How the Puerto Rico Department of Health is Taking Advantage of ESSENCE® TO Advance Public Health

Key Take Away

The partnership between the Puerto Rico Department of Health and InductiveHealth demonstrates how strong local leadership, combined with expert training and technical support, can transform a public health program into a national model.

By fully leveraging the ESSENCE® syndromic surveillance system, the Puerto Rico Department of Health have strengthened their tools to detect, monitor, and respond to emerging health threats across the island.

Situation

With Puerto Rico facing unique public health challenges—from hurricane-related disruptions to the ongoing need for infectious disease monitoring—syndromic surveillance offered an essential opportunity to strengthen the island’s ability to safeguard its residents. In 2021, the Puerto Rico Department of Health implemented ESSENCE to identify abnormal health conditions and enable early detection and monitoring of events of public health importance. As the sole commercial provider of ESSENCE, InductiveHealth worked closely with Puerto Rico Department of Health leaders to train the team and onboard facilities. InductiveHealth completed the initial set-up and onboarding process for the syndromic surveillance system. Through its work with local leaders on the ground, InductiveHealth identified an opportunity to support the Puerto Rico Department of Health in adapting the system’s tools and capabilities to maximize its benefits for the people of Puerto Rico.

InductiveHealth Solution

In 2022, InductiveHealth launched a series of intensive weekly training sessions with Puerto Rico Department of Health staff. These sessions emphasized best practices in syndromic surveillance, from refining syndrome definitions to setting up automated notifications of emergency department visits of interest. Working with an internal champion who is a syndromic surveillance power user, InductiveHealth assisted with available updates and added features, including new statistical algorithms and visualizations, to fully engage in syndromic surveillance across the island.

Consequently, InductiveHealth assisted the Puerto Rico Department of Health in developing a leptospirosis definition and configuring automated alerts—capabilities that proved essential during the widespread flooding and power outages from Hurricane Fiona. This initial success established programmatic baselines for ongoing syndromic surveillance of leptospirosis and other public health events. Together, the team developed automated alerts for suicide-related visits, overdoses, heat-related illnesses, foodborne diseases, waterborne diseases, and vaccine-preventable diseases. Furthermore, trend monitoring was implemented for respiratory diseases, such as COVID-19, Respiratory Syncytial Virus infections and influenza, dengue, and mass gatherings.

The Puerto Rico Department of Health’s success using ESSENCE has garnered support from the State Epidemiologist, who called for regulations requiring all health care facilities on the island to participate in ESSENCE. High level support has helped encourage hospitals across Puerto Rico to address barriers in their electronic health record systems and join the effort. As a result, the number of onboarded facilities in Puerto Rico has tripled.

Tracking Leptospirosis Outbreaks

Having syndromic surveillance capabilities proved vital during the widespread flooding and power outages caused by Hurricane Fiona in 2022. Following the devastating storm, Puerto Rico experienced outbreaks of leptospirosis; a bacterial disease spread through contact with contaminated water or soil. More than 150 patience with leptospirosis symptoms and positive lab results were reported in the 15 weeks after the hurricane.

ESSENCE helped local public health officials detect patterns and better understand the dynamics of the disease. Specifically, they found that heavy rain events coincided with increased ED visits for leptospirosis, and using this knowledge launched a proactive public health response. Epidemiologic surveillance, combined with outreach to health care providers after flooding events, improved leptospirosis case identification, early initiation of antibiotic therapy, and public messaging to avoid contact with floodwaters.

How This Improves Public Health

By providing a holistic overview of the health of Puerto Ricans through advanced analysis and visualization tools, ESSENCE remains an integral part of the Puerto Rico Department of Health’s work. Each new hospital onboarded into ESSENCE expands the Puerto Rico Department of Health’s ability to detect health threats early, monitor disease trends, and protect communities from harm. InductiveHealth continues to work with the Puerto Rico Department of Health to onboard new facilities, train staff, verify data, and support communications to maximize the benefits of ESSENCE for the people of Puerto Rico.