The NSSP Community of Practice hosted its 6th ESSENCE Q&A session on Monday, July 20, 2020. During the call, Aaron Kite-Powell (CDC) and Wayne Loschen (JHU-APL) provided NSSP-ESSENCE updates and answered the community's questions on ESSENCE functions and features.
View the webinar recording here or via the embedded video above.
On 12 January 2010 at 1652 hours local time, an earthquake measuring 7.0 on the Richter scale struck near the Haitian capital of Port-au-Prince and created enormous devastation. Florida, as the state closest to Haiti, became an initial focal point for assisting the federal repatriation and humanitarian parolee efforts. Florida supported shipments of personnel and relief supplies into Haiti, and served as the point of entry for repatriated U.S. citizens and those evacuated from Haiti for medical care. As of 9 February 2010, there were 22,500 arrivals in Florida from Haiti related to repatriation and medical humanitarian missions. These patients primarily arrived in Miami, Tampa and Orlando areas. Approximately 650 people arrived in Florida during this period as medical evacuees, and were transported to and often directly admitted to hospitals for treatment of severe or complicated injuries. Some of these patients also generated emergency department (ED) visits on arrival.
Objective
To describe the public health surveillance efforts designed to measure syndromic and disease-specific conditions in patients who were in Haiti during or after the earthquake, and evacuated to Florida.
The Duval County Health Department (DCHD) serves a community of over one million people in Jacksonville, FL, USA. Each year, DCHD Epidemiology Program reports an average of 1133 (4-year average) notifiable diseases and conditions (NDC) with the exception of STD/HIV, TB, and viral hepatitis. Within Duval County, emergency medical care is provided by eight local hospitals, including one pediatric facility and a level-1 trauma center. These facilities contribute syndromic surveillance (SS) chief complaint (CC) data to the Electronic Surveillance System for Early Notification of Community-based Epidemics of Florida.
Historically, evaluations of SS systems have used ICD-9 diagnoses as the gold standard to determine predictive values. However, limited studies have surveyed reports of NDC to identify related emergency department (ED) visits and subsequent CC-based syndrome categorization. These data may provide public health investigators insight into health seeking behaviors, interpretation of SS signals, and prevalence of NDC within ED data.
Objective
This paper characterizes ED utilization among individuals diagnosed and reported with NDC. Furthermore, it evaluates the subsequent assignment of SS syndromes based on the patient’s CC during their ED visit.
The use of syndromic surveillance systems has evolved over the last decade, and increasingly includes both infectious and non- infectious topic areas. Public health agencies at the national, state, and local levels often need to rapidly develop new syndromic categories, or improve upon existing categories, to enhance their public health surveillance efforts. Documenting this development process can help support increased understanding and user acceptance of syndromic surveillance. This presentation will highlight the visualization process being used by CDCâÂÂs National Syndromic Surveillance Program (NSSP) program to develop and refine definitions for syndromes of interest to public health programs.
Objective: To describe the use of uni-grams, bi-grams, and tri-grams relationships in the development of syndromic categories.
The ESSENCE application supports users' interactive analysis of data by clicking through menus in a user interface (UI), and provides multiple types of user defined data visualization options, including various charts and graphs, tables of statistical alerts, table builder functionality, spatial mapping, and report generation. However, no UI supports all potential analysis and visualization requirements. Rapidly accessing data processed through ESSENCE using existing access control mechanisms, but de-coupled from the UI, supports innovative analyses, visualizations and reporting of these data using other tools.
Objective: To describe and provide examples of the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) application programming interface (API) as a part of disease surveillance workflows.
Suicide is a growing public health problem in the United States. From 2001 to 2016, ED visit rates for nonfatal self-harm, a common risk factor for suicide, increased 42%. To improve public health surveillance of suicide-related problems, including SI and SA, the Data and Surveillance Task Force within the National Action Alliance for Suicide Prevention recommended the use of real-time data from hospital ED visits. The collection and use of real-time ED visit data on SI and SA could support a more targeted and timely public health response to prevent suicide. Therefore, this investigation aimed to monitor ED visits for SI or SA and to identify temporal, demographic, and geographic patterns using data from CDC's National Syndromic Surveillance Program (NSSP).
Objective: To describe epidemiological characteristics of emergency department (ED) visits related to suicidal ideation (SI) or suicidal attempt (SA) using syndromic surveillance data.
Federal laws and national directives have focused attention on the development of more robust biosurveillance systems intended to detect events of public health interest in a timelier manner. Presidential Decision Directive 21 calls for integrated biosurveillance data, enhanced clinician awareness, and an epidemiologic surveillance system with sufficient flexibility to tailor analyses to new syndromes and emerging diseases. In 2007, a statewide syndromic surveillance system (ESSENCE) was implemented and hospitals were recruited to participate. Experience with ESSENCE in the context of the ED data analysis, visualization, and reporting prompted the exploration of integrating new data sources into ESSENCE and new analyses specific to these new data. The purpose of the ESSENCE system is now to provide an intuitive environment for state and local epidemiologists to conduct routine descriptive epidemiologic analysis, to monitor morbidity and mortality trends over time and space and across multiple data sources, thereby providing information that can assist with making decisions on how to improve population health.
Objective
Use of the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) in Florida has evolved from early event detection based on emergency department (ED) chief complaints to routine descriptive epidemiologic analysis, data visualization, and reporting across four different data sources, using and building on tools originally developed for syndromic surveillance.
One objective of public health surveillance is detecting disease outbreaks by looking for changes in the disease occurrence, so that control measures can be implemented and the spread of disease minimized. For this purpose, the Florida Department of Health (FDOH) employs the Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE). The current problem was spawned by a laborintensive process at the FDOH: authentic outbreaks were detected by epidemiologists inspecting ESSENCE time series and derived event lists. The corresponding records indicated that patients arrived at an ED within a short interval, often less than 30minutes. The time-of-arrival (TOA) task was to develop and automate a capability to detect events with clustered patient arrival times at the hospital level for a list of subsyndrome categories of concern to the monitoring counties.
Objective
This presentation discusses the approach and results of collaboration to enable a solution of a hospital TOA monitoring problemin syndromic surveillance applied to public health data at the hospital level for county monitoring.
The U.S. Defense Threat Reduction Agency (DTRA) is funding multiple development efforts directed at enhanced platforms to support bio-surveillance analysts under their Bio-surveillance Ecosystem (BSVE) program. These efforts include well-integrated user interface systems and advanced algorithmic concepts to facilitate analysis of diverse, pertinent data sources including traditional bio-surveillance data sources as well as social media inputs. A central challenge in this development effort is a practical, effective, method to test these prototype systems. This presentation discusses a simulation-based testbed to allow quantitative evaluation of analytical methods through controlled injection of simulated outbreak-related information into test data streams.
Objective:
To develop a software toolset to serve as a flexible test environment for bio-surveillance systems by injecting controlled, simulation-based, data modifications into a variety of traditional and non-traditional bio-surveillance sources.
In the last decade, the scope of public health (PH) surveillance has grown, and biosurveillance capacity has expanded in Duval County. In 2004, the Duval County Health Department (DCHD) implemented a standalone syndromic surveillance (SS) system which required the manual classification and entry of emergency department (ED) chief complaints by hospital staff. At that time, this system, in conjunction with other external systems (e.g. CDC ILInet, FluStar, NRDM) were used to conduct surveillance for health events. Recommendations from a 2007 ISDS panel were used to strengthen surveillance within Duval County. Later that year, the Florida DOH moved to a statewide SS system and implemented ESSENCE which has been expanded to include 1) ED record data from 176 hospitals (8 within Duval County); 2) Reportable disease case records from Merlin; 3) Florida Poison Information Network consultations; and, 4) Florida Office of Vital Statistics death records (1). ESSENCE has subsequently become a platform for rapid data analysis, mapping, and visualization across several data sources (1). As a result, ESSENCE has improved business processes within DCHD well beyond the initial scope of event detection. These improvements have included 1) expansion of the ability to create visualizations (e.g. epi-curves, charts, and maps); 2) reduction in the time required to produce reports (e.g. newsletters, media responses); 3) reduction in staff training needs; and 4) augmentation of epidemiology processes (e.g. active case finding, emergency response, quality improvement (QI)), and closing the PH surveillance loop.
Objective
This paper reviews the evolution of biosurveillance in Duval County, FL and characterizes the subsequent improved execution of epidemiology functions as a result of the implementation of the Early Notification of Community-based Epidemics (ESSENCE) system.