Background Automatic identification of notifiable diseases from electronic medical records can potentially improve the timeliness and completeness of public health surveillance. We describe the development and implementation of an algorithm for prospective surveillance of patients with acute hepatitis B using electronic medical record data. Methods Initial algorithms were created by adapting Centers for Disease Control and Prevention diagnostic criteria for acute hepatitis B into electronic terms. The algorithms were tested by applying them to ambulatory electronic medical record data spanning 1990 to May 2006. A physician reviewer classified each case identified as acute or chronic infection. Additional criteria were added to algorithms in serial fashion to improve accuracy. The best algorithm was validated by applying it to prospective electronic medical record data from June 2006 through April 2008. Completeness of case capture was assessed by comparison with state health department records. Findings A final algorithm including a positive hepatitis B specific test, elevated transaminases and bilirubin, absence of prior positive hepatitis B tests, and absence of an ICD9 code for chronic hepatitis B identified 112/113 patients with acute hepatitis B (sensitivity 97.4%, 95% confidence interval 94–100%; specificity 93.8%, 95% confidence interval 87–100%). Application of this algorithm to prospective electronic medical record data identified 8 cases without false positives. These included 4 patients that had not been reported to the health department. There were no known cases of acute hepatitis B missed by the algorithm. Conclusions An algorithm using codified electronic medical record data can reliably detect acute hepatitis B. The completeness of public health surveillance may be improved by automatically identifying notifiable diseases from electronic medical record data.
References
[1]
Doyle TJ, Glynn MK, Groseclose SL (2002) Completeness of notifiable infectious disease reporting in the United States: an analytical literature review. Am J Epidemiol 155: 866–874.
[2]
Jajosky RA, Groseclose SL (2004) Evaluation of reporting timeliness of public health surveillance systems for infectious diseases. BMC Public Health 4: 29.
[3]
Effler P, Ching-Lee M, Bogard A, Ieong MC, Nekomoto T, et al. (1999) Statewide system of electronic notifiable disease reporting from clinical laboratories: comparing automated reporting with conventional methods. JAMA 282: 1845–1850.
[4]
Ward M, Brandsema P, van Straten E, Bosman A (2005) Electronic reporting improves timeliness and completeness of infectious disease notification, The Netherlands, 2003. Euro Surveill 10: 27–30.
[5]
Panackal AA, M'Ikanatha N M, Tsui FC, McMahon J, Wagner MM, et al. (2002) Automatic electronic laboratory-based reporting of notifiable infectious diseases at a large health system. Emerg Infect Dis 8: 685–691.
[6]
Overhage JM, Grannis S, McDonald CJ (2008) A comparison of the completeness and timeliness of automated electronic laboratory reporting and spontaneous reporting of notifiable conditions. Am J Public Health 98: 344–350.
[7]
Centers for Disease Control and Prevention (2008) Effect of electronic laboratory reporting on the burden of lyme disease surveillance–New Jersey, 2001–2006. MMWR Morb Mortal Wkly Rep 57: 42–45.
[8]
Klompas M LR, Daniel J, Haney GA, Campion FX, Kruskal BA, et al. (2007) Electronic medical record Support for Public Health (ESP): Automated detection and reporting of statutory notifiable diseases to public health authorities. Adv Dis Surv 3: 3.
[9]
van de Garde EM, Oosterheert JJ, Bonten M, Kaplan RC, Leufkens HG (2007) International classification of diseases codes showed modest sensitivity for detecting community-acquired pneumonia. J Clin Epidemiol 60: 834–838.
[10]
Kramer JR, Davila JA, Miller ED, Richardson P, Giordano TP, et al. (2008) The validity of viral hepatitis and chronic liver disease diagnoses in Veterans Affairs administrative databases. Aliment Pharmacol Ther 27: 274–282.
[11]
Wasley A, Miller JT, Finelli L (2007) Surveillance for acute viral hepatitis–United States, 2005. MMWR Surveill Summ 56: 1–24.
[12]
Ramsay ME, Rushdy AA, Harris HE (1998) Surveillance of hepatitis B: an example of a vaccine preventable disease. Vaccine 16: SupplS76–80.
[13]
Poulos RG, Ferson MJ (2004) Enhanced surveillance of acute hepatitis B in south-eastern Sydney. Commun Dis Intell 28: 392–395.
[14]
Centers for Disease Control and Prevention (2008) Automated detection and reporting of notifiable diseases using electronic medical records versus passive surveillance–Massachusetts, June 2006–July 2007. MMWR Morb Mortal Wkly Rep 57: 373–376.
[15]
Davis GL, Hoofnagle JH (1985) Reactivation of chronic type B hepatitis presenting as acute viral hepatitis. Ann Intern Med 102: 762–765.
[16]
Weber B, Muhlbacher A, Melchior W (2005) Detection of an acute asymptomatic HBsAg negative hepatitis B virus infection in a blood donor by HBV DNA testing. J Clin Virol 32: 67–70.
[17]
Gonzalez R, Echevarria JM, Avellon A, Barea L, Castro E (2006) Acute hepatitis B virus window-period blood donations detected by individual-donation nucleic acid testing: a report on the first two cases found and interdicted in Spain. Transfusion 46: 1138–1142.
