Abstract

1
LEADERS Project Overview
2
The Goal of LEADERS

• By applying state-of-the-art technologies,
  design a system to enhance the current medical
  surveillance process and provide the earliest
  possible detection of covert biological warfare
  incidents or significant outbreaks of disease.
• 
  -BGEN Klaus Schafer

3
Agenda

• Problem Description
• The LEADERS Solution
• Technical Approach
• Project History
• Medical Surveillance Modules Description
• Command and Control Modules Description
• Schedule

4
Where We Are Today...

• There is NO comprehensive approach to supporting
  joint Military and Civilian medical surveillance
  initiatives
• There is a limited ability to identify and
  confirm covert biological warfare incidents or
  significant outbreaks of natural disease
• Existing surveillance systems operate in a vacuum
  with minimal ability to share data across
  organizations

5
What is LEADERS...

• A suite of services and applications that provide
  a comprehensive, user-driven approach to medical
  surveillance and outbreak management.
• A National-level solution designed to support
  Military, Civilian, State, and Federal Healthcare
  Professionals.
• A state-of-the-art surveillance concept based on
  enhanced capabilities provided by an Application
  Services Provider (ASP) .

6
Technical Approach

• Iterative Approach
• Requirements are not assumed on day one
• Technology is accessed based on current user
  needs
• Requirements are categorized - then implemented
• Functionality is prioritized and then delivered
  based on criticality
• Needs are reprioritized after each iteration
• Extensive User Involvement
• Requirements are gathered and validated with the
  end user community
• On-going consultation during development and
  testing

7
Technical Approach (cont.)

• Application Service Provider (ASP) Model
• Participating organizations do not require any
  infrastructure to deploy LEADERS
• All hardware, databases, and application software
  reside at ASP site
• Users access LEADERS via a browser over the
  Internet
• Flexible Use Model
• Subscription based
• Participating organizations choose which
  components they would like to subscribe to

8
The LEADERS Success Story

• Nov 99 - World Trade Organization Summit
• 8 Hospitals in Seattle Metro Area
• April 00 Israeli Defense Forces Exercise
• 2 Hospitals in Downtown Tel Aviv
• Israeli CDC
• July 00 Republican National Convention
• ASP Solution - 74 Hospitals in PA, DE, NJ
• August 00 Democratic National Convention
• ASP Solution - 21 Hospitals in LA County
• Jan 01 Presidential Inaugural
• ASP Solution -16 DoD Hospitals/Clinics
• Commercial Hospitals in DC/MD/VA
• Jan 01 Super Bowl Tampa Florida
• ASP Solution
• Five Hospitals in Two Counties Plus Reach back
  to CDC

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Organizational Architecture
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Functional Architecture
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National/Global View of LEADERS
LEADERS SERVICES AND APPLICATIONS
Covert Biological Warfare Scenario
Major Disease Outbreak
Public Health Dept.
Emergency Management Agencies
Hospital Networks
Gov. Agencies
Military Support Organizations

• State PHO
• CDC
• Local PHO

• Fire
• Police
• EMS

• DoD
• Civilian
• VA
• Community Centers

• FEMA
• CDC
• Red Cross

• JFC
• CBIRF
• Special Ops

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Medical Surveillance Modules

• User-driven surveillance applications
• Monitoring and visualization capability
• based on a defined geographic area
• Knowledge discovery tools provide
• rapid ID of health anomalies
• Agent identification/confirmation
• capability
• Incident management and resource
• allocation tools

13
Data Collection

• Continuous Data Feeds
• LEADERS will publish an XML Document Type
  Definition (DTD)
• Plans support for HL7 data via XML feed
• Participating organizations EXTRACT data based on
  XML DTD
• Web-based Manual Data Collection
• Data entry based on individual patient encounters
• Minimal data entry tasking
• Focus on ease-of-use

14
Medical Surveillance Application
15
Map-Based Temporal Analysis - MedView

• MedView provides a geographical view of medical
  surveillance network
• Users have the ability to view defined syndromic
  data over time

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Investigate Detected Patterns
Alerts are automatically assigned to specific
analysts for investigation and are tracked
through to resolution.
17
Incident and Event Portal

• Supports Command and Control activities for
  incident and event planning and management
• Based on DARPA research and technology
• Deployed at multiple sites and exercises
• IEP Development Approach
• Review existing components with USAF and Civilian
  surveillance communities
• Identify and prioritize new requirements
• Develop new modules, refine existing capabilities
• Migrate existing modules to LEADERS

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IEP Functionality

• Incident Management
• Incident data entry
• Incident report generation
• Emergency contact mgmt.
• Emergency contact alerts

• IEP Dashboard
• Multiple views of IEP data
• User customizable
• Search engine
• Content management

• Medical Facility Tracking
• DEPT Status Tracking
• Bed Count Tracking
• Historical Reporting
• Alarms and Alerts

• Casualty Tracking
• Data collection
• Location and triage history
• Count reporting

• ViewPort
• Geographic display of data
• Locate assets and resources
• Spatial analysis of data

• Checklist Management
• Create checklists
• Manage checklists
• Activate checklists

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IEP Modules

• IEP Dashboard
• ViewPort
• Incident Management Module
• Emergency Contacts Module
• Checklist Manager Module
• Casualty Tracking Module
• Critical Care Tracking System

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Conceptual IEP Dashboard

• Desktop View of Available Applications
• Content Management Support
• Easily Customized by the User

21
Incident Management - ViewPort

• Incident/Event Management and Resource
  Visualization Tool
• Provides real-time situational awareness for
  Commanders and responders within a geographic
  context
• Supports incident/event pre-planning, training,
  and after-action review in a visual environment

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IEP- Emergency Contacts Module

• Real-Time Paging
• Real-Time Messaging
• Easy To Update

23
IEP - Checklist2000 Module

• Manages Checklists Using
• Playbook Approach
• Checklists Pushed to Users
• Role-Based

24
IEP - Casualty Tracking

• Palm CaTT
• Wireless Application
• Bar Code
• Captures Minimal Data Set at Incident Site
• Store/Forward Capability
• Route Ambulances
• Web CaTT
• Synchronizes Field Data to Hospital
• Allows for More Defined Data Capture at Hospital
  Site

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IEP - Casualty Tracking
Example Web CaTT Screen Shot
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IEP Critical Care Tracking System

• Tracks Critical Bed Care Availability
• Multiple Jurisdictions
• Multiple Stations
• Network Alarming
• Built-In Reporting Capability

27
Pathogen ID with R.A.P.I.D.

• Idaho Technologys R.A.P.I.D. (Ruggedized
  Advanced Pathogen Identification Device) requires
  minimal operator experience
• Designed for transport and operation under
  extreme conditions

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Security Overview

• Primary Security Concerns
• Authentication to verify the identity of the
  communicating parties
• Access Control to determine who may have access
  to information within a system
• Privacy to protect sensitive information from
  being viewed indiscriminately
• Security focuses
• Network communications
• Application Server components
• Database Access

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Security Options - Phase 1

• Secure Sockets Layer (SSL)
• Network encryption (privacy)
• Application Server authentication
• LEADERS User Accounts
• Username/password required for authentication
• Does NOT provide database access
• LEADERS System Roles
• Access Control to LEADERS modules
• Oracle8i Data Encryption

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Security Options - Phase 2

• Public Key Infrastructure (PKI)
• X.509v3 Digital Certificates for authentication
• Lightweight Directory Access Protocol (LDAP) for
  access control
• Alternative Authentication Mechanisms
• SmartCards
• Biometric authentication

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System Administration

• System Administration functions integrated into
  the IEP
• Central management of access to all LEADERS
  components
• Restricted access to System Administration
  functions
• Managed over the Web
• Delegation of responsibilities to customer
  organizations
• Creation and management of user accounts
• Management of roles and user/role assignments

32
ASP Network Infrastructure

• High Availability Design
• Fully Redundant Components
• Redundant Connections
• Full Mesh Configuration
• Complete failover systems
• QoS Bandwidth Management
• Separate Web/Application and Data Networks

33
Schedule Overview

• Months 1 - 4
• Develop LEADERS V1.0 pilot
• Deploy an initial operating capability at the
  ATIC
• Months 5 - 12
• Additional software releases
• Revised functionality for existing components
• New modules
• Staggered deployment to 5 additional sites
• Air Force will identify tiger teams for each site
• Consortium and Air Force will define schedule and
  dependencies

34
LEADERS Summary

• ASP-Based service model
• Integrated medical surveillance/command and
  control toolset
• System available 24 x 7
• Large scale data collection
• Enhanced ability to identify potential covert
  attacks and significant outbreaks of disease
• Agent identification and confirmation device
• Incident and event management and advanced
  visualization tools