Evaluation of the secondary use of electronic health records to detect seasonal, holiday-related, and rare events related to traumatic injury and poisoning

Abstract

Background: The increasing adoption of electronic health record (EHR) systems enables automated, large scale, and meaningful analysis of regional population health. We explored how EHR systems could inform surveillance of trauma-related emergency department visits arising from seasonal, holiday-related, and rare environmental events. Methods:We analyzed temporal variation in diagnosis codes over 24 years of trauma visit data at the three hospitals in the University of Washington Medicine system in Seattle, Washington, USA. We identified seasons and days in which specific codes and categories of codes were statistically enriched, meaning that a significantly greater than average proportion of trauma visits included a given diagnosis code during that time period. Results: We confirmed known seasonal patterns in emergency department visits for trauma. As expected, cold weather-related incidents (e.g. frostbite, snowboarding injury) were enriched in the winter, whereas fair weatherrelated incidents (e.g. bug bites, boating accidents, bicycle accidents) were enriched in the spring and summer. Our analysis of specific days of the year found that holidays were enriched for alcohol poisoning, assaults, and firework accidents. We also detected one time regional events such as the 2001 Nisqually earthquake and the 2006 Hanukkah Eve Windstorm. Conclusions: Though EHR systems were developed to prioritize operational rather than analytic priorities and have consequent limitations for surveillance, our EHR enrichment analysis nonetheless re-identified expected temporal population health patterns. EHRs are potentially a valuable source of information to inform public health policy, both in retrospective analysis and in a surveillance capacity.

Data and Digital Solutions to Support Surveillance Strategies in the Context of the COVID-19 Pandemic

“…Surveillance is a core component of public health and preventive medicine and can be categorised as “active” (where health authorities make direct contact with the population or care providers to measure the actual conditions) or “passive” (when the health authorities get pre-designed reports about specific conditions, typically with the care providers reporting) ( 14 ).…”

Trauma Matters: Integrating Genetic and Environmental Components of PTSD

“…To some extent, trauma‐first GWAS approaches may be approximated using electronic health records (EHR). However, we caution that trauma is likely underreported among these types of cohorts; [ 148 , 149 , 150 , 151 , 152 , 153 ] moreover, reporting of trauma will likely disproportionately take place among individuals suffering from mental illness‐ disclosed during the course of treatment or therapy. [ 154 , 155 , 156 , 157 , 158 , 159 ] As such, ascertaining sufficient trauma‐exposed controls may be difficult using this approach.…”

Digital Data Sources and Their Impact on People's Health: A Systematic Review of Systematic Reviews

“…A wide variety of EHR data has been used in infectious disease surveillance, such as the incidence of Lyme disease and identifying newly diagnosed HIV infections ( 10 ), population health surveillance platforms ( 11 ), and outlining public benefits (accuracy, reliability, sensitivity, specificity, and timeliness) for communicable disease surveillance for de-identified personal EHR data ( 12 ). Klomps developed a platform called the Electronic Medical Record Support for Public Health (ESP), integrating EHR data for use in public health, while integrating clinical data into a repository for public health surveillance: the Public Health Community Platform (PHCP) ( 11 ).…”