Loschen Wayne

Electronic disease surveillance canonically represents analysis performed on health records with respect to their syndromes, complaints, lab data, etc. This data can tell the story of a patient’s current status but does not provide a holistic look at the where the patient is from. By incorporating census data, a deeper examination of the patient’s area can be performed which may result in discovery of risk factors associated with race, economic status, and culture.

Objective

The objective of this project is to enable a deeper analysis of patient health by correlating patient health records with the census demographic data. Based upon these correlations, the ESSENCE system will be enhanced with new query filtering capabilities.

There are currently over 25 installations of ESSENCE across the US. Among these, there are 3 instances of multi-jurisdictional implementations. These include a centralized regional system in the National Capital Region for MD, DC, and VA, a Missouri system that includes hospitals and users from the St. Louis area in Illinois, and soon the National Syndrome Surveillance Program (NSSP) version of ESSENCE which will centralize data from many jurisdictions. While each of these systems provides valid ways to share data across jurisdictions, they require data to be sent to another jurisdiction. There are some jurisdictions which have legal or philosophical or technical issues with these types of data sharing arrangements. Programs like Distribute attempted to solve this by only sharing pre-aggregated data. This caused issues though for surveillance of new and emerging issues that requires a more ad-hoc query capability. This gap can be filled with a locally-ran system that has the ability to perform queries into remote systems and perform a federated query across other jurisdictions.

Objective

The objective of this presentation is to describe the new federated query capability in ESSENCE and describe how this could affect public health practice in the future. Specifically, this presentation will describe how a federated set of disease surveillance systems across the country could help improve national disease surveillance situational awareness along with its potential to connect non-ESSENCE systems in the future for even more complete coverage. It will also describe how this capability is different than other data sharing projects that attempt to centralize data, but how there is room for both to benefit from each other. 

Syndromic surveillance systems have historically focused on aggregating data into syndromes for analysis and visualization. These syndromes provide users a way to quickly filter large amounts of data into a manageable number of streams to analyze. Additionally, ESSENCE users have the ability to build their own case definitions to look for records matching particular sets of criteria. Those user- defined queries can be stored and analyzed automatically, along with the pre-defined syndromes. Aside from these predefined and user- defined syndromic categories, ESSENCE did not previously provide alerts based on individual words in the chief complaint text that had not been specified a priori. Thus, an interesting cluster of records linked only by non-syndromic keywords would likely not be brought to a user’s attention. 

Objective

The objective of this presentation is to describe the new word alert capability in ESSENCE and how it has been used by the Florida Department of Health (FDOH). Specifically, this presentation will describe how the word alert feature works to find individual chief complaint terms that are occurring at an abnormal rate. It will then provide usage statistics and first-person accounts of how the alerts have impacted public health practice for the users. Finally, the presentation will offer future enhancement possibilities and a summary of the benefits and shortcomings of this new feature.