BioSense Overview

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BioSense Overview

• Jerome Tokars, MD, MPH
• Associate Director for Science
• Division of Emergency Preparedness and Response
• Feb 14, 2006

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BioSense Overview

• Past
• BioSense system
• Special analyses
• Present
• BioSenseRT
• Future
• Some priorities for 2006

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Past (and Current)

• Department of Defense (DOD) outpatient Medical
  Treatment Facilities (n355)
• ICD-9 CM diagnosis codes
• CPT procedure codes
• Veterans Affairs (VA) outpatient medical centers
  and clinics (n849)
• ICD-9 CM diagnosis codes
• CPT procedure codes
• LabCorp
• Preliminary diagnoses (ICD-9 CM)
• Test orders
• BioWatch negative test results

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Codes Mapped to 11 Syndromes

• Botulism-like
• Fever
• Gastrointestinal
• Hemorrhagic illness
• Localized cutaneous lesion
• Lymphadenitis
• Neurological
• Rash
• Respiratory
• Severe illness/death
• Specific infection

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Analytic Home Page
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BioIntelligence Center (BIC)

• Initiated June 2004
• Dedicated monitors (personnel)
• Examine BioSense application for data anomalies
• Support for state and local personnel
• System troubleshooting and enhancement

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Spectrum of Uses for Electronic Data

• Syndromes
• Diagnoses of specific diseases
• Influenza
• RSV
• Injuries
• Viral meningitis
• West Nile Virus
• Laboratory/radiology results

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Numbers of Events, Standard vs BioSense
Influenza Surveillance
2003-2004
2004-2005
Sentinel Physician reports
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RSV Codes by Week, BioSense, July 04-Dec 05
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Present BioSenseRT

• An initiative within the BioSense Project that
  emphasizes acquisition of clinically rich data in
  real time from hospitals in major US cities
• Data transmitted within 15 min of appearance in
  HIS
• Data visualized within 2 hours of receipt

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BioSenseRT Functions

• Early Event Detection
• Early detection of disease prodromes
• Notification
• The early upswing of the epi curve
• Situational Awareness
• Information to manage an event
• Description
• All phases of the epi curve

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BioSenseRT Patient Populations

• Emergency Department
• Hospital Inpatient
• Ambulatory Care

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BioSenseRT Data Types

• Hospital level data
• Daily census (resources and bed utilization)
• Patient level data
• Chief complaint and diagnosis
• Patient demographics (obvious identifiers
  removed)
• ED data vital signs, etc
• Micro lab orders and results
• Radiology orders and results
• Pharmacy orders

Phase 1
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Cities with BioSense Hospitals 2005 Commitments

• Atlanta, GA
• Baltimore, MD
• Boston, MA
• Chicago, IL
• Columbus, OH
• Dallas, TX
• Denver, CO
• El Paso, TX
• Indianapolis, IN

• Las Vegas, NV
• Los Angeles, CA
• Miami, FL
• Milwaukee, WI
• Philadelphia, PA
• Phoenix, AZ
• Portland, OR
• San Diego, CA
• St. Louis, MO
• Washington D.C.

Currently receiving data from 32 hospitals in 10
cities
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Data Analyses and PresentationChief Complaint
and Diagnosis

• 11 standard syndromes
• 79 standard groups based on chief complaints and
  diagnoses
• Primary unit of analysis is the facility (ie
  hospital)
• Later analysis by county and/or zip code

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Diagnosis Groups (n79)

• Botulism-like
• Paralysis
• Speech disturbance
• Dysphagia
• Fever
• Fever
• Septicemia and bacteremia
• Viral infection, unspecified

• GI
• Abdominal pain
• Anorexia
• Diarrhea
• Food poisoning
• Intestinal infections, ill-defined
• Nausea and vomiting

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Diagnosis Groups

• Hemorrhagic
• Coagulation defects
• Gastrointestinal hemorrhage
• Hemorrhage
• Purpura and petechia
• Cutaneous lesion
• Insect bites
• Skin infection

• Lymphadenitis
• Lymphadenopathy
• Neurological
• Alteration of consciousness
• CNS, inflammatory disease
• Convulsions
• Gait abnormality
• Headache
• Meningismus
• Photophobia

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Diagnosis Groups

• Respiratory
• Asthma
• Bronchitis and bronchiolitis
• Chest pain
• Cough
• Cyanosis and hypoxemia
• Dyspnea
• Influenza-like illness
• Otitis media
• Pleurisy
• Pneumonia and lung abscess

• Respiratory (continued)
• Respiratory failure
• RSV
• Upper respiratory infections
• Hemoptysis
• Rash
• Rash
• Severe Illness and Death
• Coma
• Death
• Shock

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Diagnosis GroupsNot Classified Into Syndromes

• Allergy
• Anemia
• Bites, animal
• Burns
• Carbon monoxide poisoning
• Cardiac dysrhythmias
• Cerebrovascular disease
• COPD
• Dehydration
• Diabetes mellitus
• Dizziness
• Edema
• Falls
• Fractures and dislocation
• Heart disease, ischemic
• Heat, excessive
• Hypertension

• Hypotension
• Injury, NOS
• Jaundice
• Malaise and fatigue
• Mental disorders
• Migraine
• Motor vehicle traffic accidents
• Myalgia
• Neoplasms
• Numbness
• Open wound
• Poisoning by medicines
• Pregnancy, childbirth complications
• Sprains and strains
• Syncope and collapse
• Urinary tract infection
• Visual impairment

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BioSense FutureSome Priorities for 2006 (and
beyond)

• Additional data sources and types
• Revised data analysis strategy
• Monitoring and reporting protocols
• Enhance BioSenseRT application
• Evaluate current application views
• Influenza
• Evaluations

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Additional data sources and types

• Microbiology
• BT agents
• Reportable diseases
• Other organisms of interest
• Routine cultures and susceptibility
• Radiology
• CXR infiltrate, pneumonia
• Extremity fracture, dislocation
• ED-specific data fever, acuity
• Pharmacy
• Poison Control Center data
• Commercial laboratories
• Claims clearinghouse

BioSenseRT
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Evaluation

• Early
• Accuracy of data and application
• Comments from users
• Middle
• Can we detect influenza?
• Can we see known localized outbreaks?
• Data useful in an emergency?
• Later
• Is there value added?

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Themes

• Richer data
• Real-time data
• More specific events
• Situational awareness as well as early event
  detection