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Implementing a Syndromic Surveillance System in Miami-Dade County

Implementing a Syndromic Surveillance System in Miami-Dade County. Fermin Leguen, MD, MPH Chief Physician Director, Office of Epidemiology & Disease Control Miami-Dade County Health Department Guoyan Zhang, MD, MPH Senior Epidemiologist/Coordinator.

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Implementing a Syndromic Surveillance System in Miami-Dade County

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  1. Implementing a Syndromic Surveillance System in Miami-Dade County Fermin Leguen, MD, MPH Chief Physician Director, Office of Epidemiology & Disease Control Miami-Dade County Health Department Guoyan Zhang, MD, MPH Senior Epidemiologist/Coordinator 02/22/06 Working Group on BioSurveillance Data Monitoring and Information Exchange DIMACS/CDC

  2. Needs Assessment • 18 hospitals contacted • 14 hospitals have electronic data from ED • 17 hospitals willing to participate • Chief Complaint data available from 14 hospitals • Interest in adding a primary care component

  3. Attributes of the desired system • At the hospital • No additional forms or data requirements • No staff needed for data entry • Automatic capture and transfer of desired information • Web-based access • User friendly

  4. Electronic Surveillance System for the Early Notification of Community-Based Epidemics(ESSENCE) • Web based medical surveillance system • Participants can access the system at different administrative levels • Automated data collection and analysis • Data is transferred from Hospital ER to ESSENCE server by query batch file that attached to Hospital electronic database

  5. Data Elements • Hospital Name • Hospital Zip code • Date of visit • Time of visit • Gender • Race/ethnicity • Patient’s Age (in years) • Chief complaint • Zip code of patient’s residence (5 digit) • Discharge diagnosis** • Admission status** **Optional

  6. Data Collection Options Record Format • Flat file extract delimited (‘|’ or ‘,’) or fixed width Collection Frequency • Once a day batch Transmission Methods • Secure FTP

  7. Hospital Archive DoH Archive Batch File Secure FTP Connection Miami-Dade County Health Department Hospitals HospitalReporting SystemQuery SSH FTPClient SSH FTPServer Port 22 Batch FileListener Batch File

  8. ESSENCE Syndromes

  9. How do we manage the system? • Every morning each hospital transmit Emergency Department Chief Complaint data • By noon, a report is developed and emailed to staff in Office of Epidemiology and Disease Control • If further investigation is warranted, data reviewed by Epi Surveillance Coordinator and Data Analyst • If necessary, hospital ICP is contacted for chart review • Other partners are contacted/notified if needed

  10. What additional value can we get from Syndromic Surveillance in Miami? • Influenza Surveillance • Post-Hurricane Surveillance • Other Events Surveillance

  11. Influenza Surveillance • The system has an ILI Syndrome Category • Use ILI data to report the weekly and daily county influenza activity • Weekly ILI reports posted at MDCHD website and distributed to staff and community • Daily report submitted to Bureau of Epidemiology, FL DOH

  12. Influenza-Like Illness in Miami-Dade October/2005-Februray 2006

  13. Hurricane and Other Events Surveillance • Post-Hurricane Surveillance • What happens at local hospitals ED immediately after hurricanes? • Is there an increased morbidity due to respiratory, gastrointestinal illnesses, or other? • Holidays • Labor Day, Thanksgiving, Festivals, etc. • Any aberration on syndromic trends?

  14. After Hurricane Wilma 10/26/2005 After Labor Day 09/06/2005 Monday after Thanksgiving Hurricane Wilma Warning 10/22/2005 Monday after Christmas Monday 11/14/2005 Total ED Visits among 6 Hospitals in Miami-Dade 09/01/2005 - 12/31/2005

  15. Challenges • Hospital representatives not comfortable with sending their data to a 3rd party • TENET system hospitals initially declined to participate • Convincing hospital leaders  HIPAA • Completing the MOU signing process • Having the project approved by the State IT Governance Office

  16. What is Next in our To Do list? -To add medical record number to the data retrieved from hospitals It will expedite the epi investigations -To request diagnosis code (delayed data) It will help us assess syndrome alerts, and evaluate the system -Injury Surveillance - Add 8 more local hospitals to the system

  17. Lessons Learned • Enhanced communication with community partners • Understanding of the State IT Governance requirements • Reconciling State and metropolitan areas interests when federal resources are earmarked to specific localities could be challenging • DSL?  T1

  18. Summary • The syndromic surveillance system in Miami will • 15 local participating hospitals • Expanded to other counties of Florida (Broward, West Palm Beach, Monroe, Martin, etc) • Add other data sources such as 911 system, school absenteeism, poison control center • Explore value of additional applications

  19. Contact Information • Fermin Leguen, MD, MPH fermin_leguen@doh.state.fl.us (305) 470 5660 • Guoyan Zhang, MD, MPH Guoyan_Zhang@doh.state.fl.us (305) 470 5650

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