Implementing a Syndromic
Surveillance System in Miami-Dade
County
Fermin Leguen, MD, MPH
Chief Physician
Director, Office of Epidemiology & Disease Control
Miami-Dade County Health Department
Guoyan Zhang, MD, MPH
Senior Epidemiologist/Coordinator
02/22/06 Working Group on BioSurveillance Data Monitoring and Information Exchange
DIMACS/CDC
Needs Assessment
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18 hospitals contacted
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14 hospitals have electronic data from ED
17 hospitals willing to participate
Chief Complaint data available from 14 hospitals
Interest in adding a primary care component
Attributes of the desired system
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At the hospital
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No additional forms or data requirements
No staff needed for data entry
Automatic capture and transfer of desired information
Web-based access
User friendly
Electronic Surveillance System for the Early
Notification of Community-Based Epidemics
(ESSENCE)
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Web based medical surveillance system
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Participants can access the system at different administrative
levels
Automated data collection and analysis
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Data is transferred from Hospital ER to ESSENCE server by
query batch file that attached to Hospital electronic database
Data Elements
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Hospital Name
Hospital Zip code
Date of visit
Time of visit
Gender
Race/ethnicity
Patient’s Age (in years)
Chief complaint
Zip code of patient’s residence (5 digit)
Discharge diagnosis**
Admission status**
**Optional
Data Collection Options
Record Format
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Flat file extract delimited (‘|’ or ‘,’) or fixed width
Collection Frequency
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Once a day batch
Transmission Methods
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Secure FTP
Batch File Secure FTP Connection
Miami-Dade County Health Department
Hospitals
Hospital
Reporting
System
Query
SSH FTP
Client
Hospital
Archive
Batch
File
Port 22
SSH FTP
Server
Batch File
Listener
DoH
Archive
ESSENCE Syndromes
Botulism-like
Febrile Disease
Fever
Gastrointestinal
Hemorrhagic Illness
Influenza_Like
Neurological
Other
Rash
Respiratory
Shock / Coma
How do we manage the system?
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Every morning each hospital transmit Emergency
Department Chief Complaint data
By noon, a report is developed and emailed to staff in
Office of Epidemiology and Disease Control
If further investigation is warranted, data reviewed by
Epi Surveillance Coordinator and Data Analyst
If necessary, hospital ICP is contacted for chart review
Other partners are contacted/notified if needed
What additional value can we get from
Syndromic Surveillance in Miami?
•Influenza Surveillance
•Post-Hurricane Surveillance
•Other Events Surveillance
Influenza Surveillance
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The system has an ILI Syndrome Category
Use ILI data to report the weekly and daily county
influenza activity
Weekly ILI reports posted at MDCHD website and
distributed to staff and community
Daily report submitted to Bureau of Epidemiology, FL
DOH
Influenza-Like Illness in Miami-Dade
October/2005-Februray 2006
Hurricane and Other Events Surveillance
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Post-Hurricane Surveillance
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What happens at local hospitals ED immediately after
hurricanes?
Is there an increased morbidity due to respiratory,
gastrointestinal illnesses, or other?
Holidays
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Labor Day, Thanksgiving, Festivals, etc.
Any aberration on syndromic trends?
Total ED Visits among 6 Hospitals in Miami-Dade
09/01/2005 - 12/31/2005
After Labor Day
09/06/2005
After Hurricane
Wilma 10/26/2005
Hurricane Wilma
Warning 10/22/2005
Monday 11/14/2005
Monday after
Thanksgiving
Monday after
Christmas
Challenges
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Hospital representatives not comfortable with sending
their data to a 3rd party
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TENET system hospitals initially declined to participate
Convincing hospital leaders  HIPAA
Completing the MOU signing process
Having the project approved by the State IT
Governance Office
What is Next in our To Do list?
-To add medical record number to the data retrieved
from hospitals
It will expedite the epi investigations
-To request diagnosis code (delayed data)
It will help us assess syndrome alerts, and
evaluate the system
-Injury Surveillance
- Add 8 more local hospitals to the system
Lessons Learned
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Enhanced communication with community partners
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Understanding of the State IT Governance requirements
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Reconciling State and metropolitan areas interests when
federal resources are earmarked to specific localities could
be challenging
DSL?  T1
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Summary
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The syndromic surveillance system in Miami will
15 local participating hospitals
 Expanded to other counties of Florida (Broward,
West Palm Beach, Monroe, Martin, etc)
 Add other data sources such as 911 system, school
absenteeism, poison control center
 Explore value of additional applications
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Contact Information
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Fermin Leguen, MD, MPH
fermin_leguen@doh.state.fl.us
(305) 470 5660
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Guoyan Zhang, MD, MPH
Guoyan_Zhang@doh.state.fl.us
(305) 470 5650