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ISDS Annual Conference Proceedings 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
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ISDS 2012 Conference Abstracts

Evaluation of ESSENCE in the Cloud Using Meaningful
Use Syndromic Surveillance Data
Wayne Loschen*1, William Stephens2, Taha Kass-Hout3, Miles Stewart1, Dave Heinbaugh2
and Joseph Lombardo1

1Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA; 2Tarrant County Public Health, Fort Worth, TX, USA; 3Public
Health Surveillance and Informatics Program Office, Office of Surveillance, Epidemiology, & Laboratory Services, Centers for Disease
Control and Prevention, Atlanta, GA, USA

Objective
This project represents collaboration among CDC’s BioSense Pro-

gram, Tarrant County Public Health and the ESSENCE Team at the
Johns Hopkins University APL. For over six months the Tarrant
County Public Health Department has been sending data through the
BioSense 2.0 application to a pilot version of ESSENCE on the Ama-
zon GovCloud. This project has demonstrated the ability for local
hospitals to send meaningful use syndromic surveillance data to the
Internet cloud and provide public health officials tools to analyze the
data both using BioSense 2.0 and ESSENCE. The presentation will
describe the tools and techniques used to accomplish this, an evalu-
ation of how the system has performed, and lessons learned for future
health departments attempting similar projects.

Introduction
In November of 2011 BioSense 2.0 went live to provide tools for

public health departments to process, store, and analyze meaningful
use syndromic surveillance data. In February of 2012 ESSENCE was
adapted to support meaningful use syndromic surveillance data and
was installed on the Amazon GovCloud. Tarrant County Public
Health Department agreed to pilot the ESSENCE system and evalu-
ate its performance compared to a local version ESSENCE they cur-
rently used. The project determined the technical feasibility of
utilizing the Internet cloud to perform detailed public health analysis,
necessary changes needed to support meaningful use syndromic sur-
veillance data, and any public health benefits that could be gained
from the technology or data.

Methods
This project investigated database and visualization changes nec-

essary to support meaningful use syndromic surveillance data in
ESSENCE. It evaluated the Internet cloud environment and deter-
mined the benefits and disadvantages to using this technology as a
platform for ESSENCE. This included scalability, performance, and
cost analysis of the Internet cloud platform. After using the system for
a period of time, the Tarrant County users evaluated the Internet cloud
version of the system.

Results
Many technical adaptations to the ESSENCE system were made to

support the new meaningful use syndromic surveillance elements.
Several optimizations, including a new database schema and cube
table structures, were developed to improve performance of
ESSENCE in the Internet cloud and incorporating the meaningful use
requirements. The Internet cloud platform offered many levels of per-
formance that could alter the ESSENCE user experience. Smaller
configurations allowed for 100 concurrent users to experience 16 sec-
ond response times, whereas larger configurations supported experi-
ences of 2 second response times.

Conclusions
Public health departments are dealing with new meaningful use

syndromic surveillance data elements and the cost of maintaining
local systems. This collaborative team have researched and evaluated
tools, technologies, and solutions that can be used throughout the
country.

Keywords
Electronic Medical Records for Public Health; Interoperability;
Meaningful Use; Syndromic Surveillance; Internet Cloud

Acknowledgments

The ESSENCE in the Cloud initiative is supported by the CDC’s Division
of Notifiable Diseases and Healthcare Information (DNDHI) BioSense
Program.

*Wayne Loschen
E-mail: wayne.loschen@jhuapl.edu

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e54, 2013