Surveillance Systems

The 2009 H1N1 novel flu pandemic demonstrates how a rapidly spreading, contagious illness can affect the world’s population in multiple ways including health, economics, education, transportation, and national security. Pandemic disease and the threat of bio-terrorism are prompting the need for a system that integrates disparate data, makes optimal use of the breadth of available health-related analysis and predictive models, and provides timely guidance to decision makers at multiple levels of responsibility.

Objective

Traditional real time surveillance systems such as RODS and ESSENCE have focused on the task of threat detection; however, experience with the use of these systems in pandemic and disaster response settings suggests that a more common application is threat characterization and response management. This paper describes EpiSentry: a novel second generation real-time surveillance software system under development at Lockheed Martin that uses simulation to aid in threat characterization, response management and to provide decision support for disease outbreaks or bio-terror events.

The Keyhole Markup Language (KML) format has become a recognized standard for the distribution of geographic information system data. In most recent versions of the Real-Time and Outbreak Disease Surveillance (RODS) system, we standardized on KML as our mapping solution. This decision obviates the need for commercial GIS servers and clients, and permits users to easily overlay RODS map output with other websites and software that output KML, for example, EPA, NASA, and NOAA.

We quickly recognized that the mapping tools in RODS have broad applicability in public health and other domains where there is a requirement to display spatial temporal data as it relates to state, county, and zip code geographies. To facilitate these needs, we created the EpiScape map generation service for public use.

Objective

This paper describes EpiScape, our map generation service. It generates three-dimensional static or animated maps as KML files that can be used to display epidemiologic data over time and space using Google Earth or Google Maps software.

The detailed analysis of the epidemiological literature on the 2003 SARS epidemic published in peer reviewed journals has shown that a majority (78%) of the epidemiological articles were submitted after the epidemic had ended, although the

corresponding studies had relevance to public health authorities during the epidemic. The conclusion was that to minimize the lag between research and the exigency of public health practice in the future, researchers should consider adopting common, predefined protocols and ready-to-use instruments to improve timeliness, and thus, relevance, in addition to standardizing comparability across studies.

Objective

This paper describes how the ideas and tools of e-commerce can be translated to the investigation of outbreaks: epidemiologists will ‘shop’ the best available items for their

questionnaire, enhance the chances of producing interoperable questionnaires, and speed up the whole process.

Florida Department of Health has developed a statewide syndromic surveillance system based on the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE). Authorized users can currently access data from the Florida Poison Information Center Network (FPICN), Emergency Room chief complaints, Florida reportable disease system (Merlin) and the Florida death records through ESSENCE under one portal. The purpose of this paper is to summarize efforts to enhance statewide real-time chemical surveillance by incorporating FPICN data into ESSENCE.

Utah Statewide Immunization Information System (USIIS) is the state immunization registry. It is connected to about 700 organizations, including 100% public health clinics, 60% of private providers, many schools, daycares, pharmacies, and Indian Health Services. Data exchange methods range from web data entry, batch file transfer, proprietary or HL7 data interfaces, and real-time exchange with Intermountain

Healthcare’s electronic health records. Clinicians in Utah ranked immunization data as one of the first five use cases for developing the statewide clinical Health Information Exchange (cHIE) in Utah Health Information Network. Utah Department of Health has collaborated with Utah Health Information Network to develop the immunization information exchange.

Objective

The goal of the immunization information exchange is to expand the USIIS interoperability to all private providers, especially those who are not a USIIS’ user but participate in cHIE.

The global H1N1 influenza A pandemic in 2009 heightened the need for automated disease surveillance capabilities. After an initial surge in confirmatory testing, clinicians

moved to diagnosis based on patient assessment for fever combined with cough or sore throat, the influenza-like indicators (ILI). Although some organizations used automated data capture or national systems with manual data entry (www.cdc.gov/flu/weekly/fluactivity.htm), there was not a turnkey national automated system in place to support syndromic surveillance for ILI among non-affiliated organizations. Semantic interoperability through standards utilization is widely expected to simplify large-scale data initiatives but is challenging with widely disparate uses of terminology.

Objective

This paper describes a national initiative connecting 850 non-affiliated healthcare provider organizations throughout the United States in order to provide situational awareness during the 2009–2010 H1N1 influenza A pandemic. We addressed the challenge of semantic variability between organizations through a centralized data-mapping approach.

Early Aberration Reporting System (EARS, US Centers for Disease Control and Prevention, EARS Program, MS C-18, Atlanta, GA, USA) is a freeware surveillance tool that can be downloaded from the Center for Disease Control and Prevention’s website (http://emergency.cdc.gov/surveillance/ears/). It was designed for quick set-up and customization for automated monitoring of emergency department and other syndromic data sources, including, but not limited to, 911 calls, school absenteeism,

and over-the-counter medication sales. The United States’ city, county, state health departments, and various international public health organizations, use EARS software to conduct daily, near-real time surveillance of conditions easily defined by patient-reported complaints, and physician diagnoses (for example, influenza-like illness, gastroenteritis, asthma, heat-related illness). It is also used to conduct suspect case finding during outbreaks, natural disaster responses, verify that potential threats are not manifested in communities, and for supporting ad hoc analyses and research.

Objective

The objective of this poster is to highlight recent upgrades to the EARS software, and identify features planned for future releases.

Pro-WATCH (protecting war fighters using algorithms for text processing to capture health events), a syndromic surveillance project for veterans of operation enduring freedom (OEF)/operation Iraqi freedom (OIF), includes a task to identify medically unexplained symptoms (MUS). The v3NLP entity extraction tool is being customized to identify symptoms within VA clinical documents, and then refined to assign duration. The identification of medically unexplained symptoms and the aggregation of this information across documents by patient’s is not addressed here.

Objective

Pro-WATCH (protecting war fighters using algorithms for text processing to capture health events), a syndromic surveillance project, includes a task to identify medically unexplained symptoms. The v3NLP entity extraction tool is being customized to identify symptoms, then to assign duration assertions to address part of this project. The v3NLP tool was recently enhanced to find problems, treatments, and tests for the i2b2/VA challenge. The problem capability is being further refined to find symptoms. Machine learning models will be developed using an annotated corpus currently in development to find duration assertions.

Event-based biosurveillance is a practice of monitoring diverse information sources for the detection of events pertaining to human health. Online documents, such as news articles on the Internet, have commonly been the primary information sources in event-based biosurveillance. With the large number of online publications as well as with the language diversity, thorough monitoring of online documents is challenging. Automated document classification is an important step toward efficient event-based biosurveillance. In Project Argus, a biosurveillance program hosted at Georgetown University Medical Center, supervised and unsupervised approaches to document classification are considered for event-based biosurveillance.

Objective

This paper describes ongoing efforts in enhancing automated document classification toward efficient event-based biosurveillance. 

Secure and confidential exchange of information is the cornerstone of public health practice. Often, this exchange has to occur between public health agencies across jurisdictions. Examples include notification of reportable diseases when the testing and residence of the patient are in different counties. The cross-jurisdictional issues become exaggerated in times of communicable disease outbreaks or events of interest that are not yet classified as outbreaks. Currently, such communication occurs between state and local agencies and between agencies and community clinicians on a personal level, with phone, fax and snail mail. There are a multitude of secured websites hosted by the Utah Department of Health (UDOH) that offer access to single applications requiring approved users to remember multiple sites and logins/passwords. The goal of this project was to develop a centralized, single sign-on secure web portal, from which users could access multiple applications and communicate securely with each other.

Objective

There is an urgent need for improved communication between stakeholders involved in outbreak investigations, public health reporting and events of interest occurring between different jurisdictions within the same state. Currently, state and local public health agency personnel rely on personal communications involving phone, fax and snail mail. UDOH sought to develop and encourage the use of a secured web portal that allows access to a variety of applications using a single sign-on. This was achieved by developing a secured communications framework called PHAccess that allows tools and applications to be implemented within a secure web environment, using open source software and Agile methodology techniques. The user-centric design currently hosts an electronic report-staging area, ELR/EMR reporting, webbased reporting, secure messaging between stakeholders and a state laboratory result look-up feature. Currently, there are over 700 registered users; 3693 secure messages that have been exchanged and the site has been accessed over 12,205 times since January 2009. Informal feedback from users has been encouraging and formal evaluation is planned, along with expansion and integration with state level health information exchange projects.