The Evaluation of Triage Notes Using ESSENCE-FL for Active Case Finding of Zika

How to Cite

Culpepper, A. B., Atrubin, D., & Hamilton, J. J. (2017). The Evaluation of Triage Notes Using ESSENCE-FL for Active Case Finding of Zika. Online Journal of Public Health Informatics, 9(1).


ObjectiveThis study assesses the utilization of triage notes from emergencydepartments (EDs) and urgent care centers (UCCs) for active casefinding in ESSENCE-FL during the Zika response.IntroductionThe Florida Department of Health (DOH) utilizes the ElectronicSurveillance System for the Early Notification of Community BasedEpidemics (ESSENCE-FL) as its statewide syndromic surveillancesystem. ESSENCE-FL comprises of chief complaint data from231 of 240 EDs, representing 96 percent of the total number of EDsin Florida. Historically, syndromic surveillance has categorizedpatient chief complaint data into syndromes for the purpose of diseasesurveillance or outbreak detection. Triage notes are much longer free-text, pre-diagnostic data that capture the presenting symptoms andcomplaints of a patient.MethodsTriage notes are being collected from 24 EDs, representing tenpercent of total reporting EDs, and seven UCCs, representing 17%of total reporting UCCs. Triage notes were made a searchable fieldin ESSENCE-FL during Zika enhanced surveillance efforts, whichfacilitated additional case finding of Zika.During the period of February 3, 2016 – July 25, 2016, a free-textquery was created to run against the concatenated chief complaint-discharge diagnosis (CCDD) and triage note fields:^zika^,or,^ziki^,or,^zica^,or,^zeeka^,or,^zeeca^,or,^microcep^,or,^zyka^Additional queries were created to detect foreign travel visits ofinterest within the CCDD and triage note fields. Results of thesequeries were analyzed and communicated to county and regionalepidemiologists daily for investigation.ResultsThe triage note specific queries identified 18 Zika triage note and11 foreign travel triage note visits of interest. All of these visits werereviewed and investigated by county epidemiologists. These triagenote queries identified one case of Zika that had not been previouslyreported to public health. Of note, seven additional cases of Zikainfection were identified using the CCDD field in ESSENCE-FL (fiveof the seven flagged in both the CCDD and triage note field).ConclusionsResults from this analysis provide evidence that triage notes withinsyndromic surveillance systems play a role in active case finding whenemerging diseases arise. However, only 31 out of 272 total reportingfacilities are submitting triage note to ESSENCE-FL, representingonly 11% of reporting facilities.Relying on chief complaint and discharge diagnosis data onlywould have resulted in an undetected case of Zika that would havenot been captured by our free-text Zika query.The increased detection of Zika cases allows for public healthintervention, including mosquito control response, which in turnreduces the chance of Zika spreading locally in Florida. Triagenotes often provide pertinent information for determining when aflagged CCDD needs to be investigated further. Making triage notesa required data element for Meaningful Use compliance would benefitcase finding conducted through syndromic surveillance.
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