Missouri ESSENCE for Hospitals Amy Kelsey Missouri Department of Health and Senior Services Office of Emergency Coordination ESSENCE@dhss.mo.gov 573-751-6161

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

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

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 10-33.040 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)

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

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

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

-- 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

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

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

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)

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

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

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

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

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

How is ESSENCE used in MO?

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

2006-2007 Flu Season Statewide CDC Week

2007-2008 Flu Season Statewide CDC Week

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

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

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

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)

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 www.dhss.mo.gov/ESSENCE and see “Information for ESSENCE Hospitals” on left menu bar

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

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

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

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

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

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!

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 573-751-6161 to register or get on the waiting list

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 10-33.040 & our Policies and Procedures Contact Information

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

Login Page

ESSENCE Homepage

Alert List

Time Series

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)

Influenza-Like Illness Weekly % for St. Louis Region

Map Portal

Map Portal