A system overview of the Electronic Surveillance …A system overview of the Electronic Surveillance System for the Early Notification of Community-based Epidemics Presented at the

A system overview of the Electronic Surveillance System for the Early

Notification of Community-based Epidemics

Presented at the 2004 Scientific Conferenceon Chemical & Biological Defense Research

15 November 2004

Joe Lombardo1, Rich Wojcik1, Wayne Loschen1

Jay Mansfield2

1 Johns Hopkins University Applied Physics Laboratory2 Walter Reed Army Institute of Research

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4. TITLE AND SUBTITLE A system overview of the Electronic Surveillance System for the EarlyNotification of Community-based Epidemics

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13. SUPPLEMENTARY NOTES See also ADM001849, 2004 Scientific Conference on Chemical and Biological Defense Research. Held inHunt Valley, Maryland on 15-17 November 2004 . , The original document contains color images.

14. ABSTRACT

15. SUBJECT TERMS

16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT

UU

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Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18

00.10.20.30.40.50.60.70.80.9

1

0 24 48 72 96 120 144 168

Incubation Period (Hours)

Prob

abili

ty o

fD

isea

se D

etec

tion

Time (days)

Num

ber D

ead

Sensor, Animal, or Human Indicators

105

(Anthrax)

t = 0

Fatalities WithEarly Warning

Military & CivilianFatalities With

Traditional Alerting

Gain of 2 days

Effective Treatment Period

Surveillance

Traditional DiseaseDetection

TIME!

Justification for Enhanced Surveillance(Anthrax)

Definition of Surveillance

• Epidemiologic Surveillance

- Ongoing and systematic collection, analysis, and interpretation of health data

- Used to determine need for public health action and to assess the effectiveness of programs

Syndromic Surveillance is the collection and analysis of pre-diagnosis information that lead to an estimation of the health status of the community

Syndromic surveillance uses health care indicators such as:

Emergency Room Chief ComplaintInternational Classification of Disease Billing CodesRequests for Specific Laboratory TestsOver the Counter Medications Sales

Grouped into specific syndromic categories such as:Respiratory GastrointestinalNeurologicalDermatologicalFeveretc.

Syndromic Surveillance Definition

Evolution of ESSENCE

PM Resident Project

DARPABioAlirtProgram

DTRA, JPEOCBDJSIPP

OSD HA

00

01

02

03

04

05

06

ESSENCE IWalter Reed

ESSENCE IINCR

ESSENCE IB(469 users)

ESSENCE II in JMeWS(CENTCOM)

ESSENCE IV*Military 9 Regions

(248 users)

ESSENCE IV*Civilian 9 States

(38 users)

Baseline Software*All Bases Critical Civilian

OSD HA*Med Surveillance

Operations

San Diego*BioNet Test bed

DHS*BioWatch Cities

Enhancement

Military Civilian

NCR*Disease Network

(72 users)

Maryland Y2KJohns Hopkins

Local /NCR

NationalDHS

VHA*National

Surveillance

00

01

02

03

04

05

06

Older Generation Currently OperationalEarly for FY05Future * Based on ESSENCE IV

ESSENCE IV* in JMeWS(CENTCOM)

WRAIR


PM Resident Project


DTRA, JPEOCBDJSIPP

OSD HA

00

01

02

03

04

05

06


ESSENCE IINCR




(248 users)


(38 users)



Operations


DHS*BioWatch Cities

Enhancement

Military Civilian

NCR*Disease Network

(72 users)


Local /NCR

NationalDHS

VHA*National

Surveillance

00

01

02

03

04

05

06



WRAIR

ESSENCE IB Data Flow

World Wide Military Tricare Server Site JHU/APL

Prescription Meds

AmbulatoryEncounters

MilitaryTreatment Facilities

TriCareData

Archive

ESSENCEData

Archive

TemporalUnivariate

Alerts

Time SeriesData

Tables

ESSENCEFTP Server

ESSENCEWeb Server

Tables

Time Series

Alert Flags

Web PagesSAS Application

Data Collection


PM Resident Project


DTRA, JPEOCBDJSIPP

OSD HA

00

01

02

03

04

05

06


ESSENCE IINCR




(248 users)


(38 users)



Operations


DHS*BioWatch Cities

Enhancement

Military Civilian

NCR*Disease Network

(72 users)


Local /NCR

NationalDHS

VHA*National

Surveillance

00

01

02

03

04

05

06



WRAIR

Worldwide U.S. Military (DOD GEIS)Worldwide U.S. Military (DOD GEIS)

PharmacyTri-Service Healthcare

ESSENCE IARCHIVE

ESSENCE IIArchive

ESSENCE IIPROCESSING

&NOTIFICATION

National Capital Area Military & CivilianNational Capital Area Military & CivilianAbsenteeism

Over-the-Counter Sales

Doctors’ Visits

Animal Health

Diagnostic Labs

HospitalEmergency

Room

LocalMilitary & Civ.

Users

Public HealthSurveillance

&Epidemiology

Hospitals&

EmergencyResponse

SecureWeb Site

NCA ONLYNCA ONLY

Integration of Military & Civilian Indicators for ESSENCE II

ClaimsData

ERChief

Complaint

EMS Data

PrescriptionMeds

DataArchive

TemporalUnivariate

TemporalMultivariate

SpatialUnivariate

SpatialMultivariate

Web Server

GISRaw DataDisplay

GISClusterDisplay

AlertFlag Lists

DataQuery

Interface

User InterfacesAnalysis

&Alerting

Major ESSENCE II-IV Components

Health ConditionIndicator Data Comms

Real-time HL-7PHIN MSXML, etc.

Secure FTPVPN, etc.

Text Parsing

DataCleansing

Archiving

Military Data

PHIN MSEtc.

Synthetic Data Used to Show Features of Alert List

Synthetic Syndrome Time Series

Analysis Options

Stacked Graph Example

Detector Comparisons

San Diego Tabletop, Synthetic DataNov 4th, Respiratory Distribution


PM Resident Project


DTRA, JPEOCBDJSIPP

OSD HA

00

01

02

03

04

05

06


ESSENCE IINCR




(248 users)


(38 users)



Operations


DHS*BioWatch Cities

Enhancement

Military Civilian

NCR*Disease Network

(72 users)


Local /NCR

NationalDHS

VHA*National

Surveillance

00

01

02

03

04

05

06



WRAIR

NCR Disease Surveillance Network

ESSENCE IINCR

IntegratedSurveillance

MarylandSurveillance

System

VirginiaSurveillance

System

District of Columbia

SurveillanceSystem

Hospitals

Hospitals

Hospitals

Diagnostic Labs

Diagnostic Labs

Diagnostic Labs

Physician

Physician Physician

Environmental Samples

EPA

Over the Counter Sales

Animal Health

Absenteeism

ESSENCE INCR

Military Data

Tri-ServiceOutpatient Visits

Pharmacy DataFully Identified Records

De-Identified Records

De-Identified Data Sharing


PM Resident Project


DTRA, JPEOCBDJSIPP

OSD HA

00

01

02

03

04

05

06


ESSENCE IINCR




(248 users)


(38 users)



Operations


DHS*BioWatch Cities

Enhancement

Military Civilian

NCR*Disease Network

(72 users)


Local /NCR

NationalDHS

VHA*National

Surveillance

00

01

02

03

04

05

06



WRAIR

• NSWCDD

• San Diego

• Camp Lejeune

• POPE AFB

• Ft. Gordon

• Ft. Campbell

• Barksdale AFB

• Ft. Lewis

• Warner Robins AFB

• NSWCDD

• San Diego

• Camp Lejeune

• POPE AFB

• Ft. Gordon

• Ft. Campbell

• Barksdale AFB

• Ft. Lewis

• Warner Robins AFB

BSL2 LAB

C

C2

MED

EMRCC

CCB

H

HHH

PHPH

Approx.Medical SurveillancePerimeter

ESSENCE IV

Hospn ED Visit Chief Complaints

Base

B

C

Bioaerosol sampler/sensorChemical sensor

JSIPP Sites

~50 mi Public Health

Hospitals

Web Site PortalsFor local users

TRICARE

PresumptiveIDs

LRNPH LAB

Confirmatory IDsnotional NationalData Sets

Web Site Portals

Medical Surveillance Component of Installation Protection

future


PM Resident Project


DTRA, JPEOCBDJSIPP

OSD HA

00

01

02

03

04

05

06


ESSENCE IINCR




(248 users)


(38 users)



Operations


DHS*BioWatch Cities

Enhancement

Military Civilian

NCR*Disease Network

(72 users)


Local /NCR

NationalDHS

VHA*National

Surveillance

00

01

02

03

04

05

06



WRAIR

Integration of Military and Civilian Medical Surveillance in San Diego County

LaboratoryInformation

ManagementSystem

San Diego

BioWatchAir Sampling

S1

SnS4

S3

S2

IDRAE / ESSENCEPublic Health

Monitoring System

San Diego County Department of DefenseNavy Region Southwest

DoDLaboratoryAnalysisNetwork

GuardianEnvironmental

Monitoring

S1

Sn S4

S3

S2

ESSENCE IV DoD Health

Monitoring System

AmbulatoryData

PrescriptionMeds

ERChief

Complaint

ERChief

Complaint

EMSRuns

OTCMeds

PrescriptionMeds

PhysicianEncounter VA / HMO PHIN MS

Firewalls


PM Resident Project


DTRA, JPEOCBDJSIPP

OSD HA

00

01

02

03

04

05

06


ESSENCE IINCR




(248 users)


(38 users)



Operations


DHS*BioWatch Cities

Enhancement

Military Civilian

NCR*Disease Network

(72 users)


Local /NCR

NationalDHS

VHA*National

Surveillance

00

01

02

03

04

05

06



WRAIR

Summary & Conclusions

• ESSENCE is the first system to integrate both military and civilian health indicator data for early notification of health events.

• ESSENCE versions are being used for public health surveillance of naturally occurring diseases as well as bioterrorist events.

• Public health surveillance has been around since the 14th century. Recent advances information technology and outbreak detection algorithms have advanced disease surveillance to become a important factor in identification and management of major health events.

Documents

A system overview of the Electronic Surveillance …A system overview of the Electronic Surveillance System for the Early Notification of Community-based Epidemics Presented at the