TY - JOUR AU - Austin, Erin E. PY - 2017/05/02 Y2 - 2024/03/28 TI - Coordinated Enhanced Surveillance with Healthcare Entities for Mass Gathering Events JF - Online Journal of Public Health Informatics JA - OJPHI VL - 9 IS - 1 SE - Communicable Disease Surveillance Use Cases for Human, Animal, and Zoonotic Diseases DO - 10.5210/ojphi.v9i1.7678 UR - https://ojphi.org/ojs/index.php/ojphi/article/view/7678 SP - AB - <div style="left: 72px; top: 256.606px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.08137);" data-canvas-width="51.022666666666666">Objective</div><div style="left: 84px; top: 268.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.982719);" data-canvas-width="304.29886666666687">To describe the planning strategies and lessons learned by the</div><div style="left: 72px; top: 281.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.973039);" data-canvas-width="315.96200000000016">Virginia Department of Health (VDH) when conducting enhanced</div><div style="left: 72px; top: 295.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.99798);" data-canvas-width="316.7088666666667">surveillance during mass gathering events and coordinating with</div><div style="left: 72px; top: 308.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.993582);" data-canvas-width="314.56799999999976">healthcare entities to distinguish event-related emergency department</div><div style="left: 72px; top: 321.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00212);" data-canvas-width="210.91333333333333">(ED) visits from community-related ED visits.</div><div style="left: 72px; top: 347.273px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.11794);" data-canvas-width="66.10733333333333">Introduction</div><div style="left: 84px; top: 359.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03289);" data-canvas-width="305.6679333333333">Mass gatherings can result in morbidity and mortality from</div><div style="left: 72px; top: 372.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04259);" data-canvas-width="319.58866666666665">communicable and non-communicable diseases, injury, and</div><div style="left: 72px; top: 385.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.99484);" data-canvas-width="314.5849999999999">bioterrorism. Therefore, it is important to identify event-related visits</div><div style="left: 72px; top: 399.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00903);" data-canvas-width="317.0545333333332">as opposed to community-related visits when conducting public</div><div style="left: 72px; top: 412.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03199);" data-canvas-width="90.712">health surveillance</div><div style="left: 162.763px; top: 412.867px; font-size: 6.8px; font-family: serif;">1</div><div style="left: 166.268px; top: 412.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01825);" data-canvas-width="222.79293333333334">. Previous mass gatherings in Virginia have</div><div style="left: 72px; top: 425.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.999301);" data-canvas-width="314.7130666666667">demonstrated the importance of implementing enhanced surveillance</div><div style="left: 72px; top: 439.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00057);" data-canvas-width="314.8128">to facilitate early detection of public health issues to allow for timely</div><div style="left: 72px; top: 452.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00182);" data-canvas-width="39.65533333333333">response</div><div style="left: 111.656px; top: 452.867px; font-size: 6.8px; font-family: serif;">2</div><div style="left: 115.056px; top: 452.567px; font-size: 11.3333px; font-family: serif;">.</div><div style="left: 72px; top: 477.94px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.07312);" data-canvas-width="46.59133333333333">Methods</div><div style="left: 84px; top: 489.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03086);" data-canvas-width="305.5466666666667">Between June 2015 and September 2015, VDH coordinated</div><div style="left: 72px; top: 503.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.99211);" data-canvas-width="316.59893333333315">with two healthcare entities representing six acute care hospitals</div><div style="left: 72px; top: 516.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.986691);" data-canvas-width="316.5796666666665">to conduct enhanced surveillance for the 2015 World Police and</div><div style="left: 72px; top: 529.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.994147);" data-canvas-width="316.83466666666646">Fire Games and 2015 Union Cycliste Internationale (UCI) Road</div><div style="left: 72px; top: 543.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03556);" data-canvas-width="317.5361999999993">World Championships. VDH established initial communication</div><div style="left: 72px; top: 556.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03556);" data-canvas-width="315.5879999999996">with each healthcare entity between 1 week to 2 months before the</div><div style="left: 72px; top: 569.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.975679);" data-canvas-width="315.9574666666666">event start date to discuss functional requirements with technical,</div><div style="left: 72px; top: 583.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0067);" data-canvas-width="314.9805333333333">informatics, and clinical staff. Requirements included: 1) health care</div><div style="left: 72px; top: 596.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02546);" data-canvas-width="315.63786666666664">entity identifying gathering attendees during the ED registration, 2)</div><div style="left: 72px; top: 609.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.992194);" data-canvas-width="314.42633333333333">capturing a standardized mass gathering indicator within the patient’s</div><div style="left: 72px; top: 623.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.982523);" data-canvas-width="316.3722666666666">electronic health record (EHR), and 3) transmitting the gathering</div><div style="left: 72px; top: 636.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0023);" data-canvas-width="314.8558666666667">indicator to VDH through existing electronic syndromic surveillance</div><div style="left: 72px; top: 649.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.974653);" data-canvas-width="314.4229333333332">reporting processes. ED visit records with the gathering indicator were</div><div style="left: 72px; top: 663.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00628);" data-canvas-width="314.8989333333333">analyzed by VDH using the Virginia Electronic Surveillance System</div><div style="left: 72px; top: 676.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03501);" data-canvas-width="315.78066666666643">for the Notification Community-based Epidemics (ESSENCE) and</div><div style="left: 72px; top: 689.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.975198);" data-canvas-width="315.9642666666666">findings were incorporated in daily VDH situational reports. This</div><div style="left: 72px; top: 703.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00849);" data-canvas-width="316.8505333333333">same methodology will be applied for the upcoming U.S. Vice</div><div style="left: 72px; top: 716.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00199);" data-canvas-width="167.76733333333334">Presidential Debate in October 2016.</div><div style="left: 72px; top: 741.94px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.08488);" data-canvas-width="40.93600000000001">Results</div><div style="left: 84px; top: 753.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.965296);" data-canvas-width="302.1375999999999">The duration of the two gatherings in 2015 ranged from 9 to 10 days</div><div style="left: 72px; top: 767.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01703);" data-canvas-width="315.29560000000015">and the locations were categorized as urban. The population density</div><div style="left: 72px; top: 780.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.989544);" data-canvas-width="316.5717333333332">of the gathering location ranged from 1,950 to 2,889 population</div><div style="left: 72px; top: 793.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.978979);" data-canvas-width="316.5037333333335">per square mile. The estimated number of attendees ranged from</div><div style="left: 72px; top: 807.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.986546);" data-canvas-width="314.3957333333334">45,000 to 400,000. Attendees were defined as having attended at least</div><div style="left: 72px; top: 820.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04171);" data-canvas-width="315.4633333333334">one day of the mass gathering event. The mass gathering indicator</div><div style="left: 72px; top: 833.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01952);" data-canvas-width="315.4406666666666">captured during the ED registration included the gathering acronym</div><div style="left: 72px; top: 847.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.995197);" data-canvas-width="316.5388666666667">or a gathering specific field with a drop down menu containing</div><div style="left: 72px; top: 860.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02336);" data-canvas-width="315.50299999999993">true/false options. VDH utilized ESSENCE to identify 42 ED visits</div><div style="left: 72px; top: 873.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.98496);" data-canvas-width="314.5305999999999">(0.5%) with the gathering acronym out of 8,768 total ED visits during</div><div style="left: 72px; top: 887.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.974788);" data-canvas-width="316.28613333333345">the 2015 World Police and Fire Games and 60 ED visits (2.6%)</div><div style="left: 72px; top: 900.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04493);" data-canvas-width="315.5177333333336">with the gathering specific field out of 2,296 total visits during the</div><div style="left: 72px; top: 913.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01812);" data-canvas-width="315.1414666666665">2015 UCI Road World Championships. The results of the U.S. Vice</div><div style="left: 72px; top: 927.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00174);" data-canvas-width="223.78799999999995">Presidential Debate in October 2016 are pending.</div><div style="left: 408px; top: 256.606px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.10259);" data-canvas-width="68.01133333333334">Conclusions</div><div style="left: 420px; top: 268.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04302);" data-canvas-width="303.7956666666663">In 2015, VDH partnered with two healthcare entities to conduct</div><div style="left: 408px; top: 281.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02959);" data-canvas-width="315.4327333333333">enhanced surveillance during two mass gatherings. Although VDH</div><div style="left: 408px; top: 295.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.986641);" data-canvas-width="314.2121333333333">routinely uses syndromic surveillance data to identify issues of public</div><div style="left: 408px; top: 308.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.961155);" data-canvas-width="316.1399333333333">health concern, it has previously lacked the ability to identify ED</div><div style="left: 408px; top: 321.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02957);" data-canvas-width="315.6673333333333">visits specific to mass gatherings. Prior to collaboration with VDH,</div><div style="left: 408px; top: 335.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.969191);" data-canvas-width="316.02093333333346">the healthcare entities did not capture gathering-specific ED visits</div><div style="left: 408px; top: 348.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.967862);" data-canvas-width="315.8940000000002">using their EHR systems. The two healthcare entities successfully</div><div style="left: 408px; top: 361.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03144);" data-canvas-width="315.69000000000017">modified their business procedures and EHR system to capture and</div><div style="left: 408px; top: 375.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01035);" data-canvas-width="315.11199999999997">transmit a gathering indicator for ED visits despite some challenges.</div><div style="left: 408px; top: 388.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02685);" data-canvas-width="317.39793333333296">These challenges include constraints with customization of the</div><div style="left: 408px; top: 401.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02144);" data-canvas-width="317.37866666666685">EHR and syndromic surveillance systems, lack of standardized</div><div style="left: 408px; top: 415.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.971867);" data-canvas-width="316.13199999999983">training among ED registration staff for interpreting and applying</div><div style="left: 408px; top: 428.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.999253);" data-canvas-width="316.863">the gathering indicator, and limited functionality testing prior to</div><div style="left: 408px; top: 441.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.972576);" data-canvas-width="316.05493333333334">the event. Lessons learned from this coordinated effort are to: 1)</div><div style="left: 408px; top: 455.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.997924);" data-canvas-width="314.66206666666665">initiate the planning phase and identification of requirements as early</div><div style="left: 408px; top: 468.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.957042);" data-canvas-width="316.0469999999999">as possible to ensure they are well defined and understandable, 2)</div><div style="left: 408px; top: 481.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02817);" data-canvas-width="317.3106666666668">implement frequent communications with the healthcare entity,</div><div style="left: 408px; top: 495.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.969368);" data-canvas-width="316.14333333333343">and 3) customize requirements for the specific gathering as much</div><div style="left: 408px; top: 508.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03906);" data-canvas-width="315.70133333333325">as possible while balancing the burden and benefit to public health</div><div style="left: 408px; top: 521.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.995214);" data-canvas-width="316.54453333333333">and the healthcare entity. The coordinated enhanced surveillance</div><div style="left: 408px; top: 535.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.998411);" data-canvas-width="314.73233333333326">efforts provided both VDH and the healthcare entities with improved</div><div style="left: 408px; top: 548.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.970811);" data-canvas-width="315.96653333333325">situational awareness and capacity building during mass gathering</div><div style="left: 408px; top: 561.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00234);" data-canvas-width="314.8694666666666">events. The strategies and lessons learned from these two events will</div><div style="left: 408px; top: 575.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02292);" data-canvas-width="315.4848666666666">be applied to improve enhanced surveillance of public health issues</div><div style="left: 408px; top: 588.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03379);" data-canvas-width="315.61746666666625">during future mass gatherings, including the U.S. Vice Presidential</div><div style="left: 408px; top: 601.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00166);" data-canvas-width="111.41799999999998">Debate in October 2016.</div> ER -