LA County Dept. of Health Services Disease Surveillance – Applying Pathology Informatics to Public...
-
Upload
beatrice-davis -
Category
Documents
-
view
212 -
download
0
Transcript of LA County Dept. of Health Services Disease Surveillance – Applying Pathology Informatics to Public...
LA County Dept. of Health ServicesLA County Dept. of Health Services
Disease Surveillance – Disease Surveillance – Applying Pathology Applying Pathology
Informatics to Public HealthInformatics to Public Health
Raymond D. Aller, M.D.Contributing Editor, CAP Today and Director,
Bioterrorism Preparedness and Response Section Acute Communicable Disease Control Program
Los Angeles County Department of Public Health18 August 2006
LA County Dept. of Health ServicesLA County Dept. of Health Services2Pathology Informatics in Public Health - 18 Aug 06
Pathology as a clinical Pathology as a clinical informatics pioneerinformatics pioneer
First information systems used in routine patient care
First electronic longitudinal patient records
First nationwide clinical records Comfort and familiarity with building and
maintaining large analytical databases
LA County Dept. of Health ServicesLA County Dept. of Health Services3Pathology Informatics in Public Health - 18 Aug 06
.. and as pioneer of technologies and .. and as pioneer of technologies and standards for PH disease surveillancestandards for PH disease surveillance
SNOMED – 1975 (SNOP 1965) In 1970’s first automatic transfer of coded
data to a PH system (tumor registry)HL7 – from glimmer in 1979 to publication
in 1987LOINC – cooperative development with
extensive pathology/lab medicine involvement - 1994.
LA County Dept. of Health ServicesLA County Dept. of Health Services4Pathology Informatics in Public Health - 18 Aug 06
Clinical InformaticsClinical Informatics
Not about computers or information technology
Is about how we acquire, analyze, and apply clinical information
We are informaticists (Informaticians work with dead information)
LA County Dept. of Health ServicesLA County Dept. of Health Services5Pathology Informatics in Public Health - 18 Aug 06
Keys to success Keys to success
Use of data produced as a byproduct of clinical care Automatic transfer of that data from clinical care
setting, to public health database Translation functions to standardize the incoming
vocabularies and codes Mechanisms to detect outbreaks designed for both
naturally occurring (epidemics) and malicious (bioterrorism)
Informatics is today a key tool in defense against natural and man-made outbreaks.
LA County Dept. of Health ServicesLA County Dept. of Health Services6Pathology Informatics in Public Health - 18 Aug 06
ObjectivesObjectives
Describe at least 3 types of data from clinical medicine being used to detect disease outbreaks
Discuss 4 or more non-technical barriers delaying connection of clinical data sources to the public health database
List at least three types of unique contributions, critical to PH disease surveillance, that originated in pathology
Eliminate excuses as to why his/her laboratory isn’t pursuing connection with their local PH disease surveillance system.
LA County Dept. of Health ServicesLA County Dept. of Health Services7Pathology Informatics in Public Health - 18 Aug 06
Types of data from the lab Types of data from the lab to public healthto public health
First implemented: tumor diagnoses from surgical path to the tumor registry.– An entire subject in itself, and I won’t attempt to cover
today In recent years, I’ve focused on a few other areas,
from clinical lab to PH:– Transfer of reportable (mostly infectious) disease
information (for case management)– Antimicrobial susceptibility (de-identified)– All lab orders (de-identified)
LA County Dept. of Health ServicesLA County Dept. of Health Services8Pathology Informatics in Public Health - 18 Aug 06
Knowing that there is a Knowing that there is a problemproblem
Natural (epidemic) vs. malicious (bioterrorism)Most agents (biological, nuclear, incendiary,
chemical, explosive, radiologic - b-NICER) are overtBiological agents - typically covertA major portion of preparation for bioterrorism is
about detection.
LA County Dept. of Health ServicesLA County Dept. of Health Services9Pathology Informatics in Public Health - 18 Aug 06
Detection – Detection – two sides of the cointwo sides of the coin
Detecting the organism (or toxin) itself– Example – the post office Biohazard Detection
System – A point of care laboratory assay!
Detecting early signs of disease– Disease reporting by clinicians, labs– Symptoms and behavior– Animal diseases
LA County Dept. of Health ServicesLA County Dept. of Health Services10Pathology Informatics in Public Health - 18 Aug 06
Our most important data Our most important data sourcessources
The astute clinician and the telephone!
Message: If you see something that looks wrong, let public health know.
LA County Dept. of Health ServicesLA County Dept. of Health Services11Pathology Informatics in Public Health - 18 Aug 06
LA County Dept. of Health ServicesLA County Dept. of Health Services12Pathology Informatics in Public Health - 18 Aug 06
The Scope of PH Informatics (1)The Scope of PH Informatics (1)
Vital records: birth and death registries Public Health laboratory:
– biological– chemical/ environmental (potable and recreational water,
milk, etc.)– newborn screening/ management for genetic and infectious
disorders
Management of chronic conditions (disabilities, newborn abnormalities, etc.)
LA County Dept. of Health ServicesLA County Dept. of Health Services13Pathology Informatics in Public Health - 18 Aug 06
PH Informatics (2)PH Informatics (2)
Population health and perception measurement, monitoring - data acquired from:– Population-based clinical care systems (e.g., Indian Health
Service)– Telephone and other population surveys
Environmental health Reportable disease: National electronic disease
surveillance system Management of communicable disease: Acute
communicable disease, Sexually transmitted diseases, HIV epidemiology, Tuberculosis, Immunization registry
LA County Dept. of Health ServicesLA County Dept. of Health Services14Pathology Informatics in Public Health - 18 Aug 06
PH Informatics (3)PH Informatics (3)
Lead poisoning case management Electronic laboratory reporting: Syndromic surveillance Alerting and partner communications Strategic national stockpile inventory and warehouse
management Countermeasure response administration (mass prophylaxis) Education and training of medical professionals and the public
– Tracking/managing that training (learning management) Emergency management information systems:
– Coordination with other first responders, such as fire, police
LA County Dept. of Health ServicesLA County Dept. of Health Services15Pathology Informatics in Public Health - 18 Aug 06
Public Health InformaticsPublic Health InformaticsToday’s talk
– Encourage reporting of disease by clinicians– Electronic laboratory reporting– Syndromic surveillance
Other areas of interest to pathology, will not be discussed today– Lab information systems – PH, veterinary– Many others
LA County Dept. of Health ServicesLA County Dept. of Health Services16Pathology Informatics in Public Health - 18 Aug 06
How do we detect How do we detect disease?disease?
Reportable disease– Clinician – paper (underreporting)– Infection control practitioners – web entry– Electronic reporting from labs– Automatic reporting from clinical systems
Symptoms– Emergency departments (symptoms, volume - Reddinet)– 911 calls, ambulance dispatch, nurse call lines
Byproducts of care– Ambulatory diagnoses, lab orders (Biosense)
Behavior– Purchase of over the counter medications– School or work absenteeism
LA County Dept. of Health ServicesLA County Dept. of Health Services17Pathology Informatics in Public Health - 18 Aug 06
80+ reportable
diseases
(mostly infectious)
must (by law) be
reported to
Public Health
LA County Dept. of Health ServicesLA County Dept. of Health Services18Pathology Informatics in Public Health - 18 Aug 06
Reportable diseasesReportable diseases
• In the past, handwritten paper form via mail or fax
• Reporting is slow, and rates are often abysmal (5% or less) Improved by use of a web-based system However, findings diagnostic of many of these diseases
(e.g., hepatitis B) are stored in hospital, laboratory and/or clinic computers
Automatic electronic transfer of these cases to public health (e.g., Electronic Laboratory Reporting) has been shown to greatly improve the reporting rate.
LA County Dept. of Health ServicesLA County Dept. of Health Services19Pathology Informatics in Public Health - 18 Aug 06
Web-facilitated reportingWeb-facilitated reporting
Web-visual Confidential Morbidity Report (Web-vCMR)
Now called the Community Reporting Module
Anywhere with internet access Security: digital certificate on your
workstation, plus username/password
LA County Dept. of Health ServicesLA County Dept. of Health Services20Pathology Informatics in Public Health - 18 Aug 06
LA County Dept. of Health ServicesLA County Dept. of Health Services21Pathology Informatics in Public Health - 18 Aug 06
From manual to automaticFrom manual to automatic
When a reportable diagnosis is recorded in an EMR/EHR– Automatically report - or –– Pop-up question to clinician –
• OK to report?
Recognizing patterns in the EMR
LA County Dept. of Health ServicesLA County Dept. of Health Services22Pathology Informatics in Public Health - 18 Aug 06
Electronic Lab Electronic Lab Reporting (ELR)Reporting (ELR)
Software on the laboratory information system automatically selects from all laboratory results, those which are reportable to public health
In other cases, ALL results transferred to a filtering system, that selects reportables
These may be enhanced by other findings of public health importance– Antimicrobial susceptibility testing– Syndromic indications
ELR commonly doubles the reporting rate
LA County Dept. of Health ServicesLA County Dept. of Health Services23Pathology Informatics in Public Health - 18 Aug 06
Key characteristics of ELRKey characteristics of ELR Unbroken (no manual steps) electronic linkage between the database
of the laboratory’s information system and the database of the public health disease reporting system.– HL7 format– Flat file format
For a very small lab, web entry Types of data that may be sent: immunology, microbiology, tumor
diagnoses Systems the data is sent to: communicable disease reporting
systems, syndromic surveillance systems, tumor registries
LA County Dept. of Health ServicesLA County Dept. of Health Services24Pathology Informatics in Public Health - 18 Aug 06
Why Electronic Lab Reporting?Why Electronic Lab Reporting?
Community/clinician reporting rates abysmal (often less than 5%)
Laboratories typically have much better administrative organization
Positive laboratory findings more definitive than a clinical impression
Even without ELR, labs often achieve 50% or better reporting rates.
ELR permits close to 100% reporting rates
LA County Dept. of Health ServicesLA County Dept. of Health Services25Pathology Informatics in Public Health - 18 Aug 06
ELR Benefits to the LabELR Benefits to the Lab
Results to PH as soon as available – compliance with <24-hour reporting law
Every case that meets criteria is sent automatically
Some states now mandate electronic reporting
HIPAA disclosure records completeLab staff time savings.
LA County Dept. of Health ServicesLA County Dept. of Health Services26Pathology Informatics in Public Health - 18 Aug 06
ELR ImplementationELR Implementation
Format – HL7 v2.3.z, v2.3.1, now v2.5 target Security – sFTP, VPN Important to capture patient address and phone
(for PH followup) – may require additional data from ADT system, etc.
Codes converted from local to standard– Result names standardized – LOINC– Result values standardized – SNOMED– Specimen source – HL7 table, SNOMED– Appropriate tests/results to send – “Dwyer/Sable tables”
LA County Dept. of Health ServicesLA County Dept. of Health Services27Pathology Informatics in Public Health - 18 Aug 06
LOINCLOINC
Logical Observation Identifier Names and Codes In ELR, used for test names Published beginning in 1994 Freely available – copyright but royalty free Now mandated by Federal government for all
governmental healthcare programs (VA, DOD, IHS). The standard for reporting of public health data. Future standards for physicians office systems www.loinc.org
LA County Dept. of Health ServicesLA County Dept. of Health Services28Pathology Informatics in Public Health - 18 Aug 06
SNOMEDSNOMED
Systematized Nomenclature of Medicine In ELR, used for organism names Under development since the late 60’s Encompasses all areas of clinical medicine Mandated for all medical records in the UK Also used by many organizations (Kaiser) and
countries Licensed for use throughout the United States. www.snomed.org
LA County Dept. of Health ServicesLA County Dept. of Health Services29Pathology Informatics in Public Health - 18 Aug 06
Data Transformation Data Transformation
HospitalSystems
Public Health
Information System
Public Health
Information System
Public Health
Information System
Web page Data entry
Format converter
De-identification
(of “n
on
-rep
orta
ble
” find
ing
s)
Collation
Text handling
Routing
PH compliantHL7 messages
PH compliantHL7 messages
PH compliantHL7 messages
These functions may be performed in the Public Health Department, Data Producing Facility or an Intermediary
Filter
Code translationCode translationCode translations
LA County Dept. of Health ServicesLA County Dept. of Health Services30Pathology Informatics in Public Health - 18 Aug 06
To Do a LOINCingTo Do a LOINCing
Download lab’s test dictionaryTest name, test code, units, method,
specimen typeDone by Public Health staff or outside
services (probably not the lab)
LA County Dept. of Health ServicesLA County Dept. of Health Services31Pathology Informatics in Public Health - 18 Aug 06
Getting from internal test codes Getting from internal test codes to standard LOINC codesto standard LOINC codes
Today – – Laborious, mostly manual process to match description,
units, method, etc. to appropriate code– Some vendors (e.g. 3M) have a suite of automated tools
Tomorrow –– Vendors (instruments, kits, reference labs) supply the
appropriate codes– Statistical assessment of a high-volume HL7 data stream
(e.g., mean and SD of results)
LA County Dept. of Health ServicesLA County Dept. of Health Services32Pathology Informatics in Public Health - 18 Aug 06
What Data is Transmitted?What Data is Transmitted?
Now: Reportable diseases– Supporting lab findings – liver enzymes and
bilirubin on cases of positive hepatitis serologySoon: Lab orders that may help define
syndromes Future: Antimicrobial susceptibility testing –
on ALL organisms
LA County Dept. of Health ServicesLA County Dept. of Health Services33Pathology Informatics in Public Health - 18 Aug 06
Syndromic Surveillance Syndromic Surveillance using lab datausing lab data
Real-time public health surveillance using data that is routinely collected for other purposes
Not to identify individuals, but to detect atypical patterns of symptoms, orders, findings– Therefore, data can be de-identified
Real time transmission, analysis, and alerts
LA County Dept. of Health ServicesLA County Dept. of Health Services34Pathology Informatics in Public Health - 18 Aug 06
Lab Order Defined Lab Order Defined SyndromesSyndromes
Blood cultures: fever Stool cultures: GI Sputum cultures: respiratory CSF cell counts: meningeal (e.g., West Nile) This is a nascent area – may be better to get ALL
orders, as we learn what constitutes a useful pattern
The BioSense – LabCorp experience
LA County Dept. of Health ServicesLA County Dept. of Health Services35Pathology Informatics in Public Health - 18 Aug 06
Antimicrobial Antimicrobial Susceptibility TestingSusceptibility Testing
Antimicrobial resistance is an increasing problem in all communities
Traditional – collect antibiograms from hospitalsLate 90’s – commercial services such as TSN
collected susceptibility data from labsAlternative – collect raw susceptibility results from
labs, perform calculations at public health.
LA County Dept. of Health ServicesLA County Dept. of Health Services36Pathology Informatics in Public Health - 18 Aug 06
Cost of disease reporting Cost of disease reporting from labsfrom labs
Cost of manual reporting – – 0.50 to $5 per case
Interface– Initial – license fees, implementation, personnel time– Ongoing –
• Direct link - maintenance fees• Intermediary - monthly use fee.
– LA County has arranged to reimburse hospitals for costs (see next slide)
LA County Dept. of Health ServicesLA County Dept. of Health Services37Pathology Informatics in Public Health - 18 Aug 06
For once, a funded mandateFor once, a funded mandate
LA County has HRSA/NHBPP grant funding to reimburse hospitals for their out-of-pocket expenses (e.g., vendor fees) in establishing data feeds
We have already purchased lab interface modules for several hospitals
We also provide data conversion (LOINC)
LA County Dept. of Health ServicesLA County Dept. of Health Services38Pathology Informatics in Public Health - 18 Aug 06
ELR – current statusELR – current status
Nationwide, many states (and a few local jurisdictions) are now receiving ELR
Most commonly connected – national labs (LabCorp, Quest)
LA County Dept. of Health ServicesLA County Dept. of Health Services39Pathology Informatics in Public Health - 18 Aug 06
Mandatory use of Mandatory use of electronic lab reportingelectronic lab reporting
Still voluntary in most jurisdictionsSome now require by law/regulation
– New York StateOr for certain tests –
– Blood lead - California
LA County Dept. of Health ServicesLA County Dept. of Health Services40Pathology Informatics in Public Health - 18 Aug 06
Potholes in the information Potholes in the information superhighwaysuperhighway
When you are trying to travel at 186,000 mps, a pothole is a big deal!
LA County Dept. of Health ServicesLA County Dept. of Health Services41Pathology Informatics in Public Health - 18 Aug 06
The official salute of the The official salute of the governmental I/T governmental I/T insecurity officerinsecurity officer
LA County Dept. of Health ServicesLA County Dept. of Health Services42Pathology Informatics in Public Health - 18 Aug 06
The general I/T industry is The general I/T industry is beginning to recognize thisbeginning to recognize this
LA County Dept. of Health ServicesLA County Dept. of Health Services43Pathology Informatics in Public Health - 18 Aug 06
What is the biggest threat to What is the biggest threat to our informatics preparedness our informatics preparedness for biosecurity?for biosecurity?
The information insecurity officer– Fingerpointing– “Finding a way to get to NO”– The security Luddite– Forces expensive, error prone and
unsafe workarounds
LA County Dept. of Health ServicesLA County Dept. of Health Services44Pathology Informatics in Public Health - 18 Aug 06
5 I/T syndromes hazardous 5 I/T syndromes hazardous to the public’s healthto the public’s health
The security Luddite The perfect: enemy of the good Governmental bureaucracy
– Counterproductive hiring policies– Inhibitory purchasing procedures– Impossible contracting procedures
The vaporware merchant Judgments based on Insufficient data
LA County Dept. of Health ServicesLA County Dept. of Health Services45Pathology Informatics in Public Health - 18 Aug 06
Back to biological diseaseBack to biological disease
Gathering diverse dataLooking for patternsLetting key people know about it
LA County Dept. of Health ServicesLA County Dept. of Health Services46Pathology Informatics in Public Health - 18 Aug 06
Current Data Sources Current Data Sources
Disease reports – diagnosed or suspected– Telephone reports– Paper reports– VCMR– Labs
Syndromic– Sixteen hospital emergency departments– Over-the-counter pharmacy sales – Reddinet©
– Biosense– Coroners service
LA County Dept. of Health ServicesLA County Dept. of Health Services47Pathology Informatics in Public Health - 18 Aug 06
Conceptual Architectural OverviewConceptual Architectural Overview
Public Health
Information System
Web page Data entry
Pharmacy
Billing
EmergencyDepartment
ChiefComplaint Clinical
Documentation
LIS
Reference Labs
Veterinary / Zoo Labs
HIS & othersystems
Collation, transformation and routing processes
PH CompliantHL7 Messages
All are Data Producing Facilities (DPFs)
Web page Data entry
LA County Dept. of Health ServicesLA County Dept. of Health Services48Pathology Informatics in Public Health - 18 Aug 06
Assumptions – Assumptions – Bioterrorism detectionBioterrorism detection
LA County Dept. of Health ServicesLA County Dept. of Health Services49Pathology Informatics in Public Health - 18 Aug 06
Syndromic SurveillanceSyndromic Surveillance
Presenting complaints are automatically categorized into a particular syndrome
Syndrome counts are tracked over time Statistical increase in syndrome counts triggers
a signal To detect major trends from baseline patterns,
not individual cases
LA County Dept. of Health ServicesLA County Dept. of Health Services50Pathology Informatics in Public Health - 18 Aug 06
Key stepsKey steps
Getting the dataAnalyzing the dataDisseminating the findings
LA County Dept. of Health ServicesLA County Dept. of Health Services51Pathology Informatics in Public Health - 18 Aug 06
Getting ED chief complaint Getting ED chief complaint datadata
• Data use agreement – hospital – PH– May take months to get signoff
Automatic electronic connection from hospital admitting/hub system to PH information system– 12 hours of technical work, but months to get there.– sFTP, VPN, or even (+/-) encrypted eMail
De-identified – send only age, sex, date/time, chief complaint, zip code, disposition (+diagnosis if rapidly available)
LA County Dept. of Health ServicesLA County Dept. of Health Services52Pathology Informatics in Public Health - 18 Aug 06
Where do we pull data Where do we pull data from?from?
Now - ADT transactions (HL7 A04/8) to extract free text chief complaint
Future – – Emergency department systems– structured observations, impressions
and orders from the EMR/EHR
LA County Dept. of Health ServicesLA County Dept. of Health Services53Pathology Informatics in Public Health - 18 Aug 06
How would data flow from How would data flow from clinics?clinics?
Completely automatic – no ongoing manual intervention
One possible source – walk-in and same-day patients’ reason for visit
A future possible source – electronic medical records systems
LA County Dept. of Health ServicesLA County Dept. of Health Services54Pathology Informatics in Public Health - 18 Aug 06
Line ListingLine Listing
LA County Dept. of Health ServicesLA County Dept. of Health Services55Pathology Informatics in Public Health - 18 Aug 06
Key stepsKey steps
Getting the dataAnalyzing the dataDisseminating the findings
LA County Dept. of Health ServicesLA County Dept. of Health Services56Pathology Informatics in Public Health - 18 Aug 06
Analyzing the data: Analyzing the data: Syndrome ClassificationSyndrome Classification
Standard– Gastrointestinal – Respiratory– Rash– Neurological
Special categories– Influenza like illness– Heat– (Trauma)– Others as needed
LA County Dept. of Health ServicesLA County Dept. of Health Services57Pathology Informatics in Public Health - 18 Aug 06
Sample: Syndrome Trend and Sample: Syndrome Trend and CUSUM Analysis CUSUM Analysis
LA County Dept. of Health ServicesLA County Dept. of Health Services58Pathology Informatics in Public Health - 18 Aug 06
Investigation and Daily Investigation and Daily Report IReport I
Investigation—Review counts and proportions
one day increase or continued increase? coincidence with high profile public event?
—Review line listssimilar chief complaints within and across the
hospital, age and gender clustering?Unusually severe and high volume? coincident with traditional disease reports?
—Review complementary systems —Call ED, review charts, follow-up patients
LA County Dept. of Health ServicesLA County Dept. of Health Services59Pathology Informatics in Public Health - 18 Aug 06
Sample: SaTScan Sample: SaTScan Syndrome Cluster MapSyndrome Cluster Map
LA County Dept. of Health ServicesLA County Dept. of Health Services60Pathology Informatics in Public Health - 18 Aug 06
Over-the-Counter Cough & Cold Medication SalesMultiple Signals For 11/28/03
LA County Dept. of Health ServicesLA County Dept. of Health Services61Pathology Informatics in Public Health - 18 Aug 06
Key stepsKey steps
Getting the dataAnalyzing the dataDisseminating the findings
LA County Dept. of Health ServicesLA County Dept. of Health Services62Pathology Informatics in Public Health - 18 Aug 06
Reporting the dataReporting the data
Generate summary report, hospitals coded
7 days per weekSend to key public health staff, to the
LAC Terrorism Early Warning group, as well as to each participating hospital.
LA County Dept. of Health ServicesLA County Dept. of Health Services63Pathology Informatics in Public Health - 18 Aug 06
Example of daily Example of daily syndromic reportsyndromic report
Hospital Syndrome Signal Observed Threshold
A GI No 11 19
ILI No 54 92
Neuro No 1 1
Rash Yes 8 7Respiratory No 58 98
OTC No
Coroner No
LA County Dept. of Health ServicesLA County Dept. of Health Services64Pathology Informatics in Public Health - 18 Aug 06
LA County Dept. of Health ServicesLA County Dept. of Health Services65Pathology Informatics in Public Health - 18 Aug 06
What have we found in LA What have we found in LA County?County?
Onset of 03-04 flu season Diarrhea outbreak Feb 21 ‘04 – rotavirus Cluster of respiratory distress Mar 3, ‘04 Cluster of rash – Oct 15, 04 “rule out smallpox” – varicella contacts Summer surge in viral meningitis – ‘03 Retrospective analysis for West Nile meningitis
LA County Dept. of Health ServicesLA County Dept. of Health Services66Pathology Informatics in Public Health - 18 Aug 06
Syndromic surveillance: Syndromic surveillance: others findingsothers findings
Early detection of flu in NYC, Utah, others Case finding for measles, varicella outbreaks Cryptosporidium, Milwaukee, 2001 (OTC) Diarrhea following blackout – NYC, Aug 2003 Asthma, respiratory distress, SD County, Nov. 2003/4 Heat-related illness // Cipro sales after anthrax Fireworks // Dog bites/rat bites // Overdoses West Nile virus spraying // Suicide attempts Carbon monoxide poisoning – Pennsylvania, 2003 Diarrheal outbreaks: norovirus, rotavirus – NYC, 2002
LA County Dept. of Health ServicesLA County Dept. of Health Services67Pathology Informatics in Public Health - 18 Aug 06
How well do we cover the How well do we cover the population of LA County?population of LA County?
Green = well covered
Red = poorly covered
LA County Dept. of Health ServicesLA County Dept. of Health Services68Pathology Informatics in Public Health - 18 Aug 06
Improving the precision of Improving the precision of syndromic categorizationsyndromic categorization
Today – ADT transactions, extract free text chief complaint
Tomorrow - structured observations and impressions from the ED record, and EMR/EHR
LA County Dept. of Health ServicesLA County Dept. of Health Services69Pathology Informatics in Public Health - 18 Aug 06
Public Health and RHIOsPublic Health and RHIOs
Regional Health Information Organizations Focused on clinical data sharing, but serves
many needs Often, PH may be the first to connect multiple
hospitals in a community – albeit for a limited data set
Public Health is very interested in several of the data types flowing in an established RHIO.
One of the best examples is the Regenstrief/Indiana RHIO
LA County Dept. of Health ServicesLA County Dept. of Health Services70Pathology Informatics in Public Health - 18 Aug 06
Public Health Davies Public Health Davies AwardAward
To recognize outstanding achievement in using informatics to improve the public’s health
Pennsylvania disease reporting system S. Dakota Vital Records Utah – Immunization registry Indian Health Service North Carolina ED surveillance 2006 Awardees to be announced this fall
LA County Dept. of Health ServicesLA County Dept. of Health Services71Pathology Informatics in Public Health - 18 Aug 06
Key Points about Key Points about surveillancesurveillance
Avoid manual work by labs and hospitals Rapid detection of nasty disease, tracking slower public health
menaces Implementation requires expert and experienced technical
support Not a panacea, but gives some reassurance. This is a process that can easily take months – or years HIPAA compliant Need to add more data sources
LA County Dept. of Health ServicesLA County Dept. of Health Services72Pathology Informatics in Public Health - 18 Aug 06
How can your lab How can your lab contribute?contribute?
Talk with your local and state public health agencies– Are they ready to receive ELR and ED data?– If not, encourage them!– Monthly national ELR call, first Tuesday 10a PDT– Monthly national ED/SS call, 4th Thursday, q other month
Talk with your LIS vendor– What software module(s) are available for this activity?– We in LA County have had extensive discussions with
Misys, Meditech, Cerner, McKesson, some discussions with others – all have useful tools
Please let us know if we can be of assistance.
LA County Dept. of Health ServicesLA County Dept. of Health Services73Pathology Informatics in Public Health - 18 Aug 06
ResourcesResources
CAP Today – articles, Newsbytes –– www.cap.org
www.cdc.gov/phinwww.loinc.orgwww.snomed.org
LA County Dept. of Health ServicesLA County Dept. of Health Services74Pathology Informatics in Public Health - 18 Aug 06
Contact usContact us
Raymond Aller, M.D.– [email protected] 213-989-7208
Thank you !!