1. ESSENCE v1.9 Training Course: 1. Introduction to ESSENCE Emily Kuo, MPH Missouri ESSENCE Questions or concerns? Contact Training and Support at : Tel: 573-522-8329 or Email: essence@dhss.mo.gov 1

2. Core Elements 1. Introduction to ESSENCE v1.9 2. Accessing ESSENCE 3. Differences between old and new ESSENCE 4. Learning Modules in new ESSENCE 2

3. A. Purposes of Syndromic Surveillance B. ESSENCE Overview C. Data SourcesD. Data Filters Introduction to ESSENCE v1.9 3

4. Control and prevention of communicable diseases are cornerstones of public health. Disease surveillance enables public health officials and their partners to achieve such purposes by monitoring changes in the population’s health status. 4

5. However… a challenge continues to exist in public health surveillance. How do we conduct early identification of adverse health events with high potential to cause high morbidity and mortality? 5

6. Modern transportation systems complicate matters because they permit communicable diseases to be carried around the world in hours over many public health jurisdictions. Health authorities can no longer simply be concerned only with the health status of populations they serve. They must collaborate in surveillance and containment activities at regional, national, international levels. Information technology plays a vital role in the timely capture and dissemination of information needed for identification and control of outbreaks. Therefore, the internet is an enabling technology for collaboration across wide geographic areas. 6

7. In response to the need for earlier recognition of significant health events, public health institutes have developed modern surveillance applications based on the world wide web. Caution: These systems provide an early indication of a health event but additional investigation is often required to confirm presence of any particular disease. 7

8. An example of an early recognition disease surveillance system is Electronic Surveillance Syndrome for the Early Notification Community-based Epidemics. ESSENCE is also known as a syndromic surveillance system. 8

9. Two basic functions of ESSENCE: 1.Early event detection (Alert List):  Analyzes time-sensitive data for the purpose of detecting and flagging outbreaks as early as possible. 2.Situational awareness (Query Portal):  Queries data sources to obtain size, location, spread of an imminent health event.  Tracks ongoing health events to assess impact in terms of time, geography, and demography. 9

10. Alerts for possible outbreaks at hospital and/or community level are detected by ESSENCE using specially developed statistical algorithms. Such unexpected or abnormal events are then flagged using color. Red flags indicate the difference in count and expected frequency to be statistically significant at p-value ≤ 0.01. Yellow flags indicate the difference at statistical significance of a p-value between 0.01 and 0.05. 10

11. An illustrative way to describe ESSENCE is to think of the system as a set of carving tools. 11

12. ESSENCE allows us to take a block of surveillance information and query a meaningful display of health information to use or share with our public health partners. 12

13. To assemble the block, ESSENCE acquires information from several data sources: – Emergency department data – Over-the-counter drug sales (non-traditional data source) In the future, ESSENCE would like to acquire: – School Absenteeism (non-traditional data source) – Rural hospitals not required to report under 19 CSR 10-33.404 – Ambulance/Emergency Medical Services data 13

14. ESSENCE system groups the acquired data into sets of symptoms that are use to define syndrome and sub-syndromes such as: Syndromes (subsyndromes): 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 (bleeding) 14

15. The Querying function helps ESSENCE to roughly carve out a dataset first. ESSENCE can query by syndrome, by subsyndrome, or by keywords. 1) Syndrome examples: GI, Respiratory, Rash 2) Subsyndrome examples: cough, NVD, ILI 3) Keyword query: free text query of the chief complaints field. HINT: Free text query brings a flexibility to the system by allowing the search for conditions that do not fit into specific syndrome groups, such as “animal bite”, for tailored reports. 15

16. Free text function of the Advance Query webpage allows users to search keywords among all chief complaints. 16

17. Some of the data filters used by ESSENCE to refine the desired database for analysis are listed below : o Geographic Elements and Systems o Medical Grouping & Sub Grouping o Sex o Detector o Age Group o Date Range 17

18. Examples of data filters in ESSENCE 18

19. Characteristics of the final data set: Unduplicated and de-identified patient data displayed within pre- defined syndrome groups. Alerts are generated by algorithms automatically seeking anomalies. Baseline of comparison for analysis is historical hospital data. Users can “drill down” to investigate if desire. User-friendly format (Microsoft Excel or Comma delimited file). 19 Excel File.xlsPlain text file.txt

20. Primary benefits of ESSENCE for hospital users: Offers excellent “slicing and dicing” capabilities for analysis. Delivers valuable hospital view of data for Infection Control Practioners. Allows collaboration with public health while protecting hospital/patient confidentiality. 20

21. Primary benefits for public health officials: Early event detection. Outbreak case investigation and follow-up management. Assessing impacts of natural disasters or severe weather. Exposure contact tracing. Exposure source investigation and linking of cases and contacts to exposure sources. Good to know that no alerts have been generated. 21

22. This concludes the part on Introduction to ESSENCE. Proceed to the next core. 22