Government Solutions

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Capitol Hill Steering Committee on Telehealth and
Healthcare Informatics "IT Tools Toward Public
Health, Safety Biosurveillance  Nationwide
Lab Data for Biosurveillance A View from Two
Industries ATT and Quest Diagnostics Eileen
Koski, M.Phil. Quest Diagnostics Incorporated
Greg Kinne ATT Government Solutions March 9,
2005
Government Solutions
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ATT / Quest DiagnosticsPublic Health
Surveillance System

• Mission Statement
• To deploy a scalable local / national
  surveillance infrastructure
• Key Components
• Sentinel identification of health-related
  anomalies
• Rapid and effective management and dissemination
  of alerts
• Support investigation of anomaly causes and
  trends
• Integration of health data via web services

Government Solutions
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ATT / Quest Diagnostics Team
Government Solutions
Government Solutions
Quest Diagnostics Incorporated
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ATT / Quest Diagnostics Team Quest Diagnostics
Background

• Nations leading provider of diagnostic testing,
  information and services
• Broadest menu of diagnostic tests including
  cardiovascular, cancer, infectious disease and
  anatomic pathology
• More than 85 new tests introduced each year
• Leading provider of esoteric testing, including
  gene-based medical testing
• Six Sigma initiative
• The Goal Virtual Perfection (million opportunities)

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Laboratory Industry Overview

• Test results affect 70 of health care
  decisions, but represent only 3 of health care
  spending
• Test results help physicians to diagnose disease,
  select treatment and monitor treatment
  effectiveness

Virtually nothing happens in healthcare without
a lab test result
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Diagnostic Testing Market
Quest Diagnostics is the Industry Leader
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Quest Diagnostics Reach

• 33 Major Regional Laboratories
• 2 Esoteric Testing Centers
• 140 Rapid Response Laboratories
• 2,000 Patient Service Centers (PSCs)
• 4,000 Logistic Vehicles and 19 Airplanes
• Serve more than one-half of U.S. physicians and
  hospitals
• Serve over 90 million lives covered by managed
  care organizations and third-party insurers

140 Million Patient Encounters Annually
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ATT Government Solutions
A trusted, flexible and responsive IT solutions
Integrator serving all sectors of the Federal
Government

• Extensive professional services expertise
• Comprehensive portfolio of voice, data, IP,
  hosting, security, and managed services
• Integrated Global Enterprise Management System
• Support from thousands of scientists, engineers,
  analysts, program managers, and other
  professionals with security clearances
• Experience as a flexible prime or subcontractor
  with industry leading integrators as well as
  large and small businesses
• Innovative technologies from ATT Labs and other
  partners

ATT Government Solutions Integrated
solutions from a trusted sourcesm
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Extensive Professional Services Capabilities

• Information Systems Engineering
• Systems Lifecycle Management
• Data Engineering
• Network Engineering
• Software Engineering
• Information Security
• Modeling Simulation
• E-Commerce
• Scientific Engineering
• Modeling Simulation
• C4I Infrastructure
• Sensor Radar Technology
• Information Warfare
• Manufacturing Technology
• Space Operations Analysis
• Physical Prototype

• Knowledge Engineering
• Data Warehousing/ Repository Development
• Data Mining
• Multiple Source Acquisition Translation/Transfor
  mation
• Knowledge-Based Systems
• Information Visualization
• Web Site Development
• Specialized Support Consulting
• Strategic Consulting
• Systems/COTS Integration
• Project Management
• Technical Studies Analysis
• Test Evaluation
• Cost Analysis
• EAP

ATT Government Solutions Integrated
solutions from a trusted sourcesm
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Delivering Real Solutions

• GSA FirstGov.gov, NASA.gov and DOJ.gov design,
  build and manage official US government portals
• FTC design, build and manage national Do Not
  Call registry
• Army develop next generation battlefield
  simulation and training system underlying
  network
• Centers for Medicare/ Medicaid Services operate
  and manage data network in support of the
  nations Medicare system
• Marine Corps web-based system to aid Marines
  returning to civilian life
• Department of State support for passport
  registration and status system
• FDA managed web hosting, custom integration and
  professional services team supporting FDA portal
• Treasury manage IRS tax season information
  needs
• DISA DVSG global video teleconference bridging
  service for DoD

ATT Government Solutions Integrated
solutions from a trusted sourcesm
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ATT Labs

• 120 years of innovation at least one patent
  application each day

Middletown, NJ
Menlo Park, CA
Florham Park, NJ
About Us
Comprised of 5,000 of the worlds most prolific
inventors innovators, ATT Labs is the
innovation engine behind ATTsworld-class
technology and solutions
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ATT Labs Technologies
ATT Labs

• World leader in Very Large Database (VLDB)
  Management Technology
• ATTs DaytonaTM Data Management easily handles
  multi-terabyte databases.
• Won top awards in 2003 Winter Corporation TopTen
  VLDB Survey
• Real-Time Data Mining and Anomaly Detection
  Techniques
• Various anomaly detection techniques that have
  been applied reliably at massive scale in fraud
  detection.
• Signature, Hancock, Community of Interest (COI)
• Efficient Case Management
• Visualization
• Notification
• CHAINTM-EMNSM for Alert/Notification Management
• System Security, Accessibility, Reliability and
  Availability
• Comprehensive portfolio of network-centric
  services
• 21 State-of-the-art Internet Data Centers
  worldwide, with 2 million square feet of hosting
  space
• Over 3,500 Terabytes of data transported per day

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ATT Labs Research
ATT Proprietary 2005 Do Not
Distribute
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Anomaly Detection for Biosurveillance

• Traditional Surveillance
• Based primarily on confirmed occurrences of known
  conditions
• Variability in conditions reported in different
  jurisdictions
• Syndromic Surveillance
• Based on recognizing patterns of behavior
  consistent with symptoms typical of a condition
  of public health concern
• Anomaly Detection
• Large scale application of signal detection,
  pattern analysis and signal resolution to
  identify patterns of concern to public health
• Bio-terrorism
• Emerging Infectious disease
• Environmental effects
• Significant changes in chronic disease patterns

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ATT / Quest Diagnostics TeamQuest Diagnostics
Data Attributes

• The Worlds Largest Private Database of Clinical
  Test Results
• 140 million patient encounters annually
• 300 million diagnostic laboratory tests annually
• 6.5 million gene-based tests annually
• 7-8 Million individual laboratory result values
  daily
• Tests ordered by 300,000 individual physicians
  annually
• Representative of US population distribution
• National geographic coverage
• Representative distribution based on age, gender
  and ethnicity
• Compatible with overall US Health Information
  Technology (HIT) strategy

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ATT / Quest Diagnostics TeamQuest Diagnostics
Data Attributes

• What is NHII?
• The National Health Information Infrastructure
  (NHII) is
• an initiative set forth to improve the
  effectiveness, efficiency and overall quality of
  health and health care in the United States
• a comprehensive knowledge-based network of
  interoperable systems of clinical, public health,
  and personal health information that would
  improve decision-making by making health
  information available when and where it is
  needed.
• the set of technologies, standards, applications,
  systems, values, and laws that support all facets
  of individual health, health care, and public
  health.
• voluntary
• NOT a centralized database of medical records or
  a government regulation

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ATT / Quest Diagnostics TeamQuest Diagnostics
Advantages

• Access to data not generally available via
  existing surveillance streams
• Data available in aggregated form
• Data properly de-identified for HIPAA compliance
• Deep visibility of out-patient/physician office
  testing segment
• Availability of data at county, state, and
  national levels
• Single source electronic reporting of national
  surveillance data for
• Bio-terrorism and emerging infectious disease
  detection
• Enhanced surveillance for other issues of public
  health concern
• Investigation of cross-jurisdictional
  anomalies/outbreaks
• Availability of denominator data
• Large normative data pool for routine tests

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ATT / Quest Diagnostics TeamQuest Diagnostics
Experience

• History of Collaboration and Innovation in Public
  Health
• Prototype Syndromic Surveillance investigation of
  West Nile Encephalitis and Legionella with CDC,
  2000 Joint presentation with CDC at ICEID, 2000
• MRSA prevalence project for CDC, 2003
• Assisted CDC with possible Legionella outbreak
  investigation, 2003
• JAMIA publication on Syndromic Surveillance, 2004
• HCV Awareness Campaign assessment for CDC, 2004
• Assisted NYC DOHMH with investigation of highly
  resistant HIV strain, 2005
• Influenza Monitoring Project for CDC, 2004-5
  (on-going)

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ATT LabsComprehensive Approach to Data Mining
NETWORK
Operability and Auditability

• Data Transport
• Data Collection
• Data Sampling
• Data Compression

Data Validation End to end audits and
controls Highly Available/maintainable systems
SYSTEMS AND SOFTWARE

• Massive Data Ingesting
• Scalable Architecture
• Parallel Analytics
• High performing/
• Cost effective systems

DATA ANALYSIS

• Parallel Analytics
• Streaming Analysis
• Sophisticated Data
• Algorithms
• RT Pattern Analysis

DATAMANAGEMENT

• Data Cleansing
• Scalable Single DBs
• Load and Query
• Non Intrusive DataAcquisitionPrivacy/Security

Mission Statement
To Deploy a Scalable Local/National Surveillance
Infrastructure
VISUALIZATION

• Needle in a haystack
• Geographic
• Interactive tools
• Case Managers

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ATT Labs Research
ATT Proprietary 2005 Do Not
Distribute
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ATT Labs Real Time Analysis
Chain EMN
Data Repositories Forensic Analytics
Healthcare Transactions
PORTAL
Stream Analysis
Visualization
Real-time Models
Signature Database
Anomaly Database Case Manager
Detection Algorithms
ATT Labs Research
ATT Proprietary 2005 Do Not
Distribute
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Contrasting Approaches to Data Analysis
Management
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ATT Labs Research
ATT Proprietary 2005 Do Not
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Real Time - Modular Analytics Architecture
ATT Labs Research
ATT Proprietary 2005 Do Not
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Statistical Anomaly Detection Methods

• SaTScan (Kulldorff, 2003)
• Anomaly in an interval of time, up to a
  user-specified maximum retrospective vs.
  prospective method
• Single outcome measure, e.g. number of tests or
  number of abnormal results.
• Anomaly in a disk of variable radius, up to a
  specified percentage of the data.
• Square-Root Technique
• Process Control Techniques
• Anomaly triggered at first appearance of anomaly
  pattern.
• Single outcome measure.
• Single defined geographical region.
• BUT, standardized square-root scale (for SRT), or
  use of standardized residuals (in process
  control) facilitates comparisons across outcomes
  and regions.
• Kalman Filter Gamma-Poisson Shrinker
• Sequential updating of estimates anomaly
  triggered at first appearance of anomaly pattern
• Multivariate outcomes many, possibly 1000s, of
  outcomes/test types simultaneously.
• Overlapping disks of varying diameters, specified
  explicitly.
• Text Mining Capabilities, e.g. Chief Complaints
  normalization, associations, change detection,
  anomaly detection in text.

Note A surveillance system should have the
flexibility to accept/select appropriate
detection algorithms depending on the data
characteristics and/or expected anomalies.
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ATT Labs Research
ATT Proprietary 2005 Do Not
Distribute
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Case Management Tool Overview
Anomalies are detected by diverse methods
covering various geographies and medical
conditions. A case manager is an effective tool
to organize anomalies into cases and to support
responsible parties in prioritizing the cases.

• Serves as a focal point of user interaction
• The tool allows experts (public health officials,
  epidemiologists) to examine and evaluate
  anomalies efficiently, and to decide how to act
  on them.
• Groups related anomalies into cases
• A case may contain any number of anomalies, and
  anomalies may belong to several different cases.
• Allows users to manage and explore these cases
• Drill down into detail (root causes, anomalies,
  and underlying data).
• Visualize data associated with cases and
  anomalies.
• Take actions to dismiss or to annotate cases.
• Link to notification/alerting modules.
• Technology
• Uses mature Java-based toolkit developed at ATT
  and widely used internally for real-time case
  management applications (e.g., fraud detection,
  network monitoring).

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ATT Labs Research
ATT Proprietary 2005 Do Not
Distribute
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Case Selection and Investigation in the Case
Manager
Case work list window, showing a summary of each
case in a specified syndromic group
Data Source Quest Diagnostics
Dynamic visualization of data detail for a
selected case
Anomalies, case detail, and events for a selected
case
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ATT Labs Research
ATT Proprietary 2005 Do Not
Distribute
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ATT / Quest Diagnostics Team
Government Solutions
Analytic Examples
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The NJ Meningitis Scare Emergency Room Admits
Where do the patients live?
ATT Labs Research ATT Proprietary 2005
Do Not Distribute
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ATT / Quest Diagnostics TeamSyndromic
Surveillance Respiratory Disease
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ATT / Quest Diagnostics TeamData Visualization
Positive Tests Only
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ATT / Quest Diagnostics TeamData Analysis
MRSA Prevalence
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ATT / Quest Diagnostics Team Conclusions

• Quest Diagnostics has the ability to support
  bio-terrorism detection and emerging infectious
  disease detection, as well as broader public
  health surveillance needs, based on current core
  competencies
• ATT has distinguishing capabilities including
  infrastructure, security, technology, ATT Labs -
  Research capabilities and government program
  integration excellence
• The ATT Quest Diagnostics Team can provide the
  only nationally scaleable public health
  surveillance infrastructure that can be
  immediately implemented to support the goals of
  our customers.

Government Solutions
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The ATT / Quest Diagnostics Team

• ATT Government Solutions
• Maureen Kitchelt
• Greg Kinne
• ATT Labs
• Colin Goodall, Ph.D.
• Guy Jacobson, Ph.D.
• Sam Parker, Ph.D.
• Simon Tse, Ph.D.
• MedPlus, A Quest Diagnostics company
• Patrick Tellez, M.D., MPH, MSH
• Quest Diagnostics
• Biho Chung
• Jake Geller, Ph.D.
• Peter N. R. Heseltine, M.D., FACP
• Eileen Koski, M.Phil.

• Sylvia Halasz, Ph.D.
• Arnold Lent, Ph.D.
• Phil Brown

• Xiaohua Huang, M.S.
• William A. Meyer III, Ph.D.
• Matthew Scott

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ATT / Quest Diagnostics Key Contacts

• ATT Government Solutions
• Greg Kinne
• Tel. [phone]email gkinne_at_att.com
• Quest Diagnostics
• Eileen Koski, M.Phil.
• Tel. [phone]email Eileen.X.Koski_at_questdia
  gnostics.com

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