title: Automated identification of acute hepatitis B using electronic medical record data to facilitate public health surveillance.
abstract: BACKGROUND
  Automatic identification of notifiable diseases from electronic medical records can potentially improve the timeliness and completeness of public health surveillance. We describe the development and implementation of an algorithm for prospective surveillance of patients with acute hepatitis B using electronic medical record data.
  
  
  METHODS
  Initial algorithms were created by adapting Centers for Disease Control and Prevention diagnostic criteria for acute hepatitis B into electronic terms. The algorithms were tested by applying them to ambulatory electronic medical record data spanning 1990 to May 2006. A physician reviewer classified each case identified as acute or chronic infection. Additional criteria were added to algorithms in serial fashion to improve accuracy. The best algorithm was validated by applying it to prospective electronic medical record data from June 2006 through April 2008. Completeness of case capture was assessed by comparison with state health department records.
  
  
  RESULTS
  A final algorithm including a positive hepatitis B specific test, elevated transaminases and bilirubin, absence of prior positive hepatitis B tests, and absence of an ICD9 code for chronic hepatitis B identified 112/113 patients with acute hepatitis B (sensitivity 97.4%, 95% confidence interval 94-100%; specificity 93.8%, 95% confidence interval 87-100%). Application of this algorithm to prospective electronic medical record data identified 8 cases without false positives. These included 4 patients that had not been reported to the health department. There were no known cases of acute hepatitis B missed by the algorithm.
  
  
  CONCLUSIONS
  An algorithm using codified electronic medical record data can reliably detect acute hepatitis B. The completeness of public health surveillance may be improved by automatically identifying notifiable diseases from electronic medical record data.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts, United States of America. mklompas@partners.org
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
authors.forename: Gillian
authors.initials: G
authors.lastname: Haney
authors.forename: Daniel
authors.initials: D
authors.lastname: Church
authors.forename: Ross
authors.initials: R
authors.lastname: Lazarus
authors.forename: Xuanlin
authors.initials: X
authors.lastname: Hou
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D018563:Disease Notification / Q000706:statistics & numerical data; D001330:Electronic Data Processing / Q000379:methods / Q000706:statistics & numerical data; D006509:Hepatitis B / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods*; D011635:Public Health Administration; D014481:United States