Surveillance System

A more formal system, Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE), was developed by Johns Hopkins University’s Applied Physics Laboratory and the Department of Defense (DoD) for use by both the DoD and the VA for syndromic-disease surveillance. By 2008, the VA was working with Johns Hopkins and the CDC to modify ESSENCE to better monitor emerging infectious diseases or syndromes by leveraging the VHA’s advanced electronic medical-record system, according to Gina Oda, MS, CIC, associate director of the VA’s Office of Public Health Surveillance and Research.

Ultimately, that effort led to updates to ESSENCE specifically for the VA and the development of the Healthcare Acquired Infection and Influenza Surveillance System (HAIISS) suite that could incorporate more data sets, said Martinello. Beta testing of the new system finished in the first quarter of 2012. Martinello said he expects HAIISS to be rolled out nationwide by the end of the year, “but it’s still a real work in progress.”

HAIISS now includes the HAIISS Data Warehouse as well as the QC PathFinder electronic healthcare acquired infection detection application developed by Vecna Technologies and the revised ESSENCE biosurveillance application, according to Oda. The system will be used by infection preventionists, hospital epidemiologists, infectious diseases clinicians, primary-care physicians, pharmacists and national program offices.

Biosurveillance/Syndromic Surveillance is one of the four pillars of the HAIISS. The surveillance components aim to allow early event detection of outbreaks, such as seasonal flu outbreaks or emergent pandemic influenza within the VA, and to monitor the magnitude, location and rate of spread-of-disease outbreaks at the local and national level. The surveillance system also monitors seven syndrome groups that could be associated with bioterrorism. With its refinements, HAIISS “will likely serve as a model for other national and international health care systems,” Oda noted.

New sources of data have been added to improve the system’s detection abilities. “Using the existing systems, we could find hotspots of influenza during the pandemic and make calls to medical centers to see what was going on,” said Martinello. “Starting this year, we receive call-center data daily, which gives us data on the kinds of calls the centers nationwide are getting, specifically those concerning influenza-like illnesses (ILI), where the calls are coming from, and the severity of disease reported. We can see how many are told to stay home, go see a doctor or go to the hospital.”

“With the development of ESSENCE and HAIISS over the last few years, we are in a much better position to respond to a pandemic or other events that impact public health when they occur. What we learned from the 2009 influenza pandemic was the importance of communications,” added Martinello. Effective communications help all levels within the VHA understand the situation and coordinate actions. “It also is important to have systems that don’t place an undue burden on people to communicate. It is critical to have timely, accurate data,” he noted.