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1 ESSENCE: Biosurveillance in Support of the DoD Health Mission

1 ESSENCE: Biosurveillance in Support of the DoD Health Mission

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Page 1: 1 ESSENCE: Biosurveillance in Support of the DoD Health Mission

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ESSENCE: Biosurveillance in Support of the DoD Health Mission

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SurveillanceSurveillanceIs there a problem?

What is the problem?

ImplementationImplementation How is a program

deployed?

InterventionInterventionWhat can be done to

eliminate the risk factor?

Risk Factor Risk Factor IdentificationIdentification

What is causing the disease?

Public Health Approach

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

Web-based medical surveillance system developed to alert public health authorities of a possible biological warfare

attack or other infectious disease outbreaks

What is ESSENCE?

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Traditional vs. IndicatorSurveillance in Outbreak

Detection

0

0.10.2

0.30.4

0.5

0.60.7

0.80.9

1

0 24 48 72 96 120 144 168

Incubation Period (Hours)

Pro

bab

ility

of

Dis

ease D

ete

ctio

n

Time (days)

Nu

mb

er

De

ad

Sensor, Animal, or Human Indicators

105

t = 0

Fatalities WithEarly Warning

Military & CivilianFatalities With

Traditional Alerting

Gain of 2 days

Effective Treatment Period

Surveillance

Traditional DiseaseDetection

TIME!

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Prescription data for Department

of Defense beneficiaries is

captured by Pharmacy Data

Transaction System and sent

to TRICARE

Standard Ambulatory

Data Records are archived at

military treatment facilities

ESSENCE Worldwide Surveillance

MTF

Standard Ambulatory

Data is sent to EIDS

EIDS updates ESSENCE repository

Graphs of daily visit counts by syndrome

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ESSENCE Delivers

• Web-based outbreak detection and alert application– Provides interactive reporting, structured analysis, and

ad hoc queries

• Uses sophisticated event detection algorithms to alert users to possible outbreaks of infectious diseases and biological incidents– With E-mail, Pagers, or Mobile Phones

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ESSENCE Delivers

• For select users, shows actionable patient-identifiable data for further investigation and/or validation

• Supports investigation of reportable disease events

• Data frequency– Outpatient and pharmacy data updated every

24 hours– Demographic data updated monthly

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• Ambulatory data – Outpatient visits to Military Treatment Facilities– ICD9 codes (any diagnostic position, not just

primary)

• Pharmacy data– Prescriptions ordered for military beneficiaries

(MTFs, mail orders, and retail pharmacies)– Respiratory and gastrointestinal syndromes only

Current Data Sources for ESSENCE

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Broad Syndrome Groups

ICD-9

Codes

• Neurologic 77

• Botulism-like 18

• Shock or Coma 10

• Rash 20

• Gastrointestinal 73

ICD-9

Codes

• Respiratory 137• Influenza-like ill 29• Fever 14• Febrile disease 111• Hemorrhagic ill. 25

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Live Demonstration

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Ft. B.

#7

Febrile Disease

Ft. B.

#5

Febrile Disease

Febrile Illness

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Gastrointestinal Disease Outbreak

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Back-up Slides

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DoD Enhanced Surveillance Experience to Date

• Most alerts unlikely to be significant if– Low total number of cases (less than three)– Small, unsustained spike– No plausibly concerning pattern in specific ICD-9 diagnoses

• Local public health and preventive medicine staff are almost always aware of problem before electronic system triggers alarm associated with real outbreak

• Evidence of improving coding practices, data completion, and timely data submission since instituting an enhanced health surveillance program

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Planned Enhancements

• New data sources– Laboratory and radiology test orders– Chief complaint text parsing

• Add field for local input regarding validity of alarms and findings or status of any investigation

• Explore potential power of MEDCIN structured note analysis• Environmental and occupational health hazard assessments• Preventable disease and injury control• System evaluation and planning based on population health

requirements rather than historical workload data