NYC Syndromic Surveillance

1. NYC Syndromic Surveillance IFH HIT Meaningful Use Workshop 10/1/2010 Marlena Plagianos, MS NYCDOHMH mplagian@health.nyc.gov

2. What is Biosurveillance? • “Collection and integration of timely health-related information for public health action achieved through the early detection, characterization, and situation awareness of exposures and acute human health events of public health significance.” Aaron T Fleischauer, PhD; Pamela S Diaz, MD; Daniel M Sosin MD . Biosurveillance: A Definition, Scope and Description of Current Capability for a National Strategy. Advances in Disease Surveillance 2008;5:175

3. Traditional Surveillance • Case definitions • Historically low compliance • Laboratory confirmation can be slow • Still important (e.g. H1N1 in NYC)

4. Laboratory Confirmation Making firm diagnosis commonly relies on lab result Limited in-house testing in outpatient setting (minutes) Commercial laboratory testing takes time (days-weeks)

5. Traditional Reporting is Labor Intensive

6. Traditional Reporting is Labor Intensive

7. Syndromic Surveillance • Pre-diagnostic indicators of disease • Readiness scenarios: bioterrorism, pandemics • Objectives: • Timely, sensitive, specific surveillance • Detect outbreak before ‘astute clinician’ • Typical Process

8. New and Exciting Data Types

9. EHR Syndromic Surveillance • The Primary Care Information Project (PCIP) uses different EHR data sources to conduct & pilot its syndromic surveillance activities • Some syndromes tracked using EHR data are: • Influenza-like Illness (ILI) • Fever • Gastrointestinal Illness (GI) • Case definitions for these syndromes based upon text in these structured fields: • Chief Complaint • Measured Temperature • Diagnosis (ICD-9 CM Code)

10. System Screenshot

11. Aggregate Level Syndromic Data • Only “Count” Data is collected

12. Data processing and syndrome coding

13. Analysis:Calculate Baseline

14. Analysis:Test Observed vs. Expected

15. Analysis:Test Observed vs. Expected

16. Electronic Health Record Syndromic SurveillanceDuring 2009 Pandemic H1N1 in NYC

17. Friday

18. Saturday

19. Sunday

20. Monday

21. Tuesday

22. Wednesday

23. Thursday

24. Friday

25. Saturday

26. Sunday

27. Monday – Memorial Day

28. Tuesday

29. H1N1 in New York City:

30. Objective • To determine whether the timing of the increase in patient visits was different at emergency departments from primary care clinics during the spring 2009 H1N1 influenza outbreak across the 5 boroughs of NYC

31. Study Sites l 58 Primary Care Providers (PCP): • 9 Institute for Family Health (IFH) clinics • 49 practices enrolled in the NYCDOHMH PCIP (30 visits/day) v50 Emergency Departments • 247 visits/day

32. Methods • Influenza-like Illness (ILI) as a broad estimate of H1N1

33. Methods

34. ED, IFH and PCIP ILI Visits

35. ED, IFH and PCIP ILI Visits

36. ED, IFH and PCIP ILI Visits

37. Facilities with a significant increase in ILI volume

38. Results, April 24-May 8

39. Results, May 14-June 4

40. Findings • Emergency Departments experienced an increase in patients with ILI before Primary Care Providers • PCPs were vastly under-utilized during the outbreak • NYCDOHMH changed messaging to encourage visiting PCPs instead of EDs for mild illness

41. Future of Syndromic Surveillance

42. Online Resources CDC Flu Surveillance http://www.cdc.gov/flu/weekly/fluactivity.htm Distribute http://www.isdsdistribute.org/