Healthcare

Medical claims and EHR data sources offer the potential to ascertain disease and health risk behavior prevalence and incidence, evaluate the use of clinical services, and monitor changes related to public health interventions. Passage of the HITECH Act of 2009 supports the availability of standardized EHR data for use by public health officials to obtain actionable information. While full adoption of EHRs is still years away, there are presently publicly- and commerciallyavailable EHR and medical claims data sets that could enhance public health surveillance at a national, regional and state level. The purposes of this evaluation were to i.) demonstrate the feasibility of gaining access to such data, ii.) evaluate their ability to augment current surveillance activities by developing measures for twenty separate healthcare indicators (e.g., HIV screening), iii.) evaluate each data source across a set of criteria needed for an effective surveillance system, and iv.) assess the ability of the data sources to evaluate changes in healthcare utilization and preventive services that may be a result of the 2009 Health Reform legislation.

Objective:

To assess the utility of inpatient and ambulatory clinical data compiled by public and commercial sources to enhance the Centers for Disease Control and Prevention’s surveillance activities.

 

Mass gatherings can result in morbidity and mortality from communicable and non-communicable diseases, injury, and bioterrorism. Therefore, it is important to identify event-related visits as opposed to community-related visits when conducting public health surveillance. Previous mass gatherings in Virginia have demonstrated the importance of implementing enhanced surveillance to facilitate early detection of public health issues to allow for timelyresponse. Between June 2015 and September 2015, VDH coordinated with two healthcare entities representing six acute care hospitals to conduct enhanced surveillance for the 2015 World Police and Fire Games and 2015 Union Cycliste Internationale (UCI) RoadWorld Championships. VDH established initial communicationwith each healthcare entity between 1 week to 2 months before theevent start date to discuss functional requirements with technical,informatics, and clinical staff.

Objective

To describe the planning strategies and lessons learned by theVirginia Department of Health (VDH) when conducting enhancedsurveillance during mass gathering events and coordinating withhealthcare entities to distinguish event-related emergency department(ED) visits from community-related ED visits

Under the CDC STD Surveillance Network (SSuN) Part B grant, WA DOH is testing electronic case reporting (eCR) of sexually transmitted infections (STI) from a clinical partner.

Objective

We reviewed CCDs (a type of consolidated clinical data architecture (C-CDA) document) shared by our clinical partner, Planned Parenthood of the Great Northwest and Hawaiian Islands (PPGNHI) since October, 2015. Analyses focuses on:

-Completeness

-Degree to which the CCD matches program area information needs

-Differences in EHR generation methods

-Presence and location of triggers (based on the Reportable Conditions Trigger Codes) that would initiate CCD generation.

The Florida Department of Health in Hillsborough County (FDOH- Hillsborough) conducts enhanced syndromic surveillance on a daily basis. The Electronic Surveillance System for the Early Notification of Community-based Epidemics in Florida (ESSENCE-FL) is the syndromic surveillance system used by epidemiologists within the Florida Department of Health (FDOH). During the time of this study, ESSENCE-FL receives data from 210 of emergency departments (ED) and 33 urgent care centers (UCC) throughout the state of Florida, including 12 EDs and 3 UCCs in Hillsborough County. In 2014, the ESSENCE-FL system added a feature that delivers an automatic daily email to designated primary ESSENCE-FL users in each county containing all visits which have been detected by the state’s visits of interest (VOI) query. The email contains all visits which have been detected by the visits of interest (VOI) query for each ESSENCE-FL users designated county. The VOI query utilizes the combined chief complaint and discharge diagnosis (CCDD) field of a visit for keywords related to reportable diseases and exposures of public health interest. In addition to this VOI email, Hillsborough County analyzes time of arrival alerts, specialized emerging infectious disease queries, poison information center data, and volume levels of syndromes and subsyndromes predetermined by ESSENCE-FL. A daily summary report of the enhanced daily surveillance analysis is then provided to area public health officials within FDOH-Hillsborough and the surrounding counties. This study examines how visits requiring additional investigation are detected and the resources required to complete the investigation.

Objective

Enhanced daily surveillance is used to identify reportable diseases, outbreaks, and clusters and provides situational awareness. This project examines how health care visits requiring additional information are detected using enhanced syndromic surveillance and the resources required from detection through completion.

In the United States, surveillance of vaccine uptake for childhood infections is limited in scope and spatial resolution. The National Immunization Survey (NIS) - the gold standard tool for monitoring vaccine uptake among children aged 19-35 months - is typically constrained to producing coarse state-level estimates. In recent years, vaccine hesitancy (i.e., a desire to delay or refuse vaccination, despite availability of vaccination services) has resurged in the United States, challenging the maintenance of herd immunity. In December 2014, foreign importation of the measles virus to Disney theme parks in Orange County, California resulted in an outbreak of 111 measles cases, 45% of which were among unvaccinated individuals. Digital health data offer new opportunities to study the social determinants of vaccine hesitancy in the United States and identify finer spatial resolution clusters of under-immunization using data with greater clinical accuracy and rationale for hesitancy.

Objective

The purpose of this study was to investigate the use of large-scale medical claims data for local surveillance of under-immunization for childhood infections in the United States, to develop a statistical framework for integrating disparate data sources on surveillance of vaccination behavior, and to identify the determinants of vaccine hesitancy behavior.