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Automated Influenza and Pneumonia Reporting in an Electronic Death Registration System validated with Laboratory Automated Influenza and Pneumonia Reporting in an Electronic Death Registration System validated with Laboratory Confirmation Alvin T. Onaka, Ph. D. Hawaii Department of Health Office of Health Status Monitoring Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Influenza Deaths n CDC Case Definition Influenza listed anywhere on the death certificate (Part Influenza Deaths n CDC Case Definition Influenza listed anywhere on the death certificate (Part I or Part II) n Exclusions Haemophilus influenzae Parainfluenzae virus Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Pneumonia Deaths n CDC Case Definition Pneumonia listed anywhere on the death certificate (Part Pneumonia Deaths n CDC Case Definition Pneumonia listed anywhere on the death certificate (Part I or Part II) n Exclusions Aspiration pneumonia Pneumonitis Pneumococcal meningitis Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Case Definitions (continued) n If both pneumonia and influenza are listed, count as influenza Case Definitions (continued) n If both pneumonia and influenza are listed, count as influenza Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Weekly Mortality Reporting Previous Procedure n Deaths due to Influenza or Pneumonia manually counted Weekly Mortality Reporting Previous Procedure n Deaths due to Influenza or Pneumonia manually counted by DOH staff n No timely means of lab confirmation from other DOH branch that electronically reports lab data (ELR) n Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Previous Mortality Reporting Procedure Funeral Director gives death worksheet to certifier to complete Worksheet Previous Mortality Reporting Procedure Funeral Director gives death worksheet to certifier to complete Worksheet turned in to DOH and enters info. into system. DOH manually identifies Influenza & Pneumonia Weekly mortality report manually run from data system Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Weekly Mortality Reporting New Methodology n New automated method of identifying Influenza or Pneumonia Weekly Mortality Reporting New Methodology n New automated method of identifying Influenza or Pneumonia cases via the Hawaii Electronic Death Registration System (EDRS) n New electronic laboratory confirmation between EDRS and ELR n Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Current Weekly/Daily Mortality Reporting Procedure EDRS Internet Certifier enters COD in EDRS At scheduled Current Weekly/Daily Mortality Reporting Procedure EDRS Internet Certifier enters COD in EDRS At scheduled times, mortality reports automatically sent via email to Disease Outbreak Control Division & Vital Statistics NEDSS Later, Influenza/ Pneumonia lab results matched & results confirmed Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Automated Mortality Reports Adjustable interval for either hourly, daily or weekly automated reporting n Automated Mortality Reports Adjustable interval for either hourly, daily or weekly automated reporting n In addition to Pneumonia and Influenza case identification, custom reports are possible for future disease outbreaks (i. e. Syndromic Surveillance) n Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Report Interval Adjustments Gateway to the Future: Improving the National Vital Statistics System St. Report Interval Adjustments Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

User Defined Custom Reports Gateway to the Future: Improving the National Vital Statistics System User Defined Custom Reports Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Automated Mortality Reports Every automated email notification includes: n 1. Summary report in PDF Automated Mortality Reports Every automated email notification includes: n 1. Summary report in PDF format pattered after CDC’s weekly mortality report n Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Automated Mortality Reports (continued) Every automated email notification includes: n 2. Excel spreadsheet showing Automated Mortality Reports (continued) Every automated email notification includes: n 2. Excel spreadsheet showing Pneumonia and Influenza indicators, a unique case ID of decedent and the full literal COD text as entered by the certifier n Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Excel Spreadsheet Influenza & Pneumonia Indicators Unique decedent ID Full literal text of COD Excel Spreadsheet Influenza & Pneumonia Indicators Unique decedent ID Full literal text of COD by certifier Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Automated Mortality Reports (continued) n n n Spreadsheet allows review of Influenza & Pneumonia Automated Mortality Reports (continued) n n n Spreadsheet allows review of Influenza & Pneumonia status & pertinent certifier information for all deaths With full COD available, trained reviewers can ignore computer triggered flags and request record review of possible Influenza cases missed by computer Decedent privacy protected since DOH reviewers only see a Case ID Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Excel Spreadsheet–example 2 Influenza & Pneumonia Indicators Unique decedent ID Full literal text of Excel Spreadsheet–example 2 Influenza & Pneumonia Indicators Unique decedent ID Full literal text of COD by certifier Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Increasing Accuracy for Mortality Reporting and COD in general Incorporation of spell checker from Increasing Accuracy for Mortality Reporting and COD in general Incorporation of spell checker from NCHS’s Super. MICAR n Spell checker reviews COD field and opens up a spell check box for certifier to accept or change possible misspelled word(s) n Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Spell Checker for Certifiers Gateway to the Future: Improving the National Vital Statistics System Spell Checker for Certifiers Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

H 1 N 1 Influenza Mortality Surveillance n n CDC Interim H 1 N H 1 N 1 Influenza Mortality Surveillance n n CDC Interim H 1 N 1 Flu Surveillance Recommendation For vital statistics offices, CDC requests daily reporting Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

H 1 N 1 Influenza Mortality Surveillance n May 3, 2009 Daily Report n H 1 N 1 Influenza Mortality Surveillance n May 3, 2009 Daily Report n Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Lessons Learned from H 1 N 1 Surveillance Medical Examiners and Coroners often certify Lessons Learned from H 1 N 1 Surveillance Medical Examiners and Coroners often certify record with “deferred – pending lab results”. n The current automated reporting system will miss these Influenza cases n Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Lessons Learned (continued) Drop to paper cases include backdated certification information n Automated reporting Lessons Learned (continued) Drop to paper cases include backdated certification information n Automated reporting system will also miss these cases n Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

How Hawaii’s Influenza Cases are First Identified + Physicians in hospital or clinic suspects How Hawaii’s Influenza Cases are First Identified + Physicians in hospital or clinic suspects respiratory disease and orders lab test DOH-DOCD receives all lab results electronically with an Electronic Laboratory Reporting System (ELRS) DOH-DOCD identifies and investigates positive Influenza lab results Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

How Hawaii’s Influenza Cases are First Identified (continued) EDRS Internet Certifier enters COD with How Hawaii’s Influenza Cases are First Identified (continued) EDRS Internet Certifier enters COD with key terms such as Influenza, H 1 N 1, {other} in EDRS m ail e al via u an m DOH-DOCD staff receive automated EDRS email or for ‘Drop to Paper’ a direct email from Vital Stats staff DOH-Vital Stats staff enters COD for ‘Drop to Paper’ certification and identifies Influenza case before EDRS Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Hawaii’s Confirmed H 1 N 1 Influenza Death Cases n n 13 confirmed cases Hawaii’s Confirmed H 1 N 1 Influenza Death Cases n n 13 confirmed cases occurred in about a 1 year time period. About 24% cases first identified by the automatic email mortality reporting system About 38% cases first identified by Vital Statistics staff who entered in COD that was completed non-electronically About 38% cases first identified by Disease Outbreak Control Division (DOCD) staff from their Electronic Laboratory Reporting system (ELRS) Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Sample EDRS case history of an actual H 1 N 1 Death Click Link Sample EDRS case history of an actual H 1 N 1 Death Click Link Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

H 1 N 1 laboratory confirmation case details in EDRS (freeform) View Notification From: H 1 N 1 laboratory confirmation case details in EDRS (freeform) View Notification From: To: HAWAIIAN ### MORTUARY Subject: NEDSS Status Changed (VSS) Creation date: 02/22/2010 09: 00: 20 Message: Case NEDSS Influenza Status has been changed to Influenza Test Confirmed as Positive while case has already been Sent to VSS. The new status was modified in NEDSS: No. Confirmation Status Comments: Influenz A/Swine- Positive Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010

Questions? Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO Questions? Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010