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Successful Alerts and Responses: Real-time Monitoring of ED Chief Complaints and Investigation of Anomalies

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Successful Alerts and Responses: Real-time Monitoring of ED Chief Complaints and Investigation of Anomalies CDC Public Health Preparedness Conference – PowerPoint PPT presentation

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Title: Successful Alerts and Responses: Real-time Monitoring of ED Chief Complaints and Investigation of Anomalies


1
Successful Alerts and Responses Real-time
Monitoring of ED Chief Complaints and
Investigation of Anomalies
  • CDC Public Health Preparedness Conference
  • February 23, 2005
  • Loren Shaffer, MPH
  • Ohio Department of Health

2
Real-time Outbreak and Disease Surveillance (RODS)
  • Developed by team at the University of Pittsburgh
    led by Mike Wagner, MD, PhD
  • Utilizes existing data (HL7 format) from
    hospitals registration database
  • Interprets and maps free-text chief complaint
    into syndrome category
  • Interprets and maps sales of over-the-counter
    medication
  • Accessed by end user via the internet

3
Syndromic Surveillance Data Flow
Daily
Continuous
Emergency Department
Categorize Into Syndromes
Daily Totals
Totals Higher Than Expected?
Alert
Continuous
Chief Complaint and Patient Demographics In HL7
messages
Historical Models
Review Trends
Updated monthly
Valid Alert?
Initiate Response
4
Sample HL7 ADT Message
MSH\xxxRODS200202241715ADTA042002022X
XXXXXXXP2.3ltCRgt PID020M84204
ltCRgt PV1E98765432
200202151830ltCRgt DG1SORE
THROAT,COUGHltCRgt IN1
84056ltCRgt ltETXgt
5
RODS Navigation EpiPlot Screen
6
RODS Navigation Mapplot
7
RODS Navigation Chief Complaints
8
Ohios Approach
9
Some Bottom Lines (Incentives) for Hospitals
  • Cost for RODS installation paid for by ODH with
    HRSA grant money
  • Minimal configuration time - via telephone with
    assistance of RODS engineers
  • Runs in background No additional duties for ED
    or IT personnel
  • Data are secure and de-identified
  • patient privacy is maintained
  • HIPAA compliant
  • JCAHO Standards

10
RODS Project Progress
11
RODS Project Progress
12
Geographic Coverage
13
Example 1 Respiratory Visits
  • 12/24/2004 _at_ 1458 alert for all Ohio
  • Normalized increase from 11.5 to 15

14
Example 1 Respiratory Visits
  • 12/23/2004 Severe ice storm results in massive
    power outages.
  • Stores throughout area sell out of kerosene and
    other supplemental heating units.
  • Review of chief complaints reveals carbon
    monoxide poisoning as culprit.
  • Total preliminary investigation 10 minutes

15
Example 2 Norwalk Virus Outbreak
  • January 11, 2005 Norwalk-like outbreak involving
    4 staff and 7 residents of nursing home reported
    to State. Later confirmed via bulk stool
    analysis.
  • January 4, 2005 Disease first reported locally
    with nausea, diarrhea, and vomiting lasting
    between 12 and 48 hours.

16
Example 2 Norwalk Virus Outbreak
  • 12/31/2004 gt3 SD from moving average for
    anti-diarrhea medications in ZIP code 44024
  • Possibility community infection brought into
    nursing home by employee/visitor

17
Example 3 Influenza
  • Influenza surveillance includes lab results, ILI
    sentinel providers, VA Clinic Visits, Class B,
    OTC sales, and school closings,

18
Example 3 Influenza
19
Example 3 Influenza
  • Franklin Co. resident confirmed with influenza A
    (H3N2) via lab isolate1/19/05
  • Specimen date1/4/2005
  • Illness Onset date1/1/2005

20
Integrating RODS Into Ohios Surveillance Program
  • Establishing intrastate user visibility
  • Who gets access
  • Area of surveillance
  • Data made available
  • Inter-state visibility
  • Identifying other states using
  • How much visibility into each others jurisdiction

21
Integration Continued
  • Review and analysis
  • Frequency
  • At what level
  • Standardization of analysis
  • What to do with alerts
  • Who is alerted
  • Preliminary investigation
  • Documentation
  • Protocol for monitoring, responding, etc. 24/7

22
Ohio Department of Health Early Event
Surveillance Staff
  • Loren Shaffer, Supervisor
  • lshaffer_at_odh.ohio.gov
  • Shannon Rowe, Immunization Epidemiologist
  • srowe_at_odh.ohio.gov
  • Brian Fowler, Syndromic Surveillance Epi.
  • bfowler_at_odh.ohio.gov
  • Muhammad Abbasi, Bio-terrorism Epi.
  • mabassi_at_odh.ohio.gov
  • Brenda Mocarski, Infec. Dis. Control Consultant
  • bmocarsk_at_odh.ohio.gov
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