User Manual for RODS 3E - KFL&A Public Health Informatics
Contents
1. Ontario PublicHealthe REAL TIME OUTBREAK AND DISEASE SURVEILLANCE RODS User Manual for RODS 3E Updated May 2013 Adapted for Use By KFL amp A Public Health Kingston ON RODS 3E Adapted from RODS Version 3 0 By Emergency Department Syndromic poet cat a EDSS Team 2005 RODS Laboratory University of Pittsburgh RODS 3E User Manual EDSS Version 05132013 1 Table of Contents Overview Privacy Security Information Data Capture within RODS RODS User Interface Logging In Screen Navigation Area e Main e Epiplot e MapPlot e Options e Help e Contact e Logout RODS Integration with Public Health Evaluation Contact Information List of Public Health Units and Hospitals Participating in EDSS Figure 1 ED Data Capture and Flow Cycle for Syndromic Surveillance Figure 2 Process flow for investigation of alerts generated by RODS Table 1 Syndrome Classification revised from original RODS syndromes Table 2 Participating Hospitals and ICP Contacts Table 3 Lab Contacts for Participating Hospitals and Public Health RODS 3E User Manual EDSS Version 05132013 oe Page No 10 17 19 19 19 19 20 26 28 31 23 21 22 Overview Real time Outbreak and Disease Surveillance RODS is a computer based system that automatically collects public health surveillance data from multiple sources The system analyzes these sources for possible outbreaks and notifies Public Health2. Min Age 0 Max Age 120 aan ke https www quesst ca rods2 2 0 epiplot_controls jsp B internet Inbox Microsoft Out Z RODS Main Interfac EARS B Documenti Microsof RODS 3E User Manual EDSS Version 05132013 By ig ae Action Selection Found at the left side of the screen this enables the user to select the action which will be performed by clicking on the map It also allows you to perform some one click actions The buttons from top left to bottom right are Toggle between layers and legend This allows you to display a legend showing the graphical representation of all currently selected layers see below as well as the case counts indicated by the colours Clicking again will return you to the layer selection menu 2 Toggle Overview map Turns on off the overview map 4 Zoom in Zooms in one of two ways A single click will zoom in by a fixed amount to a spot centered on the point you clicked Alternatively you may drag and form a rectangle and this will become the extent of your zoom Zoom out Zoom out by a fixed amount centered on the point you clicked 3 Zoom to full extent Zoom out entirely to the provincial map amp Zoom to active layer Zoom to the smallest extent in which all members of the active layer see below are visible Back to last extent Undo the most recent zoom pan operation Pan Drag the map to move the visible area T Pan up A single click operation t
3. lUIMOE z UNESH IEUSI g SNONIAJU UON eolbojomnen c SNONIAJU OINON eoIBojounayy EWUISY e Jemo7 lojelldse z Jedd Asojelidser Aloyesidsay aWEN RODS 3E User Manual EDSS Version 05132013 RODS User Interface The RODS user interface is a secure web based interface for displaying public health surveillance data The RODS user interface is comprised of 7 sections Each of these sections can be accessed from the screen navigation area Logging In To access RODS visit the following website http www quesst ca CRYPTOCard Logon Microsoft Internet Explorer provided by KFL amp A Public Health File Edit View Favorites Tools Help ay i m k SA O O AOD Oua kras A D aA s Address http fwww quesst ca 808 1 http fwww quesst ca 80 findex html i Go Links cavecoceasd Y Secure Password TECHNOLOGY User name Response To authenticate press this button Login IMPORTANT For the response enter your PIN if applicable and THEN the token code with NO spaces between the pin and the token code The PIN is the number that was provided to you when you received the token not applicable to all users The token code is a 6 digit random number that is generated each time you press the button on the token DO NOT press this button repeatedly only press it when you need a new code Pressing the button frequently when not used as part of a login procedure may result in your
4. February 2013 _ EE September 2010 September 2010 September 2010 eptember 2010 eptember 2010 nson General Hospital AGH July 2011 July 2011 July 2011 July 2011 July 2011 February 2013 February 2013 February 2013 ee Kirkland amp District Hospital KDH uly 2011 uly 2011 uly 2011 L ep ay E a ae W eh nd D 3 oy D S No s oO PHU gt H ek APH ady Dunn Health Centre WAW July 2011 St Joseph s General Hospital QEL July 2011 Blind River District Health Centre BRH February 2013 nn HRHD Halton Healthcare Services Georgetown October 2011 GEO ctober 2011 ctober 2011 ctober 2011 Pe es GBHU Grey Bruce Health Services Lion s Head November 2011 LHSH Grey Bruce Health Services Markdale November 2011 MDSH Grey Bruce Health Services Meaford MFSH November 2011 Grey Bruce Health Services Owen Sound November 2011 OSSH Grey Bruce Health Services Southampton November 2011 SSH ovember 2011 ovember 2011 ovember 2011 ovember 2011 ovember 201 1 RODS 3E User Manual EDSS Version 05132013 30 Z South Bruce Grey Kincardine KSH November 2011 South Bruce Grey Chelsey CSH November 2011 EE eed Hamilton Health Sciences Corp McMaster March 2012 Children s Hospital MCM Hamilton Health Sciences Corp Hamilton General Hospital and Urgent Care Centre HAH Hospital formerly Henderson H
5. 37 F KGH Other FREQUENCY DYSURIA URGENCY 4 2006 07 11 21 01 12 F LACGH Other 50B 2 2006 07 11 20 59 11 F BGH Other FELL 3 2006 07 11 20 59 4 M LACGH Respiratory COUGH SHORTNESS OF BREATH 4 2006 07 11 20 58 0 F NHH _ Feverlll FEVER 4 2006 07 11 20 58 70 F TMH Other ROS 5 2006 07 11 20 569 F HDH Other RIGHT ARM INJURY 4 2006 07 11 20 55 85 F PEC Gastroenteritis DIARRHEA 4 2006 07 11 20 55 58 F LACGH Other ALLERGIC REACTION 2 2006 07 11 20 54 50 F TMH Other RIGHT RIB PAIN 4 2006 07 11 20 52 27 M TMH Other HEADACHE 2 2006 07 11 20 48 5 M HDH Other ABDOMINAL PAIN 3 2006 07 11 20 49 45 M BGH Other RASH 4 2006 07 11 20 48 35 F TMH Other SOB 4 2008 07 11 20 47 55 F KGH Other INFECTED SUTURE LINE RECHECK 4 2006 07 11 20 47 71 M LACGH Other LAC T LT ARM AND LT LEG 4 g Period Custom Dates g Gender All F Health Unit All iv Postal Code _ Normatize Create Epiplots Start Jul EJ 6 E2006 E Age All E Hospital AN Iv aT A C wavelet GetAlets ia m e E a cS sg End vu Eaa aeoo f as o aaas so ee ov BATT taba Triage Acuity This data is currently only provided by 7 of the 9 hospitals excludes SFH B internet and GWMH Triage acuity refers to the health care professionals assessment of the patient at ED registration Patients are triaged or prioritized on the basis of their condition at registration The acuity scale determines the time to see a physician The scale ranges from Tria
6. Data Type and Health Unit Selection Area The data type allows the user to switch between data sources currently Admissions and ED Registrations are available Similarly the health unit allows the user to switch between participating health units Normalize You can also normalize the frequencies of the charts For ED registration data the normalize function divides the number of visits over a 24 hour period for a specific syndrome category by the total number of visits in the same 24 hour period plots the number of cases as a percentage of total cases Chart Area There are 4 charts displayed on the main screen Respiratory Constitutional Gastrointestinal and All Healthcare Registrations System Message Log This area displays messages from the outbreak detection algorithms of RODS RLS CuSUM and WSARE are currently under investigation The display will show the following elements of the alert Date and time of the alert syndrome health unit algorithm that generated the alert observed count and threshold 2 EPIPLOT Epiplot allows the user to plot time series graphs of case counts for geographic regions at the health unit or and or postal code level for any time interval For convenience standard time intervals are provided You must select one or more syndromes which are simultaneously plotted In addition you may restrict your counts to specific demographic selections such as age gender and or hospita
7. EDSS Version 05132013 me tools within RODS can be used to aid Public Health surveillance and investigation of Infectious disease outbreaks Privacy and Security Information Privacy Background On November ist 2004 Ontario s new healthcare privacy legislation Personal Health Information Protection Act PHIPA came into effect This law was designed to govern the collection use and disclosure of personal health information within the health care sector The act further provides a set of comprehensive and consistent rules for the health care sector to ensure that personal health information is kept confidential and secure In September 2004 in anticipation of PHIPA policies were developed by both Kingston General and Hotel Dieu hospitals to ensure that all future projects involving personal information would require a detailed business plan privacy impact assessment and where applicable written approval from the Queens University Research Ethics Board QREB Privacy and Security Charter In September 2004 prior to project commencement the EDSS Project Directors in consultation with legal council developed a document entitled Privacy and Confidentiality for Health Information for Emergency Department Chief Complaint Syndromic Surveillance Privacy and Confidentiality Charter dated September 2004 This Charter contained an executive summary of the project as well as the principles policies and procedures necessary to meet the
8. Home Postal Code Hospital Type Chief Complaint 2005 08 22 09 12 52 M ken EDAdmission QUERY SMALL BOWEL OBSTRUCTION 2005 06 22 09 09 79 M IKGH Elective Admission CHEST PAIN 2005 06 22 08 46 28 F KGH _ Elective Admission ENDOMETRIOSIS 2005 06 22 08 21 41 M IKGH _ Elective Admission BULLOUS EMPHYSEMA 2005 06 22 07 11 31 F KGH _ Elective Admission PREGNANCY 2005 06 22 06 47 24 F IKGH Elective Admission LEFT RENAL CALCULI 2005 06 22 06 40 77 F IKGH Elective Admission CARCINOMA CECUM 2005 06 22 08 29 52 M KGH ED Admission LEFT CALCANEUS FRACTURE 2005 08 22 06 26 58 F IKGH Elective Admission OVARIAN TUMOUR 2005 06 22 06 17 77 M Ikan Elective Admission NONE GIVEN V All Admissions 2005 08 22 06 16 les F keH Elective Admission OVARIAN TUMOR rie ardin 2005 08 22 05 45 77 F KGH ED Admission SYNCOPE PROFOUND LEG WEAKNESS eee ene 2005 06 22 05 44 e3 F KGH__ ED Admission CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATION 2005 08 22 05 25 se F KGH__ ED Admission SYNCOPE AND FALLS 2005 06 22 02 07 71 M KGH ED Admission ACUTE CORONARY SYNDROME 2005 06 22 01 52 45 F KGH ED Admission INFECTIOUS DIARRHEA 2005 08 22 01 22 8 M IkGH ED Admission PARTIAL LOWER BOWEL OBSTRUCTION 2005 08 22 00 423 75 F IKGH ED Admission WOUND HEMATOMA 2005 06 22 00 28 80 m ken ED Admission WOUND INFECTION 2005 08 22 00 24 84 M IKGH ED Admission NON ST ELEVATED MYOCARDIAL INFARCTION 2005 08 21 23 37 l
9. unusual events in the data potentially an outbreak NOTE The Gastroenteritis Respiratory and Fever ILI syndromes are the primary syndromes of interest However all other syndromes are included to maximize the potential of the system to detect any disease events of interest including bio terrorism events RODS 3E User Manual EDSS Version 05132013 zi Table 1 Syndrome Classification revised from original RODS syndromes UOISUa OdAH SUMO A sixejsidg spuejs ualloms g4 Iamun suoneadwon Aue Sq MOT Jo U IH ssjedeid ysnauj 340S yjnow uonaajur JO peajq wnb Buijems jeej ued mef ewneij uoijpejui ued jejusg 10 uijsui uonesipew ic YUM Juewjurodde eanjns Bulysed yaeuyden 3123 jseo Hodes Aey Jo punoseun yel uonduasald UONPIPEY pajejay JUSWPel pejepsy Je9ueg AdeJayjoway JO uoneadwon eiusdorjnen ade fuses ydeaxg eanperoud Aue Jo uoneaydwon Ue q UdIJIeJU do Jsod WIG D uoIdeJuI aed PUNOAA SUOIPJUSS Ald Ily SIUSq UBIJOMS UIE YUR 4 OLS WNeILfuled EMINA HA sUydeuojadd 31 05 LUSH Hulpea g euueyn jeUONDUNIJS G UIEd dAL9d abseudsig Ben abeweossiyy Buipseig ber eaipuner sjoojs poorg Ued epey 1e an SUYOID sq uorjsebipuj sdwe1g uonediysuo oqs sy wsiseiungroug pled sijoipueddy uled jeuIWOPGY uolsusped H Iwas Iwy oljewnesj UONUIEd 15349 xoleq esnay nig snouenesui asnqy
10. 1epinoys aios IEN a108 ayuy suens sueids seunjoel4 adwis nog siuypy Ued julor sie erdwis oipedoyuo xe Joujo wneud SPUNOAA GEIS swers S nny uepiay apkaojon e g yH Ay 1U9PIIIY Yaa e 2A01g yeH wos sie anpes Anfu sayn xeroujoweH Anful peaH JAN UNS Jepun g4 sg ea uoiseigy asinig wing Ubid YH yound punom anpund sse uo paddajs ynessy sina uonelaseT SOY 13d SY Bulsnoo4 Aynoiiq eibeuds g eidojdiq sis jesed Bupuassaq SiSold sied Japlosiq Jejodig Jepsosiq piouesed eluauydoziyss sasoy2 sd ssas payl y aom enos 335 oL aposig uopippy Japos jaixuy snorxuy Jepnmns uolsseideq eydepesH zziq SNIS ejua palay puy yyeaH elua sepniaxg s Jewleuziy eyUsWa Snels jeuan palayy 207 seunzies ssouyeayy BAD SUIEIBIN YON PIS 19494 snjeydasop H Saa wieyziy enua weg auei sapnxa JeAe4 puy wnidjeq speydasug sijbulueyy Jee puy SUIEPESH Buiujeaug Aynoiig elxodAH JHA gos ewas ydwa Odon Buizeeun ewujsy aseasig Aemuly 3Apesy siiGukue synod Gosueaey ASH sieysed uonsefuon jseyo 6un7 ynon eruownsud siyoyauoig siyyauoig siuke uonsebuog pop e3 pex901g LON un simojida sBukueyd dnog sy ukie sijsnuIs ued 3 SIO uonduosag glbojorewleg snongeJu LL Jearbojojeu lag MSW or ewnel g Anfu g eUNeIL
11. Brug swooysnyy aules0 peuojs yung pejeugeu peye I1x0ju Iseuy vs vuieeg eiuedoupnen aqe epnyox erweI90 306 ue siose4 BuIzIj01dEN YI0US ewang elWasajoeg sisdesoin sisdes sjoojs uj poorg Bulpss q puy eeyuelg uorespyeg Buruosiod poo uled jeurwopgy puy eayueg 13494 puy eayueg Rupwog puy eayueg eeyuelg ueljed 139Ue dO S0d PNIXJ SS UII 8417 NA Ued Llor sBIBjeAy Syo 18A34 pajenuaiaypun epgjsou dun uopeay sie use payeluseyipur wiombung eneun SeAIH ysey Jedeig use paynadsun A uoslod ewazxg wag pejuon uinguns Jabul4 pejpejur ssesqy s3105 NJUled silog eN UMOJBUT SA spunom papayul song papajul 1004 seqeiq esebues spase sejediskug Synes J UJO ez SULIOPUF gz uled EJUSQ zz dnMo O4 gz BIIBO OOUO gz SUOPIIIGWOD jeydsopH sagesado ISOd pz JWUJeydo ez jeuay eoiBojoln zz UAD SAO 12 EIMMOPGY D oz JEINOSPAOIDIED 6 Buiuoslod esopien0 g SSOU SNONIEJU J A S SIUAJUBONSED g SAS co IYO Ibojoreuwled Jeua oeg jeIbojorewleg snoljoeju oi useyjeney sjodg US 13494 UNON 1004 puey aseasiq yyl eljeany sarseaw ejoesoy EJIA JEenasaA UON AGojozewaq SNoloaju z geny peselsijg SININ NOJ XOd ews sadiay s lfulys Xod uay sejdISEA MIEN 0 S SNYA Y JUSTE UIE NSSIL YOS Ued aalen Bums Be uonexergns uonedorsig suar panfu
12. PS Royal Victoria Hospital RVH May 2010 gt EEE be NRPH Douglas Memorial Hospital DMH February 2010 Greater Niagara General Hospital GNG February 2010 Hotel Dieu Hospital OSS Closed as of February 2010 March 25 2013 Welland County General Hospital WHS February 2010 Port Colborne General Hospital PCG February 2010 St Catharines General Hospital SCG February 2010 NBPH North Bay General Hospital NBGH April 2010 West Nippissing General Hospital WNGH April 2010 WNG Mattawa General Hospital MH MGH April 2010 EE ee Rod EOHU Glengarry Memorial Hospital HGMH April 2010 eee ee ee ee oe esd TBDHU Thunder Bay Health Sciences Center TBRH May 2010 Wilson Memorial General Hospital WMGH September 2010 The McCausland Hospital MCCA September 2010 Nipigon District Memorial Hospital NDMH September 2010 fF Geraldton District Hospital GDHO September 2010 Z Manitouwadge General Hospital MGHO September 2010 ey ee eee St Joseph s Health Centre STJOE June 2010 Etobicoke General Hospital EHC January 2011 ef RODS 3E User Manual EDSS Version 05132013 _ 29 PEEL Brampton Civic Hospital BCH January 2011 Credit Valley Hospital CVH November 2011 FY Trillium Health Centre Mississauga MISS February 2013 re ree ee po Chapleau General Hospital CHS July 2011 __ Espanola General Hospital EGH February 2013 ___ Manitoulin Health Centre MHC
13. if an alert is generated The system employs a web based user interface that enables the user to examine the captured data RODS was developed at the University of Pittsburgh by the RODS Laboratory within the Center for Biomedical Informatics The tool was first deployed in 1999 at a single hospital in Pittsburgh Pennsylvania As of 2004 RODS performs emergency department ED surveillance for multiple states across the United States Ohio New Jersey Michigan California and Texas In the United States RODS surveillance is focused primarily on Bioterrorism related events however in Canada we are utilizing RODS to enhance existing public health surveillance with the aim of integrating RODS into current public health practice In September 2004 Kingston Frontenac and Lennox and Addington KFL amp A Public Health began conducting a 2 year pilot project to develop and evaluate an Emergency Department Syndromic Surveillance EDSS System in collaboration with the Ontario Ministry of Health and Long Term Care MOHLTC Public Health Branch Queen s University Public Health Agency of Canada PHAC Kingston General Hospital KGH and Hotel Dieu Hospital HDH The RODS system was selected as the surveillance tool best suited for the project The University of Pittsourgh s RODS Version 3 0 was modified to meet Canadian surveillance requirements The Canadian implementation is known as RODS 3E As of September 2005 data from KGH HDH Lennox a
14. lf syndrome classification is correct examine the cases Look at the time period date and time demographics age gender and area specifics hospital health unit postal code to see if any patterns or anomalies exist Plot the cases using Epiplot note that a default Epiplot view will be provided with an Alert display when the link is selected from the Get Alerts page to examine trends Use the wavelet function to display the threshold limit on the graph Map the cases using Mapplot to observe the location of residence of the cases This information may be valuable depending on the type of infection and its communicability to examine spread of disease and clustering If clustering is evident the investigator may examine schools daycares long term care facilities etc in the area and contact information will be available Note steps 3 and 4 are interchangeable If possible determine who is at risk e g children elderly living in long term care facilities individuals residing in an area defined by a postal code or FSA etc from the above steps NOTIFY Hospital s Physicians Doc Alert Branch Offices Cloyne Napanee Sharbot Lake and potentially other health units depending on the scope that this may be an outbreak situation and further investigation is required Public Health can raise awareness among hospital s of concerns related to infectious disease such that cases may be more readily diagnosed and the necessary pre
15. periods single tests can appear deceptively high on the graph We hope to address this in a principled way soon We also hope to provide data for additional lab tests and to eventually provide this data in real time Additionally iPHIS includes an outbreak module which will allow Public Health to collect information in a more timely manner nearly real time in the event of an outbreak The RODS system as modified for Canadian surveillance needs is designed to integrate with the applications and functionality of the new iPHIS system RODS 3E User Manual EDSS Version 05132013 ios Other Options Get Alerts Within the Epiplot screen selecting the Get Alerts option enables the user to display all alerts for the selected parameters data type time period and area The Alert will display information on the type of algorithm that generated the alert date and time of the alert syndrome observed count alert threshold and a data link to the view the alert in more detail The data link will provide a page containing graphs of the total visits visits by syndrome and normalized visits by syndrome for the two months leading up to the event In addition the data for all patients seen on the day of the alert will be displayed see below for a description of view of cases The detection algorithms are run every 6 hours In the event of the detection of a possible outbreak the appropriate authorities are notified via email Additionally th
16. token losing syncronization CryptoCard key fob All authorized RODS users are given a CryptoCard key fob Along with this they are provided with a user name which they are instructed to keep secure Logging into RODS requires that the user enter his her user name in the User name box In the Response box the user must enter the pseudo random 6 digit number generated by the key fob In order to prevent brute force approaches to hacking the site a key fob will be disabled after three failed login attempts If this happens the user will have to contact staff for re authorization see end of document for contacts RODS 3E User Manual EDSS Version 05132013 _8 Screen Navigation Area The screen navigation area offers 7 selections to choose from Main screen Epiplot Mapplot Options Help Contact and Logout 1 MAIN The first time you log into the RODS system you will see the Main Screen The Main screen provides the user with a simple overview of recent activity captured by the surveillance system and more importantly notifies the user of any ALERTS visible in the System Message Log This main screen will refresh itself every 2 minutes if you leave it displayed RODS Main Interface Microsoft Internet Explorer provided by KFL amp A Public Health Sais e Fie Edit View Favorites Tools Help Q zee Q x E A DO search Sie Favorites 2 En wi LJ 33 Address https www quesst ca rods2 2 0 authentica
17. EN St Joseph s Healthcare STO1 Hamilton Health Sciences Corp Juravinski March 2012 Key to Table Above KFLA Kingston Frontenac amp Lennox and Addington Public Health HPECHU Hastings and Prince Edward County Health Unit LGLHU Leeds Grenville and Lanark County Health Unit PCCHU Peterborough County City Health Unit SMDHU Simcoe and Muskoka District Health Unit NRPH Niagara Region Public Health NBPH North Bay Public Health EOHU Eastern Ontario Health Unit TBDHU Thunder Bay District Health Unit TOR Toronto Public Health NWHU Northwestern Health Unit PEEL Peel Region Health Unit SDHU Sudbury District Health Unit PHU Porcupine Health Unit THU Timiskaming Health Unit APH Algoma Public Health HRHD Halton Regional Health Unit GBHU Grey Bruce Health Unit CHPHS City of Hamilton Public Health Services RODS 3E User Manual EDSS Version 05132013 sgl
18. a collected during the registration triage process is much more detailed than the data set required by RODS The RODS ED data set requires only six data elements e Age Gender Postal Code 1st five digits Chief complaint as entered by the triage nurse Date time of visit Hospital Name Triage Acuity Level FRI score In addition similar elements are captured for emergency and elective admissions with the admission diagnosis captured in place of the chief complaint Figure 1 ED Data Capture and Flow Cycle for Syndromic Surveillance Step at Step VII Patient arrives al emergency Aggregated data is spatially mapped to show syndromic department for treatment distribution by postal codes 5 digits only ae a Data is also graphed to Indicate trands Access to this data is limited to authorized public health official via two factor authentication Crypto Secure ID fobs and Secure Socket certificates Step Il Patient Patient is triaged Ward Clerk records damographics amp chief presenting complaint details for purpese of clinical management hin Data Samples a E Record 1 Sore Throat 22 Male K7M 8G 01 01 05 10 35 02 Record 2 Stomach Pains 43 Female K7L 8G O7 07 05 70 36 79 Note This data is considered to be sufficiently depersonalized as not to constitute a threat to a specific person Step Ill ia Data is stored electronically in Health Information System HIS for retrieval by authorized healthcare pr
19. a combination of one recommended by PHAC and one recommended by the Centers for Disease Control and Prevention CDC The evaluation for the RODS 3E system examined the overall system and its ability to collect analyze and disseminate information related to infectious disease outbreaks The following elements of the system were evaluated System wide issues data sources data preprocessing statistical analysis epidemiologic analysis interpretation and investigation RODS 3E User Manual EDSS Version 05132013 _ 26 References Canadian Association of Emergency Physicians CAEP Implementation guidelines for the Canadian emergency department triage and acuity scale CTAS Version 16 11 30 1998 Available at http www caep ca 002 policies 002 docs ctased16 pdf Ontario Medical Association OMA Recommended Clinical Guidelines May 2003 Available at http www oma org pcomm OMR jul 03gac2 htm Public Health Agency of Canada PHAC Framework and tools for evaluating health surveillance systems Centre for Surveillance Coordination Population amp Public Health Branch March 2004 Version 1 0 Available at http www phac aspc gc ca csc ccs pdf i Surveillance Evaluation Framework v1 pdf Centers for Disease Control and Prevention CDC Framework for evaluating public health surveillance systems for early detection of outbreaks recommendations from the CDC Working Group MMWR 2004 53 No RR 5 inclusive page num
20. arly the spread of disease geospatial analysis changes in patient demographics and disease severity acuity levels Monitor the admissions primarily ED admissions to detect any patterns or anomalies in demographics or reason for admission Contact Hospital s as required Using RODS to examination of the demographics of an outbreak will allow the user to determine at an early stage the population who may be at greatest risk e g the very young or very old Through spatial soread and temporal analysis of the outbreak the user may readily determine the areas within which residents are at greatest risk and also monitor the spread of disease Refer to Figure 2 for a process flow of investigation of RODS generated alerts RODS 3E User Manual EDSS Version 05132013 Be gee Figure 2 Process flow for investigation of alerts generated by RODS public health Implement Public Health Intervention Monitor RODS for response to intervention Notify public health EH and CD hospital ED and infection control labs of potential outbreak CD EH processes for example Verify hospital records through VPN Consult iPHIS where appropriate Conduct additional case finding Examine cases by PERSON PLACE TIME Sample collection patient follow up as required Does the anomaly remain NO Is it of public health STEP 4 Collect significance additional information as required to prepare for public YES communicat
21. bers Available at http Avwww cdc gov mmwr PDE rr rr5305 pdf RODS 3E User Manual EDSS Version 05132013 gen RODS 3E CONTACTS QPHI EDSS TEAM Dr Kieran Moore QPHI Director Emergency Department Syndromic Surveillance EDSS Team 613 549 1232 x1121 Kieran Moore kflapublichealth ca Adam van Dijk Epidemiologist 613 549 1232 x1510 Adam Vandijk kflapublichealth ca RODS 3E User Manual EDSS Version 05132013 28 Schedule A List of Public Health Units and Hospitals Participating in EDSS Key below Abbreviation KFL amp A Kingston General Hospital KGH September 20050 SC Hotel Dieu Hospital HDH September 2005 Co Lennox amp Addington County General Hospital September 2005 LACGH ee Re HPECHU Belleville General Hospital BGH September 2005 _ pT Trenton Memorial Hospital TMH September2005 ______ _ po Prince Edward County Hospital PEC September 2005 __ North Hastings Hospital NHH September 2005 ___ D A Pe LGLHU Smiths Falls Hospital SFH July 2008 Fs Great War Memorial Hospital GWMH November 2008 Brockville General Hospital BRGH July 2009 aS ee a PCCHU Peterborough Regional Hospital PRH April 2009 ES ae _SMDHU Orillia Soldiers Memorial Hospital OSMH February 2010 Cd Georgian Bay General Hospital GBGH February 2010 __ _ en Muskoka Algonquin Hospital Bracebridge February 2010 MAH Muskoka Algonquin Hospital Huntsville MAH
22. cautions such as infection control procedures taken where appropriate The hospital s may also provide additional information to aid the investigation such as identifying RODS 3E User Manual EDSS Version 05132013 lt 90 additional cases refer to Table 1 for hospital ED hours of operation and other relevant information The Hospital Infection Control Practitioner ICP or designate Infection Control staff member is the contact for Public Health at the hospital The call Nurse on the floor may be contacted for information pertaining to admitted patients Ensure that the proper information date time of visit hospital number of cases comparison to seasonal trends lab data if available etc is ready at the time of call to ICP to facilitate efficient investigation ICP or designate staff member Contact Number 613 549 6666 x4015 613 544 3310 x2262 613 354 3301 x400 Refer inquiries to Public Health at HPE Quinte Health Care sites 613 966 5500 ask for Communicable Disease The Patient Care System PCS is accessible through VPN Virtual Private Network at KFL amp A Public Health This allows Public Health to access patient information that may be useful for investigative purposes including admission diagnosis demographics family doctor lab results x ray results patient history and bed history The downfall to this data source is that access is unreliable and there is a time lag for entry approximately o
23. e event is logged for future access File Edit View Favorites Tools Help sack 2 gt lt E En P Search Ze Favorites GF gt mj l rel C 3 Address https wew quesst cafrods2 2 0fauthenticate jsp sessionid 742024edgarb ED Registrations H u A hm D S m O me C Alert T d View Da L All Visits KFLA RLS Feb 28 2006 00 00 Gastroenteritis 73 0 72 926 Lini lioeerocntens KFLA RLS Feb 28 2006 00 00 Fever ILI 57 0 47 ess Lin rin me HPE RLS Feb 27 2006 00 00 Fever ILI 56 0 45 273 Lin a Few KFLA cusur Feb 27 2006 00 00 Gastroenteritis 23 0 15 876 Lin TI KFLA RLS Feb 26 2006 00 00 Fever IL 45 0 42 704 Lin eon HPE RLS Feb 26 2006 00 00 Respiratory 3510 297 689 Lin _ Derm Infectious HPE RLS Feb 25 2006 00 00 FeveriILI 49 0 43 857 Lin C Neuro Infectious HPE RLS Feb 24 2006 00 00 Respiratory 322 0 295 36 Lin C Severe Infectious KFLA CUSUM Feb 24 2006 00 00 FeverILI 7 0 12 426 Lin _ KFLA CUSUM Feb 23 2006 00 00 Gastroenteritis 12 0 10 822 Lin Admissions HPE CUSUM Feb 20 2006 00 00 Respiratory 53 0 52 636 Lin GET ALERTS at u ealth Unit All Start a 19 EA 200s Ass All E Hospital AN et Ale Elze Eazos f min Ave lo Tus sso len O oe Done B RODS 3E User Manual EDSS Version 05132013 EA ee Get Cases ED Visits Within the Epiplot screen selecting the Get Cases option enables the user to display a line listing o
24. f all cases for the selected parameters data type time period and area NOTE that cases can only be displayed for up to a one week period Aa PODS ei liter fies erosotanternetstplorer File Edit View Favorites Tools Help aa y Q peck QJ Address https www quesst ca rods2 2 0 authenticate jsp sessionid 742024edgarb x a vain SouthEast Data Type Al 3 P Search Pp Favorites Se TLE Triage Acuity FRI gt cs NS 2006 07 11 21 21 54 M BGH Oth IR WRIST INJURY 4 ED Registrations A a F M au visits 209 mM HDH Other PAIN RIGHT FLANK 3 F L Gastroenteritis All 1436 M HDH Other CRUSH INJURY RIGHT BABY FINGER 3 Ll Respiratory 1430 F PEC Oth RASH 4 es er revert V 1S1tS mi 1319 F KGH Other CHEST PAIN SHARPANORSE UPON MOVEMENT 3 _ Derm Infectious 2006 07 11 24 130 M PEC Other BITES 4 Neuro Infectious 2006 07 11 21 12 57 M NHH Other FB L EYE 3 O Severe Infectious 2006 07 11 21 11 48 M LACGH Other RENAL COLIC 3 ains 2006 07 11 21 08 52 M KGH Other UNRESPONSIVE OVERDOSE 1 CIAN Admissions 2006 07 11 21 08 32 F PEC Other SYNCOPE 4 _ Emergency Admissions 2006 07 1121 07 2 M TMH Fever lll FEVER 3 O Elective Admissions g 2008 07 11 21 06 10 F BGH Other L UPPER LEG PAIN 2 2008 07 11 21 05 12 F HDH Other INJURY RIGHT ARM BIKE ACCIDENT 4 2006 07 11 21 03 21 F NHH Other VAGINAL SPOTTING 4 2006 07 11 21 02
25. ge Level I the most severe where the patient requires immediate attention to Level V non urgent where the patient can wait to see a physician Each acuity level is based on a relationship between sentinel events as defined by ICD 9 diagnosis at discharge RODS 3E User Manual EDSS Version 05132013 _14 from ED and the usual way a patient presents with given conditions Interim assessment and or a change in the patient s condition may result in a new acuity level assignment Febrile Respiratory Illness FRI screening This data is only available for 7 of the 9 hospitals excludes SFH and GWMH The FRI questionnaire screens incoming patients for symptoms of cough or shortness of breath AND fever Sections A and B If the patient responds Yes to both of these sections they are asked questions from two follow up sections The first subsequent section asks about travel history or contact with others who have traveled to areas that would place them at high risk for infectious disease Section C In the second follow up section KG seen the patient is asked whether they work for a healthcare stp RERA TAAN ILLNESS SCREENING TOOL agency faci ity or organ ization ee or whether they are a resident ee of a long term care facility Please circle either yes or no for all questions Section D l A positive FRI test SECTION A Symptoms s oe results from positive responses Are you experiencing any new or worse cough OR shortness of b
26. hat moves the map display up by a fixed amount Pan down A single click operation that moves the map display down by a fixed amount Pan left A single click operation that moves the map display left by a fixed amount Pan right A single click operation that moves the map display right by a fixed amount Identify When this is active clicking on the map will reveal information in the data frame see below pertaining to the current active layer see below The information revealed depends on the active layer amp Print This button pops up a window containing the map and legend You are able to change the title of the map then select File gt Print to print the map Layer Selection Area This area located at the right of the screen displays a list of selectable layers It enables the user to turn on and off layers such as schools and hospitals It also enables you to select between the two data display types The square check boxes allow you to alter the visibility of layers Clicking Refresh Map will refresh the map with the new layer selections The circular radio boxes allow you to select a single active layer This is used for the identify function see above Some layers are only visible on the map at certain map scales If you turn on a layer and no information for that layer appears on the map try zooming in to a smaller map area Note The layers are currently under revision to incorporate additional sources as well a
27. intent of PHIPA Privacy Impact Assessment Document A Privacy Impact Assessment PIA document was also prepared which specifically addressed privacy issues as they related to the syndromics project The PIA addressed the following areas e Strategic plan addressing privacy protection Privacy procedures quidelines and controls Physical security and access control documentation Records management policies and procedures for personal information Project summary and description Listing of all personal data elements for project Personal Information Data flow diagram Personal Information access documentation Access Matrix Statutory authority documentation Both documents were submitted to the appropriate hospital authorities for review and comments Subsequently a formal request was submitted to the Queens University Research Ethics Board to proceed with the Syndromics Project Approval was granted on October 15th 2004 RODS 3E User Manual EDSS Version 05132013 _4 Data Capture within RODS 3E All data used in the RODS system is collected by the participating health care facilities during the registration triage process no additional workflow is required During registration at an Emergency Department details are collected and recorded describing both the patient and the visit Figure 1 This data is sent in Health Level 7 HL7 format to the facility s HL7 message router which in turn sends the data to all appropriate systems The dat
28. ions STEP 3 Communicate with YES Is further investigation NO or action required RODS 3E User Manual EDSS Version 05132013 93a Note Documentation for each action decision is required refer to Excel Spreadsheet In the event of that Public Health is notified of a respiratory or gastrointestinal outbreak occurring within the community How RODS can help Public Health staff will be notified via telephone call fax and or mail from a laboratory an institution such as long term care or daycare physician etc of an infectious disease event requiring further investigation In most cases this notification is concerning a reportable disease which must be reported by law to Public Health Public Health investigation is warranted for most reportable diseases unusually high incidence of disease particularly in institutions new or emerging diseases or any other infectious disease event deemed to be a threat to the health of the public Notification may come to any of the appropriate CD or EH team members during regular business hours Mon Fri 8 30am 4 30pm or to the Medical Officer of Health cell phone pager or assigned back up during evenings and weekends RODS may be utilized CONCURRENTLY or IN ADDITION TO standard investigative processes as follows o Following notification to Public Health examine the syndrome of interest time period demographics and location of interest One or more of these features may be explored ind
29. ividually to characterize the potential outbreak o Use Epiplot or Mapplot to display the desired information Contact ED for additional case finding o NOTIFY Hospital s Physicians Doc Alert Branch Offices Cloyne Napanee Sharbot Lake and potentially other health units depending on the scope that this may be an outbreak situation and further investigation is required Public Health can raise awareness among hospital s of concerns related to infectious disease such that cases may be more readily diagnosed and the necessary precautions such as infection control procedures taken where appropriate o Monitor RODS on a regular basis to assess real time ED visits of syndrome of interest use Epiplot and Mapplot to track changes in disease patterns O RODS 3E User Manual EDSS Version 05132013 DAs Dissemination of Alerts Automatic real time email notification of alert to syndromic surveillance team 24 7 If Alert is not acknowledged within 6 hours a phone call will automatically go to Project Director Dr Kieran Moore Monday to Friday 8 30 4 30 Regular KFL amp A Public Health business hours alerts requiring action will be sent manually by syndromic surveillance team to Marg McReynolds manager of Communicable Disease at KFL amp A Public Health or Communicable Disease nurse on call Marg will then delegate the alert as required to the appropriate person s Weekends and after hours alerts will be directed to the
30. l You select one or more syndromes to plot from the list on the left of the screen You select the time interval demographic and area selections from the menu at the bottom of the screen To create graphs in EpiPlot 1 Choose a data type currently only ED registrations and hospital admissions are available from the data type selection area Multiple selections can be made 2 Choose a time period from the time period selection area The default time period is last week The period field drop down selection button offers more time periods to choose from Highlight the time period you are interested in Additionally a custom time period can be chosen using the start and end date drop down buttons 3 Choose the demographic specifics you would like to plot Cases can be restricted by Gender M or F or by age you may select an age range specified by a minimum and or maximum age age ranges are inclusive or a commonly used age range from drop down menu e g school age senior 4 Choose the area specifics you would like to plot Here different Health Unit Hospital and Postal Codes may be chosen The Postal Code may be represented by either a 5 digit Postal Code or Forward Sortation Area FSA first three digits of the postal code RODS 3E User Manual EDSS Version 05132013 10 Which is used is determined by whether the area is rural or urban In urban areas the FSA represents a fairly small geographical area and thus is u
31. mp Addington County General Hospital LACGH in Napanee and 4 Hospitals in Hastings amp Prince Edward HPE Counties were being captured including Belleville General Hospital BGH North Hastings Hospital NHH Trenton Memorial Hospital TMH and Prince Edward County PEC hospital In addition to real time data retrospective data was provided from all hospitals A complete list of all our hospitals and health units are shown at the end of this manual The goal of the system is to monitor changes in the incidence of endemic disease and also detect new or emerging infectious disease threats The 2 syndromes of primary interest are respiratory and gastrointestinal RODS has a dual use in that it may enable Public Health to protect the health of the community and it may be used by the hospital emergency departments ED and administration to monitor ED volume ED admissions and surge capacity In turn this will allow hospitals to prepare for high volumes of patients particularly in the event of a flu pandemic The Canadian RODS 3E system has been designed to reflect the recommendations set forth in the Walker Kirby Naylor and Campbell Reports on Public Health This user manual introduces concepts of the RODS system outlines how to navigate the user interface and provides specific instructions for viewing Healthcare Registration data ED Visits and Hospital Admissions Additionally this manual will demonstrate how the RODS 3E User Manual
32. nd also ensure the system is classifying appropriately o ED Admissions examine trends or anomalies by demographics area and or reason for admission Hospital administration can monitor ED volume and prepare for added volume in the event of an outbreak e Hospital admissions will be monitored daily for the occurrence of admissions of interest to Public Health for example encephalitis hepatitis pneumonia clusters and meningococcal disease Public Health will be notified of these and other admissions of interest o Elective Admissions examine volume of patients admitted reason for admission predict admission volume given surgery days primarily for use by Hospital administration RODS WEEKLY MONITORING RODS bi weekly reports are generated and distributed to CD and EH teams as well as to participating hospitals Infection Control Communicable Diseases Emergency Departments Physicians and residents Nurses etc These summary reports include alerts if applicable of admissions increases in syndromes graphs tables etc From the Public Health standpoint these reports should provide the impetus for further investigation into areas of interest and also raise awareness of trends and unusual events such that Public Health can continue to monitor for these trends or anomalies EVALUATION An evaluation framework for the RODS system as it is utilized by KFL amp A Public Health is completed The evaluation framework included
33. ne day Similarly information is available from patient records but it is approximately one day delayed NOTE THAT NO LAB TEST HAS BEEN IMPLICATED IN STEPS 1 6 OF THE INVESTIGATION AS OUTLINED ABOVE The early lead time provided by a RODS Alert may be crucial to preventing and controlling an outbreak within a healthcare setting institution the community or both CONTACT Hospital Laboratory for ED visits or admitted patients Public Health Laboratory for samples related to outbreak investigation and tests outlined on the Ontario Public Health Laboratory Testing Menu and or private laboratories to request number of test requisitions positive results preliminary or otherwise negative results type species identification etc Table 4 Access to information and timeliness of results will depend on the laboratory and the outbreak Microbiological lab data is available from patient records This data should be examined initially and where not available the lab should be contacted for preliminary results RODS 3E User Manual EDSS Version 05132013 1 Table 3 Lab Contacts for Participating Hospitals and Public Health Laboratory Name Contact Number KGH 613 549 6666 x4178 Samples sent to KGH LACGH Samples sent to KGH Kingston Public Health 613 548 6630 Pre op blood work only samples sent to MDS Labs Quinte Health Care sites 8 Continue to monitor RODS for real time ED visits of syndrome of interest particul
34. o M KGH_ ED Admission HYPERBILIRUBINEMIA SPELL NOT YET DIAGNOSED 2005 08 21 23 00 78 M HDH Elective Admission DEMENTIA 2005 08 21 22 41 77 M KGH ED Admission SUBDURAL HEMATOMA 2005 06 21 22 13 48 M ken Elective Admission INFERIOR MYOCARDIAL INFARCTION 2005 06 21 20 50 47 M ken ED Admission CHEST PAIN QUERY ANGINA 2005 06 21 20 16 71 F KGH__ ED Admission TRAUMA 2005 08 21 19 39 78 M KGH__ ED Admission RESPIRATORY FAILURE 2005 08 21 19 11 se F KGH ED Admission RIGHT ANKLE FRACTURE 2005 08 21 19 05 62 m KGH__ ED Admission UPPER GI BLEED 2005 08 21 19 03 63 M KGH__ Eledtive Admission MYOCARDIAL INFARCTION 2005 08 21 19 00 lee F IKGH Elective Admission WOUND INFECTION 2005 06 21 18 52 73 F IKGH EDAdmission SMALL BOWEL OBSTRUCTION 2005 06 21 18 49 33 F ken ED Admission ABDOMINAL PAIN NOT YET DIAGNOSED 2005 06 21 18 25 88 F IKGH ED Admission RIGHT HIP FRACTURE 2005 06 21 18 03 lo F KGH Elective Admission 2005 06 21 18 00 73 F KGH ED Admission CRESCENDO TRANSISCHEMIC ATTACKS Period Last 2 Days v Gender al v Health unit An w PostalCode Normalize CresteEpiplots Stat Jun vl2o wilfzoos Age An E Hospital Al v wassat End Jun vll22 wlfzoos Min Age o Max Age 120 KV ee ww Documenti Microsof lt RODS 3E User Manual EDSS Version 05132013 16 3 MAPPLOT Mapplot allows the user to examine the spatial di
35. onse RODS 3E User Manual EDSS Version 05132013 19 RODS Integration into Public Health The following section will outline how the RODS system can be integrated into the existing Public Health outbreak investigation process RODS can provide the Public Health staff with valuable information by 1 notifying them of a potential outbreak situation through automatic alerts generated by the RODS system and 2 providing a resource of additional information in the event that they are notified about an outbreak within the community The steps to the investigation process including the integration of RODS will be outlined below In the event of a RODS alert Public Health staff will be notified via email that an alert threshold has been reached through one of the detection algorithms meaning that the observed count for a particular syndrome exceeds the expected by a pre determined amount For the initial stages RODS 3E team members will investigate the alerts and then where warranted pass on the alert via email to Communicable Disease CD and or Environmental Health EH teams Steps in the investigative process are as follows 1 Confirm the syndrome classification Verify by viewing the cases via the Get Alert link that the syndrome classification correctly corresponds to the chief complaint lf syndrome classification is incorrect or inconsistent please make note of the discrepancies and contact RODS staff member s
36. otal cases The graph for All Visits is unaffected Wavelet The wavelet is a form of smoothing which attempts to fit a weighted average to the data accounting for natural sources of variance such as day of the week and time of year in addition to overall trends in the data e g a general upward trend caused by an increase in the population The line presented on the graph is actually a wavelet representing the average plus two standard deviations Any time the data moves above this point it represents an interesting event which should be investigated Lab Data Select this to show the number of positive lab results for your given age and gender selected from the Reportable Disease Information System RDIS database Currently we have RDIS data for flu tests until the end of 2004 The existing RDIS system was replaced by the Integrated Public Health Information System IPHIS in June 2005 The iPHIS system collects additional lab information and enables the user to easily create reports of the lab data Flu is shown both on the Respiratory and Constitutional graphs Because flu tests are quite rare relative to the case counts we typically see it is necessary to exaggerate the values We do this by applying a factor making the highest point on the flu line three quarters the height of the highest point on the case count line This tends to give a reasonable representation for long time periods one year and over Bear in mind that for short
37. oviders Storage and management practices comply with FHIPA Triage Syndromics a H DataBase Public Health Kingston Frontenac Lenox amp Addington VPH Firewall mini at Pam at in mn oe AT ee HIS 5 Fi Che ckp oint Firewall f VPN Firewall Step IV Step V SONT HL7 data is routed via a point to point VPN tunnel to the Data is routed over a secure provincial health network Data is parsed structured then classified into syndromes Syndromic Surveillance Engine located at the local Public know as Smart Systems for Health counted then stored in a SQL database Anomaly Health Facility KFL amp A Detection Algorithms analyze the data for tends or unusual events and generate alerts as appropriate _KFILAA h te of A Aligistey of Se Health and Long Term Care ee oto HealthUn RODS 3E User Manual EDSS Version 05132013 5 In order to comply with PHIPA the HL 7 message router deletes identifiable information from the data and transmits this minimal data set to RODS A Bayesian text classifier then categorizes the visit into one of seven syndromic categories based on the chief complaint refer to Table 2 for examples These 7 Categories are Gastroenteritis Respiratory Fever ILI Asthma Dermatological Derm Infectious Neurological Neuro Infectious and Severe Infectious These syndrome categories are then sorted and analyzed by various detection algorithms designed to detect anomalies
38. reath denn ae to Sections A AN D B in arith Alco ana conjunction with positive Are you feeling feverish have you had shakes or chills in the last 24 hours NO YES Take temperature Take temperature responses to either Section C nominee B beeren OR Section D Hospital continue to Section Section C en C H lt 2 no infection control is notified TEMPERATURE here c immediately upon a positive FRI Ferree ovate reg gen Aia surgical mask and eye protection on healthcare worker scree ni ng resu It Th e F R SECTION C ContactTravel History screening questionnaire is Ken amin nne MAAD AADO ee Oris re recautions and recom mended practice to all ii dii next notify Infection Control 1 1 1 Check the KGH intranet site for additional high risk geographical question pb pg vee h ospitals n the provi nce and areas ontinue to ction x A epe arbei Sra eega ii to spain ere and th e travel h sto ry CO m po ne nt a Ape can be quickly altered to Continue to Section D highlight areas with SECTION D Additional Questions for Patients who answered YES to Sections A and B 1 Do you work for a healthcare agency Facdity or organization NO YES epide miolog ical lin ks to Cu rre nt Continue to Identify facility and leave a i i P outbreaks The inclusion of Aen EESTE REE OENE i entity facity and leave a these elements in the RODS message including patient s i nae ane ON ond RF data set provides tools to info
39. rm If YES Facility name Infection Control notified by any Public Health response to O an alert generated by the KGH Stores XXXXX 2004 02 Page 1 of 1 system FEBRILE RESPIRATORY ILLNESS SCREENING TOOL NON OUTBREAK Both Triage Acuity and FRI screening data are valuable tools for monitoring the morbidity of disease and its associated mortality For example patients are not admitted for pneumonia unless their symptoms result in a sufficiently high score on the Pneumonia Severity Index PSI When more patients are admitted with pneumonia morbidity is higher and thus associated mortality is likely to increase RODS 3E User Manual EDSS Version 05132013 15 Get Cases Admissions Hospital admissions both ED and elective are captured in real time from all hospitals A RODS Main Interface Microsoft Internet Explorer File Edit View Favorites Tools Help Q x x a A J search jg Favorites 4 B ey wj hang ga 3 SouthEast Address https www quesst ca rods2 2 0 authenticate jsp sessionid 894048edgarb Inbox Microsoft Out Zj RODS Main Interfac A EARS Date Admitted f lage Gender
40. s contact information RODS 3E User Manual EDSS Version 05132013 _18 Information Area This area located immediately below the map displays information generated by the Identify function For layers such as hospital and school this will display the name of the institution clicked the address and any available specific information For the data layers this will display the geographical area and the raw case count as well as the normalized value and percent of average Query Area Located at the bottom of the page this menu allows you to select the data you want to map Pressing the Query button will refresh the map with your selected data There are several independent options 4 Options The user can select default settings for the Main Page EpiPlot and MapPlot within the limits of RODS capabilities Once the default settings have been made the display will be customized for the user s preferences 5 Help This function allows the user to view a brief description of the tools within RODS similar to the user manual The information will be specific to the active page For example selecting Help within Epiplot will display the functions within Epiplot 6 Contact The user is able to send an email to RODS staff regarding questions or concerns related to the system 7 Logout The Logout function will disconnect the user from the system In order to access RODS again the user is required to re enter User name and Resp
41. sed However in rural areas FSA is far too large to be of use Therefore the first five digits of the postal code are used instead After choosing data type time period demographics and area specifics select Create Epiplots ARDDSMaminterfaces MierssotdintenneLbalrer File Edit View Favorites Tools Help Q ee i ew x H A pO Search 5 Favorites ee ee wl a LJ rel 9 33 O Derm Infectious CJ Neuro Infectious O Severe Infectious ED Registrations All Patients Participating Hospitals All ll Admissions Jan Admissions 750 CJ Emergency Admissions C Elective Admissions eo 600 Time pene Age Gender Area health unit hospital postal code CREATE EPIPLOTS Period Custom Dates iv Health Unit All PostalCode C Normalize ER NS EO r ae i cut so e Geel EEC weal End Aug Elze E2008 C hev Z Oraisons C cecs amp Done 8 Internet Gender All K Age All w Create Epiplots Hospital All iv Min Age lo Max Age 130 FRI F i V All visits _ Gastroenteritis Ll Respiratory Data T e C Feveriki Ll Asthma RODS 3E User Manual EDSS Version 05132013 atte Additional Graphing Options Normalize Instead of graphing the total number of cases for a given syndrome which has natural variance e g by the day of the week plot the number of cases as a percent of the t
42. stribution of emergency department visits The data can be displayed in two formats Normalized Case Counts where for the selected syndrome you will see the percentage of total visits which that syndrome represents or Case Counts vs Average where you see the case count as a percentage of the average case count for that syndrome demographic for that geographical area The screen display consists of 5 areas Map Area Found in the center of the screen this displays the desired mapping information Clicking on this map performs the action specified by your selected action see below The upper left corner displays an overview map of the province Clicking the overview map moves the main map display to the selected area on the overview map RODS Main Interface Microsoft Internet Explorer File Edit View Favorites Tools Help w ar A nn VA SE Q G sex amp x A 4 p Search Se Favorites 7 Sa wj hang rel 33 Address https www quesst ca rods2 2 0 authenticate jsp sessionid 894048edgarb v rd Go Links 2 Me n SouthEast ARQ Matton O40 Layer List Local Towns b Cities Child Care Nursing Homes Hospitals Schools Major Roads Railways d O ad South East LHIN d d 0O Postal Region Labels Std Devistions Show Legend LHIN SouthEast rvs Period Today M Gender All _ std Deviation og J ede oo J O semana End Jun 22 we 2008
43. syndromic surveillance team and Dr Kieran Moore as above however if an alert requires follow up investigation on an urgent basis Dr lan Gemmill Medical Officer of Health or designate on call will be contacted Following initial assessment by the syndromic surveillance team alerts will be also be sent via email to hospital ED physicians and manager residents ICP Contact Numbers Dr Kieran Moore 613 549 1232 x 1121 Marg McReynolds 613 549 1232 x 1254 Dr lan Gemmill Pager 888 313 5097 Public Health Additional Investigation through RODS The syndromic surveillance team is on call to help ongoing Public Health EH or CD investigations The team Adam van Dijk may be contacted Monday Friday 8 30 4 30 During weekends or after hours Dr Kieran Moore may be contacted Contact Numbers Adam van Dijk 613 549 1232 x1510 Dr Kieran Moore 613 549 1232 x1121 RODS 3E User Manual EDSS Version 05132013 25 RODS DAILY MONITORING RODS is monitored DAILY for the following to ensure that the system is functioning properly and also to provide information to Public Health and Hospital Administration on infectious disease events o ED Registrations examine visits by syndrome demographics area and time period An alert will be generated automatically in the event of an aberration however daily monitoring can provide Public Health with a good indication of baseline incidence weekly and seasonal trends etc a
44. te jsp sessionid 5676 14edgarb v Go Links ALERTS Displayed Here All Patients System Message Log 07 17 2006 00 14 Derm Infectious alarm in KFLA by CUSUM where raw count 14 000 exceeded 12 686 A 07 11 2006 00 14 Fever ILI alarm in KFLA by CUSUM where raw count 11 000 exceeded 7 456 al 07 11 2006 00 14 Asthma alarm in KFLA by CUSUM where raw count 12 000 exceeded 10 181 wl ED Registrations All Patients Participating Hospitals ED Registrations All Patients Participating Hospitals ED Registrations All Patients Participating Hospitals ED Registrations All Patients Participating Hospitals All Gastroenteritis Respiratory Fever ILI EG en g sens ast Data Type Health Unit Data type ED Registrations K Health Unit All L Normalize Done amp internet 4 start E Inbox Microsoft Out Z KFL amp AHealthUnit 2 Buildings in Kingston RODS Main Interfac E RODS User Manual fo fw CE 8 48AM For performance purposes counts are computed and cached at regular intervals each day The counts you see for a given day will be the number of patients which were seen in the 24 hours leading up to that time Therefore depending on the time of day many of the recorded patients for a given day will actually have occurred on the previous day Counts are computed as follows 12 05 am 6 05 am 12 05 pm and 6 05 pm RODS 3E User Manual EDSS Version 05132013 _9
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