Syndromic surveillance hrsa
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Transcript of Syndromic surveillance hrsa
Syndromic Surveillance for Early Event Detection with Real Time Online Disease
Surveillance (RODS)
Houston Department of Health and Human Services
Wes McNeely MS, MPH, Epidemiology Supervisor (PHP)A.J. Rosario MD, MPH Systems Analyst (PHP)
Definition
Syndromic surveillance for early outbreak detection is an investigational approach where health department staff…monitor disease indicators continually (real-time) or at least daily (near real-time) to detect outbreaks of diseases earlier and more completely than might otherwise be possible with traditional public health methods. The distinguishing characteristic of syndromic surveillance is the use of indicator data types.
--Excerpt from MMWR May 7, 2004 / 53(RR05)1-11
Hardware - PHINPHIN - Public Health Information Network
Server Cluster uses Microsoft Windows Advanced Server 2003 platform
Web Server, Application Server, Database
Database Server hosts Oracle 9i
Resides at HDHHS
Software - RODS
Hospital Sends Data Hospital admits patient into Emergency
Room (ER) and generates a computer record of visit
Hospital formats ER admissions record into HL-7 or other “messaging” format
Hospital “message router” uploads record to HDHHS PHIN through a secure Virtual Private Network connection (VPN)
“Message”
MSH1|^~\&||UPMC(hosp)||RODS|200003171458||ADT^A04|20000317145841029270(message control ID)2|P|2.3|<CR>3PID|||||||^017(age)|M|||^^^^12345^^^^|<CR>PV1||E||D||||||||||||||||||||||||||||||||||||||||200109130045(admittime)||<CR>PV2|||ABDOMINAL PAIN(chief complaint)|<CR>DG1||I9|789.09|ABDOMINAL PAIN-SITE NEC(diagnosis desc.)|<CR>NK1||||^^^^12345^^|||EMP|<CR>IN1||||||||||||||||||||||||||||||||||||||||||||^^^^12345<CR><ETX>4
RODS Receives Data RODS “listens” for new data uploaded into
folder and “consumes” the message
RODS chops up the text containing the complaint information (“parses the string”)
RODS classifies the chopped up complaint text using “Natural Language Processing” (NLP) into one (1) of seven (7) possible syndromes related to bioterrorism
Complaint text classification (CoCo)
Syndrome Classification Accuracy
“The sensitivity of a naive Bayes classifier using triage diagnoses was 0.63, the specificity was 0.94, and the area under the ROC curve was 0.82”.....
“We conclude that a naive Bayes classifier of free-text triage diagnosis data provides more sensitive and earlier detection of cases [than other methods].”
“The sensitivity achieved should be sufficient for syndromic surveillance system designed to detect moderate to large epidemics.”
Ivanov, O., M. M. Wagner, et al. (2002). "Accuracy of three classifiers of acute gastrointestinal syndrome for syndromic surveillance." Proc AMIA Symp: 345-9.
SyndromesRODS assigns syndromic categories to the complaint
1. Gastrointestinal2. Constitutional3. Respiratory4. Rash5. Hemorrhagic6. Botulinic7. Neurological8. Other
DatabaseRODS imports the data with syndrome field
added into Oracle 9i database
MSH1|^~\&||UPMC(hosp)||RODS|200003171458||ADT^A04|20000317145841029270(message control ID)2|P|2.3|<CR>3PID|||||||^017(age)|M|||^^^^12345^^^^|<CR>PV1||E||D||||||||||||||||||||||||||||||||||||||||200109130045(admittime)||<CR>PV2|||ABDOMINAL PAIN(chief complaint)|<CR>DG1||I9|789.09|ABDOMINAL PAIN-SITE NEC(diagnosis desc.)|<CR>NK1||||^^^^12345^^|||EMP|<CR>IN1||||||||||||||||||||||||||||||||||||||||||||^^^^12345<CR><ETX>4
Pretty data
Pretty data
Pretty data
Graphs
RODS Analyzes the Data
RODS analyzes the data to detect unusual patterns every 4 hours Time Series
Recursive Least Squares (RLS) CuSum Linear Models
Spatial analysis Scan Statistics
Multivariate analysis WSARE (What’s Strange About Recent Events?)
Alerts
Output
Output
Syndromic Trends
Graph3 Gastrointestinal
Graph2 Neurological
Graph4 Botulinic
Graph1 Respiratory
Graph1 RespiratoryBURN-IN PHASE
Interface Upgrades
Version 4.0
Upgrades1
Upgrades2
Upgrades3
Upgrades4
Upgrades5
Contact Information
[email protected] Specialist
Shola Adeleye, MD, MPH
[email protected] Supervisor
Wes McNeely, MS, MPH
[email protected] Chen, OCA
[email protected] Analyst IVAJ Rosario, MD, MPH
RODS Laboratory
[email protected] 917-254-7278User Interface, Developer
Jeremy Espino, MD
[email protected] ManagerDaphne Henry
HDHHS
Extra info - RODS Syndromes Botulinic – ocular abnormalities, difficulty speaking,
and difficulty swallowing. Constitutional – non-localized, systemic problems
including fever, chills, body aches, flu symptoms. Gastrointestinal – pain or cramps anywhere in the
abdomen, nausea, vomiting, and diarrhea. Hemorrhagic – bleeding from any site, vomiting
blood, nose bleed, or gastrointestinal bleeding. Neurological – non-psychiatric complaints that
relate to brain function. Rash – any rash such as macular, papular,
vesicular, petechial, purpuric, or hives. Respiratory – problems of the nose, throat, and
lungs. The presence of both clod and flu symptoms is counted in this category, not constitutional.
Extra info - Sensitivity and Specificity
Test Result+ -
Has
Conditio
n
N
o Y
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Extra info - ROC Curve“In signal detection theory, a receiver operating characteristic (ROC) is a graphical plot of the sensitivity (fraction of true positives - TP) vs. 1-specificity (the fraction of false positives - FP) for a binary classifier system as its discrimination threshold is varied.” http://en.wikipedia.org/wiki/ROC_Curve