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Hicks Peter

Between 2006 and 2013, the rate of emergency department (ED) visits related to mental and substance use disorders increased substantially. This increase was higher for mental disorders visits (55 percent for depression, anxiety or stress reactions and 52 percent for psychoses or bipolar disorders) than for substance use disorders (37 percent) visits. This increasing number of ED visits by patients with mental disorders indicates a growing burden on the health-care delivery system. New methods of surveillance are needed to identify and understand these changing trends in ED utilization and affected underlying populations. Syndromic surveillance can be leveraged to monitor mental health-related ED visits in near real-time. ED syndromic surveillance systems primarily rely on patient chief complaints (CC) to monitor and detect health events. Some studies suggest that the use of ED discharge diagnoses data (Dx), in addition to or instead of CC, may improve sensitivity and specificity of case identification.

Objective: The objectives of this study are to

(1) create a mental health syndrome definition for syndromic surveillance to monitor mental health-related ED visits in near real time;

(2) examine whether CC data alone can accurately detect mental health related ED visits; and

(3) assess the added value of using Dx data to detect mental health-related ED visits.

Submitted by elamb on

The May arrival of two cases of Middle East Respiratory Syndrome (MERS) in the US offered CDC’s BioSense SyS Program an opportunity to give CDC’s Emergency Operations Center (EOC) and state-and-local jurisdictions an enhanced national picture of MERS surveillance. BioSense jurisdictions can directly query raw data stored in what is known as “the locker.” However, CDC cannot access these data and critical functions, like creating ad-hoc syndrome definitions within the application are currently not possible. These were obstacles to providing the EOC with MERS information. BioSense staff developed a plan to 1) rapidly generate query definitions regardless of the locally preferred SyS tool and, 2) generate aggregate reports to support the national MERS response.

Objective

Demonstrate that information from disparate syndromic surveillance (SyS) systems can be acquired and combined to contribute to national-level situational awareness of emergent threats.

Submitted by teresa.hamby@d… on

The US Department of Health and Human Services has mandated that after October 1, 2015, all HIPAA covered entities must transition from using International Classification of Diseases version 9 (ICD- 9) codes to using version 10 (ICD-10) codes (www.cms.gov). This will impact public health surveillance entities that receive, analyze, and report ICD-9 encoded data. Public health agencies will need to modify existing database structures, extraction rules, and messaging guides, as well as syndrome definitions and underlying analytics, statistical methodologies, and business rules. Implementation challenges include resources, funding, workforce capabilities, and time constraints for code translation and syndrome reclassification.

Objective

To describe the process undertaken to translate syndromic surveillance syndromes and sub-syndromes from ICD-9 diagnostic codes to ICD-10 codes and how these translations can be used to improve syndromic surveillance practice.

Submitted by rmathes on

This roundtable provided a forum for a diverse set of representatives from the local, state, federal and international public health care sectors to share tools, resources, experiences, and promising practices regarding the potential impact of the transition on their surveillance activities. This forum will promote the sharing of lessons learned, foster collaborations, and facilitate the reuse of existing resources without having to 'reinvent the wheel.' It is hope that this roundtable will lay the ground-work for a more formal, collaborative, and sustainable venue within ISDS to aid in preparing the public health surveillance community for the coming ICD-9/10 CM transition.

Referenced File
Submitted by ctong on

On October 1, 2015, the number of ICD codes will expand from 14,000 in version 9 to 68,000 in version 10. The new code set will increase the specificity of reporting, allowing more information to be conveyed in a single code. It is anticipated that the conversion will have a significant impact on public health surveillance by enhancing the capture of reportable diseases, injuries, and conditions of public health importance that have traditionally been the target of syndromic surveillance monitoring. For public health departments, the upcoming conversion poses a number of challenges, including: 1) Constraints in allocating resources to modify existing systems to accommodate the new code set, 2) Lack of ICD-10 expertise and training to identify which codes are most appropriate for surveillance, 3) Mapping syndrome definitions across code sets, 4) Limited understanding of the precise ICD-10 CM codes that will be used in the US Healthcare system, and 5) Adjusting for changes in trends over time that are due to transitions in usage of codes by providers and billing systems. To accommodate the ICD-9 to ICD-10 transition, the Centers of Disease Control and Prevention (CDC) partnered with the International Society of Disease Surveillance (ISDS) CoP to form a workgroup to develop the Master Mapping Reference Table (MMRT). This tool maps over 130 syndromes across the two coding systems to assist agencies in modifying existing database structures, extraction rules, and messaging guides, as well as revising established syndromic surveillance definitions and underlying analytic and business rules.

Objective

This roundtable will provide a forum for the syndromic surveillance Community of Practice (CoP) to discuss the public health impacts from the ICD-10-CM conversion, and to support jurisdictional public health practices with this transition. It will be an opportunity to discuss key impacts on disease surveillance and implementation challenges; and identify solutions, best practices, and needs for technical assistance.

Submitted by teresa.hamby@d… on

As of October 1, 2015, all HIPAA covered entities transition from the use of International Classification of Diseases version 9 (ICD-9-CM) to version 10 (ICD-10-CM/PCS). Many Public Health surveillance entities receive, interpret, analyze, and report ICD-9 encoded data, which will all be significantly impacted by the transition. Public health agencies will need to modify existing database structures, extraction rules, and messaging guides, as well as revise established syndromic surveillance definitions and underlying analytic and business rules to accommodate this transition. Implementation challenges include resource, funding, and time constraints for code translation and syndrome classification, and developing statistical methodologies to accommodate changes to coding practices.

To address these challenges, the International Society for Disease Surveillance (ISDS), in consultation with the Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial Epidemiologists (CSTE), has conducted a project to develop consensus-driven syndrome definitions based on ICD- 10-CM codes. The goal was to have the newly created ICD-9-CM to-ICD-10-CM mappings and corresponding syndromic definitions fully reviewed and vetted by the syndromic surveillance community, which relies on these codes for routine surveillance, as well as for research purposes. The mappings may be leveraged by other federal, state, and local public health entities to better prepare and improve the surveillance, analytics, and reporting activities impacted by the ICD-10-CM transition.

Objective

To describe the process undertaken to translate syndromic surveillance syndromes and sub-syndromes consisting of ICD-9 CM diagnostic codes to syndromes and sub-syndromes consisting of ICD-10-CM codes, and how these translations can be used to improve syndromic surveillance practice.

Submitted by teresa.hamby@d… on

Many public health programs use hospital administrative and claims data for assessment and surveillance purposes. They are preparing their data collection processes to make the transition from accepting data coded with ICD-9-CM to ICD-10-CM in preparation for the October 1 implementation date set by Congress. MapIT is a tool that was developed with funding from AHRQ and CDC to support these transition efforts.

Peter Hicks, an epidemiologist from the Centers for Disease Control and Prevention, will present an expanded version of the 2013 ISDS Pre-Conference Workshop on the ICD-9/10 CM Transition and the impact upon Public Health. His presentation will include specifics on the differences between ICD-9 and ICD-10 codes, highlighting the potential utility of the more granular ICD-10 codes.

Healthcare data, including emergency department (ED) and outpatient health visit data, are potentially useful to the public health community for multiple purposes, including programmatic and surveillance activities. These data are collected through several mechanisms, including administrative data sources [e.g., MarketScan claims data1; American Hospital Association (AHA) data2] andpublic health surveillance programs [e.g., the National Syndromic Surveillance Program (NSSP)3]. Administrative data typically become available months to years after healthcare encounters; however, data collected through NSSP provide near real time information not otherwise available to public health. To date, 46 state and 16 local health departments participate in NSSP, and the estimated nationalp ercentage of ED visits covered by the NSSP BioSense platform is 54%. NSSP’s new data visualization tool, ESSENCE, also includes additional types of healthcare visit (e.g., urgent care) data. Although NSSP is designed to support situational awareness and emergency response, potential expanded use of data collected through NSSP (i.e., by additional public health programs) would promote the utility, value, and long-term sustainability of NSSP and enhance surveillance at the local, state, regional, and national levels. On the other hand, studies using administrative data may help public health programs better understand how NSSP data could enhance their surveillance activities. Such studies could also inform the collection and utilizationof data reported to NSSP.

Objective

This roundtable will address how multiple data sources, including administrative and syndromic surveillance data, can enhance public health surveillance activities at the local, state, regional, and national levels. Provisional findings from three studies will be presented to promote discussion about the complementary uses, strengths and limitations, and value of these data sources to address public health priorities and surveillance strategies.

Submitted by teresa.hamby@d… on
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