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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
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
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
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
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
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
Hurricane Isabel, October 2003
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
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”
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
NC DETECT Data Volume
Hospital Emergency Departments
Ambulance Runs
Poison Center Calls
(Over 4 Million
ED visits/year)
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
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
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
Hospital ED data shared with BioSense for national surveillance
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
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
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
NC DETECT Purpose
• Early Event Detection
• Situational Awareness
• Broader public health surveillance including– Injuries– Reportable diseases– Chronic diseases (asthma, diabetes)
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
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
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
Syndrome Case Report
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
Separate system allows reach back in some hospitals
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
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
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
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
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
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)
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
Katrina Evacuees Monitoring, 2005
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
Katrina Evacuees ED visits in NC
• Illness/medical reason 61%
• Prescription refill or medication 15%
• Injury 11%
• Psychiatric/mental health 7%
• “Medical examination” 6%
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
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
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
Heat injury surveillance – August, 2007
Daily temperature peaks
Heat-related ED visits
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
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
APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT
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