Electronic Health Records

Effective and valid surveillance of syndromes can be extremely useful in the early detection of outbreaks and disease trends. However, medical chart checks without patient identifiers and lack of diagnoses in A08 data has made validation difficult. With the rising availability of electronic health records (EHRs) to local health departments, the ability to evaluate syndromic surveillance systems (SSS) has improved. In LAC, ED data are collected from hospitals and classified into categories based on chief complaints. The most reported syndrome in LAC is the respiratory classification, which is intended to broadly capture respiratory pathogen activity trends. To test the validity of the LAC Department of Public Health (DPH) respiratory syndrome classification, ED syndromic surveillance data were analyzed using corresponding EHRs from one hospital in LAC.

Objective

To compare and validate syndromic surveillance categorization against electronic health records at one hospital emergency department (ED) in Los Angeles County (LAC).

The Veterans Affairs (VA) ESSENCE obtains electronic health record data from 152 medical centers plus clinics in all 50 states, U.S. territories, and the Philippines. ESSENCE analyzes ICD-9 diagnosis codes and demographic data from outpatient and emergency department visits using complex aberrancy-detection algorithms. In 2010, a new instance was stood up (VA Inpatient ESSENCE) which receives weekly feeds of inpatient data from all VA acute care hospitals starting at the beginning of the Fiscal Year (FY10, Oct. 1, 2009). Data include demographics, admission/discharge data (including ICD-9 diagnosis codes), diagnosis related group, bedsection, procedure and surgery data.

Objective

To describe the utility of inpatient data in VA ESSENCE biosurveillance system for healthcare-associated infection and public health surveillance.

During the 2009 H1N1 influenza pandemic, the Washington State Department of Health (DOH) temporarily made lab-confirmed influenza hospitalizations reportable. Reporting of influenza hospitalizations is resource intensive for hospitals and local health jurisdictions. As a result, electronic sources of influenza hospitalization data are being explored. A Regional Health Information Exchange (HIE) in Washington currently sends DOH ICD9 coded discharge diagnoses and microbiology laboratory orders and results for all patients admitted to 17 hospitals throughout Washington, including four of the five hospitals in Spokane County. The HIE hospitalization and laboratory data may be a valuable replacement for mandatory notifiable condition reporting to monitor the basic epidemiology and severity of influenza in Washington.

Objective

To evaluate the sensitivity, positive predictive value (PPV), timeliness, completeness, and representativeness of lab-confirmed influenza hospitalization data from a health information exchange with respect to traditional notifiable condition reporting.

National Health IT Initiatives are helping to advance the state of automated disease surveillance through incentives to health care facilities to implement electronic medical records and provide data to health departments and use collaborative systems to enhance quality of care and patient safety. While the emergence of a standard for the transfer of surveillance data is urgently needed, migrating from the current practice to a future standard can be a source of frustration. This project represents collaboration among the CDC BioSense Program, Tarrant County Public Health and the ESSENCE Team at the Johns Hopkins University APL. The objectives of the project are to: develop reusable meaningful use messaging software for ingestion health information exchange data available in Tarrant County, demonstrate the use of this data for supporting surveillance, demonstrate the ability to share data for regional and national surveillance using the messaging guide model, and demonstrate how this model can be proliferated among health departments that use ESSENCE by investigating the potential use of cloud technology. The presentation will outline the steps for achieving this goal.

Although development of computerized medical record systems in the United States is a high priority, there are relatively few instances of such systems supporting disease surveillance systems. The Indian Health Service (IHS) has had an electronic record database for over 30 years, however, implementation of point of care electronic health records (EHR) and use of these data for public health surveillance has begun only over the past 4 years.

Objective

To develop a robust, sensitive, and specific local, regional, and national public health surveillance system utilizing an electronic clinical information system.

Using an electronic health record (EHR) system, we tracked an outpatient population from a series of primary care providers to identify influenza-like illness (ILI) as part of a multi-state effort directed by the Centers for Disease Control and Prevention. From these patients, we also collected de-identified project-specific information and symptoms using an electronic template to evaluate possible differences among patient groupings as well as longitudinal population patterns.

Objective

Evaluate the use of an EHR network to track ILI incidence in an outpatient population and using laboratory testing, identify influenza cases by subtype as well as other respiratory viruses.

Multiple options (1,2) are available for health care provider organizations to receive assistance in demonstrating compliance with meaningful use requirements for public health reporting (3). A certified EHR solution is a requirement for participation in these programs; vast majority of health care providers do not yet have such a solution. No funding programs are currently available to assist public health agencies, especially local public health departments (4). As a result, most providers and local public health agencies are seemingly left without viable options except spending significantly in a tight budget environment.

Objective

To describe a real-time reportable disease and surveillance solution focused on local public health department needs and compatible with state health departments, regardless of meaningful use certification status of health care providers.

Electronic laboratory reporting (ELR) was demonstrated just over a decade ago to be an effective method to improve the timeliness of reporting as well as the number of reports submitted to public health agencies. The quality of data (inc. completeness) in information systems across all industries and organizations is often poor, and anecdotal reports in the surveillance literature suggest that ELR may not improve the completeness of the data in the submitted reports.

Objective 

To examine the completeness of data submitted from clinical information systems to public health agencies as notifiable disease reports.