Syndromes

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.

The Risk Identification Unit (RIU) of the US Dept. of Agriculture’s Center for Epidemiology and Animal Health (CEAH) conducts weekly surveillance of national livestock health data and routine coordination with agricultural stakeholders. In an initiative to increase the monitored species, health issues, and data sources, CEAH epidemiologists are building a surveillance system based on weekly counts of laboratory test orders along with Colorado State Univ. laboratorians and statistical analysts from the Johns Hopkins Univ. Applied Physics Lab. Initial efforts used 12 years of equine test records from 3 state labs covering most Colorado horse testing. Trial syndrome groups were formed based on RIU experience and published articles. Data analysis, stakeholder input, and discovery of laboratory workflow details were needed to modify these groups and filter test records to eliminate alerting bias. Customized statistical monitoring methods were sought based on specialized lab information characteristics and on likely presentation and health significance of syndrome-associated diseases.

Public health practitioners endeavor to expand and refine their syndromic and other advanced surveillance systems which are designed to supplement their existing laboratory testing and disease surveillance toolkit. While much of the development and widespread implementation of these systems was previously supported by public health preparedness funding, the reduction of these monies has greatly constrained the ability of public health agencies to staff and maintain these systems. The appearance of highly-pathogenic avian influenza (HPAI) H3N2v, and other novel influenza A viruses required agencies to carefully identify systems which provide the most cost-effective data to support their public health practice. The global emergence of influenza A (H7N9), Ebola virus strains, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and other viruses associated with high mortality, emphasize the importance of maintaining vigilance for the presence of emerging diseases.

Objective

To continue efforts in characterizing the challenges experienced by influenza surveillance coordinators and other practitioners conducting surveillance for the presence of avian influenza, novel respiratory diseases, and other globally emerging viruses in an era of limited resources among public health agencies.

Nationally, deaths due to opioid overdose have continually increased for the past 15 years . Deaths specifically related to heroin increased more than four-fold between 2002 and 2014. Hospital inpatient discharge data provide information on non-fatal overdoses, but include a significant lag in reporting time. Syndromic ED visit data provide near real-time identification of public health issues and can be leveraged to inform public health actions on the emerging threat of drug overdose.

Objective

To develop and evaluate syndrome definitions for the identification of acute unintentional drug overdose events including opioid, heroin, and unspecified substances among emergency department (ED) visits in Virginia.

In 2016, the World Health Organization declared Zika virus a global public health emergency. Zika infection during pregnancy can cause microcephaly and other fetal brain defects. To facilitate clinicians’ ability to detect Zika, various syndrome definitions have been developed. 

Objective

To develop and validate a Zika virus disease syndrome definition within the GUARDIAN (Geographic Utilization of Artificial Intelligence in Real-Time for Disease Identification and Alert Notification) surveillance system.