1. Emergency Department Syndromic Surveillance (EDSS): A public health unit perspective alPHa Meeting Feb 1, 2007

2. Emergency Department Syndromic Surveillance KFL&A – data collection, analysis – alerting and investigation – examples of use Grey Bruce – examples of use Live Demonstration Objectives

3. Ontario Pilot Project MOHLTC PHD funded – partners include: KFL&A Public Health, Queen’s University, PHAC, local acute care hospitals 2 year pilot project Sept/04-Aug/06 – Implement and evaluate EDSS system Primary goal – Respiratory, GI ‘Live’ alert investigation Aug/05-present Evaluations – comprehensive 3 parts

4. Real-time - ED visits to 7 area hospitals (KFL&A and HPE Health Units), admissions to 3 hospitals Date and Time of Visit or Admission Hospital Age/Sex Postal Code (5 digits) Chief Complaint Triage Score Febrile Respiratory Illness (FRI) Screening results Syndromes: Gastroenteritis, Respiratory, Fever/ILI, Asthma, Derm-infectious, Neuro-infectious, Severe Infection, Other What information are we collecting?

5. Data Analysis Anomaly detection runs 4x daily 4 years of historical data GIS mapping – ArcIMS (5-digit PC)

6. Alerts and Investigation Automatic email notification of alerts System is monitored 7 days a week As per protocol – notify CD/EH staff of anomalies, admissions of interest Resource for CD/EH outbreak investigation Bi-weekly reports to ED, ICP, Lab, public health Approx. 10% of alerts passed on

11. Using Real-time data to support public health decision-making and monitor the effectiveness of public health interventions Examples of use

12. GI and Respiratory

13. Retrospective Analysis - EARS graph of revised GI syndrome (diarrhea +/- other Sx) for patients visiting KGH and HDH ED - Nov/05 Initial cluster of patients presents to ED with diarrhea +/- other symptoms – cultures taken

14. Fig.2 – Prospective Monitoring 2005/06 flu season System Alerts ED visits by Syndrome Positive Influenza Laboratory Results Respiratory Admissions September 2005 to April 2006 January 4, 2006 – First Positive Influenza 2 December 31, 2005 - Alert circulated based on - increasing ED visits for respiratory syndrome - increasing FRI positive patients - rise in admissions with respiratory diagnosis 1

15. Other Uses Environmental (heat alerts) Disaster Medicine Detect new/emerging diseases Sentinel/event surveillance

16. Grey Bruce ECADS System (NRC) 12 hospitals 400-500 daily ED visits Area covered: Grey and Bruce Counties (8664 sq km) Population 153,000 plus higher during summer season

17. Other Uses in Grey Bruce BWA’s OTC Sales Migraines

18. Cryptosporidium in Grey Bruce Average number of cases per year is 13 (range 7 to 19) Crude incidence rates more than double the provincial average Local cases usually associated with direct exposure to livestock manure or swallowing recreational water One outbreak in region in 1998 associated with Collingwood municipal water system

23. Conclusions Now have a clearer picture of what is going on in the community System is easy to install, monitor, access, maintain Did not require changes to existing staff, procedures Most ED staff were not aware that the system was in place Opportunity for Public Health and Grey Bruce hospitals to work together, share information

24. Live Demonstration

25. THANKS! Contacts (KFL&A) Dr. Kieran Moore moorek1@kgh.kari.net moorekieran@hotmail.com Bronwen Edgar bedgar@healthunit.on.ca Contacts (Grey Bruce) Dr. Hazel Lynn hlynn@publichealthgreybruce.on.ca Alanna Leffley aleffley@publichealthgreybruce.on.ca

26. Ontario’s Telehealth System Data Elements and Timelines Timelines – June 1, 2004 until June 30, 2006 Data Elements – Date and Time of Call – Patient’s Age and Sex – Forward Sortation Area of patient’s residence – Call Type – Guideline – Recommended Disposition

27. Telehealth – Call Volumes and Types June 1, 2004 – June 30, 2006 – Over 2,000,000 calls – Over 1.7 million ‘Symptom’ Calls Call Type# of Calls Health Information 231,453 Service Referral 99,653 Symptom1,711,344 All Calls2,042,450

28. Telehealth Respiratory Calls (3 day MA) and Flu A and B isolates All Resp Flu B isolates Flu A isolates

29. Telehealth Respiratory Calls (x 5) and ED Visits - Ontario ED Resp Visits Telehealth Resp Calls