Queen’s University Emergency Syndromic Surveillance Team ... · Siemens Confidential:©2002...

Queen’s University Emergency Syndromic Surveillance Team

(QUESST)Dr Kieran MooreSSM Innovation CentreGIS in Health Care DayMay 17 2007Algoma University College


Objectives

What is Syndromic Surveillance?

Emergency Department Syndromic Surveillance Project

Ontario’s Telehealth Surveillance Project

GIS-mapping the data


Who we are-QUESST

ITSoftwareGISEpidemiologistsPublic HealthAcute Care SectorGrants/MOH LTC


Syndromes SARS


Water…food…


Food…

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©2002 Siemens Medical Solutions Health Services Corporation.Siemens Confidential:

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Num

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Onset of SymptomsSpecific SyndromeDeaths

Intel

Demographics, Chief Complaint, Visit Data

Lab results, X-Rays, etc.

Courtesy: Michael Wagner, MD, University of Pittsburgh

Biosensors

Potential Strategies for Early Detection


Innovative electronic surveillance systems

Action oriented-integrated-change from passive to active

Capture existing health data automatically in Real Time including demographics



Syndromic Surveillance Systems

IT linking data sources

Natural language processing-text mining

Syndromes of interest

Anomaly detection

Temporal Spatial analysis-Mapping


Work-school

Primary CareClinic

Emergency Dept

Lab test

Pharmacy

Telehealth

Surveillance Options


Emergency Department Visits – Respiratory SyndromeKingston Hospitals, August 2001 to August 2005

70

60

50

40

30

20

10

# of

Vis

its


Goal of Syndromic Surveillance

Enhanced communication, collaborationImproved response times – data available 24/7/365 in real-timeSituational awarenessImproved epidemiological analysis and outbreak detection– FOCUS: GI and Respiratory


What should be collected?

Collect real time anonymous data from…– Emergency Department visits

Date and Time of VisitHospitalAgeSexPostal Code (5 digits)Chief ComplaintCTAS Triage ScoreFebrile Respiratory Illness (FRI) Screening results

– Admissions to hospital


Canadian Triage and Acuity Scale(CTAS)

NON URGENTV

LESS URGENTIV

URGENTIII

EMERGENTII

RESUSCITATIONI

TRIAGE LEVELS Formal method of prioritizing patients- Based on ‘Usual

Presentation’ of patients discharged with a sentinel (ICD9CM) diagnoses


Febrile Respiratory Illness (FRI)Screening Tool – Non-outbreak

CBA

3 SECTIONS

CONTACT/TRAVEL HISTORY

TEMPERATURESYMPTOMS

If ‘YES’ to A (new or worse cough or shortness of breath)

B (fever, shakes or chills in last 24 hrs) – temperature taken

If ‘YES’ to A and B

Contact precautions implemented.

If ‘YES’ to A, B and C – notify Infection Control immediately.


DEMO - Using the RODS TOOL

Log InMain PageEpiPlot‘Get Cases’ line listingMapPlot


RODS log in

Cryptocard access, etc.


Scenarios – RODS Main Page Date accessed:


Scenarios – RODS EpiPlot

Real-time ED data Applications

Using real-time data for syndromic surveillance – GI

syndrome

Salmonella enteritidis outbreak Nov/05-Jan/06

Syndrome Surveillance (GI): Salmonella outbreak Province-wide: source unknown

Epi curve of S . Enteriditis in Ontario, June 1 - November 26, 2005 (n=589)

0

50

100

150

200

250

June

1-4Ju

ne 5-11

June

12-18Ju

ne 19-25

June

26-July2

July 3

-9Ju

ly10-16

July1

7-23Ju

ly 24-30

July 3

1-Aug 6Aug 7

-13Aug 1

4-20Aug 2

1-27Aug 2

8-Sep 3Sep 4

-10Sep 1

1-17Sep 1

8-24Sep 2

5-Oct

1Oct

2-Oct8

Oct 9-15

Oct 16-2

2Oct

23-29

Oct 30-N

ov 5Nov

6-12

Nov 13

-19Nov.

20-26

Week received at Ontario Central Public Health Lab

Num

ber o

f cas

es

Other SEs

PT pending

PT13

Courtesy of Public Health Agency of Canada, Guelph, ON.

Epidemic curve of S . Enteritidis cases in Ontario, by day received at CPHL, October 1 - December 6, 2005 (n=612)

0

10

20

30

40

50

60

70

Oct. 3

Oct. 5

Oct. 7

Oct. 12

Oct. 14

Oct. 17

Oct. 19

Oct. 23

Oct. 25

Oct. 27

Oct. 31

Nov. 2

Nov. 4

Nov. 8

Nov. 1

0Nov

. 14

Nov. 1

6Nov

. 18

Nov. 2

1Nov

. 23

Nov. 2

5Nov

. 28

Nov. 3

0Dec

. 2Dec

. 5

Day received at Ontario Central Public Health Lab

Num

ber o

f cas

es

Other SEs

PT pending

PT13

Courtesy of Public Health Agency of Canada, Guelph, ON.

Salmonella outbreak Province-wide: source unknown


Figure 4 - KFL&A Salmonella Enteritidis outbreak – ED visits for GI syndrome mapped to 5-digit Postal Code areas Nov 16-25/05

Queen’s University and KGH

Queen’s University Emergency Syndromic Surveillance TeamRetrospective 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

Using Real-time data to support Public Health decision-making

and monitor the effectiveness of Public Health interventions

Queen’s University Emergency Syndromic Surveillance TeamQueen’s University Emergency Syndromic Surveillance Team

Secondary Uses – Heat Alerts

For immediate releaseTuesday, July 12, 2005 Level 1 Heat Alert issued for KFL&A areaKingston�KFL&A Public Health is issuing a Level 1 Heat Alert to residents of the KFL&A area with hot, humid weather forecast for the next few days. A Level 1 Heat Alert is issued when temperatures or humidex are forecast to be 36°C for two or more consecutive days.

Sentinel Surveillance

The ‘Homecoming’Effect


2005 Homecoming Sept 23-25

0

50

100

150

200

250

9/9/05

9/10/0

59/1

1/05

9/12/0

59/1

3/05

9/14/0

59/1

5/05

9/16/0

59/1

7/05

9/18/0

59/1

9/05

9/20/0

59/2

1/05

9/22/0

59/2

3/05

9/24/0

59/2

5/05

9/26/0

59/2

7/05

9/28/0

59/2

9/05

9/30/0

510

/1/05

10/2/

0510

/3/05

10/4/

0510

/5/05

10/6/

0510

/7/05

10/8/

0510

/9/05

Date

# of

ED

vis

its (K

GH

and

HD

H

all 17+ 17-25yrs 26-64yrs 65+ yrs

Sentinel surveillance


NO alerts homecoming weekend

Example of retrospective review of syndromic surveillance:

Anomaly Detection

Seasonal Influenza


Characterizing the Flu Seasons

2001-02 sporadic cases beginning in mid-January

2002-03 good match with Vaccine, very few positive influenza tests, beginning in mid-January

2003-04 large numbers of casesbeginning in mid-November (artifact of SARS?)

2004-05 similar to 2001-02; beginning New Years


Influenza in KFL&A – 2001/02

0

20

40

60

80

9/1/2001 10/1/2001 11/1/2001 12/1/2001 1/1/2002 2/1/2002 3/1/2002 4/1/2002

Const - all agesResp - all ages

0

1

2

3

4

5

9/1/2001 10/1/2001 11/1/2001 12/1/2001 1/1/2002 2/1/2002 3/1/2002 4/1/2002

Resp - CuSUMResp - RLSConst - CuSUMConst - RLS

0

1

2

3

9/1/2001 10/1/2001 11/1/2001 12/1/2001 1/1/2002 2/1/2002 3/1/2002 4/1/2002

Positive Influenza



0102030405060

9/1/2002 10/1/2002 11/1/2002 12/1/2002 1/1/2003 2/1/2003 3/1/2003 4/1/2003


0

1

2

3

4

5

9/1/2002 10/1/2002 11/1/2002 12/1/2002 1/1/2003 2/1/2003 3/1/2003 4/1/2003


0

1

2

3

9/1/2002 10/1/2002 11/1/2002 12/1/2002 1/1/2003 2/1/2003 3/1/2003 4/1/2003

Positive Influenza



0

20

40

60

80

100

9/1/2003 10/1/2003 11/1/2003 12/1/2003 1/1/2004 2/1/2004 3/1/2004 4/1/2004


0

1

2

3

4

5

9/1/2003 10/1/2003 11/1/2003 12/1/2003 1/1/2004 2/1/2004 3/1/2004 4/1/2004


0

2

4

6

8

9/1/2003 10/1/2003 11/1/2003 12/1/2003 1/1/2004 2/1/2004 3/1/2004 4/1/2004

Positive Influenza



0

20

40

60

80

12/1/2004 12/16/2004 12/31/2004 1/15/2005 1/30/2005 2/14/2005 3/1/2005 3/16/2005 3/31/2005


0

1

2

3

4

5

12/1/2004 12/16/2004 12/31/2004 1/15/2005 1/30/2005 2/14/2005 3/1/2005 3/16/2005 3/31/2005


01234567

12/1/2004 12/16/2004 12/31/2004 1/15/2005 1/30/2005 2/14/2005 3/1/2005 3/16/2005 3/31/2005

Positive Influenza


Telehealth Ontario

Nurse help line

Computerized decision tree

Guidelines recommended

Electronic data base


Guidelines to Syndromes

Upper Respiratory• Colds (Adult After Hours)• Colds (Pediatric After Hours)• Congestion - Guideline Selection

(Pediatric After Hours)• Croup (Pediatric After Hours)• Ear - Congestion (Adult After Hours)• Ear - Congestion (Pediatric After

Hours)• Ear - Discharge (Adult After Hours)• Ear - Discharge (Pediatric After Hours)• Earache (Adult After Hours)• Earache (Pediatric After Hours)

• Hoarseness (Adult After Hours)• Hoarseness (Pediatric After Hours)• Respiratory Multiple Symptoms - Guideline

Selection (Adult After Hours)• Respiratory Multiple Symptoms - Guideline

Selection (Pediatric After Hours)• Sinus Infection Follow-Up Call (Adult After Hours)• Sinus Infection Follow-up Call (Pediatric After

Hours)• Sinus Pain and Congestion (Adult After Hours)• Sinus Pain Or Congestion (Pediatric After Hours)• Sore Throat (Adult After Hours)• Sore Throat (Pediatric After Hours)



Lower Respiratory• Guideline• Cough - Acute Non-productive (Adult After Hours)• Cough - Acute Productive (Adult After Hours)• Cough - Chronic (Adult After Hours)• Cough (Pediatric After Hours)• Coughing Up Blood (Adult After Hours)• Wheezing - Other Than Asthma (Pediatric After Hours)



Fever/ILI• Fever (Adult After Hours)• Fever (Pediatric After Hours)• Influenza (Adult After Hours)• Influenza (Pediatric After Hours)

Gastroenteritis• Diarrhea (Adult After Hours)• Diarrhea (Pediatric After Hours)• Stools - Blood In (Pediatric After Hours)• Stools - Unusual Color (Pediatric After

Hours)• Stools - Unusual Color Of (Adult After

Hours)• Vomiting (Adult After Hours)• Vomiting (Pediatric After Hours)


Telehealth –All Respiratory Calls (3 day MA)

0

100

200

300

400

500

600

700

800

6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006


0

500

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1500

2000

2500

3000

3500

6/1/20

04

8/1/20

04

10/1/

2004

12/1/

2004

2/1/20

05

4/1/20

05

6/1/20

05

8/1/20

05

10/1/

2005

12/1/

2005

2/1/20

06

4/1/20

06

6/1/20

06Telehealth Respiratory Calls (3 day MA)and Respiratory Virus isolates (x3)

All RespFlu A

Flu B

Flu A or B

RSV

PIV

Adeno


0

100

200

300

400

500

600

700

800

6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006

Telehealth Respiratory Calls (3 day MA)and RSV isolates

All Resp

RSV isolates


0

100

200

300

400

500

600

700

800

6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006

Telehealth Respiratory Calls (3 day MA)and PIV isolates

All Resp

PIV isolates


0

100

200

300

400

500

600

700

800

6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006

Telehealth Respiratory Calls (3 day MA)and Flu A isolates

All Resp

Flu A isolates


0

100

200

300

400

500

600

700

800

6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006

Telehealth Respiratory Calls (3 day MA)and Flu B isolates

All Resp

Flu B isolates


0

100

200

300

400

500

600

700

800

6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006

Telehealth Respiratory Calls (3 day MA)and Flu A and B isolates

All Resp

Flu B isolates

Flu A isolates


0

100

200

300

400

500

600

700

800

6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006

Telehealth Respiratory Calls (3 day MA)and Flu isolates (A and B)

All Resp

Flu isolates(A and B)


Emergency Department Visits –National Ambulatory Care Reporting System (NACRS)

Timelines– April 1, 2004 until March 31, 2006

Data Elements– Date and Time– Patient’s Age and Sex– Patient’s Postal Code– Most Responsible Diagnosis (ICD-10)

Coded by Hospital Health records post-discharge

Syndromes based on Selected ICD-10 codes


NACRS RESP Classification

UNSPECIFIED ACUTE LOWER RESPIRATORY INFECTIONJ22

ACUTE BRONCHIOLITISJ21

ACUTE BRONCHITISJ20

PNEUMONIA, ORGANISM UNSPECIFIEDJ18

PNEUMONIA IN DISEASES CLASSIFIED ELSEWHEREJ17

PNEUMONIA DUE TO OTHER INFECTIOUS ORGANISMS, NOT ELSEWHERE CLASSIFIEDJ16

BACTERIAL PNEUMONIA, NOT ELSEWHERE CLASSIFIEDJ15

PNEUMONIA DUE TO HAEMOPHILUS INFLUENZAEJ14

PNEUMONIA DUE TO STREPTOCOCCUS PNEUMONIAEJ13

VIRAL PNEUMONIA, NOT ELSEWHERE CLASSIFIEDJ12

INFLUENZA, VIRUS NOT IDENTIFIEDJ11

INFLUENZA DUE TO IDENTIFIED INFLUENZA VIRUSJ10

ACUTE UPPER RESPIRATORY INFECTIONS OF MULTIPLE AND UNSPECIFIED SITESJ06

ACUTE OBSTRUCTIVE LARYNGITIS [CROUP] AND EPIGLOTTITISJ05

ACUTE LARYNGITIS AND TRACHEITISJ04

ACUTE TONSILLITISJ03

ACUTE PHARYNGITISJ02

ACUTE SINUSITISJ01

ACUTE NASOPHARYNGITIS [COMMON COLD]J00


0

500

1000

1500

2000

2500

3000

6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006

Telehealth Respiratory Callsand ED Visits - Ontario

ED Resp Visits

TelehealthResp Calls


0

500

1000

1500

2000

2500

3000

3500

6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006

Telehealth Respiratory Calls (x 5)ED Visits (x1) and Influenza Pos - Ontario

ED Resp Visits


Flu A

Flu B

Flu A or B


0

500

1000

1500

2000

2500

3000

3500

6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006

Telehealth Respiratory Calls (x 5)ED Visits (x1) and Influenza Pos (x3)- Ontario

ED Resp Visits


Flu A

Flu B

Flu A or B


0

100

200

300

400

500

600

700

6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006

Telehealth GI Callsand ED GI Visits (x5) - Ontario

ED GI Visits

TelehealthGI Calls


Telehealth Fever/ILI Calls (x5)and Positive Influenza isolates- Ontario

0

100

200

300

400

500

600

700

800

6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006

Flu A

Flu B

Flu A or B


Influenza Is Seasonal-FluWatch 2006

Influenza activity September 18–24, 2005

Influenza activity March 5–11, 2006


Conclusion: Objectives


Emergency Department Syndromic Surveillance Project

Ontario’s Telehealth

GIS-mapping the data

Queen’s University Emergency Syndromic Surveillance Team ... · Siemens Confidential:©2002...

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