Sniegoski Carol

The Veterans Health Administration (VHA) operates over 880 outpatient clinics across the nation. The Johns Hopkins Applied Physics Laboratory’s Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) utilizes VHA ICD9 coded outpatient visit data for the detection of abnormal patterns of disease occurrence. The hemorrhagic illness (HI) syndrome category in ESSENCE is comprised of 25 different ICD9 codes, including 12 codes specific for viral hemorrhagic fever (VHF) (e.g., ebola, yellow fever, CrimeanCongo hemorrhagic fever, lassa, etc.) and 13 nonspecific conditions (e.g., purpura not otherwise specified (NOS), thrombocytopathy, and coagulation defect NOS).

Objective

We sought to evaluate the functionality of the diagnosis codes which fall into the syndrome category of hemorrhagic illness.

When the Chicago Bears met the Indianapolis Colts for Super Bowl XLI in Miami in January, 2007, fans from multiple regions visited South Florida for the game. In the past, public health departments have instituted heightened local surveillance during mass gatherings due to concerns about increased risk of disease outbreaks. For the first time, in 2007, health departments in all three Super Bowl-related regions already practiced daily disease surveillance using biosurveillance information systems (separate installations of the ESSENCE system, developed at JHUAPL). The situation provided an opportunity to explore ways in which separate surveillance systems could be coordinated for effective, short-term, multijurisdictional surveillance.

Objective

This paper describes an inter-jurisdictional surveillance data sharing effort carried out by public health departments in Miami, Chicago, and Indianapolis in conjunction with Super Bowl XLI.

The practice of real-time disease surveillance, sometimes called syndromic surveillance, is widespread at local, state, and national levels. Diseases ignore legal boundaries, so situations frequently arise where it is important to share surveillance information between public health jurisdictions. There are currently two fundamental ways for systems to share public health data and information related to disease outbreaks: sharing data, or sharing information. Data refers to patient level and aggregate counts of patients, and can be difficult to share legally because of privacy issues. Information refers to summaries, opinions or conclusions about data. There are few if any legal barriers to sharing information, and by definition it includes interpretation of data by knowledgeable local personnel which is vital during outbreak investigation. Currently most shared information is unstructured text, and this format makes it difficult for computers to use the information in any meaningful way. The only thing a system can do with this unstructured information is allow users to read each message.

Objectives

Alternate methods are needed to facilitate communication between jurisdictions during potential disease outbreaks. One alternative is to share structured information. Defined at the appropriate level, information sharing can avoid traditional data sharing barriers while capturing valuable local knowledge. The key is to identify the types of surveillance information that are neither so highly interpreted as to lose their value nor so loosely interpreted as to face traditional data sharing barriers. The objective of this work is to identify the level at which surveillance information sharing can be both feasible and beneficial, and to create a vocabulary standard that supports the exchange of structured information between diverse surveillance systems. 

Regional disease surveillance systems allow users the ability to view large amounts of population health information and examine automated alerts that suggest increased disease activity. These systems require users to view and interpret which of these alerts or data streams are epidemiologically important. This interpretation is valuable information that may benefit other users. In addition to the daily interpretation of data done by users, the ability to communicate local concerns and findings during a public health event to neighboring jurisdictions is of great public health importance. Public health officials also need constant situational awareness and a venue to share their concerns about increases in disease activity before a health emergency is declared. The Event Communications Component (ECC) was created to provide this venue. The ECC was developed for the National Capital Region (NCR) public health surveillance network to facilitate the need for users to communicate. The NCR system is an operational multi-jurisdictional biosurveillance system employed in the District of Columbia and in surrounding Maryland and Virginia counties. NCR users include epidemiologists and public health officials from different levels of government. The ECC has been in operation for a year in the NCR system. ECC 2.0 is being developed to improve on the original version’s capabilities and solve its shortcomings.

 

Objective

Identify areas of improvement and establish design goals of ECC 2.0. These design goals include: the incorporation of comment centric design versus event centric, automatic notification of new events/comments, the use of action oriented concern levels and user interface improvements. Focus design goals by utilizing prototyping and user group reviews. Develop ECC 2.0 and integrate it into the NCR system.

The goal of this project is to create a set of clinical condition categories based on explicit criteria for use in biosurveillance programs. The categories will be defined and keywords and ICD-9-CM diagnosis codes for implementation will be proposed.