title: Evaluation of a pilot respiratory virus surveillance system linking electronic health record and diagnostic data.
abstract: BACKGROUND
  During the onset of 2009 pandemic influenza A (H1N1) (pH1N1), the New York City Department of Health and Mental Hygiene implemented a pilot respiratory virus surveillance system.
  
  
  OBJECTIVE
  We evaluated the performance of this pilot system, which linked electronic health record (EHR) clinical, epidemiologic, and diagnostic data to monitor influenza-like illness (ILI) in the community.
  
  
  METHODS
  Surveillance was conducted at 9 community health centers with EHRs. Clinical decision support system alerts encouraged diagnostic testing of patients. Rapid influenza diagnostic testing (RIDT) and multiplex polymerase chain reaction assay (MassTag PCR) were performed sequentially.
  
  
  METHODS
  Nine Institute for Family Health (IFH) clinics in Manhattan and the Bronx during May 26 to June 30, 2009, the pH1N1 outbreak peak.
  
  
  METHODS
  Adult and pediatric patients presenting to IFH clinics during May 26 to June 30, 2009.
  
  
  METHODS
  By using Centers for Disease Control and Prevention guidelines, we evaluated the system's completeness, sensitivity, timeliness, and epidemiologic usefulness.
  
  
  RESULTS
  Of 537 ILI visits (5.7% of all visits), 17% underwent diagnostic testing. Of the 132 specimens with both a RIDT and MassTag PCR result, 90 (68%) had a MassTag PCR-identified respiratory virus, most commonly pH1N1 (n = 69; 77%). Of the 81 specimens that met the ILI case definition, 58 (72%) were positive for a respiratory virus tested for by MassTag PCR; 48 (59%) were positive for pH1N1. Ninety-four percent of ILI patients positive for pH1N1 were 45 years or younger. Sensitivity and specificity of RIDT (29% and 94%) and ILI case definition (70% and 48%) for pH1N1 were calculated using MassTag PCR as the standard. Results of RIDT took a median of 6 days.
  
  
  CONCLUSIONS
  Despite low RIDT sensitivity for pH1N1 and limited timeliness, integration of EHR and diagnostic data has potential to provide valuable epidemiologic information, guide public health response, and represents a new model for community surveillance for influenza and respiratory viruses.
authors: Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY, USA. teeb.al-samarrai@phd.sccgov.org
authors: Teeb
authors: T
authors: Al-Samarrai
authors: Winfred
authors: W
authors: Wu
authors: Elizabeth
authors: E
authors: Begier
authors: Joseph
authors: J
authors: Lurio
authors: Rafal
authors: R
authors: Tokarz
authors: Marlena
authors: M
authors: Plagianos
authors: Neil
authors: N
authors: Calman
authors: Farzad
authors: F
authors: Mostashari
authors: Thomas
authors: T
authors: Briese
authors: W Ian
authors: WI
authors: Lipkin
authors: Carolyn
authors: C
authors: Greene
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D056902:Clinical Alarms; D003151:Community Health Centers / Q000458:organization & administration; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008498:Medical Record Linkage / Q000379:methods; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D009519:New York City / Q000453:epidemiology; D058873:Pandemics / Q000517:prevention & control / Q000706:statistics & numerical data; D010865:Pilot Projects; D011159:Population Surveillance / Q000379:methods*; D015397:Program Evaluation; D012680:Sensitivity and Specificity; D055815:Young Adult