ACES User Manual - KFL&A Public Health Informatics
Contents
1. Acute Care Enhanced Surveillance ACES USER INTERFACE MANUAL UPDATED MARCH 2015 ACES User Interface March 2015 ACES USER INTERFACE I LOGIN PAGE Welcome to ACES Please login if you do not have an account please contact KFLAPHI to get one Figure 1 ACES Login page Users can log into ACES http aces kflaphi ca using the username and password that was provided to them from the ACES administrators ACES User Interface March 2015 ll MAIN LANDING PAGE Hello Laura gy Current Syndrome Counts Current Alerts All Resp Alert Geog TAGIT m TL TINS i T F Alart Datei Tim Typa Type Geog Name Valus za18 my 10 pool a x 3015 01 09 i N HOSP Kingston General Hospital KEH Bon 1 800 15 18 35 E WW z Eo E 2 BE 2075 07 0 SFC Exireme Rose Kingston General Hosptial GH 15 18 35 5 Gl Derm i 2015 010 SPA Tenens PHU eH RONA HANN Uii PEEL 2075 01 09 CUSUM CUSUMS i Lacy Minto Hospital LIMA 15 77 00 AN g R j ane SY V z DAT 15 18 00 7015 01 04 CUSUM CUSUM Ls Lay Minko Pkespetal LM 14 77 00 Fover Asthma TT DAN 2075 01 09 SPC mig Thunder Bay Regional Health Science Genie TERA ami i 35 13 400 A ri SMi 0 F013 109 ric NR Th Scarborough Hospital General Campus TSM ae l w A 15 144300 400 2075 01 09 E NRC i Kingston General Hospital H amp H 1512 58 010TA oP l Porson General Higpit RaM 112. Durham DSH South Bruce Grey Health Centre Kincardine KSH __ South Bruce Grey Health Centre Walkerton SWH S S HKPRDHU Campbellford Memorial Hospital ee Haliburton Highlands Health Services ACES User Interface March 2015 List of Public Health Units and Hospitals within those Health Date linked to ACES Feb 2013 Jul 2011 Sept 2014 Jul 2011 Jun 2013 Jun 2013 Sep 2013 Sep 2013 Sep 2013 Sep 2013 TBD Apr 2010 TBD TBD Nov 2011 Nov 2011 Nov 2011 Nov 2011 Nov 2011 Nov 2011 Nov 2011 Nov 2011 Nov 2011 Nov 2011 Nov 2011 Nov 2011 TBD TBD Northumberland Hills Hospital TBD Ross Memorial Hospital TBD ee eee Halton Healthcare Services Georgetown GEO Oct 2011 re Halton Healthcare Services Milton MIL Oct 2011 a Halton Healthcare Services Oakville OAK Oct 2011 re Joseph Brant Memorial Hospital JBMH Oct 2011 ee a Hamilton Health Sciences Corporation Hamilton General Hospital Sep 2011 and Urgent Care Centre HAH ia Hamilton Health Sci ion inski Hospital amilton Health Sciences Corporation Juravinski Hospital and Sep 2011 Cancer Centre HEN Hamilton Health Sciences Corporation McMaster Children s Sep 2011 Hospital MCM St Joseph s Healthcare Hamilton ST01 Sep 2011 ew Quinte Healthcare Corporation Belleville BGH Sep 2005 E Quinte Healthcare Corporation North Hastings NHH Sep 2005 E Quinte Healthcare Corporation Prince Edw
3. Mi FSA O The Map Tab provides different viewing options Traffic Cameras C for the base map Forinstance the default setting is Topo however the other display options include Urban Areas L Street Satellite Hybrid Gray Oceans National o Geographic and OSM Choosing the desired option me LAIN L and clicking Update will change the base map Under this tab the user can also change the Layer Clear Layers Color and Border Color as desired Data Layers Topo Layer Color Border Color at ACES User Interface March 2015 VI ALERTS Chick arrow below for more oplions Kingston Frontenac and Lennox and Addington Health Unit Health Unit Hospitals Allert Date Time Aln Class Alert Type Syndrome Geog Type Geog Mame Value Abert ID KFLA All 2017 01 22 04525 SPE OnEdge OTHER PHU Kingston Fronlenag and L ennga and Addingian Health Leit FLA AE ERIGE 2015 01 42 064535 USUN CuSsuUMa PHU Kingston Frontenac and Lennox and Agdingion Health Unit KF LA 3491853 Date Range 2015 01 22 43 00 HRC NEURO PHU Kingston Frontenac and L NDik and Addington Health Aiit KF LA S41 BM 201360122 OF 42 00 SLA USUM PHU Kington Pronieni and L tt and 4uicingion Peal Uiit KP LA 3491473 01 22 08 43 00 CLUS LAY TUSUMZ Lenno amp Addington County General Hospital LACGH a491 B27 O71 243900 CASU CUSUM3 Lenmor amp Addingion County Generasi Hospital LAG 34971828 D i USA SPE nego OTHER KI
4. 0 Kingston Frontenac andl Lennox Date Range ond Addington Health Unit A Total ILI Visits 232 1 2n 4 20 1 4 mi k hiik all The CAP ria ho Gender eh ac A Ree ie T PPE All 1 ali I MEM YORK s z Age Group Figure 10 Example of Chloropeth mapping style All Age Range 0 7 Ww Clear Data Request Data ra ACES User Interface March 2015 Proportional Symbols This option displays the ED visit data for the selected syndrome as a circle over the geographic region with the circle size increasing with increasing number of visits for that syndrome Figure 11 is showing the same information as Figure 10 but in a different graphic method Hovering the mouse over the circle for the region of interest will provide more detail on total visits for the syndrome total ED visits and the percent of total visits for that are for the selected syndrome Emergency Department d on Visits ON Sample Data om we OB 0 25 te i o 25 5 Kingston Frontenac and Lennox lt 0 wit von and Addington Health Unit Q C F T5 Ho eteaborough e 2 P mun 7 5 10 Ja of Visita 2 487 O NEW YORK ree _ _ ee Figure 11 Example of Proportional Symbols mapping style with legend Classifiers The classifiers drop down menu offers 5 options previously described in the Epicurves section Classification This option allows users to classi
5. WRH Jun 2013 Key to Table Above APH Algoma Public Health NBPH North Bay Public Health CKPHU Chatham Kent Public Health Unit NWHU Northwestern Health Unit DRHD Durham Region Health Department OPH Ottawa Public Health EOHU Eastern Ontario Health Unit PEEL Peel Public Health GBHU Grey Bruce Health Unit PCCHU Peterborough County City Health Unit Hali l PE h P Haliburton Kawartha Pine Ridge District Healt PHU Porcupine Health Unit HRHD Halton Region Health Department SMDHU Simcoe Muskoka District Health Unit HPH Hamilton Public Health SDHU Sudbury amp District Health Unit HPECHU Hastings and Prince Edward County Health Unit TBDHU Thunder Bay District Health Unit KFLA KFL amp A Public Health THU Timiskaming Health Unit a CHSD Lambton Community Health Services TPH Toronto Public Health LGLDHU Leeds Grenville and Lanark District Health Unit WECHU Windsor Essex County Health Unit YORK York Region C ity amp Health Servi NRPH Niagara Region Public Health Depi a ESR i FERE ACES User Interface March 2015 APPENDIX B ACES Syndromes Syndrome Code ALLERG AST BITE BRONCH BURN CAD CARD CDIFF CELL CHF CO CONC COPD CROUP CV DEHY DENT DERM DM ELECT ENT EOH FALL FBI FEB GASTRO GB GI GMED GNSURG GYN HEAD ENVIRO HEM HEP ILI INF INJ INS Syndrome Description allergic reaction angioedema not bee sting asthma wheeze difficulty breathing SOB human
6. animal bug not tick related bronchiolitis RSV burns chemical and thermal electrical shock coronary artery disease chest pain pericarditis effusion myocarditis endocarditis c difficile cellulitis non wound infection non abscess congestive heart failure carbon monoxide exposure or other gases sulphur etc concussion head injury chronic obstructive lung disease croup PIV cardiovascular excludes MI and strokes includes peripheral vascular disease dehydration dental pain infection trauma to tooth etc rash undifferentiated lesion wart diabetes and its complications electrolyte imbalance hyperkalemia hypomagnesium hyponatremia related to ears nose throat surgery non infectious tinnitus not in GNSURG alcohol and complications intoxication addiction withdrawal or end organ damage falls undifferentiated foreign body ingestion nose to anus febrile neutropenia gastroenteritis Guillain Barre syndrome flaccid paralysis GI bleed upper and lower epistaxis hemoptysis general medical admission other unconscious weakness unwell chronic diseases general surgical admission appendicitis cholecystitis bowel obstruction gynecological bleed hysterectomy PID undifferentiated headache non traumatic heat stroke heat syncope heat exhaustion cold frost bite hypothermia hematological condition anemia thrombocytopenia not oncological hepatitis undifferentiated and A B C fever myalgia undifferenti
7. days or Max gives an overall average for the data and time period selected Lines showing either 1 Standard Deviation Std 1 or 2 Standard Deviations Std 2 can also be chosen There is also the option to Normalize the data By selecting on instead of graphing the total number of cases for a given syndrome which has natural variance e g by day of the week this will plot the number of cases as a percentage of the total visits per day NOTE The graph for All visits is unaffected by this feature Epicurve Examples Figure 6 shows an example of an Epicurve The epicurve displays visit counts for all hospitals in the KFL amp A Health Unit with the following parameters Syndrome RESP respiratory Gender All Age Adult Date Range December 15 2014 to January 15 2015 Kingston Frontenac and Lennox and Addington Health ma posing Forage Unit a on None 7 i4 Standard Dewinton Max None sg 1 Sid 2 ealh Unit Hospitals ai AMSTOREV ant day Ave AP LA E Daie Range la Teo Gender AJI Age AVN Classifications Bucket Al Bee 13 314 Det 22 3014 Bec 23 314 Jan 02 2015 Jan 05 2015 Jan 09 2015 dn 12 2015 Jan 15 20405 m Alperithm Daj Figure 6 Example epicurve ACES User Interface March 2015 The time period is displayed on the x axis and the number of visits for the syndrome is on the y axis The red line displays the visit counts over the specified time period The dotted li
8. making up the least number of visits under that syndrome and Q4 will show 25 of the data making up the most number of visits with Q3 and Q4 making up the other 50 of the data Standard Deviation will map the data based on a range of standard deviations below and above the mean for the syndrome chosen and based on the geography type selected The legend will show gradients between 3 standard deviations in 1 standard deviation categories No further classification definitions are needed under this category Number of Classifications This menu option is only valid when using the Chloropleth mapping style and either the Equal Interval and Quantile Data Classifications Users have the option between choosing 4 5 6 or 10 under this menu option Percentage Range This menu option is only valid when using the Proportional Symbols Mapping Style or when using the Chloropleth Mapping Style along with the Equal Interval Data Classification This option allows the user to choose the percent range for their legend under the above stipulations With this option the user needs to be aware that for each syndrome the percent range can vary and therefore a good knowledge of how the syndrome in question behanves is needed For instance when mapping the Respiratory syndrome in the summer months a basic guideline would be to choose a percent range between 0 and 20 However in the winter months the upper extreme needs to be increas
9. 2075 01 05 CUS 3 d Lady Minto Hospital LMH 15 1100 2012010 CURSUM LES LIMZ Lady Minto hespiial LMM 171 2015 01 07 CUFUM CUSMIMS i Lacy Minto Hospital LMH ima ATO 1e Calta GLUES LN i Lady Minka hospital LMHN Figure 2 ACES Main Upon logging in the user will be directed to the main page Figure 2 This page provides a simple overview of recent activity past 2 weeks captured by the surveillance system and notifies the user of any alerts On the left side of the page there are a series of charts that display all ED visit counts across Ontario as well as ED visit counts broken down by five different syndromes Respiratory Gastrointestinal Dermatological Fever ILIl and Asthma The right side of the page displays a table with a list of the current alerts that have been generated by the system Clicking on a specific alert will bring up a window displaying the alert graphically Clicking the Data tab within this window will provide additional details surrounding the alert Using the grey arrow on the right upper corner of the alerts table allows the user to customize what information will be provided on this list see Figure 3 Clicking on each individual heading will arrange the information according to that heading ACES User Interface March 2015 Alert Date Time Alert Class Alert Type Syndrome Geog Type Geog Name _ AlertID Search Choose Columns w Alert Date TimE Alert Class Alert Type W
10. At anytime clicking Submit will generate the Epicurve with the desired parameters Clicking Reset will reset all parameters back to the default setting ACES User Interface March 2015 Epicurve Parameters Tools The Tools tab on the right side of the page includes the following sections Health Unit and Hospitals The first option is to choose which hospitals data will be displayed in the Epicurve using the dropdown menu There is also the option to view data from all hospitals in the selected Health Unit Which hospitals data can be displayed in the Epicurve depends on your user rights assigned to your login credentials Hospital users will only have the option to view their own hospitals data Users from the local Health Unit however will be able to view each hospital within their Health Unit as well as all hospitals together Date Range Under this section the user can choose the time period for which the data will be displayed Clicking Date From and Date To will bring up a calendar to choose the desired dates Gender Gender may be specified as either Male Female or All using the associated buttons The default is set on All Age Clicking on the dropdown menu in this section gives six age group options for the Epicurve All Child ages 0 to 17 School Child ages 5 to 17 Adult ages 18 to 64 Senior ages 64 to 130 and Adult Senior ages 18 to 130 Alternatively the user can manually input th
11. East 2015 01 23 14 41 00 LACGH Other RT ANKLE INJURY MONDAY South East 2015 01 23 14 38 14 HDH Other South East 2015 01 23 14 34 09 KGH Other South East 2015 01 23 14 33 00 LACGH Other SKINTEAR LEFT ARM South East South East 2015 01 23 14 30 49 HDH Respiratory SORE THROAT 2015 01 23 14 24 19 Other South East 2015 01 23 14 17 33 j Other South East 2015 01 23 14 16 04 Other South East Oo GCG S amp S SE AlO O S SCF G A 2015 01 23 14 15 00 Other LEFT FLANK LOW BACK PAIN X 1 WEEK South East O 2015 01 23 14 10 24 i Other South East 2015 14 10 07 l Respiratory COUGH FEVER 2 South East 2015 14 08 00 Other MY HEART IS POUNDING 2 South East 2015 Other INJURY TO TRUNK South East 2015 Other South East i i i N N N N L oo jw QJ QJ HDH Other South East GWMH Fever ILl V South East HDH Other z South East i i J N N Oo ww wo Other 0 South East Other South East Other Imaging Results South East Other 2 South East Page Size 25 Figure 8 ACES Line Listing Line listings display emergency department visits as a textual list with the standard patient information we receive directly from hospitals Date Time Age Gender FSALDU Hospital Syndrome assigned by ACES after classifier has read the chief complaint Complaint CTAS FRI EMS Arrival and Patient LHIN When the user first navigates to the Line Listings page they are presented with data from the past week for their assigned user
12. 1 13 2015 01 16 2015 01 18 2015 01212015 2015 01 22 14 3500 2015 01 22 14 18 59 ELLE pk Prk 14 1451 Kinnsinn Frontenac and lennni and rddinntan Heath int KF A Figure 13 Graphical representation of alert ACES User Interface March 2015 Choosing the Data tab within this window Figure 13 will list aggregate details pertaining to the alert for more in depth analysis Figure 14 CUSUMS Alert for at 10 06 22 January 2015 Graph Data 24 Hrs Ending Std Dev Visits Z Geography Class CUSUM Visits Avg Visits 10 06 22 January 2015 10 06 21 January 2015 10 06 20 January 2015 10 06 19 January 2015 10 06 18 January 2015 10 06 17 January 2015 10 06 16 January 2015 10 06 15 January 2015 10 06 14 January 2015 10 06 13 January 2015 10 06 12 January 2015 10 06 11 January 2015 10 06 10 January 2015 10 06 9 January 2015 Figure 14 Alert specifics under Data tab ACES User Interface March 2015 0 87701 0 79239 1 40155 1 32264 0 00000 0 00000 0 00000 0 00000 0 00000 0 17257 0 00000 0 00000 0 00000 0 00000 321 292 310 343 267 263 278 279 250 317 318 264 264 2604 205 2057 281 7143 261 2857 201 4286 282 2857 202 42806 285 7143 285 5714 207 1429 286 0000 299 2857 299 0000 299 0000 256 6667 32 9278 26 3168 26 6190 26 5070 26 4746 26 4566 22 9544 22 7293 25 0901 24 7319
13. 23 9841 23 9583 116 3930 127 3227 0 08462 0 60916 0 07871 1 32284 1 57737 1 73436 1 33607 1 28912 2 45373 0 17257 0 05294 2 46087 0 95704 0 78532 KFLA KFLA KFLA KFLA KFLA KFLA KFLA KFLA KFLA KFLA KFLA KFLA KFLA KFLA APPENDIX APPENDIX A Units Participating in EDSS ACES Health Unit Key to Hospitals within Health Unit lesen Blind River District Health Centre BRH ed Lady Dunn Health Centre WAW J Sautt Area Hospital SAH ar St Joseph s General Hospital QEL ee Chatham Kent Health Alliance Chatham CKHA ff ee Chatham Kent Health Alliance Wallaceburg CKHAW ee Se Se P Lakeridge Health Oshawa LHO gt S J lakeridge Health Port Perry LHP o J Rouge Valley Health System Ajax and Pickering APG __ ie Vn aa F eee Cornwall Community Hospital Glengarry Memorial Hospital HGMH iT Hawkesbury and District General Hospital Winchester District Memorial Hospital PD ee J Grey Bruce Health Services Markdale MDSH J Grey Bruce Health Services Meaford MFSH _ _ Grey Bruce Health Services Owen Sound OSSH Grey Bruce Health Services Southampton SSH Grey Bruce Health Services Tobermory TSH Grey Bruce Health Services Wiarton WSH Hanover and District Hospital HADH S South Bruce Grey Health Centre Chesley CSH _ _ South Bruce Grey Health Centre
14. Hospital SRH Feb 2011 TBDHU Dryden Regional Health Centre DRH Sep 2010 SS Geraldton District Hospital GDHO Sep 2010 es Manitouwadge General Hospital MGHO Sep 2010 Sa McCausland Hospital MCCA Sep 2010 LS Nipigon District Memorial Hospital NDMH Sep 2010 ns Thunder Bay Regional Hlth Sciences Centre TBRH May 2010 ACES User Interface March 2015 Health Unit Key to Hospitals within Health Unit Date linked to Table o o o ACES Sep 2010 SSS eae Englehart And District Hospital EDH Jul 2011 re Kirkland And District Hospital KDH Jul 2011 a Temiskaming Hospital TEM Jul 2011 Ce ee The Hospital for Sick Children TBD i Mount Sinai Hospital MSH Oct 2013 Lt North York General Hospital TBD J Rouge Valley Health System Centenary RVC Sep t 2013 Ly The Scarborough Hospital General Site TSH Jan 2014 ee The Scarborough Hospital Birchmount Site TSHB Jan 2014 a i St Joseph s Health Centre STJOE Jun 2010 St Michael s Hospital SMH Mar 2013 LC Sunnybrook Health Sciences Centre TBD E Toronto East General Hospital Oct 2014 University Health Network General Site TGH July 2013 University Health Network Princess Margaret PMH July 2013 University Health Network Western Site TWH July 2013 te William Osler Health System Etobicoke General Hospital EHC Jan 2011 Yl a OO Hotel Dieu Grace Hospital HDGH Jun 2013 fF Leamington District Memorial Hospital LDMH Jun 2013 a Windsor Regional Hospital
15. NGS Prone and Lanne and AGIngion Heath ril KF LAJ HIET 01 23 0841 59 CUSA DUSUMA Kingston Frontenac and Lennox and Addingion Healh Unit FLA Msi 01 22 08 40 34 SP OnEdge Kingston Frontenac and Lennox and Agdingion Health Unit KF LA 3491795 01 22 05 40 CUSUNMS Kingston Frontenac ami Lennon and Addingion Health Uit RFLA Be eT 1 30 0 35 36 Cec OnEdoge Kingston Proni nac and L nor and Adno Bako Unit FLA 3491785 08 39 46 CUSUN SuUSUMS 4 Kingston Frontenac and Lennox and Addington Health Unit KFLA 3491784 Lennox amp Addington County General Hospital LACGH 3491719 Lennox amp Addington County General Hospital LAOGH Kingston Frontenac and Lennox and Addington Health Unit KFLA Kingston Frontenac and Lennox and Addington Health Unit KF LA DnEdge 2 Kingston Frontenac and Lennox and Addingion Health Unil KELA SUSUM3I HL Kingston Frontenac and Lennox and Addingion Health Unit KFLA CUSUM3 HU Kingston Frontenac and Lennox and Addington Health Unit KFLA Lennox amp Addington County General Hospital LACGH Lennox amp Addington County General Hospital LACGH nist 77 1A 1 7R ST meine d Kinnsan Frontenac and Pon And AMminnmnn Health mit i r Total items 2326 ACRI Page Size 25 gt KFLA 2015 Figure 12 ACES alert page The Alerts page Figure 12 lists all alerts being generated by the ACES system The table that lists the alerts includes columns with information for Date T
16. Syndrome Ww Geog Type Geog Name K Alert ID Figure 3 Drop down menu to customize the alerts table The subsequent four sections of this manual pertain to the following tabs shown in Figure 4 below To navigate to each page on the site click on the appropriate tab se ACES Epicurves Line Listings Maps Alerts Figure 4 ACES features ACES User Interface March 2015 ll EPICURVES Kingston Frontenac and Lennox and Addington Health Unit een aaO Bl Pace sale Health Unit Hospitals Miche l 14 K T n he 149 EFLA All 104 i PT 2 ra N Date Range 270 la ae s CIm amp Age AH Classifications Classiier Bucket ped da 74 Dee 1a 201 Dec 71 3014 dan gi F005 Jan Ga 2005 Jan Of 2015 Jan 11 3015 Jan 14 2045 S705 AR Syndroma Algerihm Focus Chart is T wml aaaea 700 Ti s Det is eta Dec 18 21a Dec 21 201d C25 Fe Jan 51 2005 Jan 04 2005 Jan 14 2015 E Gevnleed Chart Figure 5 ACES Epicurve page The Epicurves page allows the user to plot time series graphs of case counts for various geographic regions for any time interval In this section options in the box on the right side of the screen allow the user to select the syndrome hospital time period and specific patient attributes they would like to view data for Generating an Epicurve To generate an Epicurve data parameters must first be defined using the options found at the right hand side of the page
17. ard County PEC Sep 2005 E Quinte Healthcare Corporation Trenton TMH Sep 2005 KFLA Hotel Dieu Hospital HDH Sep 2005 F R Kingston General Hospital KGH Sep 2005 es Lennox amp Addington County General Hospital LACGH Sep 2005 LAMBTON CHSD Bluewater Health Sarnia BWH Jun 2013 Charlotte Eleanor Englehart Hospital of Bluewater Health Petrolia BWHP Jun 2013 LGLDHU Brockville General Hospital BRGH Jul 2009 i WZ Carleton Place and District Memorial Hospital CCC Oct 2014 Perth amp Smiths Falls District Hospital Great War Memorial Site Nov 2008 Perth GWMH Perth amp Smiths Falls District Hospital Smiths Falls Site SFH Jul 2008 w Niagara Health System Douglas Memorial Hospital Site DMH Feb 2010 E Niagara Health System Greater Niagara General Site GNG Feb 2010 Health Unit Key to Hospitals within Health Unit Date linked to Table E ACES DSSS Niagara Health System Port Colborne General Site PCG Feb 2010 Niagara Health System St Catharine s General Site SCG Feb 2010 es Niagara Health System Welland Hospital Site WHS Feb 2010 NBPH West Nipissing General Hospital WNGH amp WNG Apr 2010 aaa North Bay General Hospital NBGH Apr 2010 ACES User Interface March 2015 Health Unit Key to Hospitals within Health Unit Date linked to Table a ACES General Hospital MH amp MGH Apr 2010 r Atikokan General Hospital ATGH Sep 2010 Pee Lake Of The Woods Dis
18. ated flu non specific infections potential interest to public health epiglotitis tonsil abscess sprain strain laceration dislocation bruise swelling insomnia sleep disorder ACES User Interface March 2015 INT LAC MEDREN MEDSE MEN MH MHS MIGR NEC NEURO NEUS NEWB OBS ONC OPI OPTH ORTHF ORTHH ORTHO OTHER PAIN PE PHYSC PN PO REN REPORT RESP SEP SI SOC TEST THOR TICKS TOX TRMVC TRO TRW TRS URO VOM intussecption lacerations medication renewal request medication side effect not OD meningitis and encephalitis mental health suicidal ideation attempt or overdose migraine necrotizing fasciitis severe cellulitis gangrene dementia Alzheimer s stroke seizure vertigo syncope fainting neurosurgery aneurysm bleed etc subdural SAH newborn related to obstetrics oncology opioid intoxication addiction overdose withdrawal general ophthalmological condition fracture non hip fracture of the femur or hip orthopedic elective surgery cast change or assessment null missing other pain undifferentiated non cancer radiculopathy back pain sciatica pulmonary embolism DHT VTE physician consultation pneumonia post op infection or complication renal failure dialysis renal disease and its complications reportable diseases respiratory infection non croup non bronchiolitis bacteremia SEPSIS smoke inhalation chemical gases social admission test results bloo
19. d or diagnostic imaging xray US biopsy transfusion tube change thoracic pneumothorax ticks toxicology not alcohol or opioids withdrawal substance abuse chemical exposure trauma from a MVC ATV trauma from another means fall etc gunshot or stab violence assault sexual assault rape urological stones prostate UTI vomiting alone NORO like illness not secondary to chemo or with other symptoms ACES User Interface March 2015
20. e desired age range The default is set to All ages Classifications Tools Advanced Health Unit KFLA All Hospitals Date Range 12 15 201 01 15 201 Mlale Female Age All Classifications Classifier Bucket 22006 All Syndrome All ME Algorithm Reset Under this category the user is able to make more specific requests as to what syndromic data will be displayed Under Syndrome the dropdown menu gives options for which syndrome the ACES User Interface March 2015 user would like to analyse The user may also choose to display all syndromes together which will show data for all hospital ED visits and admissions Under Classifier the dropdown menu gives the option to either display syndrome data that was classified according to the older EDSS RODS classifier by choosing EDSS Standard Syndromes v2006 or by the new ACES classifier by choosing ACES Standard Syndromes v2014 If the EDSS Standard Syndromes is selected then only the 8 standard syndromes will be provided as options under the Syndrome dropdown menu Respiratory Gastrointestinal Fever ILI Asthma Derm Infectious Severe Infectious Neuro Infectious and Other However if the ACES Standard Syndromes Classifier is selected there are over 80 syndrome options that the user can choose from see Appendix B for a list and description of these When the Classifier is set to ACES Standard Syndromes the Bucket dropdown menu gives the us
21. ed because if a given HU has a higher percentage than what was chosen it will not be included in the legend Date Range Gender Age Group Age Range With these categories the user can customize the map to display hospital data by gender age and desired time period ACES User Interface March 2015 Once all desired parameters are entered clicking the Request Data button will generate the map Pressing Clear Data will clear the map created and revert back to the default settings NOTE While the user can in fact choose as wide a date range as they like it is advised to use windows of a month or less A request for large time periods of data can cause the system to time out and crash Map Features Layers Data Layers The second tab in the box on the right side of the map screen named Layers allows users to add Daycares iv additional information to their maps that could be useful for public health purposes Checking the Pharmacies L desired layer for example Daycares will add all sie eae PHU Satellite Offices daycare facilities on the map Clicking Clear Layers a will clear all layers added NOTE Users can click on BB Public Health Units E multiple layers but keep in mind that the more that are added the more messy the map may become Long Term Care E The ACES team is also considering adding more layers as we continue the systems development Schools LI Map Features Map
22. ed below the Epicurve is a Focus Chart This chart allows the user to easily adjust the graph to focus on a narrower time period without having to make a new graph Clicking on the desired date s on the Focus Chart creates a window that can slide back and forth to either widen or narrow in on the date range Focus Chart 35 30 20 pa TS A Q Dec 15 2014 Dec 19 2014 Dec 22 2014 Dec 26 2014 Dec 29 2014 Jan 02 2015 Jan 05 2015 Jan 09 2015 Jan 12 2015 Jan 15 2015 e Hovering the mouse over a point on the All All Jan 05 2015 Visits 29 exactly how many visits there were on that Click to see line listings Epicurve line will prompt a box that displays day for that syndrome In this box selecting Click to see line listings will open the line listings for that day giving more details Surrounding each visit for more in depth analysis e Atthe bottom left corner of the page clicking on the button Download Chart will download a picture of the current epicurve that the user has created This allows the user to save their work in picture form to be used in presentations or reports ACES User Interface March 2015 IV LINE LISTINGS Date Time Age Gender FSALDU Hospital Syndrome Complaint EMS Arrival Patient LHIN Oo 2015 01 23 14 49 35 KGH Other false South East 2015 01 23 14 47 19 V Other HEAD INJURY false South East 2015 01 23 14 46 23 V Other false South East 2015 01 23 14 42 35 KGH Other false South
23. er more options to customize the epicurve using pre defined groupings of certain syndromes of interest These Bucket categories and their definitions are still a work in progress Lastly the Algorithm dropdown menu provides 5 options for which algorithm was used to categorize the visits into the selected syndrome The algorithm options are Balanced Winnow C4 5 Decision Tree Maximum Entropy Naive Bayes and Winnow2 Maximum Entropy is the default setting and was used in the old EDSS RODS system Descriptions of the new algorithms will follow in our User Manual once completed CTAS CTAS stands for Canadian Triage Acuity Score Under this section the user can choose whether the epicurve will only display data from one of the 5 CTAS categories or whether visits for all CTAS scores will be displayed All is the default setting ACES User Interface March 2015 Epicurves Parameters Advanced Clicking on the Advanced tab at the top of the box on the right hand side of the screen provides more Tools Advanced options to customize the Epicurve NOTE One of Patients or Hospitals will always have to have a Locality local option chosen Patients Local PHU Patients Locality Hospitals In the Patients dropdown menu the user can choose whether the Epicurve will display data from patients who are Local PHU Patients i e reside in that particular Health Unit Province Wide i e reside FSA anywhere in Ontario essentia
24. fy the data being displayed by either the older classification system which was used in the previous EDSS RODS system by choosing S2006 or by the new ACES classifications system by choosing 2014 Syndromes Under this tab users can choose which syndrome will be displayed on the map There are over 80 syndromes to choose from under classification 2014 and 8 syndromes under classification S2006 Level of Geography ACES can display ED visit and admission information by different levels of geography FSA Public Health Unit and LHIN ACES User Interface March 2015 Data Classifications When using the Chloropleth mapping style there are three different ways in which the data can be classified These include Equal Interval Quantile and Standard Deviation Equal Interval will map the data in equally spaced out gradients based the normalized values Percentages for that syndrome in the chosen geography The number of gradients is determined by the user when they specify how many Classifications they desire and the size of those gradients is determined by the user when they specify the Percentage Range For example if a user chooses 6 under Classifications and a Percent Range between 0 24 the legend will have 6 equal gradients of 4 each Quantile is a more simplistic method to map the data and all the user needs to define are the number of quantiles they desire If 4 quantiles are chosen then Q1 will show 25 of the data
25. ime of alert Alert Class CUSUM SPC or NRC Alert Type numerous Syndrome Geog Type Geog Name and the Alert ID Clicking on the grey arrow at the top right corner of the table prompts a menu that allows the user to customize which columns will be displayed Clicking on one of these columns will list the alerts by that column NOTE Further detail on Alert Class and Alert Type will be made available in the near future Alert Date Time Alert Class Alert Type Syndrome Geog Type Geog Name Value Alert ID 2015 01 22 15 09 47 USUM CUSUM3 PHU Kingston Frontenac and Lennox and Addington Health Unit KFLA USUM CUSUM3 PHU Hastings and Prince Edward Counties Health Unit HPE Choose Columns Alert Date Time v Alert Class C 2015 01 22 15 09 19 C CG 2015 01 22 15 06 31 CUSUM CUSUM3 PHU Kingston Frontenac and Lennox and Addington Health Unit KFLA Alert Type C C C c 2015 01 22 15 06 46 USUM CUSUM3 PHU Kingston Frontenac and Lennox and Addington Health Unit KFLA 2015 01 22 15 03 00 USUM CUSUM3 PHU Hastings and Prince Edward Counties Health Unit HPE Syndrome 2015 01 22 15 03 00 USUM CUSUM3 HOSP Lennox amp Addington County General Hospital LACGH Geog Type v Geog Name Valu 2015 01 22 15 02 07 USUM CUSUM3 PHU Kingston Frontenac and Lennox and Addington Health Unit KFLA vi Alert ID 2015 01 22 14 54 00 USUM CUSUM3 HOSP Lennox amp Addington County General Hospital LACGH ACES Use
26. lly an ALL category or Outside of PHU Patients i e patients who do not reside in that particular Health Unit essentially shows patients who are visiting that health unit The Hospitals dropdown menu provides 3 options for Submit further breaking down the data Choosing Local PHU Hospitals will add additional lines to the Epicurve that show data broken down by hospital in that Health Unit The legend will appear at the top right corner of the graph An example of how this would look is shown in the next section below with the three hospitals in the KFL amp A Health Unit Province Wide will show data for local patients who go to any hospital that is connected to ACES Outside of PHU Hospitals will show data for local patients visiting hospitals outside of their health unit of residence Province Wide All FSA FSA stands for Forward Sortation Area which are the first three digits of a postal code This dropdown menu lists all FSAs in the selected Health Unit By selecting a specific FSA the epicurve will display the hospital visit data from patients who reside in that specific geography ACES User Interface March 2015 Moving Average and Standard Deviation Normalize Moving Average standard Deviation OTT On None f 14 Max None Stid 1 Std 2 At the top of the Epicurve there are options to add lines on the graph that display the Moving Average and or Standard Deviation Users can select a moving average of either 7 days 14
27. ne is displaying the 7 day moving average average number of reported cases for the current and preceding six days and the dash dotted line is displaying all cases plus 2 standard deviations By using options in the Advanced tab the graph below in Figure 7 shows the Epicurve for the RESP respiratory syndrome in adults of all genders now broken down by hospital in the KFL amp A Health Unit This was done by choosing the option Local PHU Hospitals option under the Hospitals section Also by selecting Local PHU Patients in the Patients section the graph is only showing the user a graph of residents in that health unit that are being seen at that health units local hospitals The black line represents data from all hospitals combined The red line represents data from Hotel Dieu Hospital the green line represents data from Kingston General Hospital and the blue line represents data from the Lennox and Addington County General Hospital Kingston Frontenac and Lennox and Addington Health mu sanen Doreen __ Unit n one j Max jone 3 an 2 HOH KGH LACGH A m VORA Qo Dec 15 2014 Jec 19 2014 ec 22 201 26 201 an Jan 05 2015 2015 Jan 15 7015 Focus Chart Dec fs 2014 Dec 19 2014 Dec 22 2014 Dec 26 2014 Dec 29 2014 Jan 02 2015 Jan 05 2015 n 12 2015 Jan 15 2015 Download Chan KFLA 2015 Figure 7 Example epicurve broken down by hospital ACES User Interface March 2015 Additional Features e Locat
28. on gives six Syndrome Algorithm age group options All Child ages 0 to 17 School Child ages 5 to 17 Adult ages 18 to 64 Senior ages 64 to 130 and Adult Senior ages 18 to 130 Alternatively the user can manually input the desired age range CTAS All ME Classifications Selecting a specific Syndrome from the dropdown menu will list the visit details for patients whose chief complaint or admission diagnosis was categorized into that syndrome The user may also choose to display all syndromes together which will list visit information for all hospital ED visits and admissions Under Classifier the dropdown menu gives the option to either display syndrome data that was classified according to the older EDSS RODS system by choosing EDSS Standard Syndromes ACES User Interface March 2015 v2006 or by the new ACES system by choosing ACES Standard Syndromes v2014 Please refer to the Epicurves section above for further information on the Classifier Bucket and Algorithm options CTAS CTAS stands for Canadian Triage Acuity Score Under this section the user can choose whether the line listing will only list visits that were categorized into one of the 5 CTAS categories or whether visits for all CTAS scores will be displayed Advanced The Advanced tab allows users to further specify which hospital visits will be included of their line listing Please Tools Advanced refer to the Epicurves section above for f
29. r Interface March 2015 The box on the right side of the table can be used to specify whether the list will display all alerts being generated in the health unit or whether only alerts at Health Unit Hospitals a specific hospital will be listed This is done by KFLA All selecting the desired hospital in the drop down menu The options available to each user are Date Range dependent on their level of access Date From pan 01 22 201 In this box the user can also specify the date range 01 15 201 for the alerts being listed Clicking on the alert of interest will bring up a window with a graph that displays the hospital visit data for the two weeks leading up to the event Figure 13 e ACES FReurves Line Listings Maps aknti Helio Laura CUSUMS Alert for at 10 06 22 January 2015 Kingston Frontenac and Le Alert Date Time Alert Class Alert Type S01S 0122T16 0847 CUSUM CUSUMS 2018 01 22 15 0219 GUSU CUSUMS Health Unit Hospitals 20I5 01 227150648 CUSUM CUSUMI 2015 01 27 15 0601 CURSUM TSUMI 2015 01 2271 0100 CUSUM CusUMS 2015 01 22 15 03 00 CUSsuM Cusuis mn i OOo o OE ti OAS 2015 01 22 13 020F CUSUM CUSUMI 2015 01 22 1454900 CUSUMI 2015 01 22 14 54 00 2015 01 22 14 52 31 2015 01 22 14 50 32 2015 01 22T 14 50 10 2015 01 22 14 47 32 2015 01 22 14 46 31 2015 01 22 14 46 21 2015 01 22 14 44 00 2015 01 22 14 4400 2015 01 22 14 37 21 0 2015 01 22 14 35 00 01082015 01 11 2015 0
30. role i e PHU Hosp only etc The box on the right hand side of the screen allows the user to set the parameters to generate the line listing which are the same as those described in the Epicurves section Generating a Line Listing To generate a line listing enter the desired parameters into the box on the right side of the screen Selecting Submit at any time with generate the Line List with the details provided Selecting Reset will reset the screen to the default settings ACES User Interface March 2015 Health Unit and Hospitals The first option is to choose which hospitals visit details Tools Advanced will be shown There is also the option to view data from all hospitals in the selected Health Unit Which Health Unit Hospitals hospitals information can be displayed in the line listing depends on the user accessing ACES Hospital users will only have the option to view their own hospitals data Users from the local Health Unit however will be able to view each hospital in their Health Unit as well as all Date From hate To hospitals together 01 13 201 01 20 201 KFLA All Date Range Date Range Under this section the user can choose the desired time period Clicking Date From and Date To will prompt a calendar to choose the desired dates Gender Gender may be specified as either Male Female or All Classifications Age Classifier Bucket 52006 All Clicking on the dropdown menu in this secti
31. tion using their mouse The bar on the top left side of the page allows users to zoom in or out of the map The picture of a house above this bar takes the map to the default view The right side of the page contains a box with various features that allow the user to manipulate the map tool these features are described in the next section ACES User Interface March 2015 Map Features Data Layers The box on the right hand side of the page provides options for customizing the map Mapping Style In the Data tab of this box under each heading is a Choropleth drop down menu providing options for that category Entering the desired parameters will give Classifiers the necessary information to customize the map Maximum Entropy Mapping Style Classification There are two options on how the data can be 32014 visualized on the Map Syndromes Chloropleth This option displays the ED visits for ALLERG the selected syndrome by colour with darker colours representing more visits in the region Level Of Geography compared to lighter colours Figure 10 is showing FSA ILI syndrome data by Health Unit level of geography Hovering the mouse over one of the Data Classifications outlined regions will provide more details on total visits for the syndrome total ED visits and the percentage of total ED visits that are for the selected Number Of Classifications syndrome Equal Interval A Percentage Range
32. trict Hospital LWDH Aug 2010 rs Riverside Health Care Facilities Inc RHF Sep 2010 es Sioux Lookout Meno Ya Win Health Centre SLH Sep 2010 Queensway Carleton Hospital QOQ Oct 2014 PEEL Trillium Health Partners Credit Valley Hospital CVH Nov 2011 LS aa Trillium Health Partners Mississauga Hospital MISS Feb 2013 a William Osler Health System Brampton Civic Hospital BCH Jan 2011 PCCHU Peterborough Regional Health Centre PRH Apr 2009 MICs Group of Health Services Anson General Hospital AGH Jul 2011 SSS MICs Group of Health Services Bingham Memorial Hospital BMH Jul 2011 LG MICs Group of Health Services Lady Minto Hospital LMH Jul 2011 a Hopital de Smooth Rock Falls Hospital FSR Jul 2011 tr Hopital Notre Dame Hospital NDH Feb 2013 es Hornepayne Community Hospital HPH Feb 2013 Sensenbrenner Hospital SBH Feb 2013 fF OO N Timmins amp District General Hospital TDH Jul 2011 SMDHU Georgian Bay General Hospital Midland Site GBGH Feb 2010 L Muskoka Algonquin Healthcare Huntsville amp Bracebridge MAH Feb 2010 r CSS North Simcoe Hospital Alliance Huronia District Hospital TBD gt J Orillia Soldiers Memorial Hospital OSMH Feb 2010 a Wa Royal Victoria Hospital RVH May 2010 i Wi Stevenson Memorial Hospital TBD SDHU Chapleau General Hospital CHS Jul 2011 a Espanola Regional Hospital and Health Centre EGH Feb 2013 ee Manitoulin Health Centre MHC Feb 2013 re Sudbury Regional
33. urther Locality Patients Local PHU Patients information on the Locality Patients Locality Hospitals and FSA options for your line list search Hospitals Province Wide FSA All ACES User Interface March 2015 ACES Mello Laura pee A trail Lialaine i i MANITOBA E s Dala Layers Map Pole haii Prownced Him h Flin F Kapy Fever Mapping Style A Chorapketh hall tibi Classifiers Fi i Maximum Entropy wr i aav igathid Classification zapia w Fert al Syndromes ag k Di p Moe fap hin 6 Riseng pad ae i 4 er Level Of Geography Mould 7 nee yr 49 k Hanat ONTARIO 7 w Annaa Data Classmcations is E areri PA pama E Himla COU imena ka Wn Humber Of Classifications QUEBEC 1 hair hal B z if idit K Percentage Range HY NORTH DAKOTA Date Range Besnard an i Ji Ora ne Fang Lies i UE MINNESOTA is j j te EETHEN Clear Dati Pepe Chat Cica Data apek Entit l Fiian lew Pau atawa ai MAINT G REAT P L A I N 5 ilil 5 i eg 2 sired CEET SOUTH DAKOTA WISCONSIN r MECHEL G A M j liiin VERHGHI 7 fungston alia f Pierre i Monipsliar Fh m x r o ii Piim dany Laber Chelair SHN F amilt Ear Deler FAD USGS NOAA EF Figure 9 ACES Map page The Map page Figure 9 allows the user to examine the spatial distribution of ED visits and admissions When the user navigates to this page they are first presented with a map view of Ontario Users can move the map to the desired loca
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