Validation of ESPnet for use as an alternative to Lyme Disease Surveillance in Massachusetts
Project Name: Validation of ESPnet for use as an alternative to Lyme Disease Surveillance in Massachusetts
Project Status: Proposed
Point of Contact: Alison Hinckley
Center: National Center for Emerging and Zoonotic Infectious Diseases
Keywords: Lyme disease, Electronic Health Records, data extraction tool, alternative surveillance
Project Description: ESPnet was developed by the CDC Center of Excellence in Public Health Informatics at the Harvard Pilgrim Health Care Institute and Children’s Hospital (Curtis et al., 2014). The Harvard Medical School’s Department of Population Medicine at the Harvard Pilgrim Health Care Institute and the Massachusetts Department of Public Health (MDPH) lead the development of ESPnet, in partnership with Atrius Health. ESPnet extracts and analyzes data from EHR systems making it available for querying by authorized Department of Public Health users through PopMedNet software. ESPnet integrates surveillance results from distributed ESPnet installations and facilities custom queries from health department officials to run in parallel on distributed ESPnet systems. Hospitals and clinics can give health departments controlled access to their EHR data to study specific health indicators in their patient population and health departments can easily query EHR systems of multiple providers at once to get a population view of health indicators.
ESPNet is currently used to report viral hepatitis cases to MDPH from Atrius Health (a coalition of seven community-based medical groups that serve more than 1 million adult and pediatric patients in over 3.5 million visits annually to 50 practice locations). An algorithm designed to extract demographic information on patients that likely meet the criteria for a confirmed or probable case of Lyme disease has been developed but not validated. Validation would consist of chart review of the extracted patients to confirm that they meet the current Lyme disease case definition. It should also include review of a random selection of charts to ascertain if any patients are being missed. Statistics will be used to evaluate if the proportion of sampled patients meeting the case definition after chart review differs significantly from the proportion of originally extracted patients.
There are limitations on the potential for this system to replace traditional surveillance for Lyme disease. ESPNet cannot currently extract information from free-text fields and therefore symptom information captured in those fields cannot be reported. This prevents MDPH from being able to individually review each case and assign a classification, which is why validation of the extraction algorithm is essential. If validated and implemented, this system could offer a significant reduction in workload for both MDPH and providers within the Atrius System. This study is a proof-of-concept approach that, if shown to work, could serve as a template for other states/jurisdictions looking for more efficient alternatives to Lyme disease surveillance.