APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT APHA – Innovation Projects System Changes and Solutions in State

APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT

APHA – Innovation ProjectsSystem Changes and Solutions in State Public Health

The North Carolina Experiencewith NC DETECT

NC Disease Event Trackingand Epidemiologic Collection Tool

Jean-Marie Maillard, MD, MScNC Division of Public Health

Credits:Lana Deyneka & Heather Vaughan-Batten (NC-DPH)

Anna Waller & Amy Ising, on behalf of the UNC-DEM DETECT Team


Presenter Disclosures

Jean-Marie Maillard

The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

No relationships to disclose


Hospital public health surveillance- before automation

• September 1999: Hurricane Floyd

• October 2001: Anthrax index case– Regional retrospective and prospective

surveillance in 17 NC hospitals

• October 2003: Hurricane Isabel– 30 hospitals, 12 days, 25,000+ ED visits


Hurricane Isabel, October 2003



Emergency Department Visits after Hurricane Isabel, NC 9/18/2003

0

200

400

600

800

1000

1200

1400

9/12

/200

39/

13/2

003

9/14

/200

39/

15/2

003

9/16

/200

39/

17/2

003

9/18

/200

39/

19/2

003

9/20

/200

39/

21/2

003

9/22

/200

39/

23/2

003

9/24

/200

39/

25/2

003

9/26

/200

39/

27/2

003

9/28

/200

3

Date

E.D

. Vis

its

N=11,707

12-day series available from 13 hospitals

Hurricane Isabel

(Data not collected)

NC Public HealthInformation Network (NC PHIN)

Early Detection:Suspected Cases

Hospital EmergencyDepartments (EDs)

Alerting & Paging

NC EDSSEMS

Poison Center

Health Alert

Network

ImmunizationRegistry

Vet Lab

Physician Reported Cases

Lab Results

Case Reports

Wildlife

“Traditional surveillance”“Enhanced surveillance”


NC DETECT Data Volume

Hospital Emergency Departments

Ambulance Runs

Poison Center Calls

(Over 4 Million

ED visits/year)


Legal Mandate - GS § 130A‑480

Emergency department data reporting

(a) For the purpose of ensuring the protection of the public health, the State Health Director shall develop a syndromic surveillance program for hospital emergency departments in order to detect and investigate public health threats that may result from

(i) a terrorist incident using nuclear, biological, or chemical agents or

(ii) an epidemic or infectious, communicable, or other disease. The State Health Director shall specify the data to be reported by hospitals pursuant to this program…

*Effective 1/1/2005

*Law modified in 2007 to allow sharing of reported hospital ED data with CDC



Hospital ED data shared with BioSense for national surveillance


NC DETECT Data ElementsED Data• Patient and Visit IDs• Date of Birth, Sex• City, County, State, ZIP• Hospital • Arrival Date/Time• Chief Complaint• Initial Vital Signs• Diagnosis, Injury and Procedure

Codes (ICD-9-CM, CPT)• Transport Mode to ED• Insurance Coverage• ED Disposition• Triage Notes (not mandatory)

Poison Center Data• Unique ID• Patient demographics• Clinical effects• Scenarios, Therapies,

Substances involved (if any)

EMS Data• Unique ID• Patient Demographics• Dispatch complaint, chief

complaint, primary symptoms


NC DETECT Purpose

• Early Event Detection

• Situational Awareness

• Broader public health surveillance including– Injuries– Reportable diseases– Chronic diseases (asthma, diabetes)


NC DETECT Reporting Basics

• Updates twice a day

• 24/7/365 Secure Web access• Role-based access; over 200 users at

state, regional, local and hospital level

• Tables, graphs and maps• Aggregate and line listing reports with

customization options


Syndrome Case Report


Separate system allows reach back in some hospitals


2007-2008 Influenza Season

0%

2%

4%

6%

8%

10%

12%

40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

WEEK#

%IL

I

ED

SPN

Influenza-Like Illness Surveillance in North Carolina, 2007-2008 Influenza Season Comparative trend between two surveillance systems:

Sentinel Provider Network (SPN) and Hospital Emergency Department (ED)

HOSPITAL ILI E.D. VISITSBY AGE GROUP

0

10

20

30

40

50

60

70

1 2 3 4 5 6 7 8 9 10 11 12

WEEK #

%IL

I Adult

Child

ILI E.D. Visits by Disposition

0

10

20

30

40

50

60

70

80

90

1 2 3 4 5 6 7 8 9 10 11 12WEEK#

Per

cen

tag

e

Admits Discharged Died Unknown


Age DistributionSentinel Provider Network Data

Influenza-Like IllnessBY AGE GROUP

Sentinel Provider Network Data, NC, 2007-2008

0

1

2

3

4

40 42 44 46 48 50 52 2 4 6 8 10 12

WEEK #

Pe

rce

nta

ge

% 0-4 yo

% 5-24 yo

%25-64 yo

%over 64 yo


Environmental Disaster Surveillance Explosion at a

chemical plantTerms used in filter: fire, disaster, Apex, toxic

gas, hazard, waste plant, evac, Hazmat, chlorine, clorine, petrol, chemical, explosion

(abbreviations and misspellings taken into account)


Katrina Evacuees Monitoring, 2005


Katrina Evacuees ED visits in NC

• Illness/medical reason 61%

• Prescription refill or medication 15%

• Injury 11%

• Psychiatric/mental health 7%

• “Medical examination” 6%


Food Product Recall

On February 14, 2007, the FDA warned consumers not to eat certain jars of Peter Pan peanut butter or Great Value peanut butter due to risk of contamination with Salmonella Tennessee

Poison Center calls

Hospital ED visits


Heat injury surveillance – August, 2007

Daily temperature peaks

Heat-related ED visits


Improving Situational Awareness with NC DETECT

• Effective statewide public health surveillance• Timeliness greatly improved

(1-2 hours to establish custom event report)

• Major reduction in redundant manual data entry

• Data sources allow monitoring of rural and underserved populations

• Improved case finding after outbreaks are detected


NC DETECT as innovation• Catalyst

– Bioterrorism and natural disasters

• New approach– Secondary use of existing data– Standardization: data formatting and transmission

• “Bonus”– Flexibility (w. triage notes)– Communication (Annotation left by analysts)– Environmental exposure monitoring (Poison Center calls)– National biosurveillance player

• Challenges– Mandate; Standardization; Maintenance budget

• Next Steps– Urgent care centers; Ambulance run data; Sustainable funding

Documents

APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT APHA – Innovation Projects System Changes and Solutions in State