# Presentation: 511682

## The BioSense Influenza Module

**Craig Hales MD MPH, Roseanne English BS, Paul McMurray MDS, Michelle Podgornik MPH, Jerome Tokars MD MPH**
*Centers for Disease Control and Prevention*
*National Center for Public Health Informatics*
- August 26, 2008

*The findings and conclusions in this report are those of the authors and do not *
*necessarily represent the views of the Centers for Disease Control and Prevention.*

## Outline

- What is the BioSense Influenza Module?
- Data sources
- Influenza module functionality
- Performance of BioSense influenza indicators
- Potential improvements to BioSense indicators
- New data sources

## What is the Influenza Module?

- Collaboration
- Influenza Division/NCIRD
- BioSense Program/NCPHI
- Deployed December 2007
- Purposes
- Collate available surveillance data
- Present in a single application
- Common format and user interface
- State and local users have access to
- National and regional level data
- State-specific data

## Slide 4

## Slide 5

## Traditional Influenza Data Sources

- U.S. Influenza Sentinel Provider Network
- % Influenza-like Illness (ILI)
- WHO/National Respiratory and Enteric Virus Surveillance System (NREVSS)
- # positive influenza isolates by type (e.g. B, H3N2); Percent positive
- State and Territorial Epidemiologists Reports
- No Activity, Sporadic, Local Activity, Regional, Widespread

## BioSense Influenza Data Sources

- BioSense hospital emergency department (ED) chief complaints
- Flu OR Fever OR Cough mentioned in chief complaint
- 543 facilities reporting
- BioSense hospital emergency department final diagnosis (ICD-9-CM)
- Acute Respiratory Illness (ARI)
- ICD-9-CM codes 460-466, 480-488
- Upper respiratory tract infections
- Bronchitis/Bronchiolitis
- Pneumonia
- Influenza
- 172 facilities reporting
- DoD/VA outpatient clinics final diagnosis (ICD-9-CM)
- Acute Respiratory Illness (ARI)
- 1188 facilities reporting

## BioSense Influenza Module Functionality

- Flu Kiosk
- Maps
- Time Series
- User-defined customized dashboard

## Slide 9

## Slide 10

## Slide 11

## Slide 12

## Performance of BioSense Influenza Indicators Potential Improvements 

## Acute Respiratory Illness (ARI)

- Current
- ICD-9-CM codes 460-466, 480-488
- Upper respiratory infections, bronchitis/bronchiolitis, pneumonia, influenza
- Did not reflect increased influenza activity in 2007-8 season
- Proposed
- Indicator is closer to standard definition of influenza-like illness
- (Fever AND (Cough OR Upper Resp Infx)) OR ILI

## Current and Proposed BioSense VA/DOD Indicator vs. Sentinel Provider %ILI, 2005-2008: U.S.

## BioSense ED Chief Complaint

- Current
- Flu OR Fever OR Cough mentioned in chief complaint
- Proposed
- Indicator is closer to standard definition of influenza-like illness
- (Fever AND (Cough OR Upper Resp Infx)) OR ILI

## Current and Proposed BioSense ED Indicators vs. Sentinel Provider %ILI, 2005-2008: U.S.

## New Data Sources

- Laboratory data
- Lab Corp – 93 labs, 3711 healthcare providers
- Quest – 30 labs, 4274 healthcare providers
- # of influenza isolates; percent positive
- Influenza antiviral data
- 20,000-30,000 outpatient pharmacies
- Antiviral %: Ratio of influenza antiviral prescriptions to all anti-infective prescriptions

## Lab Corp and Quest, # of Influenza Isolates, 2007-2008: U.S.

## Influenza Antiviral %*, 2003-2008: U.S.

***** Ratio of influenza antiviral prescriptions to all anti-infective prescriptions

## State-Specific Webinars

- March-April 2008
- Separate webinars for 7 states and 1 metropolitan health department
- Focused on state-specific data
- Additional training + feedback
- Main feedback:
- Would like to see more recent data
- Would like to download data from table
- Would like to see data from adjacent jurisdictions
- Interest in new laboratory and antiviral data

## Conclusions

- BioSense Influenza Module is a novel application combining traditional and automated data sources on influenza activity
- Goal: Single application with common format and user interface for all federally available influenza data
- Improvements for upcoming influenza season based on first year experience and user feedback
- Appreciate your continued feedback and suggestions

## Questions:

**Craig Hales MD, MPH**
**chales@cdc.gov**
**BioSense e-mail address:**
**biosensehelp@cdc.gov **