Boyd Laurel

Unlike other health threats of recent concern for which widespread mortality was hypothetical, the high fatality burden of opioid overdose crisis is present, steadily growing, and affecting young and old, rural and urban, military and civilian subpopulations. While the background of many public health monitors is mainly infectious disease surveillance, these epidemiologists seek to collaborate with behavioral health and injury prevention programs and with law enforcement and emergency medical services to combat the opioid crisis. Recent efforts have produced key terms and phrases in available data sources and numerous user-friendly dashboards allowing inspection of hundreds of plots. The current effort seeks to distill and present combined fusion alerts of greatest concern from numerous stratified data outputs. Near-term plans are to implement best-performing fusion methods as an ESSENCE module for the benefit of OHA staff and other user groups.

Objective: In a partnership between the Public Health Division of the Oregon Health Authority (OHA) and the Johns Hopkins Applied Physics Laboratory (APL), our objective was develop an analytic fusion tool using streaming data and report-based evidence to improve the targeting and timing of evidence-based interventions in the ongoing opioid overdose epidemic. The tool is intended to enable practical situational awareness in the ESSENCE biosurveillance system to target response programs at the county and state levels. Threats to be monitored include emerging events and gradual trends of overdoses in three categories: all prescription and illicit opioids, heroin, and especially high-mortality synthetic drugs such as fentanyl and its analogues. Traditional sources included emergency department (ED) visits and emergency management services (EMS) call records. Novel sources included poison center calls, death records, and report-based information such as bad batch warnings on social media. Using available data and requirements analyses thus far, we applied and compared Bayesian networks, decision trees, and other machine learning approaches to derive robust tools to reveal emerging overdose threats and identify at-risk subpopulations.

Oregon’s statewide syndromic surveillance system (Oregon ESSENCE) has been operational since 2012. Non-federal emergency department data (and several of their associated urgent care centers) are the primary source for the system, although other data sources have been added, including de-identified call data from OPC in 2016. OPHD epidemiologists have experience monitoring mass gatherings and have a strong relationship with OPC, collaborating on a regular basis for routine and heightened public health surveillance. Nevertheless, surveillance for the Great American Solar Eclipse (August 2017) presented a challenge due to the 107 reported simultaneous statewide eclipse-watching events planned for the day of the eclipse (some with estimated attendance of greater than 30,000 people and most in rural or frontier regions of the state). Scientific literature is limited on mass gathering surveillance in the developed world, particularly in rural settings, so OPC and OPHD worked together to develop a list of health conditions of interest, including some that would warrant both an ED visit and a call to OPC (e.g., snake bites). Monitoring visits in both data sources in would allow for assessment of total burden on the healthcare system, especially in the case of snake bites where only specific bites require administration of anti-venom.

Objective:

Identify surveillance priorities for emergency department (ED) and Oregon Poison Center (OPC) data ahead of the 2017 Great American Solar Eclipse gatherings in Oregon and create a suite of queries for use in the Health Intelligence Section of the Oregon Public Health Division (OPHD) Incident Management Team (IMT).

Oregon Public Health Division (OPHD), in collaboration with The Johns Hopkins University Applied Physics Laboratory, implemented Oregon ESSENCE in 2011. ESSENCE is an automated, electronic syndromic surveillance system that captures emergency department data from hospitals across Oregon. While each hospital system sends HL7 2.5.1-formatted messages, each uses a uniquely configured interface to capture, extract, and send data. Consequently, ESSENCE receives messages that vary greatly in content and structure. Emergency department data are ingested using the Rhapsody Integration Engine 6.2.1 (Orion Health, Auckland, NZ), which standardizes messages before entering ESSENCE. Mechanisms in the ingestion route (error-handling filters) identify messages that do not completely match accepted standards for submission. A sub-set of these previously-identified messages with errors are corrected within the route as they emerge. Existence of errors does not preclude a message’s insertion into ESSENCE. However, the quality and quantity of errors determine the quality of the data that ESSENCE uses. Unchecked, error accumulation also can cause strain to the integration engine. Despite ad-hoc processes to address errors, backlogs accrue. With no meta-data to assess the importance and source of backlogged errors, the ESSENCE team had no guide with which to mitigate errors. The ESSENCE team needed a way to determine which errors could be fixed by updating the Rhapsody Integration Engine and which required consultation with partner health systems and their data vendors. To formally address these issues, the ESSENCE team developed an error-capture module within Rhapsody to identify and quantify all errors identified in syndromic messages and to use as a guide to prioritize fixing new errors.

Objective:

To streamline emergency department data processing in Oregon ESSENCE (Oregon’s statewide syndromic surveillance) by systematically and efficiently addressing data quality issues among submitting hospital systems.

The Great American Solar Eclipse of 2017 provided a rare opportunity to view a complete solar eclipse on the American mainland. Much of Oregon was in the path of totality and forecasted to have clear skies. Ahead of the event, OPHD aggregated a list of 107 known gatherings in mostly rural areas across the state, some with estimated attendance of up to 30,000 attendees. Temporary food vendors and a range of sanitation solutions (including open latrines) were planned. International travelers were expected, along with large numbers of visitors traveling by car on the day of the eclipse. The potential for multiple simultaneous mass gatherings across the state prompted OPHD to activate an incident management team (IMT) and to create a Health Intelligence Section to design a mass gathering surveillance strategy. Statewide syndromic surveillance (Oregon ESSENCE) has been used to monitor previous mass gatherings (1) and captures statewide emergency department (ED), urgent care, Oregon Poison Center, and reportable disease data.

Objective:

Develop a public health surveillance plan for the Oregon Public Health Division (OPHD) in anticipation of the expected influx of visitors for the 2017 Great American Solar Eclipse.

Since 2008, poisoning is the leading cause of injury-related death in the United States; since 1980, the poisoning-related fatality rate in the United States (U.S.) has almost tripled. Many poison-related injuries and deaths are reported to regional PCs which receive about 2.4 million reports of human chemical and poison exposures annually. Federal, state, and local PH agencies often collaborate with PCs and use PC data for PH surveillance to identify poisoning-related health issues. Many state and local PH agencies have partnerships with regional PCs for direct access to local PC data which help them perform this function. At the national level, the National Center for Environmental Health (NCEH) of the Centers for Disease Control and Prevention (CDC) conducts PH surveillance for exposures and illnesses of PH significance using the National Poison Data System (NPDS), the national PC reporting database and real-time surveillance system. Though most PC and PH officials agree that PC data play an important role in PH practice and surveillance, collaboration between PH agencies and PCs can be hindered by numerous challenges. To address these challenges and bolster collaboration, the PC and PH Collaborations Community of Practice (CoP) has collaborated with members to provide educational webinars; newsletters highlighting the intersection of PH and PC work; and in-person meetings at relevant national and international conferences. The CoP includes over 200 members from state and local PH departments, regional PCs, CDC, the American Association of Poison Control Centers (AAPCC), and the U.S. Environmental Protection Agency (EPA).

Objective:

To discuss the use of poison center (PC) data for public health (PH) surveillance at the local, state, and federal levels. To generate meaningful discussion on how to facilitate greater PC and PH collaboration.