Emergency Department (ED)

As syndromic surveillance systems continue to grow, new opportunities have arisen to utilize the data in new or alternative ways for which the system was not initially designed. For example, in many jurisdictions syndromic surveillance has recently become population-based, with 100% coverage of targeted emergency department encounters. This makes the data more valuable for real- time evaluation of public health and prevention programs. There has also been increasing pressure to make more data publicly available – to the media, academic partners, and the general public. 

Objective

This roundtable will provide a forum for national, state, and local managers of syndromic surveillance systems to discuss how they identify, monitor, and respond to changes in the nature of their data. Additionally, this session will focus on the strengths and weakness of the syndromic surveillance systems for supporting program evaluation and trend analysis. This session will also provide a forum where subject matter experts can discuss the ways in which this deep understanding of their data can be leveraged to forge and improve partnerships with academic partners. 

In New Jersey, Health Monitoring Systems Inc.’s (HMS) EpiCenter collects chief complaint data for syndromic surveillance from 79 of 80 emergency departments (ED). Using keyword algorithms, these visits are classified into syndrome categories for monitoring unusual health events.

HAIs are infections that patients acquire while they are receiving treatment for a health condition in a health care setting. Following the 2014 Ebola outbreak in West Africa, the New Jersey Department of Health (NJDOH) Communicable Disease Service (CDS) started recruiting EDs to include triage note data in addition to chief complaint data to enhance surveillance capability for Ebola and other HAIs. Research by the University of North Carolina suggests triage note data improve the ability to detect illness of interest by fivefold. Currently, there are three NJ EDs with triage note data in EpiCenter along with ICD 10 codes which can be used for comparison.

This pilot study will assess whether infections following a surgical procedure can be captured in triage note data along with ICD codes. Also, this evaluation will determine if triage note data can be used to create HAI custom classifications for syndromic surveillance. These classifications can potentially be used by surveillance and/or preparedness personnel and local health departments, as well as hospitals, to better prepare for detecting and preventing HAIs that are a significant cause of morbidity and mortality in the U.S. 

Objective

Evaluate the usage of triage note data from EpiCenter, a syndromic surveillance system utilized by New Jersey Department of Health (NJDOH), to enhance Healthcare-Associated Infections (HAIs) surveillance for infections following a surgical procedure. 

Overdoses of heroin and prescription opioids are a growing cause of mortality in the United States. Deaths from opioids have contributed to a rise in the overall mortality rate of middle-aged white males during an era when other demographics are experiencing life expectancy gains. A successful public health intervention to reverse this mortality trend requires a detailed understanding of which populations are most affected and where those populations live. While mortality is the most relevant metric for this emerging challenge, increased burden on laboratory facilities can create significant delays in obtaining confirmation of which patients died from opioid overdoses.

Emergency department visits for opioid overdoses can provide a more timely proxy measure of overall opioid use. Unfortunately, chief complaints do not always contain an indication of opioid involvement. Overdose patients are not always conscious at registration which limits the amount of information they can provide. Menu-driven registration systems can lump all overdoses together regardless of substance. A more complete record of the emergency department interaction, such as that provided by triage notes, could provide the information necessary to differentiate opioid-related visits from other overdoses. 

Objective

To identify heroin- and opioid-related emergency department visits using pre-diagnositc data. To demonstrate the value of clinical notes to public health surveillance and situational awareness. 

In 2016, the World Health Organization declared Zika virus a global public health emergency. Zika infection during pregnancy can cause microcephaly and other fetal brain defects. To facilitate clinicians’ ability to detect Zika, various syndrome definitions have been developed. 

Objective

To develop and validate a Zika virus disease syndrome definition within the GUARDIAN (Geographic Utilization of Artificial Intelligence in Real-Time for Disease Identification and Alert Notification) surveillance system.