Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) In Miami-Dade County

1
Implementing a Syndromic Surveillance System in
Miami-Dade County
Fermin Leguen, MD, MPH Chief Physician Director,
Office of Epidemiology Disease Control
Miami-Dade County Health Department Guoyan
Zhang, MD, MPH Senior Epidemiologist/Coordinator
02/22/06 Working Group on BioSurveillance Data
Monitoring and Information Exchange DIMACS/CDC
2
Needs Assessment

• 18 hospitals contacted
• 14 hospitals have electronic data from ED
• 17 hospitals willing to participate
• Chief Complaint data available from 14 hospitals
• Interest in adding a primary care component

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Attributes of the desired system

• At the hospital
• No additional forms or data requirements
• No staff needed for data entry
• Automatic capture and transfer of desired
  information
• Web-based access
• User friendly

4
Electronic Surveillance System for the Early
Notification of Community-Based
Epidemics(ESSENCE)

• Web based medical surveillance system
• Participants can access the system at different
  administrative levels
• Automated data collection and analysis
• Data is transferred from Hospital ER to ESSENCE
  server by query batch file that attached to
  Hospital electronic database

5
Data Elements

• Hospital Name
• Hospital Zip code
• Date of visit
• Time of visit
• Gender
• Race/ethnicity
• Patients Age (in years)
• Chief complaint
• Zip code of patients residence (5 digit)
• Discharge diagnosis
• Admission status
• Optional

6
Data Collection Options

• Record Format
• Flat file extract delimited ( or ,) or
  fixed width
• Collection Frequency
• Once a day batch
• Transmission Methods
• Secure FTP

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Batch File Secure FTP Connection
Miami-Dade County Health Department
Hospitals
HospitalReporting SystemQuery
SSH FTPClient
SSH FTPServer
Port 22
Batch FileListener
Batch File
8
ESSENCE Syndromes


Botulism-like
Febrile Disease
Fever
Gastrointestinal
Hemorrhagic Illness
Influenza_Like
Neurological
Other
Rash
Respiratory
Shock / Coma
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How do we manage the system?

• Every morning each hospital transmit Emergency
  Department Chief Complaint data
• By noon, a report is developed and emailed to
  staff in Office of Epidemiology and Disease
  Control
• If further investigation is warranted, data
  reviewed by Epi Surveillance Coordinator and Data
  Analyst
• If necessary, hospital ICP is contacted for chart
  review
• Other partners are contacted/notified if needed

10
What additional value can we get from Syndromic
Surveillance in Miami?

• Influenza Surveillance
• Post-Hurricane Surveillance
• Other Events Surveillance

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Influenza Surveillance

• The system has an ILI Syndrome Category
• Use ILI data to report the weekly and daily
  county influenza activity
• Weekly ILI reports posted at MDCHD website and
  distributed to staff and community
• Daily report submitted to Bureau of Epidemiology,
  FL DOH

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Influenza-Like Illness in Miami-Dade
October/2005-Februray 2006
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Hurricane and Other Events Surveillance

• Post-Hurricane Surveillance
• What happens at local hospitals ED immediately
  after hurricanes?
• Is there an increased morbidity due to
  respiratory, gastrointestinal illnesses, or
  other?
• Holidays
• Labor Day, Thanksgiving, Festivals, etc.
• Any aberration on syndromic trends?

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Total ED Visits among 6 Hospitals in Miami-Dade
09/01/2005 - 12/31/2005
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Challenges

• Hospital representatives not comfortable with
  sending their data to a 3rd party
• TENET system hospitals initially declined to
  participate
• Convincing hospital leaders ? HIPAA
• Completing the MOU signing process
• Having the project approved by the State IT
  Governance Office

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What is Next in our To Do list?

• -To add medical record number to the data
  retrieved from hospitals
• It will expedite the epi investigations
• -To request diagnosis code (delayed data)
• It will help us assess syndrome alerts, and
  evaluate the system
• -Injury Surveillance
• - Add 8 more local hospitals to the system

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Lessons Learned

• Enhanced communication with community partners
• Understanding of the State IT Governance
  requirements
• Reconciling State and metropolitan areas
  interests when federal resources are earmarked to
  specific localities could be challenging
• DSL? ? T1

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Summary

• The syndromic surveillance system in Miami will
• 15 local participating hospitals
• Expanded to other counties of Florida (Broward,
  West Palm Beach, Monroe, Martin, etc)
• Add other data sources such as 911 system, school
  absenteeism, poison control center
• Explore value of additional applications

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Contact Information

• Fermin Leguen, MD, MPH
• fermin_leguen_at_doh.state.fl.us
• [phone]
• Guoyan Zhang, MD, MPH
• Guoyan_Zhang_at_doh.state.fl.us
• [phone]