ESSENCE

ESSENCE Background
Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) software is a system that inputs electronic emergency department (ED) data for the purpose of syndromic surveillance. 

Syndromic Surveillance Background
Syndromic surveillance is the use of non-traditional data sources in order to detect public health events earlier than possible with other methods (laboratory confirmed diagnosis, physician diagnosis).  Examples of syndromic surveillance data include over-the-counter drug sales, laboratory report orders, and absenteeism rates. 

Missouri conducts syndromic surveillance using electronic hospital emergency department (ED) visits.  DHSS receives data from hospitals meeting certain criteria under 19 CSR 10-33.040 specifically for syndromic surveillance.

ESSENCE groups chief complaints from electronic ED data into ‘syndrome’ categories.  This information is used to determine if the number of visits is greater than expected for that facility based on historical data and statistical analyses to conduct early event detection.  Syndrome groups used are: botulism-like, fever, gastrointestinal, hemorrhagic illness, neurological, rash, respiratory, and shock/coma.

ESSENCE can also be used for situational awareness during known health events by querying all ED visits for a particular syndrome or by keyword (such as carbon monoxide, animal bite, injury, etc.). 

Missouri ESSENCE Contributors
The Missouri ESSENCE Project is made possible by a number of internal and external partners.  These partners include:

• Johns Hopkins University Applied Physics Lab (who developed and supports ESSENCE software)
• DHSS Information Technology Services Division
• Missouri ESSENCE Workgroup and Senior Epidemiologists
• Hospitals that send electronic data under 19 CSR 10-33.404
• Public Health Event Detection and Assessment (PHEDA) Program (which oversees the Missouri ESSENCE Project)

Missouri ESSENCE Access
Only authorized users who have been issued a username and password may access Missouri ESSENCE.  It is important for DHSS to grant access to relevant partners to fulfill project’s mission, which is to help state and local partners respond to adverse public health events by providing information and tools for early event detection and situational awareness.

DHSS may grant Missouri ESSENCE access to:

• Public health authorities including those employed at DHSS or local public health agencies so they can view statewide data. (See http://www.dhss.mo.gov/ESSENCE/ASAP_Instructs_LPHAs.doc for instructions for public health professionals to register for Missouri ESSENCE access.)
• Staff from hospitals or hospital groups that send electronic ED data under 19 CSR 10-33.404 so they can view their own data. (See http://www.dhss.mo.gov/ESSENCE/ASAP_Instructs_Hospitals.doc for instructions for hospital staff to register for Missouri ESSENCE access.)

Future Missouri ESSENCE Plans
DHSS is exploring the best approach to obtaining new data sources to enhance the Missouri ESSENCE system including:

• School absenteeism
• Over-the-counter pharmacy sales
• Rural hospitals not required to report under 19 CSR 10-33.404   
• Other patient-level data sources

Missouri ESSENCE Map

Missouri ESSENCE Policies and Procedures

Bioterrorism Surveillance System