This poster was created for the Engineered Solutions course in partial fulfillment of the MS in Conservation Medicine program at the Cummings School of Veterinary Medicine at Tufts. It describes the "Veterinary Health Event Reporter" as a proposed technological solution to improving data sharing between agencies involved with zoonotic disease outbreaks.

1. Improving Disease Surveillance in the United States
Using Companion Animal Data
Pamela A. Okerholm
Tufts University Cummings School of Veterinary Medicine
THE UTILITY OF SURVEILLANCE DATA
REFERENCES
ABSTRACT
CONTACT
Pamela A. Okerholm
MS Candidate in Conservation Medicine 2013
Tufts Cummings School of Veterinary Medicine
Email: pamela.okerholm@tufts.edu
Zoonotic diseases, those transferred
from animals to humans, comprise
approximately 60% of all human
pathogens and account for 75% of recent
emerging diseases. Although the main
host for only 3% of known zoonoses,
humans are the primary source of public
health surveillance data. Detecting a
zoonotic disease outbreak in its primary
reservoir would allow public health officials
to reduce its impact on the human
population by initiating containment
protocols earlier. However, efforts to
strengthen disease-reporting systems in
the U.S. through biomedical informatics
have largely neglected companion animals
due to infrastructure and financial
constraints.
We propose to create a Veterinary
Health Event Reporter (VHER) web
application that will serve as an
information node for public health officials,
doctors, and veterinarians. VHER will
accept two data streams. First, practicing
veterinarians may enter case data for
notable or legally reportable diagnoses.
Second, trends in microbiological testing
at veterinary diagnostic laboratories will
serve as a source of syndromic
surveillance data. A published cumulative
sums algorithm will be used to analyze the
veterinary diagnostic laboratory reports.
The VHER application will incorporate
existing code from the Wildlife Health
Event Reporter web application, allowing
data to be collected online and alerts to be
issued via RSS feed, Google Maps, and
email. Providing electronic web-based
access to companion animal diagnostic
data, will give health officials real-time
access to a previously under reported
source of zoonotic disease surveillance
data.
VETERINARY DATA SHARING BARRIERS
• Paper medical records and laboratory reports still in use
• Electronic laboratory and clinical records stored separately
• Sensitivity of information (client privacy)
• Practice Management software systems designed for hospital
administration, not medical record keeping
• Limited use of biomedical informatics
• Lack of inter-agency terminology and messaging standards
• Budgetary constraints impacting staff, IT resources, sample testing, etc.
• Automated linkage of veterinary and human electronic databases is rare
1. Companion Animal Parasite Council: Parasite Prevalance Maps http://www.capcvet.org/parasite-prevalence-maps/
2. Day MJ, Breitschwerdt E, Cleaveland S, Karkare U, Khanna C, Kirpensteijn J, et al. (2012) Surveillance of Zoonotic Infectious
Disease Transmitted by Small Companion Animals. Emerging Infectious Diseases :1-10.
3. HealthIT.gov: Meaningful Use. http://www.healthit.gov/policy-researchers-implementers/meaningful-use
4. IDEXX Laboratories LabREXX http://www.idexx.com/view/xhtml/en_us/smallanimal/reference-laboratories/integrated-
services/integrated-labrexx.jsf?SSOTOKEN=0
5. International Society for Disease Surveillance: Meaningful Use Resources. http://syndromic.org/programs/meaningful-
use/meaningful-use-resources
6. Nsubuga P, White ME, Thacker SB, et al. Public Health Surveillance: A Tool for Targeting and Monitoring Interventions. In: Jamison
DT, Breman JG, Measham AR, et al. (2006) Disease Control Priorities in Developing Countries. 2nd edition. Chapter 53. Available
from: http://www.ncbi.nlm.nih.gov/books/NBK11770/
7. Scotch M, Mattocks K, Rabinowitz P, Brandt C (2011) A qualitative study of state-level zoonotic disease surveillance in new
England . Zoonoses and public health 58:131-9.
8. Scotch M, Rabinowitz P, Brandt C (2011) State-level zoonotic disease surveillance in the United States . Zoonoses and public
health 58:523-8.
9. Shaffer LE, et al. (2008) Evaluation of Microbiology Orders from a Veterinary Diagnostic Laboratory as a Potential Data Source for
Early Outbreak Detection. Adv Dis Surv 6(2): 1–7.
10. Small Animal Veterinary Surveillance Network http://www.savsnet.co.uk/
11. Wildlife Health Event Reporter http://www.whmn.org/wher/
Table 1. Adapted from Nsubuga et al. 2006 Table 53.1
Immediate detection of Epidemics
Newly emerging health problems
Changes in health practices
Changes in antibiotic resistance
Changes in distribution of population at risk for Disease
Periodic dissemination for Estimating magnitude of a health problem, including cost
Assessing control activities
Setting research priorities
Determining risk factors for disease
Facilitating planning
Monitoring risk factors
Monitoring changes in health practices
Documenting distribution and spread of disease and injury
Stored information for Describing natural history of diseases
Facilitating epidemiologic and laboratory research
Validating use of preliminary data
Setting research priorities
Documenting distribution and spread of disease and injury
EXISTING DATA SHARING SCHEMES
Annual Parasite Prevalence Maps provided by the Companion Animal
Parasite Council are made available to the public using veterinary
diagnostic laboratory test results shared by and Antech Diagnostics.
Both laboratories now also provide online test result access to
providers. The LabREXX software by IDEXX even enables providers to
import test results into their existing practice management software.
The Small Animal Veterinary Surveillance Network in the United
Kingdom developed a scheme to allow veterinarians to enter case data
into shared practice record keeping software. The network is recruiting
veterinary diagnostic laboratories to implement a syndromic
surveillance effort using commercial laboratory test order reports.
The Wildlife Health Event Reporter website allows citizen scientists to
report dead, sick, or injured wildlife. It then generates a publicly
available RSS Feed and Google Map of reported events. This output,
and mobile app technology, is similar to that of HealthMap, a web data
aggregator reporting both human and animal health related news.
PROPOSED DATA SHARING SOLUTION
We propose an alternate strategy for incorporating companion
animal veterinary data into public health disease surveillance,
without a major advance in veterinary biomedical informatics.
The new Veterinary Health Event Reporter (VHER) website
will combine existing data sharing schemes with a veterinary
diagnostic laboratory data feed.
Microbiological order reports will be automatically fed into
the system and analyzed using a cumulative sums algorithm
tested by Shaffer et al. (2008). This algorithm will issue an
alert when order numbers exceed the programmed threshold
(Figure 2). Veterinarians may also enter case data into the
VHER database.
Figure 2. Time series of weekly counts of IDEXX microbiology orders from
veterinary practitioners in central Ohio, January through December, 2003,
showing alerts that were determined using C3 analysis with a 5-week
baseline, 1-week buffer, and threshold statistic = 1. (Shaffer et al. 2008)
This data will issue a report to the VHER
website, including the RSS feed, Google
Map, and “Outbreaks Near Me” mobile
app (HealthMap).
The data and summary reports will be
accessible to practicing veterinarians,
doctors, and public health officials.
Limitations: This will not initially feed into
the state public health database. The use
of two data streams may occassionally
double count some incidences of disease.
EXAMPLE ZOONOTIC DISEASES
Tuleremia
Lyme Disease
Giardiasis
Cryptosporidiosis
Rabies
Hantavirus
Salmonellosis
Listeriosis
Plague
Anthrax
Botulism
Influenza A Virus
Psittacosis
West Nile Virus
Eastern Equine
Encephalitis
Rocky Mountain
Spotted Fever
ELECTRONIC HEALTH RECORDS
Human healthcare advanced significantly with the advent of
electronic health record meaningful use codes. These
streamline healthcare data collection, storage, and sharing
among hospitals, diagnostic laboratories, and public health
officials. Terminology and information exchange standards
were created with help from the CDC’s Public Health
Information Network. Federal assistance in the form of grants
and training is currently available to any human healthcare
providers interested in upgrading their record keeping
systems. This is not available to the veterinary medical
community.
Figure 1. Sending Electronic Syndromic Surveillance Data to a Public Health
Agency. Image from www.siframework.org
Figure 3. May 2013 Lyme Prevalence Map for Middlesex County, MA. www.capcvet.org