The Delaware Electronic Reporting and Surveillance System (DERSS) Philip G. Cabaud Homeland Security Director State of Delaware

DERSS GOAL Provide users with the ability to enter, manage, and view information in support of disease reporting, syndromic surveillance and event management Syndromic surveillance is the collection of information about symptoms (e.g. neurological symptoms, respiratory symptoms, etc.) as opposed to diagnosed diseases (e.g. encephalitis, SARS, etc.)

Public Health Role in Emergency Response: Terrorism Early identification of event Ongoing assessment of risk Case and contact management Implement disease control measures Provide medical management and infection control guidance Environmental health assessment Carry out Public Health and Medical Plan (ESF-8) These are the public health responsibilities in connection with terrorism and its aftermath. The “red” font items are those that DERSS was created to to address.

Identifying an “Event” The Perfect Surveillance System Real time 100% complete reporting Surveillance for symptoms and diagnosed illnesses (e.g. anthrax) Reporting by non-traditional sources Easy for health care providers Rapid analysis of incoming data This is the goal. DERSS will bring us closer.

Identifying an “Event” Traditional (current) information flow Physician Hospital Lab Other Report Card Report Card Report Card Report Card The current system was designed before computers and before the internet. Reporters, such as hospitals, transfer their records from paper to computer, and then to DPH’s paper reporting forms. The forms are then placed in the U.S mail. (Some diseases require a telephone report, e.g. meningitis). DPH then transfers the information from the paper form to an electronic record. The system is obviously inefficient, and full of time delays. Public Health

Needed Disease Surveillance Identifying an “Event” Traditional is not good enough Initial Symptoms Acute Illness Needed Disease Surveillance Time Gain Traditional Disease Detection This chart is for illustrative purposes only. Our traditional system (right curve) would probably detect an event well into the first incubation period, and after treatment would most likely be effective. The system we want (left curve) will detect an event much sooner, as much as three days sooner. Effective Treatment Period

DERSS Automates as much of the current system as possible Uses national standards (CDC’s National Electronic Disease Surveillance System) More accurate data, faster Syndromic surveillance and 65 “diagnosed” diseases Enhanced tools for data analysis Automatically flags and notifies when aberrations HIPAA compliant and secure Expandable: backbone for other applications Notes: Syndromic surveillance is the monitoring of symptoms (e.g. respiratory or dermatological) rather than discrete diagnosed illnesses. The 65 diseases are those that are required by Delaware regulation to be reported by hospitals, laboratories, physicians, and other health care providers. The system will automatically detect aberrations (departures from the expected incidence) of symptoms or diseases, flag those aberrations, and even page our epidemiologists when they occur. HIPAA is the Health Insurance Portability and Accountability Act of 1996, national standards to protect the privacy of personal health information

Automated Scanning of Databases ANALYSIS & INFORMATION OUTPUT DERSS Information Flow WEB PAPER Automated Scanning of Databases DERSS Schematically, the system gets its data from three sources: DERSS will extract data from existing data bases on a constant basis, hourly if necessary. DPH will instruct the system regarding what information to “collect,” either syndromes or “reportable” diseases. Identifying information, which we are authorized by law to collect, will only be abstracted for the reportable diseases. This part of the system is customized to fit hospital databases. No translation of the data by the hospital is necessary. The software only needs to know how your data is structured. Health care providers can manually enter information on a secured website We will still accommodate paper reports, but clearly want to phase those out. DERSS then processes the information: Checks the data for errors Checks and eliminates duplicates Merges records DERSS then provides advanced analytic analysis, including comparing the frequency of reports against an expected range. ANALYSIS & INFORMATION OUTPUT

DERSS Data Sources First phase: hospitals and laboratory Then: pharmacies, smaller providers, other non-traditional sources Secure WEB Portal for entry of individual reports if economy of scale too small for automated scanning of databases Paper reports will continue for partners without WEB Our first priority are hospitals and laboratories. Hospitals and laboratories have larger databases for the DERSS to scan, and are our traditional surveillance partners. We will then expand to the system providers with smaller databases and who are non-traditional, such as pharmacies. Where automated scanning of databases is not appropriate due to the economy of scale, a secured web portal for manual data entry will be made available, and paper reports will still be accepted.

DERSS Analysis Automated data checking and elimination of duplicate information Integration of health information from multiple sources Extensive analytic tools for event detection and epidemiologic decision-making Mapping and GIS Automated notification of aberrations Incident management DERSS also is designed to improve our ability to analyze the information we receive. Incident management - It will also provide new methods for us to track our response to events and assure sharing of relevant information to those involved in the response.

DERSS Prototype Home Page This is a draft of the home page for the system.

DERSS Prototype Alerts Page This is a draft alert page. Obviously there is no SARS in Dover. (There is West Nile in Kent County). Access to information will be controlled based on need-to-know.

DERSS Includes GIS Capability

Timeline Hospitals participated in pre-development assessment (July 2002) Contract awarded August 2003 to Northrop Grumman Interface with hospitals, laboratories to begin in March, 2004 Base system expected to be completed by Oct 2004 System capable of expansion (additional data sources) thereafter The July 2002 assessment was conducted (by a contractor) in order to make sure that we knew exactly what to ask for from the contractor who develops the system. We wanted to be clear about the capabilities of the hospitals, laboratories and other reporting facilities. This time was also used to determine the interest of the hospitals. While reporting of the 65 communicable diseases is required by law, current regulations do not require participation in DERSS as the reporting mechanism, and there is no requirement for reporting symptoms without identifiers. Hospitals and laboratories in Delaware have been active participants in the development of the system. DPH has received two grants from CDC for development and implementation, totaling $2.9 million. Congressman Castle was instrumental in obtaining this funding. In addition, $900,000 of Delaware’s Bioterrorism Cooperative Agreement is used to fund this project.

Public Health Infrastructure Public Health Response Bioterrorism Emerging Infections Other Public Health Programs Essential Scientific Capabilities Surveillance Laboratory Practice Epidemic Investigations This slide is to remind us that in order to effectively respond (top of triangle), we need to assure that essential capabilities (middle) are in place. This in turn requires an adequate infrastructure (bottom). DERSS will be an important piece of the infrastructure. By using it every day for traditional disease control, we are assured to have, and to have practiced, the capability to respond to a terror event. Basic Infrastructure Workforce Information Systems Organizational Capacity