BioSense is a CDC initiative to support enhanced early detection, quantification, and localization of possible biologic terrorism attacks and other events of public health concern on a national level. The goals of the BioSense initiative are to advance early detection by providing the standards, infrastructure, and data acquisition for near real-time reporting, analytic evaluation and implementation, and early event detection support for state and local public health officials. BioSense collects and analyzes Department of Defense and Department of Veterans Affairs ambulatory clinical diagnoses and procedures and Laboratory Corporation of America laboratory-test orders. The application summarizes and presents analytical results and data visualizations by source, day, and syndrome for each ZIP code, state, and metropolitan area through maps, graphs, and tables. An initial proof of a concept evaluation project was conducted before the system was made available to state and local users in April 2004. User recruitment involved identifying and training BioSense administrators and users from state and local health departments. User support has been an essential component of the implementation and enhancement process. CDC initiated the BioIntelligence Center (BIC) in June 2004 to conduct internal monitoring of BioSense national data daily. BIC staff have supported state and local system monitoring, conducted data anomaly inquiries, and communicated with state and local public health officials. Substantial investments will be made in providing regional, state, and local data for early event detection and situational awareness, test beds for data and algorithm evaluation, detection algorithm development, and data management technologies, while maintaining the focus on state and local public health needs.

The BioSense Initiative

BioSense is a CDC initiative to support enhanced early detection and situational awareness for possible biologic terrorism attacks and other events of public health concern on a national level. It is the primary early event detection component of CDC's Public Health Information Network (1). BioSense Initiative goals include the advancement of analytics for pre-diagnostic and diagnostic data; collaboration with state, local, and regional systems to provide data in near-real time; increased sharing of approaches and technology among federal, state, and local levels of public health; and the promotion of national standards and specifications to ensure integration with other public health systems (2).

The BioSense software application and the BioIntelligence Center (BIC) are two key components of CDC's BioSense Initiative. The BioSense application is an Internet-based software system for collecting, analyzing, and visualizing data reported to BioSense. Since June 2004, BIC has conducted monitoring and investigation of BioSense national data daily and supports state and local system monitoring and data anomaly investigations. Although the BioSense Initiative involves broader activities in the public health context, this report is primarily focuses on surveillance use of the BioSense application.

The BioSense Application

Overview

The purpose of the BioSense application is to provide early event detection and situational awareness critical for biologic terrorism surveillance and routine public health event management. BioSense uses near-real time reporting of health data, performing analysis and data visualization techniques on diagnostic and pre-diagnostic electronic data sources and providing the results to state and local public health departments for use in detecting and characterizing events of potential public health importance. BioSense summarizes and presents analytical results and data visualizations by source, day, and syndrome for each state and metropolitan area (MRA) through maps, graphs, and tables. States and MRA jurisdictions are defined by a set of ZIP codes.

Data Sources

BioSense has implemented three national data sources: Department of Defense (DoD) Military Treatment Facilities, Department of Veterans Affairs (VA) treatment facilities, and Laboratory Corporation of American (LabCorp[R]) test orders. Approximately 700 DoD and 1,100 VA medical facilities report data to BioSense (3,4). LabCorp operates a nationwide network of 31 primary testing locations and more than 1,100 patient service centers (5). Data are received and analyzed daily and historical data are available; DoD data have been collected since May 2003; VA, December 2003; and LabCorp, June 2004. Since October 2004, the average number of daily records received for DoD has been 98,000; VA, 151,800; and LabCorp, 137,600. Both DoD and VA provide ambulatory-care data in the form of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes and current procedural terminology (CPT[R]) medical procedure codes. LabCorp provides test orders and ICD-9-CM codes associated with the reason for the orders. All data sources include additional information with each record (e.g., patient age, sex, ZIP code of residence, and facility identifier and ZIP code). Experts from different agencies participated in mapping each data source to 11 syndrome categories: botulism-like, fever, gastrointestinal, hemorrhagic illness, localized cutaneous lesion, lymphadenitis, neurologic, rash, respiratory, severe illness and death, and specific infection (6,7).