Our Vision Healthy Kansans Living in Safe and Sustainable Environments

Transcription

1 Our Vision Healthy Kansans Living in Safe and Sustainable Environments

2 Syndromic Surveillance at KDHE: Successes, Challenges and Opportunities September 16 th, 2015 Charles Hunt, MPH Dan Dao, MPH Henri Ménager, MPH Farah Naz, MPH Daniel Neises, MPH Ericka Welsh, PhD, MPH Bureau of Epidemiology and Public Health Informatics Bureau of Health Promotion Division of Public Health Kansas Department of Health and Environment

3 Overview of Syndromic Surveillance Program at KDHE Farah Naz, MPH Syndromic Surveillance Coordinator Bureau of Epidemiology and Public Health Informatics Division of Public Health Kansas Department of Health and Environment

4 What is Syndromic Surveillance (SyS)? Collection and analysis of health data from electronic health record (EHR) in real time for: Early detection of outbreaks Following size, spread and tempo of outbreaks Monitoring disease trends Reassurance that an outbreak has not occurred

5 Syndromic Surveillance Data Collection and analysis of electronic health record (EHR) data in real time from health facilities Chief Complaint Syndrome Near Real Time Emergency department (ED) patients Most extreme cases Most vulnerable populations

6 What is SyS Data Used For? Initially intended for: Early detection of outbreaks Follow size, spread and tempo of outbreaks Monitor disease trends Reassurance that an outbreak has not occurred Potential for many other applications Hospitals driving force to send data: Meaningful Use

7 SyS Onboarding with Meaningful Use Guidelines Stage 1 Optional participation in KS; could claim exclusion 109 EDs connected (out of 129 EDs in Kansas) Focus on technical aspects Quality was low Stage 2 Required participation Focus on ongoing submission and data quality Onboarding data validation; time-consuming Once a hospital has passed data validation, it is moved into production

8 Meaningful Use Stage 2: Current Onboarding Status

9 Meaningful Use Stage 2: Current Onboarding Status Production Test Total % % % Hospitals Hospitals Hospitals Visits Visits Visits Total 24 17% 81 74% % Note: %Visits based on annual visits reported to American Hospital Association (AHA) over past 5 years.

10 Meaningful Use Stage 2: Current Onboarding Status Production Test Total % % % Hospitals Hospitals Hospitals Visits Visits Visits Total 24 17% 81 74% % Total Legacy Connection % Hospitals Visits No Status % Hospitals Visits 7 2% 17 9% Note: %Visits based on annual visits reported to American Hospital Association (AHA) over past 5 years.

11 National Syndromic Surveillance Platform (NSSP) A CDC program that tracks health problems as they evolve; formerly BioSense 2.0. KDHE participating with NSSP since implementing SyS in Kansas in 2011 KDHE uses the National Syndromic Surveillance Program (NSSP) as its primary SyS system Monitor (near) real-time data from across the state and nation

12 National Syndromic Surveillance Platform: Unique Features Rapidly collect, share and evaluate information Provide Data in a Distributed Cloud Environment Share Data Across Jurisdictional Lines

13 National Syndromic Surveillance Platform: Overview Facilities submit data at least once per day Data is processed into NSSP database BioSense 2.0 front-end application analyzes and visualizes data by syndrome Data can be accessed by KDHE in NSSP database or BioSense 2.0 application

14 National Syndromic Surveillance Platform: Data Quality Issues Lengthy onboarding process for MU2 compliance No official data quality metrics Insufficient quality improvement programs No alerts for data quality No threshold for timeliness Data/connection drops EHR system upgrades

15 BioSense 2.0 Application New ESSENCE Application for Visualization (May, 2016) ESSENCE = Electronic Surveillance System for Early Notification of Community-Based Epidemics

16 Syndromic Surveillance at KDHE: Current Status Data Not Representative Focus on onboarding and improving data quality Collaborate Nationally to Improve NSSP Beginning Stages of Analysis Incorporate into existing programs

17 Syndromic Surveillance at KDHE: Current Status Compare to existing data sources Enhance existing surveillance mechanisms Explore other potential applications

18 Syndromic Surveillance at KDHE: Current Applications Preparedness and Emergency Management: July 4 th Infectious Disease: Influenza-like illness Environmental Health: Extreme weatherrelated health conditions Chronic Disease and Injury: Exploration of Alcohol-Related Injuries

19 July 4 th Surveillance Farah Naz, MPH Syndromic Surveillance Coordinator, Epidemiologist Bureau of Epidemiology and Public Health Informatics Division of Public Health Kansas Department of Health and Environment

20 Syndromic Surveillance in KS: July 4 th Searched chief complaint field for visits which contained any of the following words: Firework fire work fire crack (fire cracker) Also looked for visits which contained burn (when the visit did NOT contain Firework, fire work or fire crack ) in the chief complaint

21 6/1/2015 6/3/2015 6/5/2015 6/7/2015 6/9/2015 6/11/2015 6/13/2015 6/15/2015 6/17/2015 6/19/2015 6/21/2015 6/23/2015 6/25/2015 6/27/2015 6/29/2015 7/1/2015 7/3/2015 7/5/2015 7/7/2015 7/9/2015 7/11/2015 7/13/2015 7/15/2015 7/17/2015 7/19/2015 7/21/2015 7/23/2015 7/25/2015 7/27/2015 7/29/2015 7/31/2015 Rate of Visits per 1,000 Reported Visits Syndromic Surveillance in KS: July 4 th Rate of Visits with Chief Complaint Criteria per 1,000 Reported Visits, Kansas, 6/1/15-7/31/15 Firework + Fire Work + Firecracker Visits per 1,000 Reported Visits July 4 th, June 27 th /28 th : Fireworks Season Start July 11 th -12 th : Weekend after July 4th - Visit Date

22 6/1/2015 6/3/2015 6/5/2015 6/7/2015 6/9/2015 6/11/2015 6/13/2015 6/15/2015 6/17/2015 6/19/2015 6/21/2015 6/23/2015 6/25/2015 6/27/2015 6/29/2015 7/1/2015 7/3/2015 7/5/2015 7/7/2015 7/9/2015 7/11/2015 7/13/2015 7/15/2015 7/17/2015 7/19/2015 7/21/2015 7/23/2015 7/25/2015 7/27/2015 7/29/2015 7/31/2015 Rate of Visits per 1,000 Reported Visits Syndromic Surveillance in KS: July 4 th Rate of Visits with Chief Complaint Criteria per 1,000 Reported Visits, Kansas, 6/1/15-7/31/15 Firework + Fire Work + Firecracker Visits per 1,000 Reported Visits Burn Visits per 1,000 Reported Visits Visit Date

23 Syndromic Surveillance in KS: July 4 th Why so many visits with burn? Examples Chief Complaints with "Burn" Left testicle red inflamed/noted Tuesday/itches and burns/no injury. Also thinks he may have poison ivy. Burn to right hand:sep:hot soap burn (was making soap) to 4th and 5th right digits three days ago. Was seen in immediate care last night and suggested she be seen at burn unit today. vaginal pain,swelling:sep:vaginal pain and swelling x 3dys burning and itching with unination ANTIFREEZE BURN :SEP:PAIN TO RIGHT SIDE OF HEAD. REPORTS "BURNING WHERE STENT IS." :SEP:BLACK PLASTIC PIPE HEATED UP AND BURNT LT HAND, DONE AT WORK. Psych eval - self mutilation:sep:here due to self mutilation. burn marks to left forearm denies SI SUNBURN,NAUSEA :SEP:BURNING PAIN TO LEGS. STATES SHE CAN'T FEEL THE GROUND SHES WALKING ON.PT STATES SHE IS UNABLE TO GRIP WITH LEFT HAND BURN TO LEFT LEG

24 Influenza-like Illness Surveillance Daniel Neises, MPH Senior Epidemiologist Bureau of Epidemiology and Public Health Informatics Division of Public Health Kansas Department of Health and Environment

25 ILINet KDHE recruits outpatient providers to track Influenza-Like Illness (ILI)

26 Data Collection Providers track ILI patients and total patients seen minutes of work each week

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28 Data Submission Difficulties Deadline is 11:00 AM every Tuesday Data often sent after deadline Can impact ILI trendline ILINet Reporting , (n=36)* No Report Late On Time 0 *Three sites dropped out during the week ending November 9, 2013.

29 NSSP Compared to ILINet NSSP advantages Data is automatic and updated daily ILI trendline may be more reliable More sites enrolled More data available for analysis Numerator and denominator age groups Demographics

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32 Environmental Health Surveillance Henri Ménager, MPH Senior Environmental Epidemiologist Bureau of Epidemiology and Public Health Informatics Division of Public Health Kansas Department of Health and Environment

33 Excludes excessive heat of man-made origin (W92)

34 5/1 5/3 5/5 5/7 5/9 5/11 5/13 5/15 5/17 5/19 5/21 5/23 5/25 5/27 5/29 5/31 6/2 6/4 6/6 6/8 6/10 6/12 6/14 6/16 6/18 6/20 6/22 6/24 6/26 6/28 6/30 7/2 7/4 7/6 7/8 7/10 7/12 7/14 7/16 7/18 7/20 7/22 7/24 7/26 7/28 7/30 8/1 8/3 8/5 8/7 8/9 8/11 8/13 8/15 8/17 8/19 8/21 8/23 8/25 8/27 8/29 8/31 9/2 9/4 9/6 9/8 9/10 9/12 9/14 9/16 9/18 9/20 9/22 9/24 9/26 9/28 9/30 Temperature in Fahrenheit Count of Deaths 120 Daily Maximum Heat Index and Number of Heat-Related Deaths Kansas - May 1 to September 30, DEATHS Maximum Heat Index P90 Heat Index

35 Reported Injuries and Deaths by Emergency Preparedness Hospitals by Date Source: EMResource

36 Note: Data collected on: 9/2015 Data is incomplete Data is subject to change

37 Note: Data collected on: 4/10/2015 Data is incomplete Data is subject to change

38 Note: Data collected on: 9/2015 Data is incomplete Data is subject to change

39 Note: Data collected on: 9/2015 Data is incomplete Data is subject to change

40 Other Conditions of Interest Car crashes Falls Selected skin lesions Selected GI tract disorders Drownings

41 Alcohol-Related Injuries Ericka Welsh, PhD, MPH Senior Chronic Disease Epidemiologist Dan Dao, MPH Advanced Epidemiologist Bureau of Health Promotion Division of Public Health Kansas Department of Health and Environment

42 Data Exploration Extreme cold weather surveillance inspiration Subset data to include injury records Define (and refine) acute alcohol intoxication syndrome

43 Barriers Encountered Specificity of alcohol coding Temporality Variability in chief complaint field narrative

44 Opportunities More specific injuries Drug poisoning

45 Syndromic Surveillance: Potential and Future in Kansas

46 Syndromic Surveillance: Potential Preparedness and Emergency Management Infectious Disease Environmental Health Chronic Disease and Injury

47 Syndromic Surveillance Potential: Preparedness Mass Gathering Surveillance Natural Disaster Surveillance Improving Situational Awareness

48 Syndromic Surveillance Potential: Infectious Disease Influenza-like Illness Health-Seeking Behaviors following extensive news coverage of a given disease Confirmation of timely reporting for reportable disease Non-reportable conditions of interest (e.g., animal bites, post-exposure prophylaxis for rabies)

49 Syndromic Surveillance Potential: Environmental Health Extreme weather (heat/cold) related health conditions Asthma Carbon monoxide poisoning incidents Post-analysis for random events e.g., landfill fires Skin rashes from environmental exposures

50 Syndromic Surveillance Potential: Chronic Disease and Injury Diabetes-related complications Cardiac arrests or hypertension Suicide ideation Prescription drug/drug overdose Injury/other (e.g., Falls)

51 How can I access NSSP? Access currently limited to state health department Data quality issues Must improve representativeness All new front-end analytical tool in development

52 Syndromic Surveillance: Collaboration Kansas Syndromic Surveillance Governance Group Objective: To advance the use and understanding of syndromic surveillance data among health officials in Kansas Region 7 Data Sharing Group Objective: To collaboratively engage in syndromic surveillance by sharing data, statistics and information between jurisdictions in the region

53 Syndromic Surveillance: Collaboration Kansas SyS Governance Group Regional Data Sharing National NSSP Workgroups Centers for Disease Control and Prevention Workgroups

54 Questions?

55 Contact Information Presentation available at: Farah Naz, MPH Syndromic Surveillance Coordinator Bureau of Epidemiology and Public Health Informatics Division of Public Health Kansas Department of Health and Environment Curtis State Office Building 1000 SW Jackson Street, Suite 130 Topeka, Kansas (W) (F)