Using Web-Based Search Data to Study the Public’s Reactions to Societal Events: The Case of the Sandy Hook Shooting

Background: Internet search is the most common activity on the World Wide Web and generates a vast amount of user-reported data regarding their information-seeking preferences and behavior. Although this data has been successfully used to examine outbreaks, health care utilization, and outcomes related to quality of care, its value in informing public health policy remains unclear. Objective: The aim of this study was to evaluate the role of Internet search query data in health policy development. To do so, we studied the public’s reaction to a major societal event in the context of the 2012 Sandy Hook School shooting incident. Methods: Query data from the Yahoo! search engine regarding firearm-related searches was analyzed to examine changes in user-selected search terms and subsequent websites visited for a period of 14 days before and after the shooting incident. Results: A total of 5,653,588 firearm-related search queries were analyzed. In the after period, queries increased for search terms related to “guns” (+50.06%), “shooting incident” (+333.71%), “ammunition” (+155.14%), and “gun-related laws” (+535.47%). The highest increase (+1054.37%) in Web traffic was seen by news websites following “shooting incident” queries whereas searches for “guns” (+61.02%) and “ammunition” (+173.15%) resulted in notable increases in visits to retail websites. Firearm-related queries generally returned to baseline levels after approximately 10 days. Conclusions: Search engine queries present a viable infodemiology metric on public reactions and subsequent behaviors to major societal events and could be used by policymakers to inform policy development. [JMIR Public Health Surveill 2017;3(1):e12

Validation of ICD-10-CM Codes for Identifying Cases of Chlamydia and Gonorrhea

Background While researchers seek to use administrative health data to examine outcomes for individuals with sexually transmitted infections, the ICD-CM-10 codes used to identify persons with chlamydia and gonorrhea have not been validated. Objectives were to determine the validity of using ICD-10-CM codes to identify individuals with chlamydia and gonorrhea. Methods We utilized data from electronic health records gathered from public and private health systems from October 1, 2015 to December 31, 2016. Patients were included if they were aged 13-44 years and received either 1) laboratory testing for chlamydia or gonorrhea or 2) an ICD-10-CM diagnosis of chlamydia, gonorrhea, or an unspecified STI. To validate ICD-10-CM codes, we calculated positive and negative predictive values, sensitivity, and specificity based on the presence of a laboratory test result. We further examined the timing of clinical diagnosis relative to laboratory testing. Results The positive predictive values for chlamydia, gonorrhea, and unspecified STI ICD-10-CM codes were 87.6%, 85.0%, and 32.0%, respectively. Negative predictive values were high (>92%). Sensitivity for chlamydia diagnostic codes was 10.6% and gonorrhea was 9.7%. Specificity was 99.9% for both chlamydia and gonorrhea. The date of diagnosis occurred on or after the date of the laboratory result for 84.8% of persons with chlamydia, 91.9% for gonorrhea, and 23.5% for unspecified STI. Conclusions Disease specific ICD-10-CM codes accurately identify persons with chlamydia and gonorrhea. However, low sensitivities suggest that most individuals could not be identified in administrative data alone without laboratory test results

The benefits of health information exchange: an updated systematic review

Objective Widespread health information exchange (HIE) is a national objective motivated by the promise of improved care and a reduction in costs. Previous reviews have found little rigorous evidence that HIE positively affects these anticipated benefits. However, early studies of HIE were methodologically limited. The purpose of the current study is to review the recent literature on the impact of HIE. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct our systematic review. PubMed and Scopus databases were used to identify empirical articles that evaluated HIE in the context of a health care outcome. Results Our search strategy identified 24 articles that included 63 individual analyses. The majority of the studies were from the United States representing 9 states; and about 40% of the included analyses occurred in a handful of HIEs from the state of New York. Seven of the 24 studies used designs suitable for causal inference and all reported some beneficial effect from HIE; none reported adverse effects. Conclusions The current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs

Accuracy of ICD Codes for Identification: Review of Chlamydia, Gonorrhea and Syphilis

ObjectiveThe purpose of this study is to review the extant literature for evidence on the validity of ICD-9-CM and -10-CM codes for the purpose of identifying cases of chlamydia, gonorrhea, and syphilis.IntroductionAdministrative data refers to data generated during the processes of health care. These data are a rich source of patient health information, including diagnoses and problem lists, laboratory and diagnostic tests, and medications. Established standards are used to code each data into the appropriate coding systems. The International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9-CM and ICD-10-CM) codes are the coding standard for diagnoses and have been frequently used to identify cases for the creation of cohorts in examining care delivery, screening, prevalence, and risk factors1,2. However, while some studies have assessed the validity and reliability of ICD-CM codes to identify various conditions such as cerebral palsy and rheumatoid arthritis3,4, the evidence for using ICD codes to accurately identify sexually transmitted infection (STI) cases is largely unexamined. The purpose of this study is to review the extant literature for evidence on the validity of ICD codes for identifying cases of chlamydia, gonorrhea, and syphilis. Our findings will inform efforts to improve the use of administrative data for STI-related health service and surveillance researches.MethodsOur systematic review followed a protocol consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We comprehensively searched PubMed and Scopus databases for peer-reviewed articles published before February 2018. Articles were identified with search terms related to our STIs of interest (chlamydia, syphilis or gonorrhea), pelvic inflammatory disease (PID), administrative codes, and validation studies. PID was included as 33%-50% of PID cases are due to chlamydia or gonorrhea5. Only empirical publications appearing in peer-reviewed English language journals were included. Further, we excluded articles classified as letters to the editor, policy briefs, perspectives, commentaries, summaries of future research plans, and grey literature. Additionally, articles without abstracts were also excluded. The screening process used by our review is outlined in Figure 1. Briefly, all articles were subjected to a two-step screening process. First, we reviewed articles based on title and abstract. We eliminated studies that did not focus on STIs or on validation in the context of STIs. Articles were included if they focused on any combination of the STIs of interest, or on PID, and were validation studies on diagnostic testing or administrative codes. Second, selected articles were then reviewed in full to identify studies which included the STIs of interest, assessed and listed ICD-9-CM or -10-CM codes, and measured validity. The snowball technique was used on included articles, whereby we reviewed all references found in the references of the included articles.ResultsOur search strategy identified 1,754 articles to be screened by title and abstract. Of these, only five (0.29%) articles met the initial inclusion criteria. After full text review, only two articles6,7 met the final inclusion criteria to be included in the systematic review. Both articles focused on PID with no assessment of syphilis. They utilized ICD-9-CM codes to identify cases with PID and performed chart reviews to determine true PID status. Results of both articles found positive predictive value (PPV) of PID to be between 18%–79%. Only one article7 examined the PPV of chlamydia (56%; 5/9 cases) and gonorrhea (100%; 4/4 cases) separately.ConclusionsWe identified just two studies that evaluated the validity of ICD codes in identifying the STIs of interest. Both studies focused on PID cases in which chlamydia and gonorrhea diagnoses and tests might be documented. Additionally, since both studies were published before 2015, neither evaluates the use of administrative data following the U.S. transition to ICD-10 codes. Given these findings, further studies are required to examine the predictive value of ICD-9 and -10 codes for all three diseases in the general population.References1. Tao G, Zhang CX. HIV Testing of Commercially Insured Patients Diagnosed With Sexually Transmitted Diseases. Sexually Transmitted Diseases. 2008;35(1):43-6.2. Evans HE, Mercer CH, Rait G, et al. Trends in HIV testing and recording of HIV status in the UK primary care setting: a retrospective cohort study 1995-2005. Sexually Transmitted Infections. 2009.3. Oskoui M, Ng P, Dorais M, et al. Accuracy of administrative claims data for cerebral palsy diagnosis: a retrospective cohort study. CMAJ open. 2017 Jul 18;5(3):E570-e5.4. Sauer BC, Teng C-C, Accortt NA, et al. Models solely using claims-based administrative data are poor predictors of rheumatoid arthritis disease activity. Arthritis Research & Therapy. 2017 2017/05/08;19(1):86.5. Haggerty CL, Ness RB. Epidemiology, pathogenesis and treatment of pelvic inflammatory disease. Expert review of anti-infective therapy. 2006 Apr;4(2):235-47.6. Satterwhite CL, Yu O, Raebel MA, et al. Detection of Pelvic Inflammatory Disease: Development of an Automated Case-Finding Algorithm Using Administrative Data. Infect Dis Obstet Gynecol. 2011;2011:7.7. Ratelle S, Yokoe D, Blejan C, et al. Predictive value of clinical diagnostic codes for the CDC case definition of pelvic inflammatory disease (PID): implications for surveillance. Sex Transm Dis. 2003 Nov;30(11):866-70

Trends in user-initiated health information exchange in the inpatient, outpatient, and emergency settings

Prior research on health information exchange (HIE) typically measured provider usage through surveys or they summarized the availability of HIE services in a healthcare organization. Few studies utilized user log files. Using HIE access log files, we measured HIE use in real-world clinical settings over a 7-year period (2011-2017). Use of HIE increased in inpatient, outpatient, and emergency department (ED) settings. Further, while extant literature has generally viewed the ED as the most relevant setting for HIE, the greatest change in HIE use was observed in the inpatient setting, followed by the ED setting and then the outpatient setting. Our findings suggest that in addition to federal incentives, the implementation of features that address barriers to access (eg, Single Sign On), as well as value-added services (eg, interoperability with external data sources), may be related to the growth in user-initiated HIE

Leveraging Health Information Exchange to Construct a Registry for Traumatic Brain Injury, Spinal Cord Injury and Stroke in Indiana

Traumatic brain injury (TBI), spinal cord injury (SCI) and stroke are conditions of interest to public health as they can result in long-term outcomes and disabilities. Specialized registries can facilitate public health surveillance, however only 4% of hospitals in the United States actively engage in electronic reporting to these registries. We leveraged electronic claims and clinical data from a health information exchange to create a statewide TBI/SCI/Stroke registry to facilitate the study of long-term outcomes and health services utilization. The registry contains 109,943 TBI patients, 9,027 SCI patients and 117,084 stroke patients with a mean of 3 years of follow-up data after injury. Additionally, the registry contains data on individual patient encounters, prescriptions and clinical variables. The high-dimensional data with large sample sizes may present a valuable informatics resource for injury research as well as public health surveillance