An assessment of electronically captured data in the patient care enhancement system (PACES) for syndromic surveillance.
BACKGROUND
A common approach to the surveillance of emerging infectious diseases and agents of bioterrorism is to analyse electronically captured data for disease syndromes. The Patient Care Enhancement System (PACES) is a form of electronic medical records presently in service in the Singapore Armed Forces (SAF). We assess the feasibility of PACES data for surveillance, describe time-trends, and identify methods of sub-analysis which could improve performance.


METHODS
Medical consults from July 2000 to June 2003 were extracted. Diagnosis codes were mapped to 7 infectious disease syndromes according to the categorisation in the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE): gastrointestinal (GI), fever (FEVER), respiratory, (RESP), coma (COMA), neurological (NEURO), dermatologic-haemorrhagic (DERMHEM) and dermatologic- infectious (DERM-INF).


RESULTS
A total of 732,233 episodes of care were analysed. Weekly periodicity was observed, with decreased weekend consults; there were no obvious seasonal trends in any of the syndromes. RESP, FEVER and GI syndromes were common events. Sub-analyses, either by restricting to cases with a repeated consultation, or grouping the data by medical centres, could dramatically lower thresholds used to flag outbreaks.


CONCLUSIONS
In spite of the level of background noise inherent in a system consisting mainly of primary care consults, sub-analysis by medical centre, or restriction to cases with repeated consults were able to yield sensitive thresholds for outbreak detection.
Ang
B C H
BC
Yong Loo Lin School of Medicine, National University of Singapore, Singapore. tootle@singnet.com.sg
Chen
M I C
MI
Goh
T L H
TL
Ng
Y Y
YY
Fan
S W
SW
D000293:Adolescent; D000328:Adult; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D016347:Medical Records Systems, Computerized; D011159:Population Surveillance; D013577:Syndrome