ESSENCE

BioSense was launched in 2003 by CDC with its primary aim to establish an integrated system of nationwide public health surveillance for the early detection and prompt assessment of potential bioterrorism-related syndromes or other public health emergencies. With the release of CDC’s Surveillance Strategy, BioSense evolved into the National Syndromic Surveillance Program (NSSP). To overcome the challenges experienced throughout the integration of local and state level data to produce a real-time national all-hazards surveillance, CDC sought input from the National Syndromic Surveillance Community of Practice (NSSP CoP). They requested that CDC provide advanced syndromic surveillance functionalities and analytical applications, such as ESSENCE and SAS to improve the BioSense Platform. In response, CDC led this pilot project to: 1) conduct security testing of SAS and ESSENCE in order to identify vulnerabilities; 2) test and improve a limited set of processes that occur before data are transformed; and 3) conduct testing of ESSENCE’s functions to ensure the tool worked as intended, and that it will meet user needs.

Objective

To describe the results of a pilot project that examined selected BioSense 2.0 data processing rules and tested SAS and ESSENCE products in the BioSense platform.

Many methods to detect outbreaks currently exist, although most are ineffective in the face of real data, resulting in high false positivity. More complicated methods have better precision, but can be difficult to interpret and justify. Praedico™ is a next generation biosurveillance application built on top of a Hadoop High Performance Cluster that incorporates multiple syndromic surveillance methods of alerting, and a machine-learning (ML) model using a decision tree classifier  evaluating over 100 different signals simultaneously, within a user friendly interface.

Objective

To compare syndromic surveillance alerting in VA using Praedico™ and ESSENCE.

Illnesses related to synthetic marijuana use have been reported in many states, including Florida. Because these visits can present with a variety of symptoms, as well as be attributed to numerous diagnosis codes, it can be difficult to identify and quantify these visits. The Electronic Surveillance System for the Early Notification of Community-based Epidemics in Florida (ESSENCE-FL) receives chief complaint (CC) and discharge diagnosis (DD) data as free text allowing uncommon or new terms to be searched for within each patient visit. The main source of data for ESSENCE-FL is emergency department (ED) and urgent care center (UCC) data. There are currently 210 EDs and 33 UCCs throughout Florida that send their data to the ESSENCE-FL server. Using ESSENCE-FL, a free text query of patient CCs and DDs was used to identify visits related to synthetic marijuana use. This study is designed to analyze these identified visits for trends over time, geographical distribution and descriptive statistics and demographics.

Objective

One of the numerous functions of syndromic data has been the identification of visits of public health interest using customized free text queries. A specific query of syndromic data was created to search for and identify emergency department (ED) and urgent care center (UCC) visits possibly related to the use of synthetic marijuana to describe and quantify this public health issue in Florida.

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).

In October 2015, the Centers for Disease Control and Prevention (CDC) released health advisory #384 to inform people about increases in fentanyl fatalities. Florida’s statewide syndromic surveillance system, Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL), captures electronic death record data in near real time which allows for the monitoring of mortality trends across the state. One limitation of using death record data for fentanyl surveillance is the lack of a fentanyl-specific overdose ICD-10 code; however, the literal cause of death fields (“literals”) provide a level of detail that is rich enough to capture mentions of fentanyl use. The “literals” are a free text field on the death certificate, recorded by a physician at the time of death and detail the factors that led to the death. ESSENCE-FL has the benefit of not only receiving death record data in near real-time, but also receiving the literal cause of death fields. This work analyzes trends in fentanyl-associated mortality in Florida over time by using the literal cause of death fields within death records data obtained from ESSENCE-FL.

Objective

To characterize fentanyl-associated mortality in Florida using free text queries of the literal causes of death listed on death certificates.

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.

The Florida Department of Health in Hillsborough County (FDOH- Hillsborough) conducts enhanced syndromic surveillance on a daily basis. The Electronic Surveillance System for the Early Notification of Community-based Epidemics in Florida (ESSENCE-FL) is the syndromic surveillance system used by epidemiologists within the Florida Department of Health (FDOH). During the time of this study, ESSENCE-FL receives data from 210 of emergency departments (ED) and 33 urgent care centers (UCC) throughout the state of Florida, including 12 EDs and 3 UCCs in Hillsborough County. In 2014, the ESSENCE-FL system added a feature that delivers an automatic daily email to designated primary ESSENCE-FL users in each county containing all visits which have been detected by the state’s visits of interest (VOI) query. The email contains all visits which have been detected by the visits of interest (VOI) query for each ESSENCE-FL users designated county. The VOI query utilizes the combined chief complaint and discharge diagnosis (CCDD) field of a visit for keywords related to reportable diseases and exposures of public health interest. In addition to this VOI email, Hillsborough County analyzes time of arrival alerts, specialized emerging infectious disease queries, poison information center data, and volume levels of syndromes and subsyndromes predetermined by ESSENCE-FL. A daily summary report of the enhanced daily surveillance analysis is then provided to area public health officials within FDOH-Hillsborough and the surrounding counties. This study examines how visits requiring additional investigation are detected and the resources required to complete the investigation.

Objective

Enhanced daily surveillance is used to identify reportable diseases, outbreaks, and clusters and provides situational awareness. This project examines how health care visits requiring additional information are detected using enhanced syndromic surveillance and the resources required from detection through completion.

The Centers for Disease Control and Prevention (CDC) uses the National Poison Data System (NPDS) to conduct surveillance of calls to United States poison centers (PCs) to identify clusters of reports of hazardous exposures and illnesses. NPDS stores basic information from PC calls including call type (information request only or call reporting a possible chemical exposure), exposure agent, demographics, clinical, and other variables.

CDC looks for anomalies in PC data by using automated algorithms to analyze call and clinical effect volume, and by identifying calls reporting exposures to pre-specified high priority agents. Algorithms analyzing call and clinical effect volume identify anomalies when the number of calls exceeds a threshold using the historical limits method (HLM). Clinical toxicologists and epidemiologists at the American Association of Poison Control Centers and CDC apply standardized criteria to determine if the anomaly is a potential incident of public health significance (IPHS) and then notify the respective health departments and PCs as needed. Discussions with surveillance system users and analysis of past IPHS determined that call volume-based surveillance results in a high proportion of false positive anomalies. A study assessing the positive predictive value (PPV) of this approach determined that fewer than four percent of anomalies over a five-year period were IPHS.1 A low PPV can cause an unnecessary waste of staff time and resources. We hypothesized that first stratifying call volume by exposure category would reduce the number of false positives. With the help of medical toxicologists, we created 20 toxicologically-relevant exposure categories to test this hypothesis. 

Objective

Our objective was to determine if the detection performance of current surveillance algorithms to detect call clusters is improved by stratifying by exposure category. 

The Department of Defense conducts syndromic surveillance of health encounter visits of Military Health System (MHS) beneficiaries. Providers within the MHS assign up to 10 diagnosis codes to each health encounter visit. The diagnosis codes are grouped into syndrome and sub-syndrome categories. On October 1, 2015, the Health and Human Services-mandated transition from ICD- 9-CM to ICD-10-CM required evaluation of the syndrome mappings to establish a baseline of syndrome rates within the DoD. The DoD data within the BioSense system currently utilizes DoD ESSENCE syndrome mappings. The Master Mapping Reference Table (MMRT) was developed by the CDC to translate diagnostic codes across the ICD-9-CM and ICD-10-CM encoding systems to prepare for the transition. The DoD ESSENCE and MMRT syndrome definitions are presented in this analysis for comparison. 

Objective

The transition from ICD-9-CM to ICD-10-CM requires evaluation of syndrome mappings to obtain a baseline for syndromic surveillance purposes. Two syndrome mappings are evaluated in this report.