Enhanced VADoD Biosurveillance

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Enhanced VA/DoD Biosurveillance

• Mark Holodniy, MD
• Office of Public Health Surveillance and Research
• June 5, 2009

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VA/DoD Biosurveillance Projects

• Enhanced ESSENCE utilization in a Federal Medical
  Facility
• Joint Incentive Fund (JIF) ESSENCE Proposal
• OIF/OEF Registry Project
• Healthcare Associated Infection and Influenza
  Surveillance System (HAIISS)

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Demographic Changesin a Joint VA/DoD
facilityThe North Chicago Experience

• Pre vs. Post DoD
• (August 1, 2005-May 31, 2006) vs. (June 1,
  2006-March 31, 2009)

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North Chicago ESSENCE, visits per month, August
1, 2005-March 31, 2009
Pre DoD- Median visits/month 654 (539-794) Post
DoD- Median visits/month 1689 (1,248-2,711)
DoD added
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North Chicago ESSENCE, visits by age, Pre vs.
Post DoD
Pre-DoD Median Age 62 years (19-94
years) Post-DoD Median Age 31 years (0-100
years)
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North Chicago ESSENCE, visits by sex, Pre vs.
Post DoD
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North Chicago ESSENCE, visits by syndrome
category, Pre vs. Post DoD
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North Chicago ESSENCE, visits by ICD-9 Code, Pre
vs. Post DoD
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Examples of Improved Event Detection

• North Chicago VAMC vs. Hines and Jesse Brown VAMCs

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Heat Wave, 2006

• The 2006 North America heat wave spread through
  most of U.S. and Canada, killing at least 225
  people
• Chicago City Health Department issued extreme
  temperature advisories on July 14, 2006 and July
  31, 2006

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Heat injury ICD-9 codes (992) for three
Chicago-area Veterans Affairs Medical Centers,
July 2006
North Chicago VAMC
Jesse Brown VAMC
Hines VAMC
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Influenza-like Illness Trends

• Diagnosis codes for outpatient visits analyzed
  for Influenza-like illness syndrome group
• 2007-2008 Flu season
• Compared VA ESSENCE data from Chicago-area VAMCs
  with Illinois CDC Sentinel Provider Network and
  Cook County ESSENCE System

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Percentage of Visits for Influenza-like Illness
(ILI), VA ESSENCE and the CDCs Illinois Sentinel
Providers (ILINet), 2007-2008
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Percentage of Visits for Influenza-like Illness
(ILI), VA ESSENCE and Cook County ESSENCE
Systems, 2007-2008
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Joint Incentive Fund (JIF) Proposal

• VAs Office of Public Health and Environmental
  Hazards and DoDs Office of Health Affairs are
  collaborating to create a joint VA/DoD ESSENCE
  application (JIF proposal submitted 1/2009)
• Link DoD and VA ESSENCE programs, whereby DoD and
  VA public health personnel will have access to
  joint de-identified datasets for analysis and
  strengthen the predictive capabilities
• Create redundant backup systems housing both sets
  of data at secure DoD (Oklahoma City, OK) and VA
  (Austin, TX) sites to create a backup system in
  the event that one or the other system is
  incapacitated
• Create a more robust and extensive data archive,
  combining VA and DoD ESSENCE data
• Expand data streams to include useful
  health-related data that doesn't currently go to
  the CDC, e.g., chief complaint text,
  laboratory/radiology orders, and others.

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Diagnoses for OIF-OEF Veterans Evaluated at a VA
Facilities During FY 2002-20081
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OIF-OEF Veterans Evaluated atVA Facilities
Infectious and Parasitic Diseases
1Hospitalization and outpatient visits recorded
as of March 31, 2008 (ICD-9 Code 001-139)
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HAIISS Dashboard
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Bacterial Isolates from OIF/OEF Veterans
Hospitalized at VAPAHCS Polytrauma Unit
B Dau, et al, JRRD 2009, in press
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Summary

• DoD personnel now seen at over 100 VA Medical
  centers, polytrauma units and clinics
• Biosurveillance programs available or now being
  stood up in VA to provide
• Near real time detection of acute events
  (ESSENCE)
• Ongoing tracking of existing infections or HAI
  development (OIF/OEF registry, HAIISS)
• Prospective anomaly/syndrome detection in OIF/OEF
  veterans (OIF/OEF registry-ID biosurveillance
  component)
• Collaborations between VA and DoD biosurveillance
  personnel are ongoing and continuing to grow