APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT APHA – Innovation Projects System Changes and Solutions in State Public Health The North Carolina Experience with NC DETECT NC Disease Event Tracking and 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

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

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

NC Public Health Information Network (NC PHIN) Early Detection: Suspected Cases Hospital Emergency Departments (EDs) Alerting & Paging NC EDSS EMS Poison Center Health Alert Network Immunization Registry 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 NC DETECT ETL, data repository, analytic components, Web portal EMS (PreMIS) 1600 treated / day (~ 800,000 total calls / year) ED 110 (98%) hospitals 12,000 new visits / day (95,000 total processed) CPC 120,000+ calls / year Pilot data - Wildlife -Veterinary lab -Urgent care BioSense / CDC (ED Data only) 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

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 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

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 Influenza Season

APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT Age Distribution Sentinel Provider Network Data

APHA 2008 San Diego - System Changes and Solutions in State Public Health - NC DETECT 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)

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