Real-Time Surveillance for Tuberculosis Using Electronic Health Record Data from an Ambulatory Practice in Eastern Massachusetts
Real-Time Surveillance for Tuberculosis Using Electronic Health Record Data from an Ambulatory Practice in Eastern Massachusetts
复制标题
DOI：
10.1177/003335491012500611
复制
发表时间：
2010-11-01
影响因子：
3.3
通讯作者：
Klompas, Michael
中科院分区：
文献类型：
--
作者：
Calderwood, Michael S.;Platt, Richard;Klompas, Michael
客观的。相对于传统报告，电子健康记录 (EHR) 有可能提高结核病 (TB) 监测的完整性和及时性，特别是对于培养阴性疾病。我们报告了 EHR 数据的结核病检测算法的开发和验证，以及随后在实时监测和报告系统中的实施。方法。我们使用来自马萨诸塞州东部门诊诊所的结构化电子数据开发了一种筛查算法，旨在对确诊的活动性结核病实现 100% 的敏感性，并对医生怀疑的疾病提供尽可能高的阳性预测值 (PPV)。我们通过 16 年的回顾性电子数据验证了该算法，然后将其应用于基于 EHR 的实时监控系统。我们在 18 个月的前瞻性监测中评估了 PPV 和病例捕获相对于传统报告的完整性。结果。最终算法需要吡嗪酰胺处方、国际疾病分类第九版结核病分类 (ICD-9) 代码和两种抗结核药物的处方，或者结核病 ICD-9 代码和结核病诊断测试订单。在验证过程中，该算法对于医生怀疑的疾病的 PPV 为 84%（95% 置信区间 78, 88）。三分之一的确诊病例培养结果呈阴性。所有假阳性均为潜伏性结核病病例。在使用该算法进行的 18 个月基于 EHR 的前瞻性监测中，发现了另外 7 例医生怀疑的活动性结核病病例，其中包括两名培养阴性的患者。对州卫生部门记录的审查显示，算法没有遗漏任何病例。结论。使用 EHR 数据进行实时、前瞻性的结核病监测是可行且有前景的。
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.