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ISDS 2012 Conference Abstracts

Refactoring INDICATOR into an Advanced Information
System for One Health Monitoring
Ian Brooks*1, 2, Mario Felarca1 and Bernie A’cs1

1NCSA, Urbana, IL, USA; 2University of Saskatchewan, Saskatoon, SK, Canada

Objective
To redesign INDICATOR for One Health, establish a common data

format, and provide for long term scalability.

Introduction
INDICATOR is a multi-stream open source platform for biosur-

veillance and outbreak detection, currently focused on Champaign
County in Illinois[1]. It has been in production since 2008 and is cur-
rently receiving data from emergency departments, patient advisory
nurse call center, outpatient convenient care clinic, school absen-
teeism, animal control, and weather sources. Long term scalability
was however compromised during the 2009 H1N1 influenza pan-
demic as immediate public health needs took priority over our sys-
tematic development plan. With the impending addition of veterinary
clinic data and recognizing that the health of a community also de-
pends on animal and environmental factors, we decided to revisit the
INDICATOR architecture and redesign it to be a more holistic and
scalable system. We also decided to revisit the data submission for-
mat, keeping in line with the philosophy of making opportunistic sec-
ondary use of as much data about the health of a community that we
can obtain.

Methods
Following a formal evaluation of the existing production version

of INDICATOR we established the systems architecture shown in
Figure 1 to leverage work in other cyberinfrastructure projects at
NCSA.

Results
We have now implemented the back end changes, including uni-

fying the multiple physical MySQL database systems and multiple
Apache Tomcat application engines into a single system. A web ap-
plication, using service oriented principles and the GWT library, has
been developed that can query and display the newly unified data and
provide new options for input of data to the system. 

In order to streamline and simplify the data format we decided to
define a single format that can be used by different kinds of health-
care providers, both human and veterinary. Although we recognize
the limitations in this approach we define a reported event to be a
simple what, when, and where containing the following seven fields
or the relevant subset based roughly on the ISDS meaningful use rec-
ommendations [2]

1. Date of incident
2. ICD-9 code for the primary diagnosis
3. Free text of the diagnosis (not the text definition of the

ICD-9 code)
4. Text chief complaint at triage
5. Location 
6. Count 
7. Species
In this way we can handle, in a single format, data from emergency

departments, convenient care clinics, patient advisory nurse call cen-
ters, veterinary clinics, veterinary labs, and veterinary poison control
centers.

Conclusions
INDICATOR has been significantly redesigned and is now more

integrated, scalable, and secure. It is now placed to become a One
Health integrated monitoring system.

Figure 1. INDICATOR system architecture

Keywords
Open Source; Surveillance; Informatics; One Health

Acknowledgments

We would like to thank Carle Foundation, Christie Clinic, Champaign
County animal control, Champaign County Humane Society, the Veteri-
nary Medicine Data Base, and schools in Champaign County for sharing
their data.  We would also like to thank Julie Pryde and Awais Vaid, from
Champaign-Urbana Public Health District for their ongoing support and
assistance.

References

[1] Brooks I, Edwards W, INDICATOR: A Cyberenvironment for Bio-
surveillance and Response. Syndromic 2009.

[2] ISDS Meaningful Use Recommendations.

*Ian Brooks
E-mail: ian@ncsa.illinois.edu

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e120, 2013