meghan m. weems, mph june 4, 2012
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Electronic Disease Notification (EDN). Immigrant, Refugee, and Migrant Health Branch Division of Global Migration and Quarantine. Meghan M. Weems, MPH June 4, 2012. Overview. Background The evolution of EDN Direction forward. EDN Background. - PowerPoint PPT PresentationTRANSCRIPT
National Center for Emerging and Zoonotic Infectious DiseasesDivision of Global Migration and Quarantine
Meghan M. Weems, MPH June 4, 2012
Electronic Disease Notification (EDN)
Immigrant, Refugee, and Migrant Health Branch
Division of Global Migration and Quarantine
National Center for Emerging and Zoonotic Infectious DiseasesDivision of Global Migration and Quarantine
Overview
•Background•The evolution of EDN•Direction forward
EDN Background• Immigrants and refugees
required to undergo TB screening/medical examinations before entering US.
• Over 670 panel physicians (overseas physicians), designated by the US Department of State, perform these screenings.
~450,000 new immigrants and refugees arrive in the US each year with their medical examination documentation.
• These medical documents—for all refugees and only immigrants with medical conditions such as TB—are collected at one of 20 CDC quarantine stations .
EDN Background Cont.• Refugees and immigrants with culture- or
smear-positive TB are treated prior to arrival in the US.
• After arrival, CDC’s Electronic Disease Notification system (EDN) notifies nearly 500 TB and Refugee Health coordinators in health departments of the results of overseas medical examinations.
• Heath departments can enter results of post-arrival TB evaluations into EDN (TB follow up).
• In October 2008, EDN completely replaced the previous paper-based system.
Notification History
AIS*
1995 20102000 2005
IMP* EDN200719991995
2008—100% centralization
DGMQ Quarantine Stations mail to U.S. Health Depts
EDN sends electronic notification
AIS—Alien Information SystemIMP—Information of Migrant PopulationEDN—Electronic Disease Notification
*limited medical data collected
Broad Partnerships• Division of TB Elimination (CDC)• State and local health departments–Refugee Health Coordinators– TB Controllers
• Federal partners–Department of State–Department of Homeland Security
• International Organization for Migration (IOM)
• Resettlement Agencies
EDN Information Flow
Department of State Medical Forms
(DS Forms)• Forms used under 1991 and 2007 TB Technical Instructions–DS 2053/2054 Medical
Examination for Immigrant or Refugee Applicant–DS 3024/3030 Chest X-Ray and
Classification Worksheet–DS 3026 Medical History and
Physical Examination Worksheet–DS 3025 Vaccination
Documentation Worksheet
DS-2054—Medical Examination
The Evolution of EDN
EDN User Community• Nearly 500 active users• Health Departments in all 50 States
(state, county, and local) & Washington, D.C.–263 jurisdictions
• TB Controllers (199)• TB/Refugee Health Coordinators
(176)• Refugee Health Coordinators (110)
EDN Users 2006-2011
2006 2007 2008 2009 2010 20110
50
100
150
200
250
300
Number of Users
Number of Jurisdictions Added
EDN Users Cont. • 11 states have local jurisdictions
(171 total)• Arizona- 1 County• California- 61 Counties• Colorado- 1 County• Florida- 67 Counties• Georgia- 1 County• Idaho- 3 Health Districts• Illinois- 1 City, 1 County• Michigan- 4 Counties• New York- 1 City• Oregon- 3 Counties• Texas- 27 Counties and Health
Districts
• Newly added jurisdictions in 2011 (10)• Midland County TX• DeKalb County GA• Public Health District 3 Idaho• Public Health District 4 Idaho• Public Health District 5 Idaho• Wayne County MI• Detroit City MI• Kent County MI• Oakland County MI• Maricopa County AZ
• States with first time local jurisdictions (4)• Georgia• Idaho• Michigan• Arizona
EDN Jurisdictions- 2012
EDN Jurisdictions
• Current local jurisdiction setups:• Major Metro – High-volume counties
have direct access; state controls lower volume counties (AZ, CO, GA, ID, IL, MI, OR)
• Complete Split – State is completely segmented into counties/regions, state-level users are only supervisory (CA, FL, TX)
Local Jurisdiction Access
• TB follow-up rates were greater in states where local and city health departments had access to EDN than those who did not (chi-square p <0.01).
Table. Reporting Rates Stratified by Access Type Access Type Mean Reporting (%)Local Access 80.0No Local Access 70.6• Excludes all U.S. territories• Numbers are based on arrival data from October 2010 to March 2011.
Notification Data for 2011• US Total- 73,493• Average time from arrival to notification- 5 days• FY 2010- average time was 11 days
• Immigrants- 18,412• Average time from arrival to notification- 5 days• FY 2010- average time was 13 days
• Refugees- 51,097• Average time from arrival to notification- 5 days• FY 2010- average time was 11 days
Days from Arrival to Notification 2009-2011
2009 2010 20110
5
10
15
20
25
30
35
40
45
Median Days- Total
Median Days- Immigrant
Median Days- Refugee
EDN Data January-December 2011
Visa Type n* All TB Conditions %
Refugee 51,097 4,205 8.23
Asylee 3,984 183 4.59
Immigrant 18,412 17,846 96.93
TOTAL 73,493 22,234 30.2
*Number of EDN notifications
Top 5 Birth Countries for US-bound Immigrants and Refugees- 2011
• Immigrants– Philippines–Mexico– China– Dominican
Republic– India
• Refugees– Cuba–Myanmar– Bhutan– Iraq– Nepal
Top 10 Birth Countries of US-bound Immigrants and Refugees- 2011
Areas of Progress
• EDN Improvements
• Continued partnerships
Recent EDN Improvements • Easier access to EDN
– System upgrade—Microsoft SQL server upgraded to alleviate stalls
– Single password access with 1 year expiration• Users no longer required two passwords to
access the EDN web-interface. The 30 day password expiration was removed.
• System activity reports– Percentage of TB worksheets started– Sub-migrations to and from
Recent EDN Improvements cont.• Alien information page now includes
some Pre Departure Medical Form (PDMS) data– Anti-Malarial and Anti-Helminthic
treatment– Pre Departure vaccination information
• Added Hansen’s Disease module– Federal Hansen’s disease users will
receive notifications of refugee/immigrants diagnosed with Hansen’s disease.
Continued Partnerships• EDN Workgroup• IOM (International Organization for
Migration)• Department of State (DOS): Refugee
Processing Center (RPC), Bureau of Population, Refugees and Migration (PRM), Consular Affairs (DOS)
• Department of Homeland Security (DHS): Custom Border Protection (CBP)
EDN Workgroup• Began as NTCA EDN Workgroup• Re-structured– Current Members• 2 co-chairs TB and refugee health
coordinator• 10 representatives representing US
regions• DTBE and DGMQ Federal participants
• Purpose a forum to address user needs/concerns and to provide accountability for improvements
• Meet every other month• Created subgroup to discuss TB follow up
form
EDN Worksheet Sub-Workgroup• Sub-workgroup created May 5, 2011
• Goals–Discuss and finalize goals of TB
follow-up data collection• Guide revision process
–Update current TB worksheet to increase• Consistency and accuracy of data collection• User friendliness • Overall EDN reporting
–Develop standardized protocol for secondary migration
IOM Data• Data feed ~65% of
refugee data comes from IOM’s MiMOSA database
• Providing additional data to better assist US health coordinators– Information refugee
camp, language, ethnicity, etc.
– Pre-departure treatment against intestinal parasites and malaria, and pre-departure vaccinations
Refugee Processing Center
• Receive scan documents for 100% of refugees within 24-48 hours of arrival
• Coupled with ~65% electronic refugee data from IOM
• Outcome=Improved notification time
Consular Affairs and CBP• Collaborate with US Department of State
and Custom Border Protection (CBP) on Consular Electronic Application Center (CEAC) project• To provide electronic medical data from overseas panel
physicians• Decreased need for manual data entry at
CDC• Improved accuracy of data• Faster notification times• A work in progress
Direction forward• Continue to improve notification time
• Improve data quality–Data from panel physicians
• Establish new users– Encourage local health department
access– Users in Puerto Rico, Virgin Islands,
Guam, etc.
Direction forward continued• Fulfill DTBE/DGMQ MOU
- Implement new TB follow up form• Implement recommendations to improve
TB follow-up reporting–New access types for local health
departments– System reports
• Continue active collaboration with Federal partners
EDN Team• Medical Director Rossanne Philen, MD, MS, CAPT USPHS
• Program Coordinator Meghan M. Weems, MPH
• Public Health Advisor Kendra Cuffe, MPH
• Data Entry Center (DEC) Manager Nekeia Gray, BS
• Data Entry Center Staff Ashley Mizell, Iris Gaye, Willie Bradley, Rhonda Rhodes-Price, Keisha Thomas, Dale Atkinson, Tanya Garcia, Mytrice Grier, Matrilla King, Sharon Davenport, Kourtney Powers, Jason Rochon
• Informatics team Daniel Wenger, Charlie Miller, Wei-Lun Juang, Dan Reed
National Center for Emerging and Zoonotic Infectious DiseasesDivision of Global Migration and Quarantine
Thank you!
Meghan M. [email protected]
1-866-226-1617