Re-purposing The Electronic Medical Record For Public Health Sylvain DeLisle MD, MBA VA Maryland Health Care System and University of Maryland.

Slides:

Advertisements

Similar presentations

Artrelle Fragher & Robert walker. 1 you look for the median 1 you look for the median 2 then you look for the min and max 2 then you look for the min.

Advertisements

ThemeGallery PowerTemplate

Surveillance in a Pandemic: Situational Awareness

CirculatingTumor Cells: Toward a clinical benefit? Giuseppe Naso MD, PhD, Associated Professor of Medical Oncology Director of Traslational Oncology Paola.

Ozone Level ppb (parts per billion)

Overall Survival (months) Cumulative Survival (%) BM negative BM positive P = Supplemental file 5 Overall survivals.

Improving Depression Treatment in Primary Care: Dissemination and Implementation Edmund Chaney, PhD Department of Veterans Affairs, Seattle AcademyHealth.

EMR Use is Not Associated with Better Diabetes Care Patrick J OConnor, MD, MPH Stephen E Asche, MA A Lauren Crain, PhD Leif I Solberg, MD William A Rush,

Paul J. Nietert, PhD Ruth G. Jenkins, MS Andrea M. Wessell, PharmD

The Impact of Drug Benefit Caps Geoffrey Joyce, PhD.

Using ESSENCE IV An Overview Objectives Explain ESSENCE and its impact Define surveillance Define syndromic surveillance and its importance Demonstrate.

1 Learning for employment vocational education and training policy in Europe in Europe Greece.

How can we tailor the delivery of the TB/HIV package to IDU? David H.-U. Haerry European AIDS Treatment Group (European Community Advisory Board, Policy.

Open Sesame: Arab Mobile Markets Michael Minges The views expressed are those of the author and may not necessarily reflect the opinions.

International Telecommunication Union Workshop on Standardization in E-health Geneva, May 2003 Digital Imaging in Pathology for Standardization Yukako.

Nick Curry, MD, MPH Infectious Diseases Prevention Section

Half Life. The half-life of a quantity whose value decreases with time is the interval required for the quantity to decay to half of its initial value.

Can Information Technology Transform Health Care? The RAND Study of Potential Costs and Benefits of Electronic Medical Record Systems Roger S. Taylor MD,

Update on Antigen Detection Paul E. Verweij, MD Nijmegen University Center for Infectious Diseases s Eukaryotic cell 2005;4:

DiseaseNo disease 60 people with disease 40 people without disease Total population = 100.

Dr Anne Raynal Senior Medical Inspector HSE March 2007

Yudatiningsih I.1,Sunartono H.1,SuryawatiS.2

10/20/ The Pharmaceutical Industry and Their Influence on Pain Management in the ED J. David Haddox, DDS, MD VP, Risk Management & Health Policy.

Examples of Sound Screening:

Duration of Serum Antibody Response to Seasonal Influenza Vaccines: Summary The level of antibody response made to seasonal influenza vaccines depends.

EXAMPLE 4 Solve a multi-step problem SHOPPING

` COMPARATIVE ACCURACY OF CARTRIDGE BASED NUCLEIC ACID AMPLIFICATION TEST AND SPUTUM MICROSCOPY FOR DIAGNOSIS OF PULMONARY TUBERCULOSIS IN HIV POSITIVE.

1 FaCES Clinic and Evaluation A Collaborative Effort….

Projecting Hospital Acute Bed Needs for Workshop organized by US Embassy and the Belgian Health Federal Public Service March 21, 2006 Prof. Dr.

Overview of Public Health Surveillance Denise Koo, MD, MPH Epidemiology Program Office Centers for Disease Control and Prevention.

Association between use of air-conditioning or fan and survival of elderly febrile patients: a prospective study George Theocharis, MD, Giannoula S. Tansarli,

Marks out of 100 Mrs Smith’s Class Median Lower Quartile Upper Quartile Minimum Maximum.

Counting coins Teacher’s Notes Slides used as worksheet print outs rather than class presentation. Variations to quantity and appearance can be made easily.

Sudden Cardiac Arrest (SCA)

Population Trends in the Incidence and Outcomes of Acute Myocardial Infarction Robert W. Yeh, MD MSc Massachusetts General Hospital Alan S. Go, MD Kaiser.

Number bonds to 10,

Beat the Computer Drill Divide 10s Becky Afghani, LBUSD Math Curriculum Office, 2004 Vertical Format.

Northern & Yorkshire Cancer Registry & Information Service NHS UKACR Conference 30 September How useful is the Cancer Waiting Times (CWT) dataset.

ADVANCING HEALTH CARE QUALITY IN 2007 AND BEYOND Margaret E. O’Kane President, NCQA.

THE CHALLENGE: CHRONIC DISEASE CARE AND THE PROMISE OF HIT Health Care Information Technology 2004: Improving Chronic Care in California San Francisco.

IDENTIFICATION OF FACTORS IMPACTING THE DETERMINATION OF HIV INCIDENCE IN NON-RESEARCH-BASED, CLINICAL POPULATIONS Sill, A.M. 1 ; Constantine, N.T. 2 ;

HIV and Aging Kathleen K Casey, MD Director, AIDS Ambulatory Care Center Jersey Shore University Medical Center.

Sep 13 Fall 05 Electronic Medical Records (EMR) Computerized Patient Record (CPR) Electronic Health Record (EHR)

Powerpoint Jeopardy Category 1Category 2Category 3Category 4Category

Outbreak Investigation Severe Acute Respiratory Syndrome SARS April 2003.

Publications Reviewed Searched Medline Hand screening of abstracts & papers Original study on human cancer patients Published in English before December.

Comparability of Electronic and Manual Influenza-like Illness (ILI) Surveillance Methods Robin M. Williams, Nebraska Department of Health & Human Services/University.

Using Indian Health Service Electronic Medical Records for Public Health Surveillance: IHS Influenza Awareness System (IIAS), 2009 Jim Cheek, MD, MPH Director,

Influenza-like Illness (ILI) Surveillance Jim Cheek, MD, MPH, FACPM Director, Div of Epi & Disease Prev Indian Health Service

Early Statistical Detection of Bio-Terrorism Attacks by Tracking OTC Medication Sales Galit Shmueli Dept. of Statistics and CALD Carnegie Mellon University.

Implementing a Syndromic Surveillance System in Miami-Dade County Fermin Leguen, MD, MPH Chief Physician Director, Office of Epidemiology & Disease Control.

Overview of ‘Syndromic Surveillance’ presented as background to Multiple Data Source Issue for DIMACS Working Group on Adverse Event/Disease Reporting,

SORE THROAT & OTITIS MEDIA

SPONSOR JAMES C. BENNEYAN DEVELOPMENT OF A PRESCRIPTION DRUG SURVEILLANCE SYSTEM TEAM MEMBERS Jeffrey Mason Dan Mitus Jenna Eickhoff Benjamin Harris.

Insert Program or Hospital Logo Introduction The Respiratory Syncytial virus (RSV) was discovered in 1956 and has been since recognized as one of the most.

1 ESSENCE: Biosurveillance in Support of the DoD Health Mission.

Dr. Zhen XU Branch of Respiratory Disease Prevention and Control Division for Disease Control and Emergency Response Chinese Center for Disease Control.

Public Health Informatics Consultants Technology bridging the gap in healthcare disparities Anthony O. Oloni, MD, MPH, CPHI.

Severe Acute Respiratory Syndrome (SARS) and Preparedness for Biological Emergencies 27 April 2004 Jeffrey S. Duchin, M.D. Chief, Communicable Disease.

Clinical Approach to the Diagnosis of SARS Joshua P. Metlay, MD, PhD VA Medical Center Division of General Internal Medicine Center for Clinical Epidemiology.

Texas ILINet Structure and Operation th Annual Texas Public Health Association Conference April 21-23, 2010 South Padre Island, Texas Gary.

Queen’s University Public Health Informatics (QPHI) Team Can Occupational Health data contribute to Public Health? Tara Donovan Institute.

Figure 1. Data Flow Diagram of Davis County School Absenteeism Surveillance System. Shuying Shen, MStat 1,2,3 ; Nicole Stone, MPH 4 ; Brian Hatch, MPH.

Comparison between pathogen directed antibiotic treatment and empiri cal broad spectrum antibiotic treatment in patients with community acquired pneumonia.

APHA, Washington, November, 2007

COPD, OPIOIDs, DMARDs.

Rapid antigen testing for the surveillance of influenza epidemics

One Health Early Warning Alert

Presentation transcript:

Re-purposing The Electronic Medical Record For Public Health Sylvain DeLisle MD, MBA VA Maryland Health Care System and University of Maryland

Parade to Promote Sale of War Bonds, Philadelphia, September 28, 1918

Overall Objective To find out if a comprehensive EMR can contribute to the early detection of an infectious disease epidemic

Stop Y N OutbreakValid? OutbreakSign.? Escalate PHS Case Detector Outbreak Detector Y CaseValid? N Y N EMR

Stop Y N OutbreakValid? OutbreakSign.? Escalate PHS Case Detector Outbreak Detector Y CaseValid? N Y N CPRS

CPRS: Provider Interface

CPRS: Free-text data entry

CPRS: Structured data entry

CPRS is really VISTA

Data Extraction: MDE

SQL: Data Transformation Sequences

SQL: Primary Warehouse

Stop Y N OutbreakValid? OutbreakSign.? Escalate PHS Case Detector Outbreak Detector Y CaseValid? N Y N CPRS

Stop Y N OutbreakValid? OutbreakSign.? Escalate PHS Case Detector Outbreak Detector Y CaseValid? N Y N Data Extractor SQL Database VISTA/CPRS Outbreak Detector

Stop Y N OutbreakValid? OutbreakSign.? Escalate PHS Case Detector Outbreak Detector Y CaseValid? N Y N Data Extractor SQL Database VISTA/CPRS Outbreak Detector

Focus on ILI We focused on influenza-like illness (ILI) as a syndrome that may indicate an event of public health significance –Anthrax –Plague –SARS –Influenza

ILI Case Definition Positive influenza culture or antigen OR Any two of the following (<= 7 days duration) –Cough –Fever or chills or night sweats –Pleuritic chest pain –Myalgia –Sore throat –Headache AND Illness not attributable to a non-infectious etiology

Gold Standard Detector: Manual Case Review VA Maryland Health Care System (VAMHCS) and the Salt Lake City VA (SLCVAMC) Study period: 10/01/03 to 3/31/04 15,377 (of 253,818) random sample, ER and selected outpatient clinics All ILI cases and a 10% subsample of the records were re- reviewed by a MD, discordant pairs were adjucated by a panel of three MDs Found 280 cases

ICD-9-based ILI Detectors Compared respiratory ICD-9 groupings from –BioSense (CDC) –Essence (DoD) –Optimized (VA)

Structured Parameters-based Case Detectors Vitals: Temp >38, RR > 22, HR > 100 Orders/dispense for Rx: expectorants, antibiotics, antitussives, decongestants, anti-emetics, antidiarrheals Order/results for tests: CBC, Diff, Strep. screen, Sputum cultures, Gram stain, Respiratory serologies, Influenza cultures/antigens, Chest/sinus XRays or CT scans

ILI Case Detector Retained parameters Cold remedies Fever >= 38ºC

Cold Remedies CN101 opioid analgesics like codeine" OR CN900 CNS medications, other acetaminophen/diphenhidramine, OR MS102 non-salicylate NSAIS (does not include antirheumatics), OR NT100 decongestants, nasal, OR NT200 anti-inflammatories, nasal, OR NT400 antihistamine, nasal, OR NT900 nasal and throat, topical, use other throat lozenge" only, OR RE200 decongestants, systemic, OR RE301 opioid-containing antitussives/expectorants, OR RE302 non-opioid-containing antitussives/expectorant, OR RE501 antihist/decongest, OR RE502 antihist/decongest/antitussive, OR RE503 antihist/decongest/expectorant, OR RE507 antihist/antitussive, OR RE508 antihist/antitussive/expectorant, OR RE513 decongest/antitussive/expectorant, OR RE516 decongest/expectorant, OR RE599 cold remedies, OR AH102 antihistamines, ethanolamine, OR AH104 antihistamines, alkylamine

TEXT-based ILI Case Detectors Examine the text of all clinical encounter notes on the day of an index visit Used modified NegEx algorithm (Wendy Chapman)

Mumbo jumbo fever nonsense trivia blabla etc TXT ILI Case Detectors NegEx

Mumbo jumbo fever nonsense trivia blabla etc TXT ILI Case Detectors NegEx

Negation? Mumbo jumbo fever nonsense trivia blabla etc

TXT ILI Case Detectors NegEx Negation? Mumbo jumbo fever nonsense trivia blabla etc

TXT ILI Case Detectors NegEx Negation? Mumbo jumbo fever nonsense trivia blabla etc

TXT ILI Case Detectors NegEx Negation? Mumbo jumbo fever nonsense trivia blabla etc

Sensitivity (%) ARIILI …OR Text)…OR Text NegEx MedLEE ICD9…(ICD9… Positive Predictive Value (%) …AND Text)…AND TextICD9… (ICD9… AND Temp

Which One Should We Use?

Stop Y N OutbreakValid? OutbreakSign.? Escalate PHS Case Detector Outbreak Detector Y CaseValid? N Y N Data Extractor SQL Database VISTA/CPRS Outbreak Detector

Number of ILI Cases Time Series: VAMHCS, Jan 1999 – Dec 2004

ILI Cases VAMHCS JulAugSepOctNovDecJanFebMarAprMayJun Number of ILI Cases

Stop Y N OutbreakValid? OutbreakSign.? Escalate PHS Case Detector Outbreak Detector Y CaseValid? N Y N Data Extractor SQL Database VISTA/CPRS Outbreak Detector Outbreak Generator

Outbreak Generator for Baltimore 1.Age-structured deterministic epidemic model generates the number of new infections in each age group, each day, for each zip code 2.Stochastic metapopulation spatial model determines how the outbreak will extend in space-time 3.Stochastic clinical features algorithm determines which of these infections will be recognized cases at the VA, and the severity, clinical profile and outcome for each recognized case

ILI Cases VAMHCS JulAugSepOctNovDecJanFebMarAprMayJun Number of ILI Cases

ILI Cases VAMHCS JulAugSepOctNovDecJanFebMarAprMayJun Number of ILI Cases

ILI Cases VAMHCS JulAugSepOctNovDecJanFebMarAprMayJun Number of ILI Cases

Stop Y N OutbreakValid? OutbreakSign.? Escalate PHS Case Detector Outbreak Detector Y CaseValid? N Y N Data Extractor SQL Database VISTA/CPRS Outbreak Detector Outbreak Generator

ILI Cases VAMHCS JulAugSepOctNovDecJanFebMarAprMayJun Number of ILI Cases

BIOSENSE (Current)

Fixed Threshold (p-value)

Optimized Threshold

Improved ICD-9 Codesets

Adding Structured Parameters

Adding Text Analysis

Optimizing for Positive Predictive Value

Surveillance for Febrile_ILI

EMR data can significantly enhance automated Case detection of ILI compared to the use of ICD- 9 codes alone Whole-system simulation and is required to evaluate and calibrate the performance of alternative single-case detectors Conclusions (1)

For influenza surveillance, case-detection algorithms should aim for high positive predictive value, and target ILI cases who are febrile Conclusions (2)

Stop Y N OutbreakValid? OutbreakSign.? Escalate PHS Case Detector Outbreak Detector Y CaseValid? N Y N Outbreak Generator Data Extractor SQL Database VISTA/CPRS Bob Sawyer Shawn Loftus Brett South Ericka Kalp Sylvain DeLisle Trish Perl Steve Altman, Raju Vatsaval Jill Anthony Shobha Phansalkar Brett South Matt Samore Gary Smith Holly Gaff Hongzhang Zheng Zhilian Ma Fang Tian Paul Sun Vibrio