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Reportable Disease

Current influenza-like illness monitoring in Idaho is on the basis of syndromic surveillance using laboratory data, combined with periodic person-to-person reports collected by Idaho state workers. This system relies on voluntary reporting. Electronic medical records with relational databases offer a method of obtaining data in an automated fashion. Clinical data entered in CPRS includes real-time visit information, vital signs, ICD-9, pharmacy, and labs. ICD-9 and vital signs have been used to predict influenza-like illness in automated systems. We sought to combine these with lab and pharmacy data as part of an automated syndromic surveillance system.

Objective

The objective of this paper is to study whether syndromic surveillance using data from the Veterans Administration electronic medical record computerized patient record system (CPRS) correlates to officially reported influenza activity levels in the State of Idaho.

Referenced File
Submitted by uysz on

Florida Department of Health has developed a statewide syndromic surveillance system based on the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE). Authorized users can currently access data from the Florida Poison Information Center Network (FPICN), Emergency Room chief complaints, Florida reportable disease system (Merlin) and the Florida death records through ESSENCE under one portal. The purpose of this paper is to summarize efforts to enhance statewide real-time chemical surveillance by incorporating FPICN data into ESSENCE.

Referenced File
Submitted by hparton on

State laws mandate clinicians and laboratories to report occurrences of reportable diseases to public health entities. For this purpose, a set of case-reporting specifications are published and maintained by public health departments. There are several problems with the existing case-reporting specifications: (1) they are described on individual state websites and posters and not structured or executable; (2) the specifications are often misleading representing case classification rather than case reporting criteria; (3) they vary across jurisdictions and change over time; and (4) reporting facilities are required to interpret the criteria and maintain logic in their own systems. To overcome these problems, we are designing and developing a prototype system to represent case-reporting specifications that can be authored and maintained by public health and published openly.

 

Objective

In this paper, we describe the content and functional requirements for a knowledge management system that can be authored by public health authorities to inform reporting facilities ‘what’s reportable where’.

Referenced File
Submitted by hparton on

When a reportable condition is identified, clinicians and laboratories are required to report the case to public health authorities. These case reports help public health officials to make informed decisions and implement appropriate control measures to prevent the spread of disease. Incomplete or delayed case reports can result in new occurrences of disease that could have been prevented. To improve the disease reporting and surveillance processes, the Utah Department of Health is collaborating with Intermountain Healthcare and the University of Utah to electronically transmit case reports from healthcare facilities to public health entities using Health Level Seven v2.5, SNOMED CT, and LOINC. As part of the Utah Center of Excellence in Public Health Informatics, we conducted an observation study in 2009 to identify metrics to evaluate the impact of electronic systems. We collected baseline data in 2009 and in this paper we describe preliminary results from a follow-up study conducted in 2010.

 

Objective

This paper describes a comparison study conducted to identify quality of reportable disease case reports received at Salt Lake Valley health department in 2009 and 2010.

Referenced File
Submitted by hparton on

Real-time Outbreak and Disease Surveillance (RODS), a syndromic surveillance system created by the University of Pittsburgh has been used in Ohio by the state and local health departments since late 2003. There are currently 133 health care facilities providing 88% coverage of emergency department visits statewide to the RODS system managed by Health Monitoring Systems Inc. (HMS). The system automatically alerts health department jurisdictions when various syndromic thresholds are exceeded.

As part of response protocols, investigators export a case listing in a comma-separated values file which typically includes thousands of lines with each row containing: date admitted, age, gender, zip code, hospital name, visit number, chief complaint, and syndrome. The HMS-RODS web site provides basic graphs and maps, yet lacks the flexibility afforded by ad hoc queries, cross tabulation, and portability enabling off-line analysis.

 

Objective

This paper describes the integration of open source applications as portable, customizable tools for epidemiologists to provide rapid analysis, visualization, and reporting during surveillance investigations.

Referenced File
Submitted by elamb on

Clinician initiated reporting of notifiable conditions is often delayed, incomplete, and lacking in detail. We report on the deployment of Electronic medical record Support for Public health (ESP), a system we have created to automatically screen electronic medical record (EMR) systems for evidence of reportable diseases, to securely transmit disease reports to health authorities, and to respond to queries from health departments for clinical details about laboratory detected cases. ESP consists of software that constructs and analyzes a temporary database that is regularly populated with comprehensive codified encounter data from a medical practice's EMR system. The ESP database resides within the host medical practice's firewall, configured on either a central workstation to service large multi-site, multi-physician practices or as a software module running alongside a small practice's EMR system on a personal computer. The encounter data sent to ESP includes patient demographics, diagnostic codes, laboratory test results, vital signs, and medication prescriptions. ESP regularly analyzes its database for evidence of notifiable diseases. When a case is found, the server initiates a secure Health Level 7 message to the health department. The server is also able to respond to queries from the health department for demographic data, treatment information, and pregnancy status on cases independently reported by electronic laboratory systems. ESP is designed to be compatible with any EMR system with export capability: it facilitates translation of proprietary local codes into standardized nomenclatures, shifts the analytical burden of disease identification from the host electronic medical record system to the ESP database, and is built from open source software. The system is currently being piloted in Harvard Vanguard Medical Associates, a multi-physician practice serving 350,000 patients in eastern Massachusetts. Disease detection algorithms are proving to be robust and accurate when tested on historical data. In summary, ESP is a secure, unobtrusive, flexible, and portable method for bidirectional communication between EMR systems and health departments. It is currently being used to automate the reporting of notifiable conditions but has promise to support additional public health objectives in the future.

Referenced File
Submitted by elamb on

Outbreaks of infectious diseases are identified in a variety of ways by clinicians and public health practitioners but not usually by analytic methods typically employed in syndromic surveillance. Systematic spatial-temporal analysis of statewide data may enable earlier detection of outbreaks and identification of multi-jurisdictional outbreaks.

 

Objective

Clusters of cases of individually-reportable infectious diseases were identified by a spatial-temporal retrospective analysis. Clusters were examined to determine association with previously reported outbreaks.

Referenced File
Submitted by elamb on

Reportable disease case data are entered into Merlin by all 67 county health departments in Florida and assigned confirmed, probable, or suspect case status. De-identified reportable disease data from Merlin are sent to ESSENCE-FL once an hour for further analysis and visualization using tools in the surveillance system. These data are available for ad hoc queries, allowing users to monitor disease trends, observe unusual changes in disease activity, and to provide timely situational awareness of emerging events. Based on system algorithms, reportable disease case weekly tallies are assigned an awareness status of increasing intensity from normal to an alert category. These statuses are constantly scrutinized by county and state level epidemiologists to guide disease control efforts in a timely manner, but may not signify definitive actionable information.

 

Objective

In light of recent outbreaks of pertussis, the ability of Florida Department of Health’s (FDOH) Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL) to detect emergent disease outbreaks was examined. Through a partnership with the Johns Hopkins University Applied Physics Laboratory (JHU/APL), FDOH developed a syndromic surveillance system, ESSENCE-FL, with the capacity to monitor reportable disease case data from Merlin, the FDOH Bureau of Epidemiology’s secure webbased reporting and epidemiologic analysis system for reportable diseases. The purpose of this evaluation is to determine the utility and application of ESSENCE-FL system generated disease warnings and alerts originally designed for use with emergency department chief complaint data to reportable disease data to assist in timely detection of outbreaks in promotion of appropriate response and control measures.

Submitted by hparton on

The Georgia DPH has used its State Electronic Notifiable Disease Surveillance System (SendSS) Syndromic Surveillance (SS) module to collect, analyze and display analyses of ED patient visits, including DDx data from hospitals throughout Georgia for early detection and investigation of cases of reportable diseases before laboratory test results are available. Evidence on the value of syndromic surveillance approaches for outbreak or event detection is limited. Use of the DDx field within datasets, specifically as it might be used for investigation of outbreaks, clusters, and / or individual cases of reportable diseases, has not been widely discussed.

Objective:

To describe how the Georgia Department of Public Health (DPH) uses ICD-9 and ICD-10-based discharge diagnoses (DDx) codes assigned to Emergency Department (ED) patients to support the early detection and investigation of outbreaks, clusters, and individual cases of reportable diseases.

Submitted by elamb on
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