An expanded ambulatory health record, the Comprehensive Ambulatory Patient Encounter Record (CAPER) will provide multiple types of data for use in DoD ESSENCE. A new type of data not previously available is the Reason for Visit (ROV), a free-text field analogous to the Chief Complaint (CC). Intake personnel ask patients why they have come to the clinic and record their responses. Traditionally, the text should reflect the patient's actual statement. In reality the staff often "translates" the statement and adds jargon. Text parsing maps key words or phrases to specific syndromes. Challenges exist given the vagaries of the English language and local idiomatic usage. Still, CC analysis by text parsing has been successful in civilian settings . However, it was necessary to modify the parsing to reflect the characteristics of CAPER data and of the covered population. For example, consider the Shock/Coma syndrome. Loss of consciousness is relatively common in military settings due to prolonged standing, exertion in hot weather with dehydration, etc., whereas the main concern is shock/coma due to infectious causes. To reduce false positive mappings the parser now excludes terms such as syncope, fainting, electric shock, road march, parade formation, immunization, blood draw, diabetes, hypoglycemic, etc.
Rather than rely on diagnostic codes as the core data source for alert detection, this project sought to develop a Chief Complaint (CC) text parser to use in the U.S. Department of Defense (DoD) version of the Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE), thereby providing an alternate evidence source. A secondary objective was to compare the diagnostic and CC data sources for complementarity.