Enhancing State Biosurveillance Capabilities:

1
Enhancing State Biosurveillance Capabilities
The Maryland Experience Heather
Brown, MPH Sadia Aslam, MPH Al Romanosky, MD,
PhD Isaac Ajit, MD, MPH Sherry Adams, RN
Maryland Department of Health and Mental Hygiene,
Office of Preparedness Response
Objective
Results
Maryland ESSENCE Hospitals
In October 2008, DHMH started the process of
introducing hospitals to ESSENCE by presenting to
the Baltimore County Emergency Management
Taskforce, which consists of representatives from
the local health department, hospitals, local law
enforcement, and other partners. DHMH has
followed up with these hospitals to work towards
incorporation into ESSENCE. In November 2008,
technical enhancements were completed to build
the infrastructure to allow additional data
sources to be incorporated into Maryland
ESSENCE. Also in November 2008, incorporation of
Maryland Poison Center data into ESSENCE was
completed. The Poison Control Center project was
accomplished in collaboration with the District
of Columbia Department of Health, the Virginia
Department of Health, and the ESSENCE contractor,
The Johns Hopkins University Applied Physics
Laboratory.
Improving biosurveillance capabilities for
Maryland is one of the Governors Core Goals for
a Prepared Maryland. The Maryland Department of
Health and Mental Hygiene (DHMH) is leading this
initiative through expansion of the states
syndromic surveillance system, the Electronic
Surveillance System for the Early Notification of
Community-based Epidemics (ESSENCE).
Maryland ESSENCE Pharmacies
Background
DHMH conducts biosurveillance activities to
detect the early presence of disease or illness
which may be indicative of a threat to public
health and well-being. Through ESSENCE, DHMHs
Office of Preparedness and Response (OPR)
monitors and analyzes health indicator data for
the early detection of disease outbreaks,
suspicious patterns of illness, and public health
emergencies. The Maryland ESSENCE system
includes emergency department chief complaint
data from 15 hospitals in the Baltimore and
National Capital Regions. Maryland ESSENCE also
includes over-the-counter medication sales data
from 2 large pharmacy chains. In 2006-2007, DHMH
began planning for the expansion of ESSENCE. An
ESSENCE expansion activity plan and timeline were
developed to help guide the project. However, the
availability of Federal funds was crucial to
infrastructure improvements and implementation of
expansion so the project was delayed. More focus
on ESSENCE expansion has developed as a result of
the emphasis on improving the states
biosurveillance capabilities from the Governors
Core Goals for a Prepared Maryland, which are
initiatives for improving homeland security core
capabilities in the state. In 2008, several
activities planned for the expansion project were
accomplished using Federal funds.
Lessons Learned
DHMH has been conducting research on how school
absenteeism data is collected across the state.
Since there is no central database in the state
and data is collected in many different ways at
the local level, this priority for the expansion
may take longer than expected. In approaching
the hospitals regarding ESSENCE participation,
hospitals showed interest in participating.
However, in our dialogue with the hospitals, it
was learned many hospitals are not aware of how
ESSENCE works. Thus, hospitals need to be
educated on ESSENCE.
Methods
To begin planning for ESSENCE expansion, DHMH
identified areas to expand and improve its
syndromic surveillance system. A project
activity plan was created to convey the
identified areas for enhancement. In addition, a
preliminary timeline was developed to set goals
for each of the priority areas identified in the
plan. ESSENCE Expansion Activity Plan Priorities
(1) Increase the number of hospitals reporting
to ESSENCE to include all 46 acute care hospitals
in Maryland (2) Increase the number of pharmacy
chains reporting over-the-counter medication
sales to ESSENCE (3) Incorporate school
absenteeism data into ESSENCE (4) Incorporate
poison control center data into ESSENCE (5)
Incorporate animal surveillance data into ESSENCE
Conclusion
To accomplish the first priority of the ESSENCE
expansion project, DHMH has been reaching out to
hospitals to introduce ESSENCE and its benefits.
Hospitals have been very receptive to this
project and few challenges are expected for this
priority. The immediate focus of the ESSENCE
expansion will remain on the hospitals, while the
other priorities may take more time to
accomplish.
Maryland Department of Health and Mental Hygiene