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Open Access Highly Accessed Research article

Using automated medical records for rapid identification of illness syndromes (syndromic surveillance): the example of lower respiratory infection

Ross Lazarus12, Ken P Kleinman3, Inna Dashevsky3, Alfred DeMaria4 and Richard Platt13*

Author affiliations

1 Chanming Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

2 Department of Public Health and Community Medicine, University of Sydney, Sydney, Australia

3 Department of Ambulatory Care and Prevention, Harvard Medical School, Harvard Pilgrim Health Care, and Harvard Vanguard Medical Associates, Boston, MA, USA

4 Bureau of Communicable Disease Control, Massachusetts Department of Public Health, Boston, MA, USA

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Citation and License

BMC Public Health 2001, 1:9  doi:10.1186/1471-2458-1-9

Published: 22 October 2001

Abstract

Background

Gaps in disease surveillance capacity, particularly for emerging infections and bioterrorist attack, highlight a need for efficient, real time identification of diseases.

Methods

We studied automated records from 1996 through 1999 of approximately 250,000 health plan members in greater Boston.

Results

We identified 152,435 lower respiratory infection illness visits, comprising 106,670 episodes during 1,143,208 person-years. Three diagnoses, cough (ICD9CM 786.2), pneumonia not otherwise specified (ICD9CM 486) and acute bronchitis (ICD9CM 466.0) accounted for 91% of these visits, with expected age and sex distributions. Variation of weekly occurrences corresponded closely to national pneumonia and influenza mortality data. There was substantial variation in geographic location of the cases.

Conclusion

This information complements existing surveillance programs by assessing the large majority of episodes of illness for which no etiologic agents are identified. Additional advantages include: a) sensitivity, uniformity and efficiency, since detection of events does not depend on clinicians' to actively report diagnoses, b) timeliness, the data are available within a day of the clinical event; and c) ease of integration into automated surveillance systems.

These features facilitate early detection of conditions of public health importance, including regularly occurring events like seasonal respiratory illness, as well as unusual occurrences, such as a bioterrorist attack that first manifests as respiratory symptoms. These methods should also be applicable to other infectious and non-infectious conditions. Knowledge of disease patterns in real time may also help clinicians to manage patients, and assist health plan administrators in allocating resources efficiently.