Petersen Paul

Syndromic surveillance data is typically used for the monitoring of symptom combinations in patient chief complaints (i.e. syndromes) or health indicators within a population to inform public health actions. The Tennessee Department of Health collects emergency department (ED) data from more than 80 hospitals across Tennessee to support statewide situational awareness. Most hospitals in Tennessee provide data within 48 hours of the patient being seen in the emergency department. The timeliness of syndromic surveillance data allow for rapid estimates of impact in emergency department populations. Tennessee has successfully used these data to monitor influenza, heat related illnesses, and emergency department impacts from disaster evacuations. In addition to assessing impact and trends, syndromic surveillance can also provide early warnings for conditions of public health concern and increase the lead time public health has to initiate a response. In Tennessee, routine syndromic surveillance for mumps, hepatitis A, and other conditions has been successfully conducted statewide. Three successes from these surveillance efforts include detecting a clinically diagnosed but unreported case of mumps, early identification of hepatitis A cases during Tennessee's ongoing 2018 hepatitis A outbreak, and the detection of an epidemiologically unlikely clinical diagnosis of mumps associated with an exposure at a recreational center.

Objective: To demonstrate the utility of syndromic surveillance data in aiding public health actions and response across multiple investigations in Tennessee.

Late in September 2012, the Tennessee Department of Health (TDH) identified a cluster of fungal infections following epidural injection of methylprednisolone acetate (MPA) from a single compounding pharmacy. This presented a public health imperative to contact, educate and monitor approximately 1,100 Tennessee residents who received injections from contaminated MPA lots that were shipped to three clinics in Tennessee. There was no precedent to accomplish this rapidly and efficiently. To accomplish this goal a secure, web-based application designed by TDH for emergency patient management was deployed. 

Objective

The purpose was to facilitate real-time information sharing and data visualization for incident management during the Fungal Infections Outbreak in Tennessee.

Syndromic surveillance is commonly supported by information generated from electronic health record (EHR) systems and sent to public health via standardized messaging. Before public health can receive syndromic surveillance information from an EHR, a healthcare provider must demonstrate reliable and timely generation of messages according to national standards. This process is known as onboarding. Onboarding at the Tennessee Department of Health (TDH) focused heavily on human review of HL7 messages. However, the visual inspection of messages was time-intensive and delayed efforts to provide constructive feedback to participating healthcare providers. To ease the quantity of manual review done during the onboarding process, TDH created an application to assist in the process of reviewing syndromic surveillance messages.

Objective:

To show how the creation of a software tool and implementation of new processes improved the efficiency of syndromic surveillance onboarding at the Tennessee Department of Health.

Syndromic surveillance is the monitoring of symptom combinations (i.e., syndromes) or other indicators within a population to inform public health actions. The Tennessee Department of Health (TDH) collects emergency department (ED) data from more than 70 hospitals across Tennessee to support statewide syndromic surveillance activities. Hospitals in Tennessee typically provide data within 48 hours of a patient encounter. While syndromic surveillance often supplements disease- or condition-specific surveillance, it can also provide general situational awareness about emergency department patients during an event or response. During Hurricanes Harvey (continental US landfall on August 25, 2017) and Irma (continental US landfall on September 10, 2017), TDH supported all hazards situational awareness using the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) in the BioSense Platform supported by the National Syndromic Surveillance Program (NSSP). The volume of out-of-state patients in Tennessee was monitored to assess the impact on the healthcare system and any geographic- or hospital-specific clustering of out-of-state patients within Tennessee. Results were included in daily State Health Operations Center (SHOC) situation reports and shared with agency response partners such as the Tennessee Emergency Management Agency (TEMA).

Objective:

To demonstrate the use of ESSENCE in the BioSense Platform to monitor out-of-State patients seeking emergency healthcare in Tennessee during Hurricanes Harvey and Irma.