National Center for Supercomputing ApplicationsUniversity of Illinois

Health Monitoring with INDICATOR

Ian Brooks, Ph.D.

Brown Dog Workshop

July 22 2014

“There’s something going around”

Everyone has an idea of the health of their community based on everyday experiences

Attendance

Social media

Sales

But is this usable information?

What is INDICATOR?

A framework for managing health data

DATA SOURCES

Veterinary Sources

Real-time Sensors

Social Media

Pharmacy Records

School Attendance

Patient Advisory Calls

Emergency Services

Insurance Data

Lab Tests

Reportable Diseases

Death Certificates

COFACTORS

Weather

Environmental Factors

OUTBREAK DETECTION

Analysis/Detection Algorithms

MODELING

Modeling Studies

Outbreaks

Parameters

PUBLIC HEALTH

DECISION MAKERS

Decisions

Scenarios

COLLABORATIVE TOOLS

INDICATOR: Philosophy

Combine multiple sources of imperfect data to create picture

It is better to have imperfect data than no data

Take the data that is available

Minimize regulatory burdensFocus on the population level

Separate outbreak detection from

case follow-up

Current Data Status

* Lyme DiseaseGranulocytic Anaplasmosis Monocytic Ehrlichiosis

Rocky Mountain spotted fever HeartwormBlastomycosis

Data Type Frequency Contents Start Date Emergency Department Daily Triage Chief Complaint, Discharge Dx April 2009 Convenient Care Ambulatory Clinic Daily ICD9 Dx January 2006 Patient Advisory Nurse Daily Chief Complaint April 2007 Reportable Diseases Monthly Reported Disease Count January 2007 School Attendance Weekday Absenteeism w or w/o illness August 2008 Animal Control Monthly Animal Bites by Species January 2006 Weather Daily Temperature, Rainfall, etc. January 2006 Humane Society Daily Animals under treatment July 2011 Sentinel Veterinary Clinics Varies Six defined diseases* January 2012 VMDB Cushing, Lyme, RMSF, Heartworm June 1999 Mosquito Trap Weekly Trap status May 2012 Pollen Daily Pollen Count July 2012

Emergency DepartmentChief Complaint ED DX

!Other Worried well; Dental caries

!Other Potential exposure to STD; Screening for STDs (sexually transmitted diseases)

Headache HTN (hypertension); Headache; Pain, dental

!Other Abscess

!Other

Chest wall pain; Headache [chronic

]

ABD Pain Chronic abdominal pain; Emesis; Diarrhea

!Other Worried well

ABD Pain Acute URI; Abdominal pain in pregnancy; Intrauterine normal pregnancy; Ear pain

ABD Pain Diaphragmatic hernia

ABD Pain Abdominal pain; Strain of ligament or muscle

ABD Pain Ureteral calculus; Flank pain

ABD Pain Gastritis; Blood in stool

ABD Pain Pregnancy as incidental finding; Tobacco abuse; Vaginal Discharge

ABD Pain Ovarian cyst; Acute abdominal pain

ABD Pain

ABD Pain Right sided abdominal pain

ABD Pain Acute abdominal pain; Ovarian cyst

ABD Pain Abdominal pain; N&V - nausea and vomiting

Upper Resp Sx GERD (gastroesophageal reflux disease); Nasal congestion

Wrist Trauma Forearm contusion

Wheezing Wheezing; Reactive airway disease; Acute URI; Cough

Wheezing Asthma with acute exacerbation

Vomiting Acute gastroenteritis

Vomiting Acute gastroenteritis

Vomiting Bilious vomiting; Chest pain; Dyspnea; Cough; Diarrhea; Acute abdominal pain; Sepsis; Pneumonia; Positive D-dimer; Dehydration; Headache

Vomiting Gastroenteritis; Diabetes mellitus

Vomiting Acute gastroenteritis

Vomiting Abdominal pain; Ulcerative colitis

Vomiting N&V - nausea and vomiting; Diarrhea

Wheezing Reactive airway disease; Bronchiolitis

Wheezing Asthma with acute exacerbation

Vomiting N&V - nausea and vomiting; Chest pain; Dyspnea; Heart palpitations; Dehydration

Vomiting During Pregnancy Vomiting; Pregnancy as incidental finding

Vomiting Viral gastroenteritis; Fever, unspecified

Vomiting

Vaginal Bleeding; Pregnant Vaginal bleeding; Threatened miscarriage in early pregnancy

Vaginal Discharge Trichomonal vaginitis; Bacterial vaginosis

Vomiting Viral gastroenteritis; Fever, unspecified

Urinary Urgency Urinary frequency

Urinary Pain UTI (lower urinary tract infection); Morbid obesity; Diabetes mellitus; Venous stasis ulcers

Urinary Retention Pyelonephritis; Cystitis

Vaginal Bleeding Vaginal spotting

Toe Pain Onychomycosis; Nail overgrowth

Toe Pain Dislocation of third toe, right, closed

Upper Resp Sx AOM (acute otitis media)

Nurse Call Center

Triage Calls

Guidelines Used in

Descending Number Order

9/3/2011 to 9/3/2011

Guideline Name Times Used

No Guideline/Advice Per Reference (Adult) 17

After Hours Medication Refill 16

Postoperative Wound Care 5

Back Symptoms 4

Postoperative Problems 4

Abortion: Less Than 20 Weeks, Threatened/Spontaneous 3

Chest Pain / Discomfort 3

Fever After 3 Months Old (Pediatric) 3

Headache 3

Urinary Symptoms - Female 3

Abrasions/Lacerations/Puncture Wounds 2

Cough (Pediatric) 2

Diarrhea / Change in Bowel Habits 2

Dizziness / Vertigo 2

Edema, Generalized Atraumatic 2

Hypertension; Known / Suspected 2

Irregular Heartbeat 2

No Guideline Or Reference Available (Pediatric) 2

Poison Ivy / Oak / Sumac Exposure 2

Preterm Labor: 20 to 37 Weeks Gestation 2

Seizure 2

Veterinary Clinic

Animals being treated between 10/1/2012 and 11/30/2012

As of : 12/3/2012 10:26:08AM

BIRD CAT DOG OTHER Total

ALOPECIA 3 15 11 3 32

COCCIDIA 0 27 15 0 42

COUGH 0 7 0 0 7

DEMODEX 0 0 3 0 3

DERMATITIS 0 2 3 0 5

DIARRHEA 0 32 1 0 33

EAR INFECTION 0 46 15 0 61

EARMITES 0 124 2 8 134

FIV 0 1 0 0 1

FLEA DERMATITIS 0 6 13 0 19

FRACTURE 0 0 2 0 2

GIARDIA 0 1 0 0 1

HEARTWORM 0 0 2 0 2

KENNEL COUGH 0 0 22 0 22

PARVO 0 0 6 0 6

RINGWORM 0 0 2 0 2

ROUNDWORMS 0 51 18 0 69

TAPEWORMS 0 80 11 0 91

VOMITING 0 19 3 0 22

WHIPWORMS 0 0 9 0 9

Total 3 411 138 11 563

treatment_date review_date breedBIRD

A070187 ALOPECIA 10/04/2012 10/20/2012 FINCH

A070187 ALOPECIA 10/21/2012 11/07/2012 FINCH

A070375 ALOPECIA 10/27/2012 11/08/2012 FINCH

CAT

A069732 ALOPECIA 07/20/2012 10/16/2012 DOMESTIC SH / MIX

A064727 ALOPECIA 08/31/2012 11/06/2012 DOMESTIC SH / MIX

A070012 ALOPECIA 09/05/2012 10/03/2012 DOMESTIC LH / MIX

A070042 ROUNDWORMS 09/06/2012 10/06/2012 DOMESTIC SH / MIXA070043 ROUNDWORMS 09/06/2012 10/06/2012 DOMESTIC SH / MIX

A056111 ALOPECIA 09/12/2012 11/14/2012 BOMBAY / MIX

A068864 COUGH 09/16/2012 11/05/2012 DOMESTIC SH / MIX

A069858 ROUNDWORMS 09/17/2012 10/01/2012 DOMESTIC SH / MIX

A070011 COCCIDIA 09/19/2012 10/03/2012 DOMESTIC MH / MIX

A069106 DIARRHEA 09/19/2012 10/25/2012 BOMBAY / MIX

Imaginations unbound

School Attendance

Codes: E Elementary A Elementary B Elementary C High School B High School High School C

07/24/2008 2

07/25/2008 5

07/28/2008 3

07/29/2008 3

07/30/2008 4

07/31/2008 12

08/01/2008 18

08/04/2008 8

08/05/2008 13

08/06/2008 9

08/07/2008 9

08/08/2008 14

08/11/2008 20

08/12/2008 17

08/13/2008 9

08/14/2008 10

08/15/2008 24

08/18/2008 9

08/19/2008 10

08/20/2008 6

08/21/2008 8 1 6 14 3 1

08/22/2008 17 2 11 44 37

08/25/2008 10 5 11 42 36

08/26/2008 11 10 13 35 43

08/27/2008 8 12 4 60 47 1

08/28/2008 9 10 15 57 56 2

One Health unified data format (draft)

1. Presentation Date

2. Dx Code (SNOMED, ICD-9, ICD-10,LOINC etc.)

3. Dx Free Text

4. Chief Complaint Free Text

5. Location of Reporting Facility

6. Count

7. Species

8. Notes

• Irrelevant or unavailable fields can be left blank

Additional datasets under discussion

Point of salePrescriptions

Over the counter drugs

Social media

Wildlife observations

Emergency service calls

Clinical laboratory results

ED/clinical wait times

Police citations

Imaginations unbound

Tools used

TalenD

mySQL

R

Drupal

HighCharts

WSARE

Weka

SpagoBI

Brown Dog opportunities

• DAP• Convert files into “One Health” format • Possible use of DFDL• How to make data management scalable

• DTS• Metadata extraction

• Data format (standard, controlled vocabulary, free text)• Free text document comparisons

• Statistics Server ?

Questions?ianb@illinois.edu