ESSENCE

Syndromic surveillance has historically been used to track infectious disease, but in recent years, many jurisdictions have utilized the systems to conduct all hazards surveillance and provide situational awareness with respect to previously identified issues. Flakka is a synthetic drug (class: cathinones) that recently has been featured in the media. Flakka is a stimulant that causes delusions, aggression, erratic behavior, a racing heart and sometimes death. Two specific counties (one in Florida and one in Kentucky) have been at the center of this emerging epidemic. In August 2015, Florida Department of Health (FDOH) partner agencies requested flakka-related health data in an effort to better understand the epidemiology and context of this problem. ESSENCE-FL is a large syndromic surveillance system, with four main data sources, that captures 87% of all emergency department (ED) visits statewide.

Objective

To characterize flakka usage in Florida using multiple data sources within the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE-FL)

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. 

The Joint Incentive Fund (JIF) Authorization creates innovative DoD/VA sharing initiatives. In 2009, DoD and VA commenced a biosurveillance JIF project whose principle objectives include improved situational awareness of combined VA/ DoD populations 1 and determining the optimal business model allowing both agency biosurveillance programs to operate more efficiently by: 1) consolidating information technology assets; 2) targeting enhanced collaboration for improved public health outcomes; and 3) improving buying power, and return on investment. We analyzed various interoperability models aimed at biosurveillance data sharing, asset consolidation and enhanced collaboration. Potential end states to be evaluated include maintaining separate Departmental systems, bidirectional exchange of data to separately managed systems, consolidation of data within one Department and shared access to a common system, consolidation of data in a neutral repository accessed by separately run legacy systems, or a custom developed biosurveillance solution utilizing a common data repository.

Objective

Determine an optimal course of action for achieving a more mission and cost-effective model for implementing combined or collaborative biosurveillance across the Departments of Veterans Affairs (VA) and Defense (DoD).

Wildfires occur annually in Oregon, and the health risks of wildfire smoke are well documented1. Before implementing syndromic surveillance through Oregon ESSENCE, assessing the health effects of wildfires in real time was very challenging. Summer 2015 marked the first wildfire season with 60 of 60 eligible Oregon emergency departments (EDs) reporting to ESSENCE. The Oregon ESSENCE team developed a wildfire surveillance pilot project with two local public health authorities (LPHAs) to determine their surveillance needs and practices and developed a training program to increase capacity to conduct surveillance at the local level. Following the training, one of the LPHAs integrated syndromic surveillance into its routine surveillance practices. Oregon ESSENCE also integrated the evaluation findings into the summer 2016 statewide wildfire surveillance plan.

Objective

To build capacity to conduct syndromic surveillance at the local level by leveraging a health surveillance need.

The Florida Department of Health (DOH) utilizes the Electronic Surveillance System for the Early Notification of Community Based Epidemics (ESSENCE-FL) as its statewide syndromic surveillance system. ESSENCE-FL comprises of chief complaint data from 231 of 240 EDs, representing 96 percent of the total number of EDs in Florida. Historically, syndromic surveillance has categorized patient chief complaint data into syndromes for the purpose of disease surveillance or outbreak detection. Triage notes are much longer freetext, pre-diagnostic data that capture the presenting symptoms and complaints of a patient.

Objective

This study assesses the utilization of triage notes from emergency departments (EDs) and urgent care centers (UCCs) for active case finding in ESSENCE-FL during the Zika response.

In 2012, the Oregon Public Health Division (OPHD) took advantage of the opportunity created by Meaningful Use, a Centers for Medicare & Medicaid Services (CMS) Incentive Program, to implement statewide syndromic surveillance. The Oregon syndromic surveillance project, or Oregon ESSENCE, began accepting MUcompliant HL7 2.5.1 data in late 2013. Early onboarding efforts were labor-intensive and led to the creation of a testing queue. As interest in submitting syndromic data increased, Oregon ESSENCE streamlined the onboarding process by creating guidance for HL7 message construction, message testing and submitter business process details (collectively referred to as “onboarding documents”). Oregon ESSENCE also built a project management database to track MU testing statuses and data quality variations. With this system, Oregon ESSENCE collected, tested and approved all 32 eligible health systems (56 hospitals) for production-level submission by mid-2015. One health system (with four hospitals) continued to send non-MU compliant syndromic data for the duration of the project period.

Objective

To design a low budget process to enroll, track and approve syndromic submitters for ongoing submission of data to the Oregon Public Health Division. 

Syndromic surveillance systems are large and complex technology projects that increasingly require large investments of financial and political capital to be sustainable. What was once a minor surveillance tool in the mid-2000s has evolved into a program that is regarded as valuable to public health yet is increasingly difficult to maintain and operate for local health departments. The Houston Health Department installed a syndromic surveillance system (SyS) six years before Meaning Use became known to healthcare communities. The system chosen at the time was the Real-time Outbreak Disease Surveillance System (RODS) which, at the time and for its purpose, was a suitable platform for syndromic surveillance. During the past 13 years however, maintaining, operating, and growing a SyS by a local health department has become increasingly difficult. Inclusion in Meaningful Use elevated the importance and profile of syndromic surveillance such that network growth, transparency of operations, ease of data sharing, and cooperation with other state systems in Texas became program imperatives.

Objective

Describe and explain the transition of the syndromic surveillance program at the Houston Health Department (HHD) from being a locally managed and aging system to an ESSENCE system governed by a regional Consortium of public health agencies and stakeholders in the 13-county area of the southeast Texas

In spite of the noted benefits of syndromic surveillance, and more than a decade after it started gaining support, the primary use for syndromic surveillance appears to be largely for seasonal and jurisdictional disease monitoring, event response and situational awareness as opposed to its intended purpose of early event detection. Research assessing the user characteristics and standards applied at local public health agencies (LPHA’s) for syndromic surveillance are scarce, and in national surveys epidemiologists frequently tend to utilize their own syndromic surveillance systems as opposed to a national system such as Biosense. While the National Syndromic Surveillance Program (NSSP) has addressed many operational concerns from stakeholders, and is in the process of providing access to the cloud based Biosense platform-along with ESSENCE as a key tool, there is still a paucity of research that exists as to what can be done to improve the utilization of syndromic surveillance systems for its primary purpose of early event detection.

Objective

A mixed methods study is being conducted on the statewide Early Notification of Community Based Epidemics (ESSENCE) system in Missouri to identify factors that can improve the timeliness and identification of outbreaks. This research will provide stakeholders with guidance on how best to implement and improve ESSENCE usage statewide, and by sharing this research input can be solicited on the utility of the applied framework as well as future implications from this body of work.

From 2001-2011, mental health-related hospitalizations and ED visits increased among United States children nationwide. During this period, mental health-related hospitalizations among NYC children increased nearly 23%. To estimate mental health-related ED visits in NYC and assess the use of syndromic surveillance chief complaint data to monitor these visits, we compared trends from a near real-time syndromic system with those from a less timely, coded ED visit database. 

Objective

To assess the use of syndromic surveillance to assess trends in mental health-related emergency department (ED) visits among school-aged children and adolescents in New York City (NYC). 

Human MERS-CoV was first reported in September 2012. Globally, all reported cases have been linked through travel to or residence in the Arabian Peninsula with the exception of cases associated with an outbreak involving multiple health care facilities in the Republic of Korea ending in July 2015. While the majority of MERS-CoV cases have been reported in the Arabian Peninsula, several cases have been reported outside of the region. Most cases are believed to have been acquired in the Middle East and then exported elsewhere, with no or rare instances of secondary transmission. Two cases of MERS-CoV were exported to the United States and identified in May 2014. One of these cases traveled from Saudi Arabia to Florida.

DOH conducts regular surveillance for MERS-CoV through the investigation of persons with known risk factors. PUIs have most often been identified by physicians reporting directly to local health departments and by DOH staff regularly querying ED and UCC chief complaint data in ESSENCE-FL. ESSENCE-FL currently captures data from 265 EDs and UCCs statewide and has been useful in identifying cases associated with reportable disease and emerging pathogens. 

Objective

To retrospectively identify initial emergency department (ED) and urgent care center (UCC) visits for Florida’s Middle East respiratory syndrome coronavirus disease (MERS-CoV) patients under investigation (PUIs) in the Florida Department of Health’s (DOH) syndromic surveillance system, the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL), using information gathered from PUI case report forms and corresponding medical records for the purpose of improving syndromic surveillance for MERS-CoV. The results of this study may be further utilized in an effort to evaluate the current MERS-CoV surveillance query.