BioSense FAQs

New Environment, Governance, Value

What will the new system do? What will it be like?

BioSense 2.0 will provide a simple, easy-to-use Web-based tool that health officials can use to monitor or assess syndromic activity within and beyond their jurisdictions. Health data within BioSense will be visualized at a basic, qualitative epidemiological level (i.e., person, place, and time), and authorized users will be able to access these analyses through a search engine-like interface. While the redesigned BioSense is meant to merely supplement current syndromic surveillance capabilities and not replace them, and since future development will be community-driven, commonly used systems (e.g. ESSENCE), may be incorporated into the BioSense platform based on the needs of the community.

What will be the governance for BioSense 2.0? 

The users will preside over BioSense 2.0 using a representative governance model. During FY 2012, in addition to managing the new system, ASTHO will develop a BioSense 2.0 Charter in collaboration with Council of State and Territorial Epidemiologists (CSTE), National Association of County and City Health Officials (NACCHO), and International Society for Disease Surveillance (ISDS). The Charter will specify the authorities and policies of an elected BioSense governance body. At a minimum, stakeholders will be able to comment on early iterations of this charter through the BioSense Redesign Collaboration Web Site .

Please submit your thoughts about BioSense 2.0 governance to

How will BioSense 2.0 add value to the work of my health department?

Initially, BioSense 2.0 will provide four main benefits to health departments, including:
  1. Greater capacity for data management and storage;
  2. Cost savings on information technology and infrastructure;
  3. Greater and more timely access to regional and national public health surveillance information; and
  4. Greater access to peers for sharing knowledge and best practices.
The BioSense 2.0 will have a menu of services with tremendous capacity to receive, process, and store data. Moreover, it’s entirely possible to participate even if you do not use BioSense 2.0 for primary data collection from Meaningful Use clinical providers. BioSense 2.0 can also serve as your agency's "catcher's mitt" for the volume of new health data incentivized under CMS's Meaningful Use programs, thereby saving your agency from purchasing and maintaining additional servers or other infrastructure required for managing an increased data volume. Once in the BioSense 2.0 environment, your agency can choose to share your jurisdiction's aggregate or record-level data with other local, state, or federal health officials, thereby enhancing situation awareness for public health response.

As a network of surveillance peers sharing analyses and data, we believe that BioSense 2.0 will become a focal point for professional development and peer-to-peer learning. This flexible and scalable system will likely provide many other benefits as it evolves to better meet users’ needs.

Why should we invest in syndromic surveillance when we don’t have evidence that it works?

Actually, significant evidence shows that syndromic surveillance does work, both within peer-reviewed literature and as evidenced by its widespread adoption among local and state health authorities. Like any surveillance methodology, syndrome-based surveillance supports situational awareness and public health response in concert with many other information sources (see references below). It serves as an additional public health surveillance tool, with limitations that must be considered when interpreting its findings.

  1. Buehler et al. (2009). Situational uses of syndromic surveillance. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, & Science, 5:165
  2. Rappold et al. (2011). Peat bog wildfire smoke exposure in Rural North Carolina is associated with cardio-pulmonary emergency department visits assessed through syndromic surveillance. Environmental Health Perspectives,
  3. Baer et al. (2011, March). Usefulness of syndromic data sources for investigating morbidity resulting from a severe weather event. Disaster Medicine and Public Health Preparedness. 5(1):37-45.
  4. McKenna et al. (2003, September-October). Local collaborations: development and implementation of Boston’s bioterrorism surveillance system. Journal of Public Health Management & Practice, 9(5):384-393.                                                                                    

Is BioSense 2.0 going to help us be more prepared? Has there ever been a big outbreak that BioSense or another syndromic surveillance system detected before an astute clinician?

BioSense 2.0 will enhance situation awareness through greater epidemiological capability. Although state-of-the-art functions and tools will be provided in the new BioSense environment, technology alone is not enough. Data quality, data representativeness, and epidemiological competencies are critical factors that will determine the sensitivity and specificity of BioSense 2.0. Although the original goal of syndromic surveillance was rapid outbreak detection, most public health professionals now find this surveillance approach provides considerable value for situation awareness, or monitoring and projecting changes in population health (see references below). During the 2009 influenza pandemic, the Distribute project (, in collaboration with BioSense, rapidly connected existing syndromic surveillance systems across the United States to provide near real-time coverage of over 40% of emergency department visits in the country. State and local public health departments used the Distribute system to understand the progression of disease in neighboring regions, while CDC used the system to provide a timely regional or national picture.

  1. Bueler et al. (2008) Syndromic surveillance practice in the United States: findings from a survey of state, territorial, and selected local health departments. Advances in Disease Surveillance, vol. 6 (3) pp. 1–20.

How will CDC use the data we contribute to BioSense 2.0?

The Centers for Disease Control and Prevention is a large organization of centers that focus on understanding and preventing infectious, chronic, workplace, and environmental diseases and injuries. Each center will benefit from more timely and representative population health information. At a minimum, CDC will use BioSense 2.0 data help guide regional or national policy and program management decisions. Sharing BioSense 2.0 data with CDC will in no way change the collaborative relationship CDC maintains with states, wherein state and local jurisdictions speak for their population's status of health. Jurisdictions will ultimately have control of what data are shared with partners, including CDC. CDC will use the information to help provide regional or national picture for all-hazards. Under the new arrangement, CDC is one of several participants in the governance of BioSense 2.0.

I don’t really know anything about syndromic surveillance. Where can I learn more?

ISDS, in partnership with NACCHO and the Tufts University School of Medicine and Tufts Health Care Institute, has created an online course in syndromic surveillance located here and has generously has made this course available to anyone who's accessing this site. This program is designed to increase knowledge and foster collaboration between public health and clinical practitioners new to syndromic surveillance. The training, which has been approved for AMA PRA Category 1 CreditTM, is divided into four 1-hour, self-paced modules and is available at no cost.

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Joining BioSense and Meaningful Use

I need a document I can provide to my coworkers, partners, management, and policymakers that describes the vision, goals, and details of the new BioSense system. Where can I get one?

Please click here to view a one-page summary of BioSense 2.0.
Please click here to view additional information on meaningful use, surveillance, and syndromic surveillance standards.          

My state is interested in joining the new BioSense 2.0. We currently do not have a syndromic surveillance system. What do we need to do?

Please click here to view a one-page summary of BioSense 2.0.
Please click here to view additional information on meaningful use, surveillance, and syndromic surveillance standards.       

My jurisdiction is interested in joining BioSense 2.0, and we currently have a syndromic system. We are facing funding difficulties and are considering dropping our current system in favor of BioSense 2.0. What do I need to do to transfer everything? What are the options?                              

Please click here to view a one-page summary of BioSense 2.0.
Please click here to view additional information on meaningful use, surveillance, and syndromic surveillance standards.

Where can I find information on what my health department needs to know about Meaningful Use?

You can click on the following links to Web pages on Meaningful Use:
For additional information, please visit the following article or click here to read: Classen and Bates (2011, September). Finding the meaning in meaningful use. New England Journal of Medicine,365(9):855-8.

How does BioSense 2.0 support government-led health IT efforts (and Meaningful Use requirements)?


BioSense 2.0 can serve as your agency's "catcher's mitt" for the volume of new health data under CMS's Meaningful Use programs, thereby saving your agency from purchasing and maintaining additional servers or other infrastructure required for managing an increased data volume. (Also, eligible providers (EDs or outpatient) can be incentivized and vendors can be certified when sending to this state-controlled environment—so it's a win-win.)

I need to send a letter to providers in my state regarding Meaningful Use, and we are not currently ready to receive data. I want to join BioSense 2.0 so my state doesn’t lose the opportunity to receive Meaningful Use data (providers “opt out”). What exactly do I need to tell my providers now?                           

Please tell your providers to begin the onboarding process and let them know they have been placed in the onboarding queue. Your agency will be able to use the new BioSense environment after you complete the onboarding process.                                                                                                                  

Do hospitals still send data directly to BioSense 2.0? If so, does BioSense 2.0 directly approve Meaningful Use?


If a state health department chooses to use BioSense 2.0 as the receiver for syndromic surveillance data, hospitals may send data directly to the BioSense system. However, the data will go into a designated, state-controlled area, where health department representatives can then determine how to share the data with the BioSense 2.0 community. In this scenario, if the data coming to the state-controlled area meet the criteria for Meaningful Use, then the hospitals will be eligible for certification, regardless of how data are shared with the larger BioSense 2.0 community.


How can BioSense 2.0 help hospital providers meet Meaningful Use for syndromic surveillance?

BioSense 2.0 can help eligible hospitals meet Meaningful Use for syndromic surveillance in two ways. First, with ISDS, the BioSense 2.0 team has developed syndromic surveillance technical standards and specifications. Eligible hospitals can learn what public health jurisdictions need from emergency departments and how these data are used in the ISDS Final Recommendation, Core Processes and EHR Requirements for Public Heath Syndromic Surveillance. A Public Health Informatics Network messaging guide based on this Recommendation is also in development and will finalized soon. Second, in November 2011, state or local public health authorities will be able to designate BioSense 2.0 as their proxy for receiving syndromic surveillance test messages. Details about this program will be available from CDC later this fall.

How much will the new system cost my state or locality?

Jurisdictions may join BioSense 2.0 at no cost. Staff time will be necessary for the initial setup of BioSense 2.0 for tasks such as signing data use agreements and working with entities that will provide data to the system (e.g., hospitals, ambulatory care providers, etc.).                                                  


I have heard that CDC will offer Challenge Grants to facilitate BioSense 2.0 adoption. What is the timeline and requirements for these grants?


The challenge grant program is under development. We welcome any ideas you have about this program. Please contact Annette Casoglos ( with your challenge grant ideas or questions. These grants will be awarded in early 2012; please come back to the site for more information.

If you would like to receive information updates on the challenge grants or other BioSense 2.0 activities, please send an e-mail to and include your name.

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The Cloud, Security, and Data Issues

I don’t know much about cloud computing, and will need to answer questions from policymakers about data security, cost, etc. Where can I find more information about it that non-informaticians will understand?

Cloud computing represents a new model for the outdated model of IT infrastructure. Under the cloud model, BioSense 2.0 will have a separate collection of servers via shared hosting providers that provide scalable, pay-per-use services at low cost. With this service model, we can avoid the expense of purchasing computer and network hardware, which must be physically housed and secured, powered, and cooled, all while rapidly becoming obsolete. By outsourcing these operations to the cloud provider, we share costs with thousands of other customers, take advantage of economies of scale, and save money. While private and confidential data are housed by the provider, professional cloud providers are very serious about protecting their customers’ data. With proper security practices, cloud hosting is just as secure, and can be more secure, than traditional self-run IT operations. In order to ensure security, ASTHO screened Amazon Web Services using strict security criteria meeting the concerns of federal, state, and local stakeholders.

Recommended further reading:

How will we know our data are secure and private? Where is our data going?

Your data, along with all data from the other BioSense 2.0 participants, will be housed on servers in a secure data center facility operated by Amazon Web Services. Maintaining the security and privacy of these data is a central component of the BioSense 2.0 IT strategy. We are employing industry-standard, state-of-the-art technologies and practices to ensure that only authorized users can access the system. We are also implementing access control tools for data providers, so that you can specify who within the community can access your data, and under what conditions. Lastly, as the system evolves, we will periodically engage outside security consultants to perform security audits and testing.

If a copy of my state’s data is downloaded to CDC for analysis, it could be subject to FOIA requests. This will be problematic for policymakers in my state. Will CDC be able to do analyses with data in the cloud without downloading it?

With the BioSense representative governance model, users can define how and what type of access CDC will have to analyze and receive data. All data/information that external organizations provide to CDC or other federal agencies, are subject to the Freedom of Information Act (FOIA) requirements.

Data shared with CDC for analysis using BioSense 2.0 are no exception. Jurisdictions will ultimately have control of what data are shared with partners including CDC, and should always consider FOIA and open records laws when they determine what and how much data they share.

Does anyone have master access to see all data in the system?

The BioSense 2.0 systems administrators, working on behalf of ASTHO and the BioSense 2.0 governance body, will require master access to all data in the system to perform maintenance and troubleshooting and provide support to all BioSense 2.0 users. However, access will be limited to a small group of users, experienced in managing personal health information, and will not include CDC personnel as system administrators.

What will be the process to grant or revoke access to my data?

Each jurisdiction will designate a point of contact, such as a state epidemiologist, who authorizes access to and the level of data to be shared. Your designated point of contact will have access to a secure Web dashboard tool for designating access control specifications.

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Technical Questions

We have too many passwords to remember for multiple surveillance systems. Can the new system be a dashboard that will include multiple surveillance systems so that we only need one password?

Our development team is evaluating the integration of other surveillance analysis systems to determine the suitability and compatibility within the new BioSense environment. We hope to offer some streamlined access to other utilities for data analysis and visualization.

We are working on a solution to ensure that a single sign- on allows access to all cloud-based tools.

Will additional CDC surveillance systems be included in the new system, like notifiable disease reporting?

The BioSense 2.0 is designed to be extensible, to grow in order to incorporate additional data feeds that would support the requirements of the system beyond syndromic surveillance. We are focused on syndromic surveillance for the initial release in November 2011. After that date, the BioSense Redesign team and the governance body will continue to work with the public health community to improve the system to meet users’ needs.

In what format should data be sent to BioSense 2.0?

Our development team is currently evaluating a variety of messaging options (i.e., PHINMS, secure FTP, and Direct/Connect), that will be supported in the BioSense 2.0 environment. Our goal is to make the provision of data as easy as possible for contributors to the system, so we expect to be able to accept a variety of data formats from simple to complex.

If a state or local health department collects data from hospitals and health providers using their own technology, they can simply send data to BioSense 2.0 through an automated feed. For states using BioSense 2.0 as a “catcher’s mitt” for Meaningful Use, hospitals and health providers will submit data directly to BioSense 2.0 (into their own private secure area in the environment), which is controlled by a health department representative.

Please view “What special hardware/software will our hospitals need to transmit the data to the new BioSense?” for additional information.

How will other data streams be handled, such as school absentee data, pharmacy data, foodborne outbreaks, etc?

In order to be “open for business” by November 2011, the BioSense 2.0 development team is focusing first on establishing data feeds from current contributors to the new environment, and ensuring that new jurisdictions using BioSense 2.0 as a Meaningful Use “catcher’s mitt” will be able to receive data elements, outlined in the ISDS Recommendation for Core Processes and EHR Requirements for Public Health Syndromic Surveillance. The development team will begin to evaluate additional data feeds to integrate in future versions of the system in 2012. If you have any specific suggestions, please submit your feedback to

Can we get census data included?

We intend to include census data, to some extent. We're focused right now on being up and running with the 32 Meaningful Use [or ED data] data elements by November 2011. Our development team will begin to evaluate addition data feeds to integrate in future versions of the system in early 2012. If you have any specific suggestions, please send your feedback to

The VA and DoD contributed the majority of data for the original BioSense, how will these data sources be integrated into BioSense 2.0?

We are currently working with DoD and VA to ensure a seamless transition of feeds into the new BioSense environment in line with our November 2011 release date.

Are there any limitations to the type and/or level of data that my jurisdiction provides to BioSense 2.0?

The type and detail of the data used in the shared BioSense 2.0 Web application is specified by the jurisdiction. The new BioSense application is designed to be a collaborative system, so the more detailed the data that are shared, the better the information within the system. The system will be able to send and accept both record-level and aggregate data. Users will be able to select an option to store and analyze data locally or sharing data with the larger BioSense 2.0 community. We anticipate jurisdictions will elect to share syndromic data within the community members they authorize while working with more detailed data within their own secure area of the BioSense environment.           

How will the system adapt to ongoing technological changes as well as work to shape them?

The initial launch of the BioSense 2.0 system in November 2011 represents an early release of the system. The BioSense 2.0 development team is focusing first on establishing data feeds from current contributors to the new environment, and ensuring that new jurisdictions using BioSense 2.0 as a Meaningful Use “catcher’s mitt” will be able to receive data elements, outlined in the ISDS Recommendation for Core Processes and EHR Requirements for Public Health Syndromic Surveillance. Our design and development team will continue upgrading and enhancing the application throughout the life of the project. Our intent is to continue working with end-users to update the system to reflect new potential uses, respond to user needs as they emerge, and adapt to an evolving technical landscape, going forward.

How do we establish data use agreements (DUAs) to participate in BioSense 2.0?

CSTE will have a DUA template that your jurisdiction can tailor to your individual policies and practices. This DUA is established between the environment and your individual jurisdiction.

If you would like additional guidance for your individual jurisdiction, please send an e-mail to

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Functioning of the BioSense Application and Program

How can BioSense 2.0 provide a complete public health surveillance picture with incomplete data?

Like all information systems, BioSense 2.0 analyses and maps are only as good as the data entered into the system. Any interpretation of prediagnostic data (syndromic data) should be done with the strengths and limitations of the data streams and the surrounding context in mind. Part of the value of BioSense 2.0 is the ability to share data and insights among jurisdictions, so the more state and local health departments that share data, the better the coverage and resulting analysis, or "picture" will be. Likewise, the utility of BioSense 2.0 will increase with the number and distribution of hospitals providing data.

Why is there so much focus on including SAS with the new application?

Many health department staff prefer to use SAS to analyze data, but its cost can be prohibitive. SAS is only one package being considered as an offering with BioSense. Users will be able to export data from BioSense 2.0 into their preferred data analysis program.

What happens if BioSense 2.0 makes a mistake and you issue a false alert?

The BioSense 2.0 application is intended primarily as a situational awareness tool. While the system will allow for automated, customized alerting based on specific criteria, these alerts will serve as an entry point into the system for expert analysts. Analysts can then use BioSense 2.0 tools to examine the data with varying methodologies, create reports, and gain an overall situational awareness picture.

What happens if the BioSense system goes down?

As part the BioSense 2.0 cloud deployment, we are working to create a highly reliable system. Failures of individual system components are inevitable over time, but we have designed the architecture with redundancies and backups in place. When something goes wrong, we plan to be able to either restore service rapidly (for example, within 20 minutes) or even adapt automatically and sustain normal service without any interruption. As part of the process of bringing individual data providers on board, we will discuss different failure scenarios and put in place measures to adapt accordingly.

As with any IT system, we expect some amount of downtime or service interruption, both planned and unplanned. However, in the event of a public health situation, where the system is likely to see a spike in utilization and any downtime is undesirable, with our cloud-based hosting, we can allocate more resources instantly to increase both performance and redundancy.

Who can help us if we have a problem with BioSense 2.0?

Problems related to using and analyzing data in the BioSense environment should be directed to Tonya Farris, a member of the RTI BioSense Redesign team. She will work with you to pinpoint your specific needs and provide you with the resources to address your issue or problem (e: ; p: 202-974-7823).

Technical problems related to the application itself can be directed to Adam Vincent, also a member of the RTI BioSense Redesign team. He will be working closely with information technical specialist at ASTHO to manage and resolve technical problems and questions (e:; p: 781-370–4009).

Will BioSense 2.0 help me easily determine which hospitals are contributing to my daily data pool?

Yes, a data dashboard will be part of the “catcher’s mitt” for those health departments who elect to participate. For health departments collecting data themselves directly from their hospitals, we will provide similar analytics tools, based on the data feed provided by the department. The system will indicate what sources are supplying data, how many records they are transmitting, and recent activity. You will be able to set custom alerts, such as “notify me if no data are transmitted from this provider for 24 hours.” However, in all cases, health department officials will manage the relationships directly with their providers. While we hope to provide useful IT tools, coordinating with data providers and responding to notifications will be the health department’s responsibility.

What are some of the bells and whistles that make BioSense's 2.0 data visualization capabilities different from other systems?

  • Easy-to-use interactive mapping and time series visualization tools.
  • At-a-glance dashboard functionality allows you to rapidly check your stats daily; rich visualization, sharing, discussion, and export tools allow you to take a deeper dive.
  • Animated views showing how syndromic activity changes over time.

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Data Providers

What special hardware/software will our hospitals need to transmit the data to the new BioSense?

The BioSense 2.0 team is working to reduce or eliminate the need for any special hardware or software requirements for hospitals and health departments.

BioSense 2.0 is designed to make it easy for hospitals and health departments to share data. State health departments can direct their hospitals to report data directly to them so that the state/local health department can pre-process (filter, de-identify, etc.) the data and then forward data to the BioSense 2.0 environment. Or they can direct their hospitals to send data directly to the secure space they own in the BioSense 2.0 environment where they will be labeled as state-owned data until the jurisdiction decides how much and what type of data to share.

A number of transport mechanisms aresupported within the BioSense 2.0 environment. Data can be sent using PHINMS, Secure HTTP, SFTP, or across a VPN. Other transport mechanisms will be supported as needed. The BioSense team is also working with EHR vendors to openly share information so that EHR vendors can integrate reporting capabilities into their offerings.

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Other Questions

Have the cost estimates of the cloud done by CDC assumed space and processing time only for the current rendition of the Redesigned BioSense? If we're able to get a more robust system like ESSENCE in the cloud, will the costs become prohibitive?

The current cloud cost estimates are designed with significant room for expansion beyond the initial implementation of BioSense 2.0 in November 2011. The cloud hosting solution will offer cost-effective infrastructure that will support very high user adoption and heavy traffic for the BioSense 2.0 system.

The BioSense 2.0 governance team is working with ESSENCE representatives to discuss the details of deploying ESSENCE in the cloud environment. Additional details regarding the service and resource requirements will be shared as they become available.

What happens if states/locals go to the cloud to take advantage of the potential financial savings by not having to maintain their own systems, and CDC decides not to fund the local system any longer? Or asks states to pay into the cloud? Doesn't this mean potentially same or higher costs with less control of data/system? Is this sustainable?

CDC is committed to supporting the nation’s public health surveillance infrastructure, and believes that state and local health departments are the foundation of that infrastructure. While every effort will be made to maintain financial support for the distributed data model for public health surveillance, it is impossible to predict future budgets or the future cost to maintain the BioSense 2.0 cloud environment.

At this time, the cloud environment is the most cost-effective solution, but technology changes rapidly. With the BioSense 2.0 representative governance model, users will be able to determine how the cloud is funded and whether or not to accept federal support if it is available. Users will also be able to migrate to a different solution if more cost-effective technology becomes available.

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