TEDMED at CDC!: Epi Info™ 7 -- Was it Really the Potato Salad?

Author: Centers for Disease Control and Prevention (CDC)

Okay Stephanie is going to talk about the following question. Was it really the potato salad from the church supper? So you might be wondering why I would talk about a 25 year-old software program at a conference focused on new ideas. It could be because Tom Frieden asked me to but more importantly, it could be because Epi Info changed my life. But mostly, it's because Epi Info 7 is so back to the future that it once again presents a disruptive innovation. The year was 1990, I was a senior medical student. And I was here on a 7 week elective at CDC.

I'd already matched into a general surgery program so even I wasn't sure why I was here at CDC. Rob Tauxe sent me and EIS officer Allen Reese [phonetic] to Miami to investigate a cruise ship full of people with gastrointestinal illness. So we wrote a questionnaire, we printed it out, and we headed to the airport for an Eastern Airline flight to Miami, you might remember them. While Allen headed to the ship's infirmary to collect specimens, he was already a licensed physician, I headed to the departure lounge with stacks of paper questionnaires, clipboards, and pencils to try to encourage hundreds of sick and somewhat angry passengers to tell us all about their experience. That night, we started entering data into our Epi Info rec file. What a revelation this was for me.

Epi Info was so intuitive and so easy. It was designed by epidemiologists for epidemiologists. It started giving us answers right away, very appealing to a surgeon. I was hooked, Allen and Rob and Epi Info pretty much changed my medical career right there and then. A year later I had bagged my surgery residency for a coveted spot in the EIS class of 1991. So here we are 22 years later, I have Epi Info in my group, I will admit like many of you, I got away from using Epi Info.

We've talked to so many people over the past few months when they see a demo of Epi Info 7 they say, they sort of burst with a question, "I thought Epi Info was dead, where has it been?" The answer is that like so much technology, it got weighed down, it got complicated, it got fussy and it got unwieldy. So our team went back to the future, went back to the original intent of Epi Info. Make it intuitive, make it agile, keep it free and design it for the basic things that epidemiologists need to do.

TEDMED at CDC!: Epi Info™ 7 -- Was it Really the Potato Salad?

Do that by coming back to the future. Epidemiology hasn't changed all that much but epidemiologists have. Their expectations have changed, their expectations for how they will do their work have changed.

And the environment has changed, technology and social media surround us. So let's make Epi Info more robust with features that conform to the way we do business now. And let's prepare it to respond to our future needs. Imagine, imagine if we had Epi Info mobile in October 2010. In October 2010, epidemiologists from CDC and other international aid organizations were fanning out over Haiti to collect information as quickly as they could about the number and severity of cases of cholera. Some clinics were incredibly hard to reach and sometimes involved hiking many miles from the roads. Travel and communication of data were slow.

Word of mouth, the information was unreliable. Paper questionnaires were difficult to read and may have skip patterns hard to enforce. Data entry required days, large teams and extensive data validation correction and cleaning. But how the visuals needed accurate daily reports to monitor the epidemic spread and to position cholera treatment and prevention resources across the country. Imagine if those field workers had mobile phones or other devices with built-in GPS to guide them to destinations and to map places needing immediate resources. Imagine if they could collect data on the spot with real time aggregation. Imagine if they could validate their data at the point of interview.

Imagine if they could shorten the time between data collection and reporting to make informed response decisions more quickly. What if we had Epi Info web survey in November 2008? In November 2008, CDC PulseNet staff noted a small and highly dispersed cluster of 13 salmonella typhimurium isolates reported from 12 states. By December it was 41 isolates and by the following March, it was 714 cases in 46 states. Coordination of questionnaires and data collection was challenging to say the least. Identifying the source of the outbreak was paramount. It probably wasn't the potato salad at a church supper. It was the peanut butter. What if the EIS officers could publish their questionnaires to the web and then let's send the link to each state and local health department with guidance about the type of case control study that would be helpful? What if they could analyze the data locally and send it to a central point for collective analysis? What if they could find controls by rapid dissemination of a web-based questionnaire to social networking sites? What if they could simply make sure that everyone was using the same questionnaire, a questionnaire with built-in codes, error checks, and standard language? What if they could collect the data on the cloud to assure that states could protect their data and share it at the same time? So those of you who have a CDC Blackberry, a CDC web account, e-mail account and if you registered for this conference, if you accepted the conference, you've just received the first Epi Info web survey.

And I invite you to take your Blackberry out now and check your e-mail and respond to the survey. I don't know if you've ever been asked to do that in the middle of a presentation before. You can also respond later if you like but it's a one-question survey so we invite you to do that. It's really that simple. I see Marty going for his Blackberry. Visualize this, visualize Epi Info map today in April 2012.

In March 2012, the ACA requirement for non-profit hospitals to do community health needs assessment went into effect. No big deal for us, right? Well it might be. Just in the Atlanta Metro area, the overlapping responsibilities for community health of not for profit hospitals, public health departments and community transformation grant recipients is profound. Visualize a situation where these various organizations are not only aware of each other but can easily see how their interests intersect. Visualize a situation where they collect data in a synchronized way. Visualize them working together to create a dashboard to display and track the most important health indicators for their communities.

Visualize them agreeing on how they will work collectively to address the most critical health problems, each bringing their greatest strengths to the fight. The future is now. Visualizing an outbreak through data is not only a science but an art and a creative force in public health. We can paint an analytic canvas so that we have the information we need to take action. [Background music] It starts slowly, an n of one. A parent calls their child in, sick from school or my office mate leaves early not feeling well, or an unusual lab result starts to work its way through the system.

More cases start to appear. The epidemic begins to emerge. [ Music ] An investigation is launched. [Background music] A case definition is created and cases identified. We begin to paint the picture of the epidemic in time to create a questionnaire and gather demographic data.

Who is susceptible? What do we learn as we continue to collect and add data to this canvas? A picture of who is affected starts to emerge. We map the epidemic from our basic demographic data, now we know where this is happening and paint our canvas with a sense of place. Why is this happening here? But what is it? Can we confirm the diagnosis? What are the symptoms? Is this what we thought it was when we started? Does the case definition still hold? What does the picture tell us now? Why are these people sick? Why are others not? What is the source? What are the odds? [ Music ] Is it really the potato salad at the church supper? [ Music ] What can we do? [Background music] Remove the pump handle, develop immunization, isolate the ill, eliminate the source, control the outbreak.

[ Applause ].

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