1. Missouri ESSENCE for Hospitals
Amy Kelsey
Missouri Department of Health and Senior Services
Office of Emergency Coordination

2. What is ESSENCE? Electronic Surveillance System for the Early
Notification of
Community-based
Epidemics

3. What is ESSENCE?
Developed by Johns Hopkins University and Department of Defense
Automated surveillance tool
Analysis & reporting of pre-defined syndrome groups
Data mining ability
Web based

4. Where do ESSENCE data come from?
ESSENCE was acquired by DHSS in order to utilize the electronic emergency department (ED) data sent to DHSS under 19 CSR
This Rule requires that 85 out of about 120 hospitals with ED’s send data to DHSS for the purpose of syndromic surveillance
83 of those hospitals are currently loaded in ESSENCE (See Map)

5. Hospital Data
Utilizes data from the “Hospital Information System” that each hospital maintains for its own purposes, like billing and patient records
Put into the HL7 format by each hospital and sent to DHSS
Each have their own methodology and criteria
No special data entry required: use data already being entered into hospital’s information system

6. Hospital Data DHSS processes data and loads into ESSENCE each day
Including weekends and holidays
Approximately 8,000 ED visits per day
Data are presented to public health authorities and hospital staff via the Missouri ESSENCE website
Available 24/7 but only loaded once per day

7. Data Displayed in ESSENCE
Patient data are unduplicated and de-identified
Data are displayed within pre-defined syndrome groups & are available for data mining using custom queries
All available ED data are loaded
Varies by hospital, but some hospital data date back to January 1, 2004

8. -- Public Health Event Detection & Assessment Program
Purpose of ESSENCE
Our mission is to help state and local partners respond to public health events by providing information and tools for early event detection and situational awareness
-- Public Health Event Detection & Assessment Program

9. What is syndromic surveillance?
Utilization of nontraditional data sources to detect health events earlier than possible with traditional methods like laboratory-confirmed diagnoses
Early event detection
Situational awareness

10. What is early event detection?
Analysis of time-sensitive data for the purpose of detecting outbreaks as early as possible
ESSENCE will “flag” a syndrome group whose number of visits was higher than expected to detect anomalies as early as possible

11. ED Chief Complaints are Clustered in Broad Syndrome Groups
Respiratory (cough, pneumonia, influenza)
Gastrointestinal (vomiting, diarrhea)
Neurological (meningitis, altered mental status, dizzy)
Fever
Rash (vesicular rash, chicken pox)
Botulism-like (weakness, blurred vision, speech)
Shock/Coma (syncope)
Hemorrhagic Illness (blood)

12. Active Surveillance vs. Traditional Disease Tracking Methods
Johns Hopkins Applied Physics Laboratory

13. What is situational awareness?
ESSENCE can be used during ongoing health events to track impact in terms of time, geography, and demography
Example: foodborne illness outbreak in a neighboring community
Example: carbon monoxide poisonings following an ice storm

14. How is ESSENCE used? According to Johns Hopkins University
Early event detection
Monitoring for disease outbreaks following planned events
Assessing effects of natural disasters or severe weather
Rumor control
Good to know that no alerts have been generated

15. How is ESSENCE used in MO?
Office of Emergency Coordination staff review ESSENCE Alert List each working day
Staff use internal protocols to review ESSENCE alerts, or flags, and determine whether further investigation is needed
Only about five flags a month are investigated further, coordinated through local health departments

16. How is ESSENCE used in MO?
Aid in surveillance efforts
Work with Bureau of Environmental Epi on carbon monoxide, hypothermia, and hyperthermia case finding
Monitor communities affected by Department of Natural Resources-issued Boil Water Orders
For those orders associated with bacteriological and/or turbidity findings
Create situational awareness reports

17. How is ESSENCE used in MO?

18. How is ESSENCE used in MO?
Special projects
Working with partners in St. Louis County on flu assessment
Compared ESSENCE “Influenza-like Illness” cases to lab-confirmed cases during previous flu seasons
Interesting findings

19. Flu Season Statewide
CDC Week

20. Flu Season Statewide
CDC Week

21. Missouri ESSENCE Users
Johns Hopkins University has said that ESSENCE is only as good as the people who monitor it
We agree: that’s why we want professionals from all different points of view to be able to access ESSENCE
We have granted access to 200+ users and are in the process of training everyone who is interested

22. Who is eligible for ESSENCE access?
Any public health authority
Local public health agency
Missouri DHSS
Any staff from a hospital that sends data to DHSS and that are displayed in ESSENCE
Usually infection control staff
Anyone concerned with communicable disease or overall ED trends

23. What data can hospital users view?
Hospital users may view the entire state’s data in aggregate
But may only view “record level” data for their own hospital and/or hospital group
Although data are de-identified, hospital data like number of visits, chief complaints, etc. are protected by DHSS

24. What patient level data are displayed?
Admission date and time
Hospital name
Zip code (patient)
County (patient)
Age group
Age
Sex
Chief complaint
Category (Rash, GI, etc.)
Discharge diagnosis (ICD-9 code, if available)
Discharge disposition (chief complaint, working diagnosis, final diagnosis)
Medical Record Number
County (hospital)
Zip Code (hospital)

25. How to apply for access
The Automated Security Access Processing (ASAP) system helps users from various institutions register for a variety of health applications at DHSS
See ASAP Requesting Access to ESSENCE (for private providers) handout or visit and see “Information for ESSENCE Hospitals” on left menu bar

26. ASAP Tips http://www.dhss.mo.gov/ASAP/
Links to ASAP logon and helpful guides
If you have never registered using ASAP, follow the instructions from the “New User” point in the instructions

27. ASAP Tips
If you already have access to a DHSS health application like MHIRS, BTSurv, or MOHSIS, you may already have an ASAP password
May request a reminder on the ASAP Login screen and they will send it to you quickly
Still need to complete ASAP for ESSENCE specifically
We will issue an ESSENCE-specific password, but we try to keep your ASAP username

28. Why is hospital ESSENCE access important?
To provide feedback to hospitals demonstrating how we use the data you provide
To ensure hospitals can view statewide, regional, and local health trends
To help public health and health care providers communicate effectively about health events at the community level

29. What do you expect of hospitals?
May need help investigating unusual clusters found in ESSENCE
Just as with any other surveillance system or outbreak investigation
Hospital ESSENCE users are valuable partners in assessing these findings

30. How will ESSENCE communications be accomplished?
All contact with hospitals is coordinated through their local public health agency
Or at least with the permission of the agency
LPHAs and hospitals are often familiar with each other and comfortable discussing communicable disease issues
Ensures LPHAs are kept in the loop on health concerns

31. How is ESSENCE useful for hospitals?
May be integrated into existing ER tracking or infection control procedures
May query for complaints of interest like “animal bite” or “ILI”
May be forewarned about health trends (flu season, GI outbreak) affecting neighboring regions
Other applications we have not considered
We would like to know what those are!

32. Training Opportunities
Individuals who are registered for ESSENCE access may attend training
Central District (Jefferson City) – March 17
SE District (Poplar Bluff) – April 23
SW District (Springfield) - April 24
NW District (Independence) – April 29
Eastern District (St. Louis) – June 3
Morning (8:30am-12:00pm) & afternoon (1:00 pm – 4:30 pm) sessions
Call to register or get on the waiting list

33. Online Resources http://www.dhss.mo.gov/ESSENCE/
Training and Technical Support
User Guide and Quick-start Guide
Information for Public Health Authorities
Information for ESSENCE Hospitals
Laws, Regulations, Manuals
Copy of 19 CSR & our Policies and Procedures
Contact Information

34. ESSENCE Demo ESSENCE System Status Page Alert List Summary Alerts
Configuration options
Bookmarks
Summary Alerts
Query Portal
Syndrome-based queries
Free text queries
Custom reports: Matrix Portal
Weekly percent: Influenza-like Illness
Maps

35. Login Page

36. ESSENCE Homepage

37. Alert List

38. Time Series

39. Fields in ESSENCE Patient List
Admission date and time
Hospital name
Zip code (patient)
County (patient)
Age group
Age
Sex
Chief complaint
Category (Rash, GI, etc.)
Discharge diagnosis (ICD-9 code, if available)
Discharge disposition (chief complaint, working diagnosis, final diagnosis)
Medical Record Number
County (hospital)
Zip Code (hospital)

40. Influenza-Like Illness Weekly % for St. Louis Region

41. Map Portal

42. Map Portal