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Swenson David

On 24 December 2009, a female New Hampshire resident was confirmed to have gastrointestinal anthrax on the basis of clinical findings and laboratory testing. Her source of anthrax was not immediately known, so the New Hampshire Department of Health and Human Services, in conjunction with several other state and federal agencies, conducted a comprehensive epidemiologic investigation, which included active surveillance to identify any additional anthrax cases from a similar exposure. It was determined that the index patient participated in a drumming event with animal-hide drums on 4 December, one day before the onset of symptoms. Two drums used at the event were later found to be contaminated with Bacillus anthracis.

 

Objective

This paper describes the use of customizable tools to query electronic emergency department data, as part of case finding, during the response to a community anthrax exposure in New Hampshire.

Referenced File
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As part of a greater statewide excessive heat response plan, New Hampshire (NH) has been performing HRI surveillance since 2010 to guide response efforts and ultimately reduce HRI morbidity and mortality during situations of excessive heat. Historically, NH hospital Emergency Department Heat illness discharges average around 150 per year, typically in the summer months. NHÕs Excessive Heat Emergency Response Plan documents appropriate state-wide readiness, alerting, emergency, and recovery level of response for heat emergencies with its partners. Together with near real-time surveillance data, flexible query tools, and communication templates, NH is better able to respond to excessive heat emergencies at a moment's notice and take action with its partners to reduce HRI emergencies. Objective: During this presentation NH Division of Public Health Services (NH DPHS) will share how it was able to develop an effective HRI surveillance response through the development of partners, which allowed State of NH decision makers to affect action beyond detection.

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Under the Electronic Health Record Incentive Program Rule, hospitals are eligible to receive incentive payments from the Centers of Medicare and Medicaid Services provided they meet certain requirements including Meaningful Use (MU). Demonstrating MU requires meeting a core and menu set of objectives including the capability to submit electronic syndromic surveillance, Electronic Lab Reporting (ELR), and immunization data in accordance with state law and practice. NH is building a NH Heath Information Exchange to serve all NH's MU needs including those of public health. This represents a huge opportunity for public health to collect more data to enhance disease detection and control, improve safety, and reduce health disparities, but also presents an integration challenge.

 

Objective

To describe steps used to build the required infrastructure to meet Public Health MU reporting requirements for electronic syndromic surveillance, ELR, and immunization data in NH Division of Public Health Services.

Referenced File
Submitted by elamb on

In response to the terrorist attack of September 11, 2001, the NH Department of Health and Human Services (NH DHHS) engaged state and external partners in the design of an early warning surveillance system to support bioterrorism and emergency preparedness. Initially, NH DHHS began collecting four syndrome counts from thirteen hospital Emergency Departments (ED) by fax. Automation began in 2002, when an over the counter (OTC) syndromic surveillance pilot system was implemented by Scientific Technologies Corporation (STC). In 2003-2004 this system, the Syndromic Tracking and Encounter Management System (STEMS), was expanded to include school absentee and occupational health reports. Over time, an internal Death Data application was automated to query vital record deaths, and in 2005 a real-time ED surveillance pilot, the Automated Hospital ED Data System (AHEDD), was developed by STC to replace manual ED surveillance. Over the past decade NH continued to expand the original concept with innovative approaches to identify undetected or under reported disease outbreaks.

Objective

To illustrate development of syndromic surveillance in NH, share innovation experience with the public health community, and contribute to the syndromic surveillance body of knowledge in the new public health Information Technology landscape.

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Submitted by elamb on

Presented January 31, 2018

 

David Swenson presented the following slides during the 2018 ISDS Annual Conference in Orlando, Florida. This presentation provides a use case for developing and implementing surveillance prodocols to conduct public health monitoring, analyze data collected, and engage partners/leadership in follow-up procedures.

 

Presenter: David Swenson, AHEDD Project Manager, Infectious Disease Surveillance Section DPHS, DHHS, New Hampshire

Submitted by elamb on

Inter-jurisdictional data sharing can enhance disease surveillance capabilities for local, state, regional and national public health situational awareness and response. BioSense 2.0, a cloud-based computing platform for syndromic surveillance, provides participating local, state and federal health jurisdictions with the ability to share aggregated data; a functionality that is easily activated by selecting an administrative checkbox within the BioSense application. Checking the data-sharing box, however, is a considerable decision that comes with benefits and consequences. On May 20-21, 2013, nine city, county, and state public health department jurisdictions (mainly from the mid-western region of the U.S.) met to explore data sharing for Heat Related Illness (HRI) surveillance using BioSense 2.0. During the workshop, all participants agreed to share data (using the BioSense 2.0 front-end application) in real-time to investigate HRI trends in regional populations during May-August 2012, evaluated HRI case-definitions, and documented benefits and barriers to inter-jurisdictional data sharing. The workshop was convened by ISDS, in collaboration with the Association of State and Territorial Health Officials (ASTHO), with the support of the U.S. Centers for Disease Control and Prevention. Staff from BioSense programmatic and technical teams were also present for the workshop.

Objective

Build upon the findings of a Regional Data Sharing workshop with the larger surveillance community to more clearly describe the benefits, barriers, and needs for data sharing on the BioSense 2.0 platform.

Submitted by knowledge_repo… on

The Automated Hospital Emergency Department Data System is designed to detect early indicators of bioterrorism events and naturally occurring public health threats. Four investigatory tools have been developed with drill-down detail reporting: 1. Syndromic Alerting, 2. Chief Complaint Data Mining, 3. ICD9 Code Disease, and 4. Influenza-Like-Illness Tracking.

All analysis processing runs on the server in seconds using ORACLE PL/SQL stored procedures and arrays.

 

Objective

This paper details the development of electronic surveillance tools by Communicable Disease Surveillance, which have increased detection and investigation capabilities.

Referenced File
Submitted by elamb on

The Automated Hospital Emergency Department Data (AHEDD) System was designed to detect early indicators of bioterrorism and naturally occurring health risks. Initial development includes real-time data collection from four pilot hospitals, an automated syndromic surveillance application, and the capability of raw data analysis for further investigation and follow-up. This automated system frees hospital and State staff from manual reporting and analysis; and has a broad application for Public Health, collecting both chief complaint and diagnosis codes. As the project expands we plan to add the remaining 22 acute care hospitals; include poisoning, asthma, and injury surveillance; and assess electronic disease reporting from diagnosis codes and data linkage with other public health data stores, such as Environmental Health Tracking, and pre-hospital data.

Objective

This paper describes the use of technology to create an automated, real-time surveillance system with the capacity for early detection and alerting of potential health threats, and the capability to facilitate prompt investigation and increased efficiency for both New Hampshire hospital and the Division of Public Health Service resources.

Referenced File
Submitted by elamb on

Researchers have demonstrated benefits to identifying and developing interventions for patients that frequently seek healthcare services in the ED. The New Yorker Magazine, recently published an article titled The Hot Spotters, summarizing work being done in the United States to lower medical costs by giving the neediest patients better healthcare (1). In Camden, NJ, Physician Jeffrey Brenner closed his regular practice to focus on Hot Spotter patients (directing resources and brainpower to help their improvement) and measured a 40% reduction in hospital inpatient and ED visits and a 56% medical cost reduction for the first 36 Hot Spotters. A 2008 NH Office of Medicaid Business and Policy (OMBP) outpatient Medicaid ED frequency visit study was conducted, which cited that frequent ED users were more likely to have higher costs and rates of illness or disease than all Medicaid members (2). It was noted that increased prevention and wellness could reduce frequent ED use and increase cost savings (5% of the NH Medicaid population contributed to approximately 38% of ED costs). The NH Division of Public Health Services initiated a pilot project to examine NH Emergency Department (ED) surveillance data to identify high utilizer patients and realize improved health benefits and medical cost reductions.

Objective:

To develop a manageable surveillance methodology to detect Emergency Department (ED) patients with the highest healthcare utilization, and monitor their targeted treatment improvement and medical health cost reductions over time for overall improvements in statewide health.

 

Submitted by Magou on

Syndromic surveillance uses near-real-time emergency department and other health care data for enhancing public health situational awareness and informing public health activities. In recent years, continued progress has been made in developing and strengthening syndromic surveillance activities. At the national level, syndromic surveillance activities are facilitated by the National Syndromic Surveillance Program (NSSP), a collaboration among state and local health departments, the CDC, other federal organizations, and other organizations that enabled collection of syndromic surveillance data in a timely manner, application of advanced data monitoring and analysis techniques, and sharing of best practices. This panel will highlight the importance of success stories. Examples of successes from state and local health departments will be presented and the audience will be encouraged to provide feedback.

Objective:

This panel will: 

  • Discuss the importance of identifying and developing success stories
  • Highlight successes from state and local health departments to show how syndromic surveillance activities enhance situational awareness and address public health concerns
  • Encourage discussion on how to further efforts for developing and disseminating success stories.
Submitted by elamb on
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