Hospital electronic medical record-based public health surveillance system deployed during the 2002 Winter Olympic Games
Hospital electronic medical record-based public health surveillance system deployed during the 2002 Winter Olympic Games
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DOI：
10.1016/j.ajic.2006.08.003
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发表时间：
2007-04-01
影响因子：
4.9
通讯作者：
Samore, Matthew H.
中科院分区：
文献类型：
--
作者：
Gundlapalli, Adi V.;Olson, Jonathan;Samore, Matthew H.
背景：一些计算机生物监测系统用于检测具有公共卫生意义的事件；然而，大多数缺乏及时和详细的患者层面数据和对警报的调查，给PH资源带来了压力。方法：医院感染控制专业人员带领一个多学科团队开发了一个基于计算机规则的系统，该系统依赖于患者的电子病历。这些规则在临床计算系统传输的HL7消息上运行，并包含各种类型的患者级数据，包括实验室检查订单和结果、放射科订单和报告、急诊室和门诊就诊以及医院入院情况。实验室数据被映射到标准词汇表，放射学数据在应用规则过滤PH感兴趣的事件之前使用自然语言处理算法进行处理。对于每个规则，应用统计过程控制，当水平超过平均值以上两个标准差时产生警报。该系统在2002年冬季奥运会期间部署在盐湖城的一家大型医院，每天被访问3次以执行监视。在对警报进行初步调查后，向当地卫生机构提供了每日报告。结果：在监控的24条规则中，有9条在不同场合产生警报。在监测期间注意到的PH值的唯一重大事件是奥运会期间流感的增加。这些规则的阳性预测值各不相同，通过自然语言处理算法从胸片报告中识别肺炎的值很高（89%）。结论：在一种新型的基于计算机的监测系统的帮助下，与使用客观、可量化事件和患者数据访问的电子病历相关联，感染控制从业者可以在生物监测中发挥一线作用，并促进与PH机构的双向沟通。
Background: Several computer biosurveillance systems are in place to detect events of public health (PH) significance; however, most lack access to timely and detailed patient-level data and investigation of alerts places a strain on PH resources.Methods: Hospital-based infection control professionals led a multi-disciplinary team to develop a computer rule-based system that relies on the patient's electronic medical record. The rules operated on HL7 messages transmitted by clinical computing systems and encompassed a variety of types of patient-level data, including laboratory test ordering and results, radiology ordering and reports, emergency room and outpatient clinic visits, and hospital admissions. Laboratory data were mapped to standard vocabularies, and radiology data were processed using natural language-processing algorithms before the rules were applied to filter for events of PH interest. For each rule, statistical process controls were applied to generate alerts when levels exceeded two standard deviations above the mean. The system was deployed at a large hospital in Salt Lake City during the 2002 Winter Olympic Games, and it was accessed 3 times a day to perform surveillance. Daily reports were provided to local PH agencies after preliminary investigation of the alerts.Results: Of the 24 rules monitored, 9 generated alerts on I I different occasions. The only significant event of PH interest that was noted during the surveillance period was an increase in influenza during the Games. The positive predictive value of the rules varied with a high value (89 %) noted for identification of pneumonia from chest radiograph reports by natural language-processing algorithms.Conclusions: With the assistance of a novel computer-based surveillance system linked to the electronic medical record that uses objective, quantifiable events and access to patient data, infection control practitioners could play a front-line role in biosurveillance and facilitate bidirectional communication with PH agencies.