Document Detail

Real-time surveillance for tuberculosis using electronic health record data from an ambulatory practice in eastern Massachusetts.
MedLine Citation:
PMID:  21121229     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Electronic health records (EHRs) have the potential to improve completeness and timeliness of tuberculosis (TB) surveillance relative to traditional reporting, particularly for culture-negative disease. We report on the development and validation of a TB detection algorithm for EHR data followed by implementation in a live surveillance and reporting system.
METHODS: We used structured electronic data from an ambulatory practice in eastern Massachusetts to develop a screening algorithm aimed at achieving 100% sensitivity for confirmed active TB with the highest possible positive predictive value (PPV) for physician-suspected disease. We validated the algorithm in 16 years of retrospective electronic data and then implemented it in a real-time EHR-based surveillance system. We assessed PPV and the completeness of case capture relative to conventional reporting in 18 months of prospective surveillance.
RESULTS: The final algorithm required a prescription for pyrazinamide, an International Classification of Diseases, Ninth Revision (ICD-9) code for TB and prescriptions for two antituberculous medications, or an ICD-9 code for TB and an order for a TB diagnostic test. During validation, this algorithm had a PPV of 84% (95% confidence interval 78, 88) for physician-suspected disease. One-third of confirmed cases were culture-negative. All false-positives were instances of latent TB. In 18 months of prospective EHR-based surveillance with this algorithm, seven additional cases of physician-suspected active TB were detected, including two patients with culture-negative disease. A review of state health department records revealed no cases missed by the algorithm.
CONCLUSIONS: Live, prospective TB surveillance using EHR data is feasible and promising.
Michael S Calderwood; Richard Platt; Xuanlin Hou; Jessica Malenfant; Gillian Haney; Benjamin Kruskal; Ross Lazarus; Michael Klompas
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Public health reports (Washington, D.C. : 1974)     Volume:  125     ISSN:  0033-3549     ISO Abbreviation:  Public Health Rep     Publication Date:    2010 Nov-Dec
Date Detail:
Created Date:  2010-12-02     Completed Date:  2010-12-23     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  9716844     Medline TA:  Public Health Rep     Country:  United States    
Other Details:
Languages:  eng     Pagination:  843-50     Citation Subset:  AIM; IM    
Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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MeSH Terms
Electronic Health Records*
Group Practice / statistics & numerical data
Health Maintenance Organizations / statistics & numerical data
Massachusetts / epidemiology
Population Surveillance / methods*
Tuberculosis / epidemiology*
Grant Support
8P011HK000016-04/HK/PHITPO CDC HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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