ESSENCE

In 2015, suicide was the 8th leading cause of death in Salt Lake County, Utah, and has recently been identified as a priority public health issue. For suicide, suicide ideation and suicide attempts surveillance, Salt Lake County Health Department staff use National Violent Death Reporting System (NVDRS) mortality data to monitor historical trends and vital records mortality data and ESSENCE ED encounter morbidity data to monitor trends and populations in real time. To improve surveillance and better identify populations at higher risk of suicide, we tested whether we could retrospectively identify residents who died from suicide and visited an ED in the year before death.

Objective:

To explore the use of ED syndromic surveillance data to retrospectively identify individuals who died from suicide and visited an ED before death in order to improve suicide surveillance and inform planning and prevention efforts in Salt Lake County, Utah.

Indiana utilizes the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) to collect and analyze data from participating hospital emergency departments. This real-time collection of health related data is used to identify disease clusters and unusual disease occurrences. By Administrative Code, the Indiana State Department of Health (ISDH) requires electronic submission of chief complaints from patient visits to EDs. Submission of discharge diagnosis is not required by Indiana Administrative Code, leaving coverage gaps. Our goal was to identify which areas in the state may see under reporting or incomplete surveillance due to the lack of the discharge diagnosis field.

Objective:

To identify surveillance coverage gaps in emergency department (ED) and urgent care facility data due to missing discharge diagnoses.

Opioid ODs have been rising globally and nationally. The death rate from ODs in the United States has increased 137% since 2000, including a 200% increase of OD deaths involving opioids1. The pilot project, a collaboration across 3 states, allowed information sharing with Syndromic surveillance (SyS) partners across jurisdictions, such as sharing a standard SyS case definition and verifying its applicability in each jurisdiction. This is a continuation of the work from an initial pilot project presented during the ISDS Opioid OD Webinar series.

Objective:

The objective is to develop a standard opioid overdose case definition that could be generalized nationally

The United States is in the midst of a drug crisis; drug-related overdoses are the leading cause of unintentional death in the country. In Colorado the rate of fatal drug overdose increased 68% from 2002-2014 (9.7 deaths per 100,000 to 16.3 per 100,000, respectively), and non-fatal overdose also increased during this time period (23% increase in emergency department visits since 2011). The CDC’s National Syndromic Surveillance Program (NSSP) provides near-real time monitoring of emergency department (ED) events across the country, with information uploaded daily on patient demographics, chief complaint for visit, diagnosis codes, triage notes, and more. Colorado North Central Region (CO-NCR) receives data for 4 local public health agencies from 25 hospitals across Adams, Arapahoe, Boulder, Denver, Douglas, and Jefferson Counties. Access to local syndromic data in near-real time provides valuable information for local public health program planning, policy, and evaluation efforts. However, use of these data also comes with many challenges. For example, we learned from key informant interviews with ED staff in Boulder and Denver counties, about concern with the accuracy and specificity of drug-related diagnosis codes, specifically for opioid-related overdoses.

Objective:

In order to better describe local drug-related overdoses, we developed a novel syndromic case definition using discharge diagnosis codes from emergency department data in the Colorado North Central Region (CO-NCR). Secondarily, we used free text fields to understand the use of unspecified diagnosis fields.

In preparation for mass gathering events, DPH conducts enhanced syndromic surveillance activities to detect potential cases of anthrax, tularemia, plague, and other potentially bioterrorism-related communicable diseases. While preparing for Saint Louis to host a Presidential Debate on October 9, 2016, DPH was asked by a partner organization whether we could also detect emergency department (ED) visits for injuries (e.g., burns to the hands or forearms) that could possibly indicate bomb-making activities.

Objective:

To describe a novel application of ESSENCE by the Saint Louis County Department of Public Health (DPH) in preparation for a mass gathering and to encourage discussion about the appropriateness of sharing syndromic surveillance data with law enforcement partners.

Timeliness of emergency room (ER) data is arguably its strongest attribute in terms of its contribution to disease surveillance. Timely data analyses may improve the efficacy of prevention and control measures. There are a number of studies that have looked at timeliness prior to the advent of Meaningful Use, and these studies note that ER data were not fast enough for them to be useful in real time2,3. However, the change in messaging practices in the Meaningful Use era potentially changes this. Other studies have shown that changes in processes and protocol can dramatically improve timeliness1,4 and this motivates the current study of timeliness to identify processes that can be changed to improve timeliness.

Objective:

To explore the timeliness of emergency room surveillance data after the advent of federal Meaningful Use initiatives and determine potential areas for improvement.

Overdose deaths involving opioids (i.e., opioid pain relievers and illicit opioids such as heroin) accounted for at least 63% (N = 33,091) of overdose deaths in 2015. Overdose deaths related to illicit opioids, heroin and illicitly-manufactured fentanyl, have rapidly increased since 2010. For instance, heroin overdose deaths quadrupled from 3,036 in 2010 to 12,989 in 2015. Unfortunately, timely response to emerging trends is inhibited by time lags for national data on both overdose mortality via vital statistics (8-12 months) and morbidity via hospital discharge data (over 2 years). Emergency department (ED) syndromic data can be leveraged to respond more quickly to emerging drug overdose trends as well as identify drug overdose outbreaks. CDC’s NSSP BioSense Platform collects near real-time ED data on approximately two-thirds of ED visits in the US. NSSP’s data analysis and visualization tool, Electronic Surveillance System for the Notification of Community-based Epidemics (ESSENCE), allows for tailored syndrome queries and can monitor ED visits related to heroin overdose at the local, state, regional, and national levels quicker than hospital discharge data.

Objective:

This paper analyzes emergency department syndromic data in the Centers for Disease Control and Prevention's (CDC) National Syndromic Surveillance Program’s (NSSP) BioSense Platform to understand trends in suspected heroin overdose.

The use of social media as a syndromic sentinel for diseases is an emerging field of growing relevance as the public begins to share more online, particularly in the area of influenza. Several applications have been developed to predict or monitor influenza activity using publicly posted or self-reported online data; however, few have prioritized accuracy at the local level. In 2016, the Cook County Department of Public Health (CCDPH) collected localized Twitter information to evaluate its utility as a potential influenza sentinel data source. Tweets from MMWR week 40 through MMWR week 20 indicating influenza-like illness (ILI) in our jurisdiction were collected and analyzed for correlation with traditional surveillance indicators. Social media has the potential to join other sentinels, such as emergency room and outpatient provider data, to create a more accurate and complete picture of influenza in Cook County.

Objective:

To determine if social media data can be used as a surveillance tool for influenza at the local level.

Standard syndrome definitions for ED visits in ESSENCE rely on chief complaints. Visits with more words in the chief complaint field are more likely to match syndrome definitions. While using ESSENCE, we observed geographic differences in chief complaint length, apparently related to differences in electronic health record (EHR) systems, which resulted in disparate syndrome matching across Idaho regions. We hypothesized that chief complaint and diagnosis code co-occurrence among ED visits to facilities with long chief complaints could help identify terms that would improve syndrome match among facilities with short chief complaints.

Objective:

We sought to use free text mining tools to improve emergency department (ED) chief complaint and discharge diagnosis data syndrome definition matching across facilities with differing robustness of data in the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) application in Idaho’s syndromic surveillance system.

In January 2017, the NSSP transitioned their BioSense analytical tools to Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE). The chief complaint field in BioSense 2.0 was a concatenation of the record's chief complaint, admission reason, triage notes, and diagnostic impression. Following the transition to ESSENCE, the chief complaint field was comprised of the first chief complaint entered or the first admission reason, if the chief complaint was blank. Furthermore, the ESSENCE chief complaint field was electronically parsed (i.e., the original chief complaint text was altered to translate abbreviations and remove punctuation). This abstract highlights key findings from Maricopa County Department of Public Health's evaluation of the new chief complaint field, its impact on heat-related illness syndromic surveillance, and implications for ongoing surveillance efforts.

Objective:

To evaluate the effect and implications of changing the chief complaint field during the National Syndromic Surveillance Program (NSSP) transition from BioSense 2.0 analytical tools to BioSense Platform ESSENCE.