Implementing a Syndromic Surveillance System in Miami-Dade County Fermin Leguen, MD, MPH Chief Physician Director, Office of Epidemiology & Disease Control Miami-Dade County Health Department Guoyan Zhang, MD, MPH Senior Epidemiologist/Coordinator 02/22/06 Working Group on BioSurveillance Data Monitoring and Information Exchange DIMACS/CDC

Needs Assessment 18 hospitals contacted 14 hospitals have electronic data from ED 17 hospitals willing to participate Chief Complaint data available from 14 hospitals Interest in adding a primary care component

Attributes of the desired system At the hospital At the hospital No additional forms or data requirements No additional forms or data requirements No staff needed for data entry No staff needed for data entry Automatic capture and transfer of desired information Automatic capture and transfer of desired information Web-based access Web-based access User friendly User friendly

Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) Web based medical surveillance system Web based medical surveillance system Participants can access the system at different administrative levels Participants can access the system at different administrative levels Automated data collection and analysis Automated data collection and analysis Data is transferred from Hospital ER to ESSENCE server by query batch file that attached to Hospital electronic database Data is transferred from Hospital ER to ESSENCE server by query batch file that attached to Hospital electronic database

Data Elements Hospital Name Hospital Name Hospital Zip code Hospital Zip code Date of visit Date of visit Time of visit Time of visit Gender Gender Race/ethnicity Race/ethnicity Patient’s Age (in years) Patient’s Age (in years) Chief complaint Chief complaint Zip code of patient’s residence (5 digit) Zip code of patient’s residence (5 digit) Discharge diagnosis** Discharge diagnosis** Admission status** Admission status** **Optional **Optional

Data Collection Options Record Format Flat file extract delimited (‘|’ or ‘,’) or fixed width Collection Frequency Once a day batch Transmission Methods Secure FTP

Hospitals Hospital Reporting System Query SSH FTP Server Batch File Secure FTP Connection Miami-Dade County Health Department Hospital Archive SSH FTP Client DoH Archive Port 22 Batch File Batch File Listener

ESSENCE Syndromes Botulism-like Febrile Disease Fever Gastrointestinal Hemorrhagic Illness Influenza_Like Neurological Other Rash Respiratory Shock / Coma

How do we manage the system? Every morning each hospital transmit Emergency Department Chief Complaint data Every morning each hospital transmit Emergency Department Chief Complaint data By noon, a report is developed and ed to staff in Office of Epidemiology and Disease Control By noon, a report is developed and ed to staff in Office of Epidemiology and Disease Control If further investigation is warranted, data reviewed by Epi Surveillance Coordinator and Data Analyst If further investigation is warranted, data reviewed by Epi Surveillance Coordinator and Data Analyst If necessary, hospital ICP is contacted for chart review If necessary, hospital ICP is contacted for chart review Other partners are contacted/notified if needed Other partners are contacted/notified if needed

What additional value can we get from Syndromic Surveillance in Miami? Influenza Surveillance Post-Hurricane Surveillance Other Events Surveillance

Influenza Surveillance The system has an ILI Syndrome Category Use ILI data to report the weekly and daily county influenza activity Weekly ILI reports posted at MDCHD website and distributed to staff and community Daily report submitted to Bureau of Epidemiology, FL DOH

Influenza-Like Illness in Miami-Dade October/2005-Februray 2006

Hurricane and Other Events Surveillance Post-Hurricane Surveillance Post-Hurricane Surveillance What happens at local hospitals ED immediately after hurricanes? What happens at local hospitals ED immediately after hurricanes? Is there an increased morbidity due to respiratory, gastrointestinal illnesses, or other? Is there an increased morbidity due to respiratory, gastrointestinal illnesses, or other? Holidays Holidays Labor Day, Thanksgiving, Festivals, etc. Labor Day, Thanksgiving, Festivals, etc. Any aberration on syndromic trends? Any aberration on syndromic trends?

Total ED Visits among 6 Hospitals in Miami-Dade 09/01/ /31/2005 After Hurricane Wilma 10/26/2005 Monday after Christmas Hurricane Wilma Warning 10/22/2005 After Labor Day 09/06/2005 Monday 11/14/2005 Monday after Thanksgiving

Challenges Hospital representatives not comfortable with sending their data to a 3 rd party TENET system hospitals initially declined to participate Convincing hospital leaders  HIPAA Completing the MOU signing process Having the project approved by the State IT Governance Office

-To add medical record number to the data retrieved from hospitals It will expedite the epi investigations -To request diagnosis code (delayed data) It will help us assess syndrome alerts, and evaluate the system -Injury Surveillance - Add 8 more local hospitals to the system What is Next in our To Do list?

Lessons Learned Enhanced communication with community partners Enhanced communication with community partners Understanding of the State IT Governance requirements Understanding of the State IT Governance requirements Reconciling State and metropolitan areas interests when federal resources are earmarked to specific localities could be challenging Reconciling State and metropolitan areas interests when federal resources are earmarked to specific localities could be challenging DSL?  T1 DSL?  T1

Summary The syndromic surveillance system in Miami will The syndromic surveillance system in Miami will 15 local participating hospitals 15 local participating hospitals Expanded to other counties of Florida (Broward, West Palm Beach, Monroe, Martin, etc) Expanded to other counties of Florida (Broward, West Palm Beach, Monroe, Martin, etc) Add other data sources such as 911 system, school absenteeism, poison control center Add other data sources such as 911 system, school absenteeism, poison control center Explore value of additional applications Explore value of additional applications

Contact Information Fermin Leguen, MD, MPH (305) Guoyan Zhang, MD, MPH (305)