An Automated Syphilis Serology Record Search and Review Algorithm to Prioritize Investigations by Health Departments

Abstract

Background: Reactive syphilis serologies are investigated by health departments to determine if they represent new infection, reinfection, or treatment failure. Serologies prioritized for investigation based on nontreponemal test titer and age (using a "reactor grid") undergo manual record search and review. We developed a computerized algorithm that automates the record search and review. Methods:We developed and tested the algorithm using a Florida Department of Health data set containing serologies reported January 2016 to December 2018 and previous records linked to each individual. The algorithm was based on the syphilis case definition, which requires (except primary cases with signs and symptoms) (1) a positive treponemal test result and a newly positive nontreponemal test result or (2) a 4-fold increase in nontreponemal test titer. Two additional steps were added to avoid missing cases. New York City Department of Health and Mental Hygiene validated this algorithm. Results:The algorithm closed more investigations (49.9%) than the reactor grid (27.0%). The algorithm opened 99.4% of the individuals investigated and labeled as cases by the health department; it missed 75 cases. Many investigations opened by the algorithm were closed by the reactor grid; we could not assess how many would have been cases. In New York City, the algorithm closed 70.9% of investigations, likely because more individuals had previous test in the database (88.2%) compared with Florida (56.5%). Conclusions:The automated algorithm successfully searched and reviewed records to help identify cases of syphilis. We estimate the algorithm would have saved Florida 590 workdays for 3 years.

Evaluation of STD Surveillance System Electronic Laboratory Processing in Florida: Automating Case Creation, Reporting, and Closure of Chlamydia and Gonorrhea Cases

“…26,27 Other programs found cost savings from automating aspects of their surveillance systems with lower volume than this evaluation. 18,19,28 Furthermore, time savings in this evaluation should be viewed as conservative estimates. Using 1-minute per step of automation method is certain to be an underestimation of some of the processes.…”

“…Person-data matching methods used by a variety of industries to assist in business practices could also be used by the STDSS to aid in laboratory results matching to person-data within the STDSS 8,9,15,16 . Moreover, other disease surveillance programs have identified algorithms that process laboratory results and determine new infections aligned with respective case definitions 17–19 . Only a few groups of people with CT and GC infections in Florida are considered priority for investigation (i.e., children younger than15 years, pregnant women, county health department patients, grant-specified enhanced surveillance cases, rectal infections, certain repeat infections, people diagnosed with other STD comorbidities).…”

“…8,9,15,16 Moreover, other disease surveillance programs have identified algorithms that process laboratory results and determine new infections aligned with respective case definitions. [17][18][19] Only a few groups of people with CTand GC infections in Florida are considered priority for investigation (i.e., children younger than15 years, pregnant women, county health department patients, grant-specified enhanced surveillance cases, rectal infections, certain repeat infections, people diagnosed with other STD comorbidities). Therefore, programs could modify their surveillance system procedures and protocols, such as reassessing which infections need supervisory review, to align with program priorities and available staff resources.…”

Creating a Sexually Transmitted Infection Disease Intervention Workforce for the 21st Century

“…For example, electronic laboratory reporting increased the timeliness of reported positive STI test result, and automated triaging of cases can improve program efficiency. 18,19 In addition, research has been evaluating the use of electronic health records for case reporting to provide more complete demographic and other data than electronic laboratory reporting typically provides. 20 Technology such as smartphone applications (apps) have also been used to assist DIS with interviews by providing a tool to immediately identify sex partners who were found on dating or hook-up apps and Web sites.…”

“…Technological advances in data management and related technology can aid in CICT and STI partner services. For example, electronic laboratory reporting increased the timeliness of reported positive STI test result, and automated triaging of cases can improve program efficiency 18,19 . In addition, research has been evaluating the use of electronic health records for case reporting to provide more complete demographic and other data than electronic laboratory reporting typically provides 20 .…”