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Wiedeman Caleb

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.

Submitted by elamb on

In late summer 2017, the United States endured two severe hurricanes back to back. On August 25, 2017, Hurricane Harvey made landfall in Texas and southwest Louisiana, dumping more than 19 trillion gallons of rain. On September 10, 2017, 20 days later, Hurricane Irma landed in Florida, leading residents across the Florida peninsula to evacuate inland and out of the path of the storm. Although Tennessee was far from the eye of the storms, state health officials knew residents from both states could choose to shelter in Tennessee.

Submitted by elamb on

In 2016, the BioSense Platform for national syndromic surveillance made substantial enhancements including data processing changes, a national ESSENCE instance, and management tools to support diverse data sharing needs. On August 21, 2017, a total solar eclipse occurred over much of the United States. The event resulted in large gatherings over multiple days to areas in the Path of Totality (PoT). In the days leading up to the event, public health and emergency preparedness included syndromic surveillance in their monitoring plans. To support this effort, Illinois (IL), Kentucky (KY), and Tennessee (TN) established inter-jurisdictional aggregate data sharing to get a more inclusive view of cause-specific illness or injury in Emergency Department (ED) visits before, during, and after the eclipse.

Objective:

Describe cross-jurisdictional data sharing practices using ESSENCE and facilitated by the BioSense Platform for a national mass gathering event, and the dashboard views created to enhance local data for greater situational awareness.

Submitted by elamb on

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.

Submitted by elamb on

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.

Submitted by elamb on

Syndromic surveillance generally refers to the monitoring of disease related events, sets of clinical features (i.e. syndromes), or other indicators in a population. Originally conceived as a tool for the early detection of potential bioterrorism outbreaks, syndromic surveillance is also used by health departments as a tool for monitoring seasonal illness, evaluating health interventions, and other health surveillance activities. Over the past decade, the Tennessee Department of Health (TDH) has utilized syndromic surveillance at the jurisdictional level. These standalone, jurisdictional systems utilized chief complaint data from local emergency departments (EDs) and the Early Aberration Reporting System (EARS) developed by CDC. Some jurisdictions integrated other local data for analysis in EARS including 911 call center data, over the counter drug sales, and other non-traditional data sources. The analyses conducted on the data varied from jurisdiction to jurisdiction. CDC dismantled the EARS program in 2011, prompting the need for a complete syndromic surveillance overhaul. TDH decided to implement a centralized, statewide system that would maintain all the capabilities that jurisdictions currently had while allowing for statewide data analysis and aggregation. During this implementation process, TDH has been balancing the short term goal of supporting and maintaining the existing jurisdictional systems while moving forward with acquiring a statewide syndromic surveillance solution and establishing the infrastructure to support it.

Objective

To share lessons learned in Tennessee during its transition from a jurisdictional syndromic surveillance system to a state-wide, centralized system.

 

Submitted by Magou on

The mission of the ISDS TCC is to bridge the gap between the analytic needs of public health practitioners and the expertise of researchers from other fields for the enhancement of disease surveillance, including situational awareness of chronic as well as infectious threats and follow-up activities such as case linkage and contact tracing. Committee activities to achieve this mission are identifying practical use cases, refining technical specifications in open forums, obtaining benchmark datasets for controlled dissemination, validating candidate methods, and sharing method documentation. In its first 2 years, the TCC has worked on three use cases and assisted with development of data use agreements to permit posting of benchmark datasets, http://www.syndromic.org/ communities/technical-conventions. Recent polling of the Biosense User Group indicated widespread interest in developing additional use cases. The proposed panel is intended to focus on practical applications of common interest, refine the use case development and dissemination process, and foster global interest in this process.

Objective

The main objective is to broaden the collection of use cases developed by the ISDS Technical Conventions Committee (TCC) to enhance effective collaboration between public health practice and analyst researchers in various disciplines and institutions. Panellists will present and motivate use case concepts including requirements for practical solution methods. Component objectives are to refine the presented use cases and to stimulate formation of new ones at local, state, and national levels.

Submitted by teresa.hamby@d… on

Syndromic surveillance refers to the monitoring of disease related events, sets of clinical features (i.e. syndromes), or other indicators in a population. Tennessee obtains emergency department data for syndromic surveillance in standardized HL7 format following the field and value set standards published by the Public Health Information Network. Messages contain information previously unavailable to syndromic surveillance systems, including quantitative values such as recorded temperature. Data are received daily and processed by a Tennessee ESSENCE application and the national BioSense platform.

These systems use chief complaint keywords, ICD9 codes, and other algorithms to assign syndromes for each record. The differences between the BioSense and ESSENCE syndrome assignments have not been well defined. Detailed comparisons of syndrome assignment across tools are difficult to perform due to the intensity of the manual review required. However, definitions of fever can be easily confirmed in HL7 messages when the recorded temperature is provided. Currently, both the BioSense and ESSENCE syndrome definitions exclude recorded temperature from consideration when assigning syndromes.

To compare the performance of the fever syndromes used by BioSense and ESSENCE, recorded temperature data was used as the gold standard.

Objective

To objectively compare the BioSense and ESSENCE fever syndromes using recorded temperature as a gold standard.

Submitted by teresa.hamby@d… on

Presenters Caleb Wiedeman and Harold Gil will describe some of the processes their organizations use to ensure the quality of data in BioSense v2.0. First, Caleb Wiedeman will review his normal routine of verifying data quality, including checking the front end of the BioSense v2.0 application for aberrations and drops in visit counts, linking front-end data to the back end using R, and using phpMyAdmin to check daily files. This portion of the presentation will focus on Tennessee’s system and the data they receive from six facilities within a single health system. 



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