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Jean-Marie Maillard, MD, MSc NC Division of Public Health Credits:

APHA – Innovation Projects System Changes and Solutions in State Public Health The North Carolina Experience with NC DETECT NC D isease E vent T racking and E pidemiologic C ollection T ool. Jean-Marie Maillard, MD, MSc NC Division of Public Health Credits:

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Jean-Marie Maillard, MD, MSc NC Division of Public Health Credits:

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  1. APHA – Innovation ProjectsSystem Changes and Solutions in State Public HealthThe North Carolina Experiencewith NC DETECT NC Disease Event Trackingand Epidemiologic Collection Tool Jean-Marie Maillard, MD, MSc NC Division of Public Health Credits: Lana Deyneka & Heather Vaughan-Batten (NC-DPH) Anna Waller & Amy Ising, on behalf of the UNC-DEM DETECT Team

  2. 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

  3. 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

  4. Hurricane Isabel, October 2003

  5. Emergency Department Visits after Hurricane Isabel, NC 9/18/2003 Hurricane Isabel (Data not collected) N=11,707 12-day series available from 13 hospitals

  6. NC Public Health Information Network (NC PHIN) Early Detection: Suspected Cases Alerting & Paging Health Alert Network Case Reports EMS Wildlife NC EDSS Vet Lab Immunization Registry Poison Center Lab Results Hospital Emergency Departments (EDs) Physician Reported Cases “Traditional surveillance” “Enhanced surveillance”

  7. NC DETECT Data Volume Poison Center Calls Hospital Emergency Departments (Over 4 Million ED visits/year) Ambulance Runs

  8. 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

  9. Hospital ED data shared with BioSense for national surveillance

  10. NC DETECT Data Elements ED 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

  11. NC DETECT Purpose Early Event Detection Situational Awareness Broader public health surveillance including Injuries Reportable diseases Chronic diseases (asthma, diabetes)

  12. 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

  13. Syndrome Case Report

  14. Separate system allows reach back in some hospitals

  15. 2007-2008 Influenza Season

  16. Age DistributionSentinel Provider Network Data

  17. Environmental Disaster Surveillance Explosion at a chemical plant Terms used in filter: fire, disaster, Apex, toxic gas, hazard, waste plant, evac, Hazmat, chlorine, clorine, petrol, chemical, explosion (abbreviations and misspellings taken into account)

  18. Katrina Evacuees Monitoring, 2005

  19. Katrina Evacuees ED visits in NC • Illness/medical reason 61% • Prescription refill or medication 15% • Injury 11% • Psychiatric/mental health 7% • “Medical examination” 6%

  20. 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

  21. Heat injury surveillance – August, 2007 Daily temperature peaks Heat-related ED visits

  22. 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

  23. 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

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