Investigation of an Electronic Emergency Department Information System as a Data Source for Respiratory Syndrome Surveillance

Abstract

Emergency department syndromic surveillance may provide early warning of disease outbreaks due to bioterrorism or natural phenomena. The purpose of this investigation was to explore how an electronic emergency department information system could be used as a data source for respiratory syndrome surveillance. The process of data collection, entry, and transmission is described, and then a subset of data elements with potential epidemiological value is selected. The quality of the data contained in the system was evaluated by conducting a retrospective analysis of emergency department visits recorded in the system during 2001 and by reviewing clinical charts of cases with respiratory diagnoses. Diagnosis codes, discharge disposition, and demographic data were relatively complete; additional clinical data were not. Diagnosis codes were rapidly and reliably recorded. Data available in the system allows a description of emergency department visits for respiratory syndrome in terms of age, gender, location, severity of illness, and distribution in time. Encrypted data were transmitted every four hours to the health department without added work for emergency department personnel. Although significant obstacles remain, electronic emergency department information systems such as this may provide rapid, reliable data for syndromic surveillance.

Detection and Early Identification in Bioterrorism Events

“…11,12 Almost all electronic surveillance systems recently developed are modified versions of the Department of Defense Electronic Surveillance System for the Early Notification of Community-based Epidemics system. 8,10, 13 Bravata et al 6 used CDC guidelines for evaluation, and conducted an exhaustive review of surveillance systems designed for early identification of a bioterrorist attack. They reviewed more than 17,000 articles and 8,000 government Web sites, with 115 sources meeting research inclusion criteria.…”

“…Validation of data entered in surveillance systems occurred in all studies, and was generally performed by randomized chart review of physician-documented histories and physicals, radiology reports, and discharge diagnoses. 13 Using an identical model, the National Bioterrorism Syndromic Surveillance Demonstration Program analyzed health data for more than 20 million persons in several states. 22 Both of these systems have large populations, increasing the validity of their findings.…”

Task Force IV: Cardiovascular Effects of Emerging Infectious Diseases and Biological Terrorism Threats

“…Syndromic surveillance is comprised of systems designed to detect in a timely manner signals of increasing events based on monitoring patterns of hospitalizations, emergency room visits, emergency medical services data, billing records, prescriptions, and so on (35)(36)(37)(38). Adhering to standard national protocols for data definition and collection, as well as ensuring compatibility of electronic medical record systems, are critical factors for developing syndromic surveillance systems.…”

Injury Prevention

“…Coding systems that allow for classification of injuries and external causes of injuries, such as the International Classification of Diseases, are also essential elements in developing data systems [10]. These efforts have proved to be valuable in injury surveillance [11] and in disease surveillance, such as surveillance of adverse drug events [12] and respiratory syndromes [13].…”