ICD-9

Characterizing mentions found in clinical texts that support, refute, or represent uncertainty for suspected pneumonia is one area where automated Natural Language Processing (NLP) screening algorithms could be improved. Mentions of uncertainty and negation commonly occur in clinical texts, and opportunities exist to extend existing algorithms [1] and taxonomies [2]. In general there are three main sources of uncertainty found in healthcare: 1) probability or risk; 2) ambiguity – lack of reliability, credibility or adequacy of the information; and, 3) complexity – aspects of the phenomenon that make it difficult to comprehend [3].

Objective

We sought to identify relevant evidence that supports, refutes or contributes uncertainty when reviewing cases of suspected pneumonia and characterize their interaction with uncertainty phenomena found in clinical texts.

 

CHIKV is transmitted by mosquitoes and often occurs in large outbreaks with high attack rates. Common symptoms (which can be severe and disabling) include fever, joint pain/swelling, headache, muscle pain and rash. In December 2013, the World Health Organization reported local CHIKV transmission in the Caribbean. In July 2014, the first locally-acquired case in the continental U.S. (Florida) and increasing cases in Puerto Rico (PR) were reported. Due to the growing outbreak, VA Office of Public Health began conducting ongoing surveillance.

Objective

We describe challenges and lessons learned conducting surveillance for Chikungunya virus (CHIKV), an emerging infectious disease in the Americas.

Near real-time emergency department chief complaint data is accessed through Florida’s syndromic surveillance system: Electronic Surveillance System for the Early Notification of Communitybased Epidemics-Florida (ESSENCE-FL). The Florida Department of Health relies heavily upon these data for timely surveillance of influenza and influenza-like illness (ILI). Hospital discharge data available from the Florida Agency for Health Care Administration (AHCA) captures information about influenza-associated ED visits and is considered complete. The delay in receiving the data (up to a year) hinders timely evidence-based decision making during the influenza season. Previous analyses (comparing the complete AHCA hospital discharge data to the ESSENCE-FL ILI syndrome and Influenza sub-syndrome) have shown ESSENCE-FL is a timely, effective tool to monitor influenza activity in the state and that the Influenza sub-syndrome most closely approximates influenza season activity in Florida. Adults > 65, pregnant women and children < 5 are at increased risk for morbidity and mortality from influenza infection. This investigation aims to determine if syndromic surveillance can be used to characterize in near real-time influenza infection in adults > 65, pregnant women, and children < 5 by comparing ED visits for influenza and ILI in ESSENCE-FL to historical AHCA records of people who incurred ED charges at a Florida hospital with diagnosed influenza.

Objective

To determine if emergency department (ED) based syndromic surveillance can be utilized to characterize in near real-time influenza infection in three high-risk populations: a) adults > 65, b) pregnant women, and c) children < 5.

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.

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.

NSSP, a Centers for Disease Control and Prevention (CDC) surveillance system, allows timely detection of emergency department (ED) trends by matching chief complaint (CC) text or diagnosis (DX) codes to established syndrome criteria [1, 2]. No CDC syndrome definition currently exists for marijuana-related visits. Accidental child ingestions and over-consumption of edible products are an emerging concern [3, 4]. A validated marijuana syndrome will allow health departments with access to ED data to measure relative trends and disparities in marijuana-related ED visits.

Objective

To evaluate methods of measuring marijuana-related emergency department visits at Denver metropolitan area hospitals participating in the National Syndromic Surveillance Program (NSSP).

Recreational drug use is a major problem in the United States and around the world. Specifically, drug abuse results in heavy use of emergency department (ED) services, and is a high financial burden to society and to the hospitals due to chronic ill health and multiple injection drug use complications. Intravenous drug users are at high risk of developing sepsis and endocarditis due to the use of a dirty or infected needle that is either shared with someone else or re-used. It can also occur when a drug user repeatedly injects into an inflamed and infected site or due to the poor overall health of an injection drug user. The average cost of hospitalization for aortic valve replacement in USA is about $165,000, and in order for the valve replacement to be successful, patients must abstain from using drugs.

Objective

To describe how the state syndromic surveillance system (NC DETECT) was used to initiate near real time surveillance for endocarditis, sepsis and skin infection among drug users.

Underage drinking is a significant public health problem in the United States as well as in Nebraska1-2. Alcohol consumption among underage youth accounts for approximately 5,000 deaths each year in the United States, including motor vehicle crash related deaths, homicides and suicides1. In Nebraska, 23% of 12-20 year olds have reported alcohol use during the past 30 days3. In 2010, the estimated total costs of underage drinking in Nebraska were $423 million. These costs included medical care, work loss along with pain and suffering2. The health consequences of underage drinking include alcohol-related motor vehicle crashes and other unintentional injuries, physical and sexual assault, suicide, self-inflicted injury, death from alcohol poisoning, and abuse of other drugs1, 4. The monitoring of near-real–time ED data could help underage drinking prevention efforts by providing timelier actionable public health information.

Objective

The objective of this pilot study was to develop and evaluate syndromic definitions for the monitoring of alcohol-related emergency department (ED) visits in near-real–time syndromic surveillance (SyS) data. This study also evaluates the utility of SyS ED data for the monitoring of underage drinking.

From 2001-2011, mental health-related hospitalizations and ED visits increased among United States children nationwide. During this period, mental health-related hospitalizations among NYC children increased nearly 23%. To estimate mental health-related ED visits in NYC and assess the use of syndromic surveillance chief complaint data to monitor these visits, we compared trends from a near real-time syndromic system with those from a less timely, coded ED visit database. 

Objective

To assess the use of syndromic surveillance to assess trends in mental health-related emergency department (ED) visits among school-aged children and adolescents in New York City (NYC). 

Patients who suffer from rare diseases can be hard to diagnose for prolonged periods of time. In the process, they are often subjected to tentative treatments for ailments they do not have, risking an escalation of their actual condition and side effects from therapies they do not need. An early and accurate detection of these cases would enable follow-ups for precise diagnoses, mitigating the costs of unnecessary care and improving patients’ outcomes. 

Objective

To identify sufferers of a rare and hard to diagnose diseases by detecting sequential patterns in historical medical claims.