Cbbs And Cbbs Projects

A computer-based biosurveillance system (CBBS) collects and analyzes surveillance data. A CBBS project manager must understand not only generic project management but also the information technology (IT) underlying a project and how such a project differs from a typical IT project.

Common IT elements found in a CBBS include the following:

• A data warehouse as a data repository for the often very large databases (VLDBs).

• Data mining and statistical tools to analyze the data in the data warehouse.

• Extract, transform, and load (ETL) tools to prepare data to be added to the data warehouse. This preparation could include field mapping, data standardization, data parsing, and data interpretation.

• Messaging components to "listen" for data newly available.

• Reporting and visualization tools.

• Geographical information systems (GIS) to support spatial analysis of the data.

• Notification systems sending alerts based on CBBS analysis.

Figure 36.1 shows the elements of the RODS (Real-Time Outbreak Detection System) developed by the University of Pittsburgh. That system includes nearly all the elements described above.

Defining characteristics of CBBS projects include the following:

• Data providers are typically entities separate from the CBBS owner. The U.S. Department of Health and Human Services recommends that CBBS use "some of the extensive information that is already collected in automated form in the process of medical care delivery or administration of medical care benefits" (Lazarus et al., 2001). Existing CBBSs use data collected by government entities, care providers, pharmacies, and clearinghouses ( Lazarus et al., 2001; Hoffman et al., 2003; Lombardo et al., 2003; Mostashari et al., 2003).

Existing CBBSs also use nonclinical data, including school and work absenteeism reports (Lombardo et al., 2003).

• The quality of the data others provide is not usually known from the outset. Recipients of data from outside the CBBS must evaluate the quality of that data, because validity of the CBBS data depends on source data quality (Buehler et al., 2004).

• Data often include health information, which is subject to Health Insurance Portability and Accountability Act (HIPAA) and other privacy regulations. Organizations providing the data may require legal agreements describing the intended use of the data, as well as the users that will have access to the data. To address data security and confidentiality, the CBBS may need to implement a variety of functions, including user authentication, user-specific filters restricting data access to appropriate subsets of the data, and de-identification schemes.

• De-identified data to protect data privacy complicates processing to protect against the same incident being reported by more than one data source. Without the identifying information checking for and removing duplicates, de-duplicating presents significant challenges (Lombardo et al., 2003).

• Data are provided by multiple sources. CBBS projects must address the key issues described above for each source of data. Project teams must re-evaluate the effectiveness of any de-identification schemes with the addition of new data sources, because additional data changes the outcome of de-identification statistical analysis.

• Systems are designed for incremental addition of data from new sources and analysis tools. CBBS often includes flexible frameworks designed to allow rapid addition of new data, and new analysis tools. Building effective frameworks for the future addition of unknown data and tools requires significant software engineering expertise.

• CBBS is a quickly evolving field, and for example, no single analysis methodology has proven to meet all the requirements (Moore et al., 2002).The implication of this evolution

figure 36.1 University of Pittsburgh RODS. (From Espino et al.,2004.)

is that CBBS project management will likely need to address not only changing requirements but also the rapid evolution of potential solutions. • Few commercially available off-the-shelf CBBSs are available, with no clear market leader at this time.

The balance of this chapter describes the project management implications of the technology elements included within CBBS and the defining characteristics of CBBS projects.

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