Staffing RODS in Ohio February 23 rd, 2006 Biosurveillance Information Exchange Working Group...
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Staffing RODS in OhioStaffing RODS in Ohio
February 23February 23rdrd, 2006, 2006Biosurveillance Information Exchange Working GroupBiosurveillance Information Exchange Working Group
Rutgers UniversityRutgers UniversityPiscataway, NJPiscataway, NJ
Loren Shaffer, [email protected]
Early Event Surveillance Supervisor
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Our Current SystemsOur Current Systems
• Real-time Outbreak and Disease Surveillance (RODS) System
• BioSense• Influenza-like Illness Sentinel Providers• School Absenteeism• Wildlife Disease Surveillance• Ohio Disease Reporting System• Early Aberration Reporting System (EARS)
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RODSRODS• Developed at the University of Pittsburgh• Utilizes a hospital’s existing HL-7 socket to receive real-time data• Interprets free-text chief complaint from emergency department
registration database and groups into one of seven prodromes• Collects information from retailers about sales of over-the-
counter medications• Provides immediate analysis for trends and anomalies
suggestive of disease outbreaks• Secure web access by users
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HIPAAHIPAA
• Export of data for public health surveillance is permitted (45 CFR 164.512)
• Prior written authorization of individual is not required (45 CFR 164.512)
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End Users of RODS in Ohio
• Total = 174– State Health Department = 6– Local Health Department = 87
• 88 of 135 LHDs represented
– Hospital = 77– Other = 4
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RODS Alerts
• February 2004 to February 2006– 310 unique alerts received
• Seasonal Elevation – 40%• Outbreaks – 22%• Data Errors – 9%• No Cause Identified – 28%
– 53% handled at State level– 47% forwarded to local epidemiologist
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RODS Alerts and Reported Outbreaks in Ohio
2/1/2004 - 2/1/2006
Date of RODS Alert
Syndrome County Outbreak Cause Number IllDate Reported to
ODH
12/24/2004 Respiratory Statewide CO Poisoning ~50 not reported
1/11/2005 Gastrointestinal Franklin Norovirus 7 1/24/2005
1/11/2005 Gastrointestinal Franklin Norovirus 3 2/16/2005
1/30/2005 Gastrointestinal Mahoning Norovirus 5 2/9/2005
3/3/2005 Gastrointestinal Mahoning C perfringens 4 3/14/2005
10/26/2005 Gastrointestinal Preble Norovirus ~300 11/4/2005
11/23/2005 Rash Jefferson Scabies 5 not reported
12/27/2005 Gastrointestinal Montgomery Campylobacter 3 1/30/2006
8/3/2005 8/4/2005 8/5/2005
Gastrointestinal Constitutional Gastrointestinal
Hamilton Cryptosporidiosis ~750 8/22/2005
1/9/2006 Constitutional Scioto Scromboid Poisoning 3 1/30/2006
1/18/2006 Respiratory Erie Influenza-like Illness 24 not reported
*Information about the number ill and date reported was obtained from the Ohio Disease Reporting System (ODRS)
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What are we doing with RODS?What are we doing with RODS?• Monitoring for patterns suggestive of an
infectious disease outbreak• Influenza surveillance study & efforts• Retrospective outbreak study (improved
specificity)• Adaptation to animal-based sources for
emerging infectious disease surveillance• Real-time clinical data analysis• Environmental surveillance• Specialized investigations
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InfluenzaInfluenza
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InfluenzaInfluenza
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Summary of Correlation Analysis 2003/2004 and 2004/2005 Influenza Seasons
Franklin Montgomery Summit Average
DataLead
(weeks)Correlation Coefficient
Lead (weeks)
Correlation Coefficient
Lead (weeks)
Correlation Coefficient
Lead (weeks)
Correlation Coefficient
Thermometer 4 0.5908 4 0.6254 3 0.5226 3.67 0.5796Cough & Cold 4 0.5592 5 0.5728 3 0.4522 4.00 0.5281Pediatric Cough Syrup 4 0.5079 4 0.5487 3 0.4591 3.67 0.5052Adult Cough Syrup 4 0.2133 4 0.2938 3 0.3042 3.67 0.2704Pediatric Cold Relief 4 0.5730 4 0.5236 4 0.4541 4.00 0.5169Adult Cold Relief 4 0.5985 4 0.5875 4 0.4783 4.00 0.5548Pediatric Antifever 5 0.5524 5 0.4626 3 0.3788 4.33 0.4646Adult Antifever 5 0.3224 1 0.3844 5 0.1901 3.67 0.2990VA Clinic Visits 7 0.3081DoD Clinic Visits 7 0.3159Class B -1 0.4470 4 0.5107 0 0.2594 1.00 0.4057Respiratory ED Visits 4 0.5544 5* 0.5227 4.00 0.5386Constitutional ED Visits 4 0.5133 4* 0.4603 4.00 0.4868
ILI Sentinel Providers 5 0.2311 5 0.5591 3 0.57054.33 (4 w /o
Franklin)
0.4536 (0.5648 w /o
Franklin)
School Absences 10 0.2852 4* 0.4540 5 0.3965 7.50 0.3786Laboratory Analysis 5 0.5943 3 0.5966 4.00 0.5955* = Data From 1 Influenza Season
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P(↑Consitutional|Outbreak N)= xc
P(↑Botulinic|Outbreak N)= xb
P(↑Respiratory|Outbreak N)= xr
P(↑GI|Outbreak N) = xg
P(↑Hemorrhagic|Outbreak N)= xh
P(↑Neurologic|Outbreak N)= xn
P(↑Rash|Outbreak N)= xra
P(↑Thermometer|Outbreak N)= xt
P(↑Cold Relief|Outbreak N)= xcr
P(↑Lozenges|Outbreak N)= xl
P(↑Chest Rubs|Outbreak N) = xchr
P(↑Bronchial Remedies|Outbreak N)= xbr
P(↑Antifever|Outbreak N)= xa
P(↑Other Categories|Outbreak N)= x
OTC SalesED Registrations
Known Outbreak
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Zoonotic Disease SurveillanceZoonotic Disease Surveillance
• Adapt RODS to …– Veterinary Diagnostics Laboratory
• Lab orders batched & transmitted via ftp• Parsed into syndrome categories based
on previous mapping of tests• Spatial/temporal analysis at the ZIP code-
level– Veterinary Clinic
• Reason for Visit field included• Near real-time export via ftp• Co-co classifier parses free text into
syndrome category• Spatial/temporal analysis at the ZIP code-
level
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EmergencyDepartment
CategorizeInto
SyndromesDailyTotals
TotalsHigher ThanExpected?
HistoricalModels
Alert
ReviewTrends
Chief Complaint andPatient Demographics
In HL7 messages
Daily
Continuous
Continuous
Updated monthly
ValidAlert?
InitiateResponse
Areas for Attention & AssistanceAreas for Attention & Assistance
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Identified NeedsIdentified Needs
• User Training → 1:1 & Conference Workshops• User Protocols → Developed Protocol Document• User Support → 24/7 Coverage Pilot• 24/7 Coverage → System Enhancement to Permit
Alerts to Jurisdictions• Advisory Group(s) → Expansion of ODRS Advisory
Committee• Integration with Other Surveillance Systems →
Ongoing Evaluations and Study Projects• Local Health Department Resources → ?