Bulletin: Change in Definition of Chief Complaint Opioid-Related Evidence Classifier

Effective date: July 1, 2018

Health Monitoring’s evidence classifiers incorporate data from emergency department chief complaints, diagnosis codes, and clinical notes. Each classifier contains the classifications related to the data type. Each classification is defined by a particular set of keywords in conjunction with an absence of specified negative indicators.

Definition Change

At the request of the Connecticut Department of Health, two new brand names have been added to the Chief Complaint Opioid-Related Evidence Classifier.

The keywords “tramadol” and “hydromorph” are being added to that classifier’s Substance Opioid Brand classification. The relevance of these changes was deemed sufficiently universal and the impact on existing classifications sufficiently minor as to warrant applying them globally.

Impact on Existing Classifications

Since January 1, 2015, the start point for applying opioid-related classifications retroactively, there have been 2,852 chief complaints containing “tramadol” and 48 containing “hydromorph.” For “tramadol” that averages to roughly 2 per day systemwide, and thus less than 1 per day per state. Of those, 174 (169 “tramadol,” 5 “hydromorph”) contain sufficient additional information to warrant the classification “Suspected overdoses involving any opioid.” That works out to an average of 8 additional suspected opioid overdoses per year per state. The other two overdose categories will not be affected by this change.

Classification definitions (inclusion of keywords and exclusion of negative indicators) are developed based on the analysis of data received by the system. Words or phrases that do not appear in the data are not included in classifier definitions.

Ebola Surveillance: Beyond the Chief Complaint

Ebola patient Thomas Eric Duncan visited the emergency department of a Dallas Hospital with a temperature of 100.1 degrees Fahrenheit, abdominal pain, decreased urination, and a sharp headache. He was sent home with antibiotics because it was not disclosed to the doctors on staff that Duncan had recently traveled from Liberia, where the disease has spread rapidly and caused more than 3,000 deaths. Officials from the hospital released a statement saying, “the travel history would not automatically appear in the physician’s standard work flow” as part of their EHR design. Instead, Mr. Duncan’s travel history was included only in the EHR’s nursing workflow.
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After Widespread Flooding, EpiCenter Monitors Disease Vector Populations

Insects and arachnids are vectors for a variety of diseases of public health importance.  In areas where these diseases are endemic, some health departments routinely monitor these populations and apply control measures as necessary.  In other areas, monitoring is infeasible or unnecessary under normal conditions, but could be of value under extraordinary circumstances such as widespread flooding.

The Ohio Department of Health demonstrated that monitoring of emergency department complaints related to mosquito and insect bites was useful for tracking increases in mosquito populations after an area experienced a major flood.  Thus, EpiCenter could be used to monitor disease vector populations during extraordinary circumstances in areas where the capacity for traditional trapping methods is not maintained.

Poster: “Monitoring Hospital Emergency Department Visits for Chief Complaints of Insect Bites after a Major Flood”, ISDS Conference 2008