staffing rods in ohio february 23 rd, 2006 biosurveillance information exchange working group...
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Staffing RODS in OhioStaffing RODS in Ohio
February 23February 23rdrd, 2006, 2006Biosurveillance Information Exchange Working GroupBiosurveillance Information Exchange Working Group
Rutgers UniversityRutgers UniversityPiscataway, NJPiscataway, NJ
Loren Shaffer, [email protected]
Early Event Surveillance Supervisor
Our Current SystemsOur Current Systems
• Real-time Outbreak and Disease Surveillance (RODS) System
• BioSense• Influenza-like Illness Sentinel Providers• School Absenteeism• Wildlife Disease Surveillance• Ohio Disease Reporting System• Early Aberration Reporting System (EARS)
RODSRODS• Developed at the University of Pittsburgh• Utilizes a hospital’s existing HL-7 socket to receive real-time data• Interprets free-text chief complaint from emergency department
registration database and groups into one of seven prodromes• Collects information from retailers about sales of over-the-
counter medications• Provides immediate analysis for trends and anomalies
suggestive of disease outbreaks• Secure web access by users
HIPAAHIPAA
• Export of data for public health surveillance is permitted (45 CFR 164.512)
• Prior written authorization of individual is not required (45 CFR 164.512)
End Users of RODS in Ohio
• Total = 174– State Health Department = 6– Local Health Department = 87
• 88 of 135 LHDs represented
– Hospital = 77– Other = 4
RODS Alerts
• February 2004 to February 2006– 310 unique alerts received
• Seasonal Elevation – 40%• Outbreaks – 22%• Data Errors – 9%• No Cause Identified – 28%
– 53% handled at State level– 47% forwarded to local epidemiologist
RODS Alerts and Reported Outbreaks in Ohio
2/1/2004 - 2/1/2006
Date of RODS Alert
Syndrome County Outbreak Cause Number IllDate Reported to
ODH
12/24/2004 Respiratory Statewide CO Poisoning ~50 not reported
1/11/2005 Gastrointestinal Franklin Norovirus 7 1/24/2005
1/11/2005 Gastrointestinal Franklin Norovirus 3 2/16/2005
1/30/2005 Gastrointestinal Mahoning Norovirus 5 2/9/2005
3/3/2005 Gastrointestinal Mahoning C perfringens 4 3/14/2005
10/26/2005 Gastrointestinal Preble Norovirus ~300 11/4/2005
11/23/2005 Rash Jefferson Scabies 5 not reported
12/27/2005 Gastrointestinal Montgomery Campylobacter 3 1/30/2006
8/3/2005 8/4/2005 8/5/2005
Gastrointestinal Constitutional Gastrointestinal
Hamilton Cryptosporidiosis ~750 8/22/2005
1/9/2006 Constitutional Scioto Scromboid Poisoning 3 1/30/2006
1/18/2006 Respiratory Erie Influenza-like Illness 24 not reported
*Information about the number ill and date reported was obtained from the Ohio Disease Reporting System (ODRS)
What are we doing with RODS?What are we doing with RODS?• Monitoring for patterns suggestive of an
infectious disease outbreak• Influenza surveillance study & efforts• Retrospective outbreak study (improved
specificity)• Adaptation to animal-based sources for
emerging infectious disease surveillance• Real-time clinical data analysis• Environmental surveillance• Specialized investigations
InfluenzaInfluenza
InfluenzaInfluenza
Summary of Correlation Analysis 2003/2004 and 2004/2005 Influenza Seasons
Franklin Montgomery Summit Average
DataLead
(weeks)Correlation Coefficient
Lead (weeks)
Correlation Coefficient
Lead (weeks)
Correlation Coefficient
Lead (weeks)
Correlation Coefficient
Thermometer 4 0.5908 4 0.6254 3 0.5226 3.67 0.5796Cough & Cold 4 0.5592 5 0.5728 3 0.4522 4.00 0.5281Pediatric Cough Syrup 4 0.5079 4 0.5487 3 0.4591 3.67 0.5052Adult Cough Syrup 4 0.2133 4 0.2938 3 0.3042 3.67 0.2704Pediatric Cold Relief 4 0.5730 4 0.5236 4 0.4541 4.00 0.5169Adult Cold Relief 4 0.5985 4 0.5875 4 0.4783 4.00 0.5548Pediatric Antifever 5 0.5524 5 0.4626 3 0.3788 4.33 0.4646Adult Antifever 5 0.3224 1 0.3844 5 0.1901 3.67 0.2990VA Clinic Visits 7 0.3081DoD Clinic Visits 7 0.3159Class B -1 0.4470 4 0.5107 0 0.2594 1.00 0.4057Respiratory ED Visits 4 0.5544 5* 0.5227 4.00 0.5386Constitutional ED Visits 4 0.5133 4* 0.4603 4.00 0.4868
ILI Sentinel Providers 5 0.2311 5 0.5591 3 0.57054.33 (4 w /o
Franklin)
0.4536 (0.5648 w /o
Franklin)
School Absences 10 0.2852 4* 0.4540 5 0.3965 7.50 0.3786Laboratory Analysis 5 0.5943 3 0.5966 4.00 0.5955* = Data From 1 Influenza Season
P(↑Consitutional|Outbreak N)= xc
P(↑Botulinic|Outbreak N)= xb
P(↑Respiratory|Outbreak N)= xr
P(↑GI|Outbreak N) = xg
P(↑Hemorrhagic|Outbreak N)= xh
P(↑Neurologic|Outbreak N)= xn
P(↑Rash|Outbreak N)= xra
P(↑Thermometer|Outbreak N)= xt
P(↑Cold Relief|Outbreak N)= xcr
P(↑Lozenges|Outbreak N)= xl
P(↑Chest Rubs|Outbreak N) = xchr
P(↑Bronchial Remedies|Outbreak N)= xbr
P(↑Antifever|Outbreak N)= xa
P(↑Other Categories|Outbreak N)= x
OTC SalesED Registrations
Known Outbreak
Zoonotic Disease SurveillanceZoonotic Disease Surveillance
• Adapt RODS to …– Veterinary Diagnostics Laboratory
• Lab orders batched & transmitted via ftp• Parsed into syndrome categories based
on previous mapping of tests• Spatial/temporal analysis at the ZIP code-
level– Veterinary Clinic
• Reason for Visit field included• Near real-time export via ftp• Co-co classifier parses free text into
syndrome category• Spatial/temporal analysis at the ZIP code-
level
EmergencyDepartment
CategorizeInto
SyndromesDailyTotals
TotalsHigher ThanExpected?
HistoricalModels
Alert
ReviewTrends
Chief Complaint andPatient Demographics
In HL7 messages
Daily
Continuous
Continuous
Updated monthly
ValidAlert?
InitiateResponse
Areas for Attention & AssistanceAreas for Attention & Assistance
Identified NeedsIdentified Needs
• User Training → 1:1 & Conference Workshops• User Protocols → Developed Protocol Document• User Support → 24/7 Coverage Pilot• 24/7 Coverage → System Enhancement to Permit
Alerts to Jurisdictions• Advisory Group(s) → Expansion of ODRS Advisory
Committee• Integration with Other Surveillance Systems →
Ongoing Evaluations and Study Projects• Local Health Department Resources → ?