Background The Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) is a secure web-based tool that enables health care practitioners to monitor health indicators of public health importance for the detection and tracking of disease outbreaks, consequences of severe weather, and other events of concern. The ESSENCE concept began in an internally funded project at the Johns Hopkins University Applied Physics Laboratory, advanced with funding from the State of Maryland, and broadened in 1999 as a collaboration with the Walter Reed Army Institute for Research. Versions of the system have been further developed by Johns Hopkins University Applied Physics Laboratory in multiple military and civilian programs for the timely detection and tracking of health threats. Objective This study aims to describe the components and development of a biosurveillance system increasingly coordinating all-hazards health surveillance and infectious disease monitoring among large and small health departments, to list the key features and lessons learned in the growth of this system, and to describe the range of initiatives and accomplishments of local epidemiologists using it. Methods The features of ESSENCE include spatial and temporal statistical alerting, custom querying, user-defined alert notifications, geographical mapping, remote data capture, and event communications. To expedite visualization, configurable and interactive modes of data stratification and filtering, graphical and tabular customization, user preference management, and sharing features allow users to query data and view geographic representations, time series and data details pages, and reports. These features allow ESSENCE users to gather and organize the resulting wealth of information into a coherent view of population health status and communicate findings among users. Results The resulting broad utility, applicability, and adaptability of this system led to the adoption of ESSENCE by the Centers for Disease Control and Prevention, numerous state and local health departments, and the Department of Defense, both nationally and globally. The open-source version of Suite for Automated Global Electronic bioSurveillance is available for global, resource-limited settings. Resourceful users of the US National Syndromic Surveillance Program ESSENCE have applied it to the surveillance of infectious diseases, severe weather and natural disaster events, mass gatherings, chronic diseases and mental health, and injury and substance abuse. Conclusions With emerging high-consequence communicable diseases and other health conditions, the continued user requirement–driven enhancements of ESSENCE demonstrate an adaptable disease surveillance capability focused on the everyday needs of public health. The challenge of a live system for widely distributed users with multiple different data sources and high throughput requirements has driven a novel, evolving architecture design.

Public health surveillance is undergoing a revolution driven by advances in the field of information technology. Many countries have experienced vast improvements in the collection, ingestion, analysis, visualization, and dissemination of public health data. Resource-limited countries have lagged behind due to challenges in information technology infrastructure, public health resources, and the costs of proprietary software. The Suite for Automated Global Electronic bioSurveillance (SAGES) is a collection of modular, flexible, freely-available software tools for electronic disease surveillance in resource-limited settings. One or more SAGES tools may be used in concert with existing surveillance applications or the SAGES tools may be used en masse for an end-to-end biosurveillance capability. This flexibility allows for the development of an inexpensive, customized, and sustainable disease surveillance system. The ability to rapidly assess anomalous disease activity may lead to more efficient use of limited resources and better compliance with World Health Organization International Health Regulations.

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This paper describes a public health alerting approach that has the potential to improve patient care during a public health outbreak and reduce healthcare costs, streamline the process of public health alert management and dissemination, and heighten the crucial feedback loop between public health officials and clinicians. The approach ties public health alerts into the diagnostic process and allows clinicians to more easily determine when an observed medical condition may be related to a more widespread disease outbreak. A prototype Alert Knowledge Repository (AKR) service using this approach was demonstrated within the Health Information and Management Systems Society (HIMSS) and the Public Health Information Network (PHIN) interoperability showcases in April and September 2009, respectively.

ObjectiveThe Florida Department of Health (FDOH), Bureau of Epidemiology, partnered with the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) to improve surveillance methods in post disaster or response events. A new process was implemented for conducting surveillance to monitor injury and illness for those presenting for care to ASPR assets such as Disaster Medical Assistance Team (DMAT) sites when they are operational in the state. The purpose of the current work was to field test and document the operational experience of the newly implemented ASPR data module in ESSENCE-FL (syndromic surveillance system) to receive near real-time automated data feeds when ASPR federal assets were deployed in Florida during the 2012 Republican National Convention (RNC). IntroductionFlorida has implemented various surveillance methods to augment existing sources of surveillance data and enhance decision making with timely evidence based assessments to guide response efforts post-hurricanes. Historically, data collected from deployed federal assets have been an integral part of this effort. However, a number of factors have made this type of surveillance challenging: logistical issues of field work in a post-disaster environment, the resource intensive manual data collection process from DMAT sites, and delayed analysis and interpretation of these data to inform decision makers. The ESSENCE-FL system is an automated and secure web-based application accessed by FDOH epidemiologists and staff at participating hospitals. MethodsESSENCE-FL was configured by the Johns Hopkins University Applied Physics Laboratory (JHU/APL) to receive ASPR electronic medical record (EMR) data. A scheduled program to generate data files for FDOH was created using SAS Enterprise Business Intelligence (EBI) software and a script was set up on the ASPR server to send an updated file via secure file transfer protocol (sftp) every 15 minutes. A case definition was created by ASPR field teams to identify which encounter visits would be entered into the electronic medical record (EMR) and received in ESSENCE-FL. To assess completeness of data elements and total patient encounters received in ESSENCE-FL, DMAT field teams maintained Excel line lists of patient encounters and emailed them to FDOH three times daily during the RNC. ASPR data were reviewed and analyzed by FDOH staff multiple times a day in near real time utilizing the existing ESSENCE-FL robust analysis tools. ResultsThree separate ASPR missions were deployed to Florida to support the RNC. ASPR EMR data files were received at 15-minute intervals by ESSENCE-FL from the ASPR central server during each day of the 2012 RNC (August 26-31). Reduced patient counts within ESSENCE-FL as compared with DMAT-maintained Excel line lists indicated an incomplete input, upload, or transfer of patient data from one of two ASPR sites to the central ASPR servers. Although only 11 of 34 total patient encounters were received by ESSENCE-FL during...