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

A system overview of the Electronic System for the Early Notification of Community-based Epidemics Presented at the 24 Scientific Conference on Chemical & Biological Defense Research 15 November 24 Joe Lombardo 1, Rich Wojcik 1, Wayne Loschen 1 Jay Mansfield 2 1 Johns Hopkins University Applied Physics Laboratory 2 Walter Reed Army Institute of Research

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Justification for Enhanced (Anthrax) Probability of Disease Detection 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 Gain of 2 days Traditional Disease Detection 0 24 48 72 96 120 144 168 Effective Treatment Period Incubation Period (Hours) TIME! (Anthrax) Number Dead 10 5 Military & Civilian Fatalities With Traditional Alerting Fatalities With Early Warning t = 0 Sensor, Animal, or Human Indicators Time (days)

Definition of Epidemiologic - 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 Definition Syndromic 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 Complaint International Classification of Disease Billing Codes Requests for Specific Laboratory Tests Over the Counter Medications Sales Grouped into specific syndromic categories such as: Respiratory Gastrointestinal Neurological Dermatological Fever etc.

Evolution of ESSENCE PM Resident Project Military ESSENCE I Walter Reed Maryland Y2K Johns Hopkins Civilian DARPA BioAlirt Program WRAIR ESSENCE IB (469 users) Military 9 Regions (248 users) Civilian 9 States (38 users) * Disease Network (72 users) Local / DTRA, JPEOCBD JSIPP OSD HA Baseline Software* All Bases Critical Civilian OSD HA* Med Operations DHS* BioWatch Cities Enhancement San Diego* BioNet Test bed VHA* DHS * Based on ESSENCE IV Older Generation Currently Operational Early for FY Future

ESSENCE IB Data Flow World Wide Military Tricare Server Site JHU/APL TriCare Data Archive Alert Flags Temporal Univariate Alerts Time Series ESSENCE Data Archive Time Series Data ESSENCE FTP Server ESSENCE Web Server Ambulatory Encounters Military Treatment Facilities Prescription Meds Data Collection Tables SAS Application Tables Web Pages

Integration of Military & Civilian Indicators for Over-the-Counter Sales Absenteeism Capital Area Military & Civilian Hospital Emergency Room Secure Web Site Local Military & Civ. Users Doctors Visits Archive PROCESSING & NOTIFICATION Public Health & Epidemiology NCA ONLY Animal Health Diagnostic Labs Tri-Service Healthcare ESSENCE I ARCHIVE Pharmacy Hospitals & Emergency Response Worldwide U.S. Military (DOD GEIS)

Major -IV Components Health Condition Indicator Data ER Chief Complaint EMS Data Prescription Meds Claims Data Military Data PHIN MS Etc. Comms Archiving Data Cleansing Data Archive Text Parsing Analysis & Alerting Temporal Univariate Temporal Multivariate Spatial Univariate Spatial Multivariate Web Server User Interfaces Data Query Interface GIS Raw Data Display GIS Cluster Display Alert Flag Lists Real-time HL-7 PHIN MS XML, etc. Secure FTP VPN, etc.

Synthetic Data Used to Show Features of Alert List

Synthetic Syndrome Time Series

Analysis Options

Stacked Graph Example

Detector Comparisons

San Diego Tabletop, Synthetic Data Nov 4th, Respiratory Distribution

Disease Network Fully Identified Records De-Identified Records Pharmacy Data De-Identified Data Sharing Hospitals Diagnostic Labs Physician Animal Health District of Columbia System ESSENCE I Military Data Tri-Service Outpatient Visits Over the Counter Sales Integrated Physician Physician Virginia System Maryland System Hospitals Absenteeism Hospitals Diagnostic Labs Environmental Samples EPA Diagnostic Labs

Medical Component of Installation Protection notional LRN PH LAB Confirmatory IDs Presumptive IDs H Hospitals H HH Hosp n ED Visit Chief Complaints TRICARE Data Sets ESSENCE IV Base BSL2 LAB MED Web Site Portals Web Site Portals For local users CC B C C2 EMR PH PH ~50 mi Public Health future Ft. Lewis Approx. Medical Perimeter B C Bioaerosol sampler/sensor Chemical sensor San Diego JSIPP Sites Barksdale AFB Ft. Campbell POPE AFB Warner Robins AFB NSWCDD Camp Lejeune Ft. Gordon

Integration of Military and Civilian Medical in San Diego County San Diego County Department of Defense Navy Region Southwest S 4 S n Firewalls S n S4 S 3 BioWatch Air Sampling Laboratory Information Management System San Diego DoD Laboratory Analysis Network Guardian Environmental Monitoring S 3 S 2 S 1 ER Chief Complaint EMS Runs IDRAE / ESSENCE Public Health Monitoring System ESSENCE IV DoD Health Monitoring System S 1 ER Chief Complaint S 2 OTC Meds Prescription Meds Physician Encounter VA / HMO PHIN MS Prescription Meds Ambulatory Data

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 14 th 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.