy Commissioner for Food Policy and Response, Frank Yiannas.
EHA provides technical guidance for the development of a Strategic Blueprint that outlines FDA’s plans to leverage technology and other tools to create a more digital, traceable, and safer food system. This work builds on past advances in FDA’s implementation of the FSMA and expands the use of current technologies including blockchain, sensor technology, the Internet of Things, and artificial intelligence.
A detailed explanation of FDA’s Technology Modernization Action Plan (TMAP) can be found online here.
BIOMOSAIC
The BioMosaic Project was launched in 2011 and is a collaborative effort between the CDC’s Division of Global Migration and Quarantine, Harvard University, and the University of Toronto.
The BioMosaic tool consolidates complex data from multiple sources into a unified visual format. This format greatly enhances CDC Public Health Officials’ ability to view census data, migration patterns, and health statuses simultaneously to help identify countries where international travel may influence the spread of emerging diseases. EHA scientists developed BioMosaic to perform as both web-based and mobile-based tool to investigate scientific, social, and public health issues. BioMosaic uses computer-supported, visually enabled analysis of the geospatial data related to mobile populations, and it performs risk assessment and data management. The emergencies that EHA has addressed using the BioMosaic includes tracking and containing Middle Eastern Respiratory Diseases Syndrome (MERS-CoV), the Ebola outbreak, and the spread of Zika virus in North and South America.
INVENTION OF EDN AND COORDINATION WITH EMEDICAL USA
Key EHA personnel involved in the creation of the BioMosaic developed an electronic medical record (EMR) system that specifically addresses the need to digitize paper/hardcopy medical records provided by immigrants, refugees, and displaced persons upon entry to the United States and in many international locations. The Electronic Disease Notification system (EDN) is utilized by public health professionals from the Division of Global Migration and Quarantine (DGMQ) and their partner organizations; EDN allows any document to be scanned or faxed to centralized data entry personal for manual upload into the EMR system. EDN is complementary to the national immigrant EMR system called eMedical USA. This cooperative effort improves access to medical history, improves the quality of medical exams, reduces the risk of missed pre-existing diseases (e.g., tuberculosis), and reduces the national public health burden. EDN is currently nearing the release of its 2.0 iteration.
MOBILE APPLICATION DEVELOPMENT FOR CHIKUNGUNYA AND DENGUE FEVER
EHA supported Digital Disease Detection requirements for the CDC’s Division of Global Migration & Quarantine (DGMQ) through the launch of the Kindenga mobile app. Kindenga, available on iTunes, was developed through a collaborative effort between EHA scientists in the CDC’s DGMQ and the University of Arizona. This app provides an early warning of outbreaks of mosquito-borne diseases in the region of the U.S.-Mexico border; the interface utilizes weekly user surveys to screen for the symptoms of the Dengue, Chikungunya, and Zika. Positive user responses are pushed anonymously in real-time to HealthMap, the leading on-line resource for disease outbreak monitoring.
This critical area of EHA’s support aligns directly with the dimension of DGMQ’s public health mission that addresses preparedness and response as core approaches to reduce the probability that communicable diseases are introduced, transmitted, or spread.
Zika Pregnancy of Interest Navigation Tool (Z-POINT)
During an emergency response, the collection of surveillance data must be rapid and dynamic. However, in the case of the Zika Emergency Response, clinical experts needed to carefully review the data to classify cases according to standardized surveillance case definitions. To streamline Zika emergency response analytics and simplify the complex review process, the Zika Pregnancy of Interest Navigation Tool (Z-POINT) was created. This tool intuitively presents a vast amount of maternal and infant data, automatically performs calculations, and allows the reviewer to record decisions about case classification.
Development of Z-POINT within the Microsoft Access platform required advanced working knowledge of SQL and VBA languages. Substantial time and human resources were allocated for both initial system development and for updates concurrent with changes to data (e.g., format, structure, management) or adjustments to surveillance case definitions. Z-POINT dramatically reduced workload for case review by re-formatting data, performing complex calculations, and writing complex clinical data summaries; CDC and EHA scientists have used this tool to review over 30,000 records (including repeats). To date, fourteen versions of Z-POINT have been successfully designed to interface with a diversity of data sets created as part of the CDC response to Zika virus (ZIKV), domestically and internationally. Z-POINT has allowed for rapid review and analysis of data that has been critical to understanding ZIKV infection during pregnancy and informing clinical guidance for the care of affected pregnant women and infants.
Following the emergence of SARS-CoV-2 in late 2019, the process used to develop Z-POINT was applied to data review needs related to the pandemic. Consideration was given to the resource costs and benefits of developing a new customized data system rather than adapting existing data systems for public health emergency use, and it was determined that there was indeed a niche for a new system. Because of the proven success of Z-POINT, a new version has been created (SET-POINT) which is currently being used for COVID-19 emergency response analytical efforts.
The preceding Z-POINT summary was provided by John F. Nahabedian III in collaboration with Nicole Roth, Sascha Ellington, and Romeo R. Galang.
GLOBAL DISEASE DETECTION
EHA provides advanced capabilities to the Global Disease Detection Operations Center (GDDOC) within the Division of Global Health Protection (DGHP). EHA scientists provide guidance to this CDC platform that is dedicated to detecting and monitoring global public health events of international importance.
The GDDOC monitors outbreaks from infectious and non-infectious causes, including public health events attributable to disasters, intoxication, and chemical, radiological, or nuclear events, to identify new or unexplained public health threats. Animal outbreaks of diseases that can be transmitted to humans (zoonotic diseases) are also monitored. EHA provides expertise to the GDD Operations Center that includes global risk and event-based surveillance, operational support, and financial support for some of CDC’s international deployments.