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Automated Influenza and Pneumonia Reporting System for Efficient Mortality Surveillance

This study showcases the implementation of an automated system for reporting and validating influenza and pneumonia deaths using laboratory confirmation. The system operates within the Hawaii Electronic Death Registration System (EDRS) and ensures timely and accurate reporting through electronic notifications to relevant health authorities. With improved efficiency and accuracy, this system enhances mortality surveillance capabilities, aids in disease outbreak detection, and protects decedent privacy.

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Automated Influenza and Pneumonia Reporting System for Efficient Mortality Surveillance

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  1. Automated Influenza and PneumoniaReporting in anElectronicDeathRegistrationSystem validated with Laboratory ConfirmationAlvin T. Onaka, Ph.D. Hawaii Department of HealthOffice of Health Status Monitoring

  2. Influenza Deaths • CDC Case Definition Influenza listed anywhere on the death certificate (Part I or Part II) • Exclusions Haemophilus influenzae Parainfluenzae virus

  3. Pneumonia Deaths • CDC Case Definition Pneumonia listed anywhere on the death certificate (Part I or Part II) • Exclusions Aspiration pneumonia Pneumonitis Pneumococcal meningitis

  4. Case Definitions (continued) • If both pneumonia and influenza are listed, count as influenza

  5. Weekly Mortality Reporting • Previous Procedure • Deaths due to Influenza or Pneumonia manually counted by DOH staff • No timely means of lab confirmation from other DOH branch that electronically reports lab data (ELR)

  6. Worksheet turned in to DOH and enters info. into system. DOH manually identifies Influenza & Pneumonia Weekly mortality report manually run from data system Funeral Director gives death worksheet to certifier to complete Previous Mortality Reporting Procedure

  7. Weekly Mortality Reporting • New Methodology • New automated method of identifying Influenza or Pneumonia cases via the Hawaii Electronic Death Registration System (EDRS) • New electronic laboratory confirmation between EDRS and ELR

  8. EDRS At scheduled times, mortality reports automatically sent via email to Disease Outbreak Control Division & Vital Statistics Internet Internet Certifier enters COD in EDRS NEDSS Later, Influenza/ Pneumonia lab results matched & results confirmed Current Weekly/Daily Mortality Reporting Procedure

  9. Automated Mortality Reports • Adjustable interval for either hourly, daily or weekly automated reporting • In addition to Pneumonia and Influenza case identification, custom reports are possible for future disease outbreaks (i.e. Syndromic Surveillance)

  10. Report Interval Adjustments

  11. User Defined Custom Reports

  12. Automated Mortality Reports • Every automated email notification includes: • 1. Summary report in PDF format pattered after CDC’s weekly mortality report

  13. Automated Mortality Reports (continued) • Every automated email notification includes: • 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

  14. Excel Spreadsheet Influenza & Pneumonia Indicators Full literal text of COD by certifier Unique decedent ID

  15. Automated Mortality Reports (continued) • 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

  16. Influenza & Pneumonia Indicators Full literal text of COD by certifier Unique decedent ID Excel Spreadsheet–example 2

  17. Increasing Accuracy for Mortality Reporting and COD in general • Incorporation of spell checker from NCHS’s SuperMICAR • Spell checker reviews COD field and opens up a spell check box for certifier to accept or change possible misspelled word(s)

  18. Spell Checker for Certifiers

  19. H1N1 Influenza Mortality Surveillance • CDC Interim H1N1 Flu Surveillance Recommendation • For vital statistics offices, CDC requests daily reporting

  20. H1N1 Influenza Mortality Surveillance • May 3, 2009 Daily Report

  21. Lessons Learned from H1N1 Surveillance • Medical Examiners and Coroners often certify record with “deferred – pending lab results”. • The current automated reporting system will miss these Influenza cases

  22. Lessons Learned (continued) • Drop to paper cases include backdated certification information • Automated reporting system will also miss these cases

  23. + DOH-DOCD receives all lab results electronically with an Electronic Laboratory Reporting System (ELRS) Physicians in hospital or clinic suspects respiratory disease and orders lab test DOH-DOCD identifies and investigates positive Influenza lab results How Hawaii’s Influenza Cases are First Identified

  24. EDRS Internet Internet Certifier enters COD with key terms such as Influenza, H1N1, {other} in EDRS DOH-DOCD staff receive automated EDRS email or for ‘Drop to Paper’ a direct email from Vital Stats staff via manual email DOH-Vital Stats staff enters COD for ‘Drop to Paper’ certification and identifies Influenza case before EDRS How Hawaii’s Influenza Cases are First Identified (continued)

  25. Hawaii’s Confirmed H1N1 Influenza Death Cases • 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)

  26. Sample EDRS case history of an actual H1N1 Death Click Link

  27. H1N1 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

  28. Questions?

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