1. Queen’s University Public Health Informatics (QPHI) Team www.quesst.ca Occupational Health Surveillance Tara Donovan QPHI Surveillance Meeting Exploring Surveillance Opportunities June 13 th, 2008

2. Innovative, Integrated, Syndromic Surveillance System  Purpose: Develop an automated, integrated, syndromic surveillance system  Method: Use routinely collected electronic Occupational Health (OH) visit data in addition to Emergency Department (ED) visit data

3. Objectives  Objective 1: Monitor respiratory and gastrointestinal illness activity both within the community (ED) and hospital (OH) To detect outbreaks earlier To facilitate investigations and necessary interventions  Objective 2: Evaluate the ability of the system to detect a sentinel event such as a nosocomial infection or the effect of a community outbreak on staffing levels at the hospital

4. Ethics  Queen’s University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board  Privacy Impact Assessment  Compliant with PHIPA

5. OH Reporting Legislation/ Recommendations  SARS Commission Final Report (Campbell)  Ontario Health Plan for an Influenza Pandemic  Recommendations for Infection Control/ Surveillance MOHLTC (Task Force)  Enteric Disease Surveillance Protocol for Ontario Hospitals (OHA & OMA – CD protocols)

6. Collected Occupational Health Visit Data  Daily Occupational Health visits at KGH – large tertiary care teaching hospital  Parklane® software  Secure VPN data transfer (Citrix Access Gateway)  Date and Time of Visit  Demographics  Department  Type of visit (i.e. Initial visit/ phone call, Follow-up)  Febrile Respiratory Illness (FRI) Screening results  Condition(s) = Syndromes: Gastrointestinal, Respiratory (Upper/ Lower), FRI, Musculoskeletal, Other

7. Value of the Integrated System  Integration of OH and ED data  Novel pilot project  Provide early warning of respiratory and gastrointestinal activity - Enhance active specimen collection - Allow managers to prepare for shortages (surge capacity) - Enable earlier public health response - Facilitate infection control procedures  Improve Communication

8. Value of the Integrated System  Lessons from SARS – electronic/ automated monitoring of HCWs  Improve communication, collaboration, coordination between Public Health and the Acute Care Sector  Bi-weekly reports

11. Respiratory-related OH Visits

12. Gastrointestinal-related OH Visits average Alerts # of Initial GI-related ED visits

13. Components of Compendium 1. Introduction paper – describes the development and implementation process, with a focus on future uses of the integrated system for public health interventions and pandemic and emergency planning

14. Components of Compendium 2. Norovirus outbreak paper – description of a Norovirus outbreak that occurred among inpatients at the local hospital

15. Components of Compendium 3. Cost – benefit of the system with a focus on the impact of vaccination rates among staff and the implications for staff absenteeism and associated costs

16. Components of Compendium 4. Technical Evaluation & Analysis paper – to describe the process of integrating the data into RODS and an explanation of the anomaly detection used for analysis

17. Components of Compendium 5. System Evaluation – using the Centers for Disease Control (CDC) Framework for Evaluating Public Health Surveillance Systems for Early Detection of Outbreaks

18. Components of Compendium 6. Spatial analysis of Occupational Health visit data – a descriptive paper explaining the development and functionality of a 3D mapping tool which tracks Occupational Health visit reporting of respiratory and gastrointestinal-related illnesses

19. Mapping – Kingston General Hospital

20. Floor Plan at KGH

21. Percent Occupational Health Visits Due to Gastrointestinal Illness March 11 th – 17 th 2007

23. Components of Compendium 7. Time-series analysis of weekly average Occupational Health and Emergency Department visits

24. How does OH surveillance contribute to Public Health?  Automatic, concise details of OH visit activity for surveillance of unusual health events or disease outbreaks  Monitoring of multiple data sources  Enhances communication and collaboration with appropriate health care professionals and stakeholders  Early Warning to facilitate public health response (eg. increased Infection Control, implementation of emergency plans)  Awareness of absenteeism  Facilitate ongoing research

25. Future Opportunities Non-Infectious Disease-Related  Musculoskeletal monitoring – intervention  [i.e. new lift equipment, lift education and techniques]  Needle-stick injury monitoring  Staff Absenteeism

26. Acknowledgements  Colleagues – Drs. Kieran Moore and Jennifer Carpenter  QUESST/ QPHI  Physician Services Incorporated Foundation  KFL&A Public Health  Kingston General Hospital

27. Thank You  Questions?