# Presentation: 740106

## BioSense Overview

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

## BioSense Overview

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

## Past (and Current)

- Department of Defense (DOD) outpatient Medical Treatment Facilities (n=355)
- ICD-9 CM diagnosis codes
- CPT procedure codes
- Veterans Affairs (VA) outpatient medical centers and clinics (n=849)
- ICD-9 CM diagnosis codes
- CPT procedure codes
- LabCorp
- Preliminary diagnoses (ICD-9 CM)
- Test orders
- BioWatch: negative test results

## Codes Mapped to 11 Syndromes

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

## Analytic Home Page

## 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

## Spectrum of Uses for Electronic Data

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

## Numbers of Events, Standard* vs  BioSense Influenza Surveillance

- 2003-2004

- 2004-2005

- * Sentinel Physician reports

## RSV Codes by Week, BioSense, July 04-Dec 05

## 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

## 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

## BioSenseRT Patient Populations

- Emergency Department
- Hospital Inpatient
- Ambulatory Care

## 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

## 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

## Data Analyses and PresentationChief 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

## Diagnosis Groups (n=79)

- 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

## 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

## 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

## Diagnosis GroupsNot 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**

## Slide 20

## BioSense FutureSome 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

## 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

## 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?

## Themes

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