title: Influenza surveillance using electronic health records in the American Indian and Alaska Native population.
abstract: OBJECTIVE
  Increasing use of electronic health records (EHRs) provides new opportunities for public health surveillance. During the 2009 influenza A (H1N1) virus pandemic, we developed a new EHR-based influenza-like illness (ILI) surveillance system designed to be resource sparing, rapidly scalable, and flexible. 4 weeks after the first pandemic case, ILI data from Indian Health Service (IHS) facilities were being analyzed.
  
  
  METHODS
  The system defines ILI as a patient visit containing either an influenza-specific International Classification of Disease, V.9 (ICD-9) code or one or more of 24 ILI-related ICD-9 codes plus a documented temperature ≥100°F. EHR-based data are uploaded nightly. To validate results, ILI visits identified by the new system were compared to ILI visits found by medical record review, and the new system's results were compared with those of the traditional US ILI Surveillance Network.
  
  
  RESULTS
  The system monitored ILI activity at an average of 60% of the 269 IHS electronic health databases. EHR-based surveillance detected ILI visits with a sensitivity of 96.4% and a specificity of 97.8% based on chart review (N=2375) of visits at two facilities in September 2009. At the peak of the pandemic (week 41, October 17, 2009), the median time from an ILI visit to data transmission was 6 days, with a mode of 1 day.
  
  
  CONCLUSIONS
  EHR-based ILI surveillance was accurate, timely, occurred at the majority of IHS facilities nationwide, and provided useful information for decision makers. EHRs thus offer the opportunity to transform public health surveillance.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Keck
authors.forename: John T
authors.initials: JT
authors.lastname: Redd
authors.forename: James E
authors.initials: JE
authors.lastname: Cheek
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Layne
authors.forename: Amy V
authors.initials: AV
authors.lastname: Groom
authors.forename: Sassa
authors.initials: S
authors.lastname: Kitka
authors.forename: Michael G
authors.initials: MG
authors.lastname: Bruce
authors.forename: Anil
authors.initials: A
authors.lastname: Suryaprasad
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Amerson
authors.forename: Theresa
authors.initials: T
authors.lastname: Cullen
authors.forename: Ralph T
authors.initials: RT
authors.lastname: Bryan
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Hennessy
mesh_terms: D057286:Electronic Health Records; D006801:Humans; D007198:Indians, North American; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000208:ethnology*; D004930:Inuit; D058873:Pandemics; D062486:Public Health Surveillance / Q000379:methods*; D014481:United States / Q000453:epidemiology
keywords: Data Collection; Electronic Health Records; Epidemiologic Methods; Influenza, Human; Medical Informatics Applications; Population Surveillance