Transcript ESSENCE: Missouri’s Syndromic Surveillance Project

Missouri ESSENCE
for Hospitals
Amy Kelsey
Missouri Department of Health and Senior Services
Office of Emergency Coordination
[email protected]
573-751-6161
What is ESSENCE?
• Electronic
• Surveillance
• System for the
• Early
• Notification of
• Community-based
• Epidemics
What is ESSENCE?
• Developed by Johns Hopkins University and
Department of Defense
• Automated surveillance tool
• Analysis & reporting of pre-defined syndrome
groups
• Data mining ability
• Web based
Where do ESSENCE data come from?
• ESSENCE was acquired by DHSS in order to
utilize the electronic emergency department (ED)
data sent to DHSS under 19 CSR 10-33.040
• This Rule requires that 85 out of about 120
hospitals with ED’s send data to DHSS for the
purpose of syndromic surveillance
• 83 of those hospitals are currently loaded in
ESSENCE (See Map)
Hospital Data
• Utilizes data from the “Hospital Information
System” that each hospital maintains for its own
purposes, like billing and patient records
• Put into the HL7 format by each hospital and sent
to DHSS
• Each have their own methodology and criteria
• No special data entry required: use data already
being entered into hospital’s information system
Hospital Data
• DHSS processes data and loads into ESSENCE
each day
– Including weekends and holidays
• Approximately 8,000 ED visits per day
• Data are presented to public health authorities and
hospital staff via the Missouri ESSENCE website
– Available 24/7 but only loaded once per day
Data Displayed in ESSENCE
• Patient data are unduplicated and de-identified
• Data are displayed within pre-defined syndrome
groups & are available for data mining using
custom queries
• All available ED data are loaded
– Varies by hospital, but some hospital data date
back to January 1, 2004
Purpose of ESSENCE
Our mission is to help state and local
partners respond to public health
events by providing information
and tools for early event detection
and situational awareness
-- Public Health Event Detection & Assessment Program
What is syndromic surveillance?
• Utilization of nontraditional data sources to detect
health events earlier than possible with traditional
methods like laboratory-confirmed diagnoses
1. Early event detection
2. Situational awareness
What is early event detection?
• Analysis of time-sensitive data for the purpose of
detecting outbreaks as early as possible
• ESSENCE will “flag” a syndrome group whose
number of visits was higher than expected to
detect anomalies as early as possible
ED Chief Complaints are Clustered in
Broad Syndrome Groups
•
•
•
•
•
•
•
•
Respiratory (cough, pneumonia, influenza)
Gastrointestinal (vomiting, diarrhea)
Neurological (meningitis, altered mental status, dizzy)
Fever
Rash (vesicular rash, chicken pox)
Botulism-like (weakness, blurred vision, speech)
Shock/Coma (syncope)
Hemorrhagic Illness (blood)
Active Surveillance vs. Traditional
Disease Tracking Methods
Johns Hopkins Applied Physics Laboratory
What is situational awareness?
• ESSENCE can be used during ongoing health
events to track impact in terms of time, geography,
and demography
– Example: foodborne illness outbreak in a
neighboring community
– Example: carbon monoxide poisonings
following an ice storm
How is ESSENCE used?
• According to Johns Hopkins University
– Early event detection
– Monitoring for disease outbreaks following
planned events
– Assessing effects of natural disasters or severe
weather
– Rumor control
– Good to know that no alerts have been
generated
How is ESSENCE used in MO?
• Office of Emergency Coordination staff review
ESSENCE Alert List each working day
– Staff use internal protocols to review
ESSENCE alerts, or flags, and determine
whether further investigation is needed
– Only about five flags a month are investigated
further, coordinated through local health
departments
How is ESSENCE used in MO?
• Aid in surveillance efforts
– Work with Bureau of Environmental Epi on
carbon monoxide, hypothermia, and
hyperthermia case finding
• Monitor communities affected by Department of
Natural Resources-issued Boil Water Orders
– For those orders associated with bacteriological
and/or turbidity findings
• Create situational awareness reports
How is ESSENCE used in MO?
How is ESSENCE used in MO?
• Special projects
– Working with partners in St. Louis County on
flu assessment
– Compared ESSENCE “Influenza-like Illness”
cases to lab-confirmed cases during previous
flu seasons
– Interesting findings
2006-2007 Flu Season Statewide
Laboratory Confirmed Flu Cases
CDC Week
20
16
18
12
14
8
10
6
4
2
52
48
50
ESSENCE ILI Cases/10,000 Visits
44
46
40
42
1000
900
800
700
600
500
400
300
200
100
0
2007-2008 Flu Season Statewide
Laboratory Confirmed Flu Cases
3500
ESSENCE ILI Cases/10,000 Visits
3000
BioSense ILI+Cough+Fever Cases/10,000
Visits
2500
2000
1500
1000
500
CDC Week
20
16
18
12
14
8
10
6
4
2
52
48
50
44
46
40
42
0
Missouri ESSENCE Users
• Johns Hopkins University has said that ESSENCE
is only as good as the people who monitor it
• We agree: that’s why we want professionals from
all different points of view to be able to access
ESSENCE
• We have granted access to 200+ users and are in
the process of training everyone who is interested
Who is eligible for ESSENCE access?
• Any public health authority
– Local public health agency
– Missouri DHSS
• Any staff from a hospital that sends data to DHSS
and that are displayed in ESSENCE
– Usually infection control staff
– Anyone concerned with communicable disease
or overall ED trends
What data can hospital users view?
• Hospital users may view the entire state’s data in
aggregate
• But may only view “record level” data for their
own hospital and/or hospital group
– Although data are de-identified, hospital data
like number of visits, chief complaints, etc. are
protected by DHSS
What patient level data are displayed?
•
•
•
•
•
•
•
•
•
Admission date and time
Hospital name
Zip code (patient)
County (patient)
Age group
Age
Sex
Chief complaint
Category (Rash, GI, etc.)
• Discharge diagnosis (ICD9 code, if available)
• Discharge disposition
(chief complaint, working
diagnosis, final diagnosis)
• Medical Record Number
• County (hospital)
• Zip Code (hospital)
How to apply for access
• The Automated Security Access Processing
(ASAP) system helps users from various
institutions register for a variety of health
applications at DHSS
• See ASAP Requesting Access to ESSENCE (for
private providers) handout or visit
www.dhss.mo.gov/ESSENCE and see
“Information for ESSENCE Hospitals” on left
menu bar
ASAP Tips
• http://www.dhss.mo.gov/ASAP/
– Links to ASAP logon and helpful guides
• If you have never registered using ASAP, follow
the instructions from the “New User” point in the
instructions
ASAP Tips
• If you already have access to a DHSS health
application like MHIRS, BTSurv, or MOHSIS,
you may already have an ASAP password
– May request a reminder on the ASAP Login
screen and they will send it to you quickly
– Still need to complete ASAP for ESSENCE
specifically
– We will issue an ESSENCE-specific password,
but we try to keep your ASAP username
Why is hospital ESSENCE access
important?
• To provide feedback to hospitals demonstrating
how we use the data you provide
• To ensure hospitals can view statewide, regional,
and local health trends
• To help public health and health care providers
communicate effectively about health events at the
community level
What do you expect of hospitals?
• May need help investigating unusual
clusters found in ESSENCE
– Just as with any other surveillance system or
outbreak investigation
– Hospital ESSENCE users are valuable partners
in assessing these findings
How will ESSENCE communications be
accomplished?
• All contact with hospitals is coordinated
through their local public health agency
– Or at least with the permission of the agency
• LPHAs and hospitals are often familiar with
each other and comfortable discussing
communicable disease issues
• Ensures LPHAs are kept in the loop on
health concerns
How is ESSENCE useful for hospitals?
• May be integrated into existing ER tracking or
infection control procedures
– May query for complaints of interest like “animal bite”
or “ILI”
• May be forewarned about health trends (flu
season, GI outbreak) affecting neighboring regions
• Other applications we have not considered
– We would like to know what those are!
Training Opportunities
• Individuals who are registered for ESSENCE access may
attend training
–
–
–
–
–
Central District (Jefferson City) – March 17
SE District (Poplar Bluff) – April 23
SW District (Springfield) - April 24
NW District (Independence) – April 29
Eastern District (St. Louis) – June 3
• Morning (8:30am-12:00pm) & afternoon (1:00 pm – 4:30
pm) sessions
• Call 573-751-6161 to register or get on the waiting list
Online Resources
• http://www.dhss.mo.gov/ESSENCE/
– Training and Technical Support
• User Guide and Quick-start Guide
– Information for Public Health Authorities
– Information for ESSENCE Hospitals
– Laws, Regulations, Manuals
• Copy of 19 CSR 10-33.040 & our Policies and
Procedures
– Contact Information
ESSENCE Demo
• ESSENCE System Status Page
• Alert List
– Configuration options
– Bookmarks
• Summary Alerts
• Query Portal
– Syndrome-based queries
– Free text queries
• Custom reports: Matrix Portal
• Weekly percent: Influenza-like Illness
• Maps
Login Page
ESSENCE Homepage
Alert List
Time Series
Fields in ESSENCE Patient List
•
•
•
•
•
•
•
•
•
Admission date and time
Hospital name
Zip code (patient)
County (patient)
Age group
Age
Sex
Chief complaint
Category (Rash, GI, etc.)
• Discharge diagnosis (ICD9 code, if available)
• Discharge disposition
(chief complaint, working
diagnosis, final diagnosis)
• Medical Record Number
• County (hospital)
• Zip Code (hospital)
Influenza-Like Illness Weekly %
for St. Louis Region
Map Portal
Map Portal