Agency Award'Military Health System | Medical alerts

2007 GCN Award: Military health system provides early warning of potential disease outbreaks, or attacks, worldwide

WHAT: The Military Health System's Electronic Surveillance System for the Early Notification of Community-based Epidemics.

MISSION: Develop and integrate a system that would give the military worldwide, real-time reporting of potential disease outbreaks and possible biological attacks.

CHALLENGE: A stand-alone application developed substantially outside of the Defense Department had to be integrated into MHS' architecture. It also was originally built for open Web access, not security, and had to be brought in line with legally mandated requirements.

SOLUTION: ESSENCE is a merging of two projects ' one in DOD and another at Johns Hopkins University's Applied Physics Laboratory in coordination with the Maryland Department of Health and Mental Hygiene and Maryland Emergency Management Agency.

IMPACT: ESSENCE went live in 2006, combining medical reports with geographic information systems to give users fast, accurate data on virus or disease outbreaks. It has been effective in curbing outbreaks of viral gastroenteritis in addition to other health issues that could affect the readiness of troops.

DISEASE TRACKERS: Lt. Col. Robert Aarhus, left, and Col. Kenneth Cox led the ESSENCE project, which identifies trends in biological events, such as virus outbreaks.

Zaid Hamid

ADAPTING: Team members integrated ESSENCE into the Military Health System.

Zaid Hamid

If you go to sick call on a military post nearly anywhere in the world, chances are you're going to end up as a data point in the Electronic Surveillance System for the Early Notification of Community-based Epidemics.

For the complete list of the 2007 GCN Award winners, click here

ESSENCE is a Web-based application integrated into the Defense Department's Military Health System (MHS) that records instances of viruses and other diseases and tracks those reports in search of trends.
Public health is a matter of national security. Regardless of whether it's something relatively commonplace such as viral gastroenteritis, or potentially life-threatening, such as influenza or SARS, any disease outbreak in the military can put entire units out of action if not quickly detected and checked. And the threat of a biological attack, both at home and abroad, has become much more tangible since the letter-borne anthrax attacks of 2001.

'What ESSENCE is, fundamentally, is a biosurveillance tool that is used for medical situational awareness,' said Lt. Col. Robert Aarhus, whose team at MHS' Executive Information Decision Support (EIDS) program office developed ESSENCE.

'What we're looking for is outbreaks of natural or potentially man-made biological events,' Aarhus said. 'It's basically an early warning system in that epidemiologists who are stationed throughout the country at these medical treatment facilities, or in regions servicing these MTFs, can see these potential outbreaks and then do further investigation to see if they're in fact a false alarm, or if there's some natural or man-made event driving them.'

[IMGCAP(2)]The system links medical data with geographic information systems, allowing DOD public health investigators to track the spread of symptoms, drilling down to a specific military unit or ZIP code. Analysis of the data can help medical personnel move quickly and early to treat affected individuals before an illness becomes an epidemic ' and before it becomes potentially life-threatening.
ESSENCE is the product of the merger of two projects ' one in DOD and the other at Johns Hopkins University's Applied Physics Laboratory in coordination with the Maryland Department of Health and Mental Hygiene and Maryland Emergency Management Agency.

Based on its success in a trial tracking cases in the National Capitol Region, 'in 2001, we expanded it beyond the NCR and brought in data from the entire military health system,' said Col. Kenneth Cox, the Air Force Medical Corps' director of force health readiness.

Cox said ESSENCE has become an essential tool in helping DOD deal with not just the threat of major infectious diseases but other public health issues in the military population that affect units' readiness.

'We track illnesses in about 10 categories,' he said, 'among them [are] respiratory diseases, influenza-like illnesses and gastrointestinal illnesses. Those get a lot of visibility already in our national planning and [the Centers for Disease Control and Prevention's] efforts.'

In the case of influenza-like illness, the early-detection capabilities of ESSENCE are important in helping medical facilities move quickly to prevent a larger outbreak.

'Systems like this can identify cases that are consistent with flu-like illness early on,' Cox said. 'And then ' once outbreaks have started at any point around the world, since this system does encompass all of our units who are in permanent sites around the globe ' then we can move to protect those people and move vaccines and antiviral drugs around, since they're in limited supply and are in regional depots.'

Aarhus assumed the role of program manager for the EIDS program office, part of DOD's Tricare Management Activity, in July 2005, shortly after responsibility for managing further ESSENCE development was brought within DOD. Another Tricare program led by Aarhus won a 2006 GCN Award. (See

At that point, Aarhus and his project team faced the challenge of taking a stand-alone application developed substantially outside DOD and integrating it into the larger MHS architecture ' and also continuing to extend its functionality.
The product of the project office's work officially went live in September 2006 and is now a continuing development project.

'Like many applications that have been developed by the services,' Aarhus said, ESSENCE 'didn't necessarily meet all the criteria for publication on the MHS system.' Significant work was needed to bring ESSENCE onto the MHS platform for data warehousing and data marts, but much of the effort was focused on security.
'When various systems are developed, the overriding concerns aren't making it impenetrable to attack,' Aarhus said. 'Once you put the system on the MHS, though, that's like putting it on top of a shining tower ' everyone wants to have a go at it.'

Initially, the application wasn't designed with security in mind ' the data was anonymized, and only aggregated data was available to users.

'The initial version of ESSENCE was available to the DOD users as a Web-based system, so all they needed was a user account and password, and they could get in,' said Cox, whose office is a primary user of ESSENCE.

But part of the advantage of complete integration with the MHS architecture was the ability to drill down to the specific medical records involved in a possible outbreak.

To do that, Aarhus' team had to extend the system to comply with the regulations set forth by the Health Insurance Portability and Accountability Act governing security and privacy of medical records.

Aarhus' team also made several enhancements to the software. Military users can now get alerts by e-mail, text message or pager when a situation that may require investigation is detected, asking them to log in for an investigation.

The speed with which new information is processed has also been increased.
New data from around the world is submitted around the clock, and the system now does full detection cycles on the data it receives six times a day, so users worldwide are constantly getting the latest data.


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