ICD-9

A retrospective analysis of emergency department data in NC for drug and opioid overdoses has been explained previously [1]. We built on this initial work to develop new poisoning and surveillance reports to facilitate near real time surveillance by health department and hospital users. In North Carolina, the availability for mortality and hospital discharge data are approximately one and two years after the event date, respectively. NC DETECT data are near real time and over 75% of ED visits receive at least one ICD-9-CM final diagnosis code within two weeks of the initial record receipt.

Objective

Twelve new case definitions were added to the NC DETECT Web Application to facilitate timely surveillance for poisoning and overdose. The process for developing these case definitions and the most recent outputs are described.

Drug poisoning, or overdose, is an epidemic problem in the United States1,2. In keeping with national trends, a recent study combining U.S. Veterans Health Administration (VHA) data with the National Death Index showed increases in opioid overdose mortality from 2001 to 20093. One of the challenges in monitoring the overdose epidemic is that collecting cohort data to analyze overdose rates can be laborintensive. Moreover, analysts are often unable to collect real-time data on overdose events. To explore solutions to these challenges, we examined opioid overdose by using Veteran healthcare data already being collected for syndromic surveillance.

Objective

To examine inpatient admissions for opioid overdose among U.S. Veterans using national-level surveillance data.

 

Bordetella pertussis infection (whooping cough) has been on the rise and the most cases in the US since 1955 were reported in 2012 (48,277 or 15.4 per 100,000). Pertussis is highly infectious and can cause serious illness in infants and children as well as adults, and in general is preventable by vaccination. Since 2005, it has been recommended that anyone 19-64 years old should have a onetime booster of the pertussis vaccine (Tdap). In 2010, that recommendation was broadened stating people 65 years old and older should also obtain a booster of Tdap. Given the increased number of pertussis cases in the Western US, and that approximately 20% of these cases occurred in patients >20 years of age, we performed pertussis surveillance in Veterans in care at VA medical facilities.

Objective

To perform pertussis surveillance in VA facilities in the Western US.

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.

The compliance date for the ICD9-ICD10 transition is October 1, 2015. The hospitals have started the ICD9-ICD10 transition. However, not all data providers will transition the data at the same time. In order to facilitate some coherence to the data during this transition period, user interface and data processing functionalities have been developed in ESSENCE to allow usage of both classification systems simultaneously. This capability will allow users to perform ICD10- based queries across all the hospitals in their system, irrespective of the exact number of hospitals that have completed the ICD10 transition.

Objective

To help users seamlessly query and analyze data in disease surveillance systems using both ICD9 and ICD10 codes during the transition period. Additionally, the mappings between ICD9 and ICD10 codes must be flexible enough to support locally required changes based upon a user’s needs.

GFT is a surveillance tool that gathers data on local internet searches to estimate the emergence of influenza-like illness in a given geographic location in real time.3 Previously, GFT has been proven to strongly correlate with influenza incidence at the national and regional level.2,3 GFT has shown promise as an easily accessed tool to enhance influenza surveillance and forecasting; however, further geographic validation of city-level data is needed. 1,2,6

Objective

To test if Google Flu Trends (GFT) is predictive of the volume of influenza and pneumonia emergency department (ED) visits across multiple United States cities.

 

The National Strategy for Biosurveillance promotes a national effort to improve early detection and enable ongoing situational awareness of all-hazards threats. Implicit in the Strategy’s implementation plan is the need to upgrade capabilities and integrate multiple disparate data sources, including more complete electronic health record (EHR) data into future biosurveillance capabilities. Thus, new biosurveillance applications are clearly needed. Praedico™ is a next generation biosurveillance application that incorporates cloud computing technology, a Big Data platform utilizing MongoDB as a data management system, machine-learning algorithms, geospatial and advanced graphical tools, multiple EHR domains, and customizable social media streaming from public health-related sources, all within a user friendly interface.

Objective

The purpose of our study was to conduct an initial assessment of the biosurveillance capabilities of a new software application called Praedico™ and compare results obtained from previous queries with the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE).

 

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.

NC DETECT receives ICD-9-CM codes for emergency department (ED) visits and uses these codes in case definitions for syndromic surveillance (e.g. infectious disease, injury, etc.). Hospitals will begin using ICD-10-CM codes on October 1, 2015. As a result, preparations have been made to accommodate ICD-10-CM codes in NC DETECT for data transmission, receipt, processing and use in the NC DETECT Web Application.

Objective

To describe lessons learned from the transition to ICD-10-CM.