Increasing the returnoninvestment from syndromic surveillance: using the systems for routine activit

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Increasing the return-on-investment from
syndromic surveillance using the systems for
routine activities

• Shandy Dearth, MPH
• Joseph Gibson, PhD
• Marion County Health Department

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Is the output worth the input?

• Syndromic surveillance
• Frequent monitoring
• Many alerts
• Few significant events
• Maximizing return-on-investment
• Minimize investment rapidly cull unimportant
  alerts
• Maximize return find other uses

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Indianapolis syndromic surveillance

• Marion Countys population 865,000
• October 2004 Electronic Surveillance System for
  the Early Notification of Community-based
  Epidemics (ESSENCE) goes live
• 14 hospitals Marion County supply ED data
• 8 syndromes are monitored
• In 3 years, 1 syndrome alert resulting in on-site
  public health action

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Additional queries yield return

• Indiana State Department of Health created a
  query based on key terms from the Communicable
  Disease Reporting Rule for the Indiana Public
  Health Emergency Surveillance System (PHESS)
• MCHD can access results via a portal
• MCHD can access patient information to follow up
  on possible public health events

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Some everyday public health uses

• Rabies prophylaxis (PHESS)
• Carbon monoxide exposure (PHESS)
• Community notification (PHESS)
• Possible bioterrorism (PHESS)
• Weather related visits (query in ESSENCE)

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Rabies prophylaxis 2 times each month

• Rabies vaccine often administered in emergency
  rooms
• The free text chief complaint captures key terms
  seen by nurse epidemiologists at LHD
• Public Health Nurses call hospital if an expected
  vaccination does not occur
• Nurses are able to see patient returns for all 5
  shots
• 3-4 patients each month

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Carbon monoxide exposure

• When MCHD epidemiologists see CO exposures, the
  MCHD indoor air specialist is contacted to
  inquire about source of exposure
• Residential exposure risks are identified and
  corrected
• 5 residences each winter

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Community notification

• Letters sent home to parents via school often
  trigger precautionary ED visits
• Examples include scabies, head lice, shigella,
  etc.
• Not the best use of an ED, but indicates that
  parents received the notices sent by the health
  department
• 5 events each year

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Possible bioterrorism Around 3 p.m. on a Friday
before a large car race

• BEING TREATED FOR POSSIBLE EXPOSURE TO MUSTARD
  GAS seen in chief complaint
• Dry cleaner employee had mixed a cleaner with
  bleach and was affected by the mixture
• Nurse in ED did not understand why mustard gas
  would raise concern
• Good reminder - not everyone has Bioterrorism on
  their mind 24/7

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Weather related visits during warm temperatures

• Data is queried for key terms such as
  heat,or,dehyd,or,hot
• Memo to EDs requested the use of heat when case
  was related to environmental factors
• Daily counts are shared with Emergency Management
  Agency when deciding to open community cooling
  centers, extend library hours, extend public
  swimming pool hours, etc.

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Weather related visits during cold temperatures

• Data is queried for key terms such as cold, or,
  frost, or,expos,or,hypothermia
• Daily counts are shared with Emergency Management
  Agency when deciding to open additional shelters

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Conclusion

• Although hard to quantify time/money saved,
  syndromic surveillance has increased skill and
  capacity for investigation events of possible
  public health importance

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The output is worth the input.

• Investment
• Initial set-up
• 15 minutes per day monitoring follow-up
• Maintenance by ISDH Regenstrief
• Return
• Triggers public health investigation 1/month
  (excluding post exposure prophylaxis for rabies)
• Population information (asthma, flu curve)
• Possible early detection of bioterrorism
• We will continue to find new uses

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Thank you to ISDH

• Mike Wade, syndromic surveillance epidemiologist
• Dave Trepanier, technical support

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Questions?

• Shandy Dearth
• 317.221.3158
• Sdearth_at_hhcorp.org