Transcript State Pilot Project Using EDRS for H1N1 Surveillance

State Pilot Project Using the Electronic
Death Registration System for H1N1
Surveillance
Linette T Scott, MD, MPH
Deputy Director
Health Information and Strategic Planning
California Department of Public Health
June 9, 2010
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Path Travelled
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Background
Data Flow in California
Query Development
Other Issues and Next Steps
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California Electronic Death Registration
System (EDRS)
• Electronic creation and registration of
Death Certificates, Amendments, and
Disposition Permits
• Went “live” January 2005
• By February 2010,
99.4% of Certificates created in EDRS
• ~ 240,000 – 250,000 deaths in California
annually
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Cause of
Death fields
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Value of EDRS Surveillance
• Identifies most serious cases for further
epidemiological investigation
• Complements other data sources
(e.g. Confidential Morbidity Reports, ED visits,
hospitalizations)
• Encompasses entire population,
not just a sample
• Minimum added resource cost—
uses data from existing system
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Data Flow in California
GG note: Would say FH
transcribes information
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Why wait until local registration?
• Quality Check: Local offices will contact
physicians if needed (e.g. Cause of Death is nonspecific)
• Prior to local registration, medical information
can be freely changed without documentation
• After local registration, certificate becomes a
legal document and further changes must be
done by filing an amendment
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Free Text Surveillance
• Free text search: Cause of Death (COD)
entries from physician
• Done before ICD-10 coding for COD assigned
to Death Certificates
• Influenza disambiguation example:
– Haemophilus influenzae
– Parainfluenza
– Misspellings
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Cautions of Preliminary Data
• Late Entries
• Pending Certificates
• Amendments
• Duplicate Entries
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Average Processing Times
(YTD 2010)
• Date of Death to Local Registration
– EDRS (fully electronic): 6.1 days
– Non-EDRS: 4.5 days
• Date of Death to State Registration
– EDRS (fully electronic): 15.7 days
– Non-EDRS: 71.0 days
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Processing Delays
• Biggest delays:
– Physician COD entry
– Physician signing of certificate
• Delays can also occur on the personal
information half of certificate
(e.g. clarifying family information)
• Can pull data prior to local registration but at
cost of decreased data quality
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How to Improve?
Physician education:
• on importance of accurate COD entry
• on importance of timely COD entry and
signature
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Steps to Develop Query
1. Obtain listing of confirmed cases
2. Look up cases in EDRS for COD
3. Select most common/promising COD text
strings and do test run
4. Of new results, how many are potential
new cases versus “noise”?
5. Refine query
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Steps 1 & 2
• Confirmed case listing from
May to August 13, 2009
• 55 out of 107 cases had
“H1N1” or “Swine” or “Pandemic” in COD
• Others were non-specific
(“Influenza”, “Pneumonia”, “ARDS”)
• Spelling variants found:
“H1 N1” “H1-N1” “N1H1” etc
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Steps 3-5
• Test queries run in same time frame in
EDRS
• “H1” “Swine” “Pandemic” brought up
21 additional deaths listed as H1N1
• “Pneumonia” “ARDS” brought up too
many non-specific results
(e.g. aspiration pneumonia, sequelae of
cancer)
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Final Query Parameters
“H1” or “Swine” or “Pandemic”
anywhere in
COD fields (107A, 107B, 107C, 107D)
or Other Significant Conditions field (112)
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EDRS Pull
• Unreported confirmed
case
• COD not confirmed
(“clinical diagnosis”)
N=21
Confirmed Cases
Case both in EDRS pull
and epidemiologyconfirmed
N = 55
• Search term not in
COD
• Delayed registration
or amendment
• Out of state death
N = 52
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Other Issues & Next Steps
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Media & Public
• EDRS deaths are not confirmed
• EDRS and epidemiology-confirmed numbers
will be different
• Media confusion regarding availability and
interpretation of source data
• Not part of Public Records Act
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Other Uses
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Seasonal influenza surveillance
Other infectious disease surveillance
Investigative resource (retrospective look)
Chronic diseases?
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Lessons Learned
• EDRS surveillance is feasible and of
potential benefit
• Importance of partnering with programs
(i.e. Vital Records and Communicable
Disease Control)
• What is the program business need that
EDRS surveillance can fulfill?
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Thank you!
Special thanks to:
• Dr. Scott Fujimoto (HISP)
• Dr. Glenna Gobar (U.C. Davis School of Medicine)
• Entire EDRS Staff
• Meileen Acosta and Division of Communicable Disease Control staff
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