Evaluation of a Pilot Respiratory Virus Surveillance System Linking Electronic Health Record and Diagnostic Data

• DOI: 10.1097/phh.0b013e3182602ef6
• Publication Date: 2013-08-29T13:16:27Z
• Authors: Teeb Al-Samarrai; Winfred Wu; Elizabeth Begier; Joseph Lurio; Rafal Tokarz; Marlena Plagianos; Neil Calman; Farzad Mostashari; Thomas Briese; W. Ian Lipkin; Carolyn Greene
• Keywords: Pandemic; Medical record; Influenza-like illness; Disease Surveillance

In Brief Context: During the onset of 2009 pandemic influenza A (H1N1) (pH1N1), New York City Department Health and Mental Hygiene implemented a pilot respiratory virus surveillance system. Objectives: We evaluated performance this system, which linked electronic health record (EHR) clinical, epidemiologic, diagnostic data to monitor influenza-like illness (ILI) in community. Design: Surveillance was conducted at 9 community centers with EHRs. Clinical decision support system alerts encouraged testing patients. Rapid (RIDT) multiplex polymerase chain reaction assay (MassTag PCR) were performed sequentially. Setting: Nine Institute for Family (IFH) clinics Manhattan Bronx during May 26 June 30, 2009, pH1N1 outbreak peak. Participants: Adult pediatric patients presenting IFH 2009. Main Outcome Measures: By using Centers Disease Control Prevention guidelines, we system's completeness, sensitivity, timeliness, epidemiologic usefulness. Results: Of 537 ILI visits (5.7% all visits), 17% underwent testing. 132 specimens both RIDT MassTag PCR result, 90 (68%) had PCR-identified virus, most commonly (n = 69; 77%). 81 that met case definition, 58 (72%) positive tested by PCR; 48 (59%) pH1N1. Ninety-four percent 45 years or younger. Sensitivity specificity (29% 94%) definition (70% 48%) calculated as standard. Results took median 6 days. Conclusions: Despite low sensitivity limited integration EHR has potential provide valuable information, guide public response, represents new model viruses. H1N1, rapid test can information response.