Defining Opioid-related Problems Using a Health Care Safety Net Institution's Inpatient Electronic Health Records: Limitations of Diagnosis-based Definitions.

Background: Measuring clinically relevant opioid-related problems in health care systems is challenging due to the lack of standard definitions and coding practices. Well-defined, opioid-related health problems (ORHPs) would improve prevalence estimates and evaluation of clinical interventions, crisis response, and prevention activities. We sought to estimate prevalence of opioid use disorder (OUD), opioid misuse, and opioid poisoning among inpatients at a large, safety net, health care institution.

A process to deduplicate individuals for regional chronic disease prevalence estimates using a distributed data network of electronic health records.

Introduction: Learning health systems can help estimate chronic disease prevalence through distributed data networks (DDNs). Concerns remain about bias introduced to DDN prevalence estimates when individuals seeking care across systems are counted multiple times. This paper describes a process to deduplicate individuals for DDN prevalence estimates.

Associations between extreme precipitation, drinking water, and protozoan acute gastrointestinal illnesses in four North American Great Lakes cities (2009-2014).

Climate change is already impacting the North American Great Lakes ecosystem and understanding the relationship between climate events and public health, such as waterborne acute gastrointestinal illnesses (AGIs), can help inform needed adaptive capacity for drinking water systems (DWSs). In this study, we assessed a harmonized binational dataset for the effects of extreme precipitation events (≥90th percentile) and preceding dry periods, source water turbidity, total coliforms, and protozoan AGIs - cryptosporidiosis and giardiasis - in the populations served by four DWSs that source surface water from Lake Ontario (Hamilton and Toronto, Ontario, Canada) and Lake Michigan (Green Bay and Milwaukee, Wisconsin, USA) from January 2009 through August 2014. We used distributed lag non-linear Poisson regression models adjusted for seasonality and found extreme precipitation weeks preceded by dry periods increased the relative risk of protozoan AGI after 1 and 3-5 weeks in three of the four cities, although only statistically significant in two.

The Detection of Opioid Misuse and Heroin Use From Paramedic Response Documentation: Machine Learning for Improved Surveillance.

Background: Timely, precise, and localized surveillance of nonfatal events is needed to improve response and prevention of opioid-related problems in an evolving opioid crisis in the United States. Records of naloxone administration found in prehospital emergency medical services (EMS) data have helped estimate opioid overdose incidence, including nonhospital, field-treated cases. However, as naloxone is often used by EMS personnel in unconsciousness of unknown cause, attributing naloxone administration to opioid misuse and heroin use (OM) may misclassify events.

Monitoring opioid addiction and treatment: Do you know if your population is engaged?

Background: Assessment of people affected by opioid-related problems and those receiving care is challenging due to lack of common definitions and scattered information. We sought to fill this gap by demonstrating a method to describe a continuum of opioid addiction care in a large, public safety-net institution.

Methods: Using 2017 clinical and administrative data from Denver Health (DH), we created operational definitions for opioid use disorder (OUD), opioid misuse (OM), and opioid poisoning (OP).

A ride in the time machine: information management capabilities health departments will need.

We have proposed needed information management capabilities for future US health departments predicated on trends in health care reform and health information technology. Regardless of whether health departments provide direct clinical services (and many will), they will manage unprecedented quantities of sensitive information for the public health core functions of assurance and assessment, including population-level health surveillance and metrics. Absent improved capabilities, health departments risk vestigial status, with consequences for vulnerable populations.

The role of public health informatics in enhancing public health surveillance.

Public health surveillance has benefitted from, and has often pioneered, informatics analyses and solutions. However, the field of informatics also serves other facets of public health including emergency response, environmental health, nursing, and administration. Public health informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning.

Web-based self-triage of influenza-like illness during the 2009 H1N1 influenza pandemic.

The sudden emergence of 2009 H1N1 influenza in the spring of that year sparked a surge in visits to emergency departments in New York City and other communities. A larger, second wave of cases was anticipated the following autumn. To reduce a potential surge of health system utilization without denying needed care, we enlisted the input of experts from medicine, public health, nursing, information technology, and other disciplines to design, test, and deploy clinical algorithms to help minimally trained health care workers and laypeople make informed decisions about care-seeking for influenza-like illness.

Occupational risks during a monkeypox outbreak, Wisconsin, 2003.

We determined factors associated with occupational transmission in Wisconsin during the 2003 outbreak of prairie dog--associated monkeypox virus infections. Our investigation included active contact surveillance, exposure-related interviews, and a veterinary facility cohort study. We identified 19 confirmed, 5 probable, and 3 suspected cases.

Inventory of electronic health information exchange in Wisconsin, 2006.

Context: The Governor's Board for eHealth Care Quality and Patient Safety plans for universal adoption of electronic health records and information exchange.

Objectives: The inventory sought to describe characteristics, challenges, and policy recommendations of health information exchange (HIE) projects and create a directory and baseline for periodic reassessment.

Design, Setting, Subjects: A cross-sectional Internet survey of any project where electronic patient information was transmitted by multiple organizations in Wisconsin in 2006.

Medical informatics in population health: building Wisconsin's strategic framework for health information technology.

Medicine is increasingly practiced through the application of information sciences. Medical informatics deals with optimal information use within bioinformatics, imaging, clinical, and population health domains. Population health informatics plays an important role in that it critically informs practice in each of the other domains.

SARS Surveillance Project--Internet-enabled multiregion surveillance for rapidly emerging disease.

Introduction: On March 15, 2003, CDC requested health-care and public health agencies to conduct surveillance for severe acute respiratory syndrome (SARS). The SARS Surveillance Project (SARS-SP) was established to rapidly implement multiregional SARS surveillance in emergency departments (EDs) by using existing Internet-based tools.

Objectives: The objectives of SARS-SP were to 1) disseminate and update SARS screening forms for ED triage, 2) establish surveillance for SARS syndrome elements by using Regional Emergency Medicine Internet (REMI), 3) expand surveillance to multiple regions, and 4) evaluate the usefulness of Internet tools for agile surveillance during a rapidly emerging global epidemic.

Syndromic surveillance using regional emergency medicine internet.

Study Objective: We demonstrate the feasibility and utility of emergency department (ED) syndromic surveillance using a regional emergency medicine Internet application to minimize impact on ED and public health staffing.

Methods: Regional (multi-ED) surveillance was established for 2 periods, one characterized by a high-profile national sports event and the other during an international disease outbreak. Counts of patient visits meeting syndrome criteria and total patient visits were reported daily on the secure regional emergency medicine Internet site and downloaded by public health staff.

Three Hundred Sixty Degree Feedback: program implementation in a local health department.

Three Hundred Sixty Degree Feedback systems, while popular in business, have been less commonly implemented in local public health agencies. At the same time, they are effective methods of improving employee morale, work performance, organizational culture, and attainment of desired organizational outcomes. These systems can be purchased "off-the-shelf," or custom applications can be developed for a better fit with unique organizational needs.

The public health dashboard: a surveillance model for bioterrorism preparedness.

The City of Milwaukee Health Department piloted a short-term, near real-time syndromic surveillance and communication tool by using an existing secure regional Internet infrastructure. Voluntary, active syndromic case reporting by hospital Emergency Departments was combined with other data streams, including clinical laboratory reports of communicable disease, hospital emergency room diversions, ambulance runs, medical examiner reports of unusual or suspicious deaths, poison control and nursing hotline call volumes, and pharmacy over-the-counter sales. These data were aggregated into a "Surveillance Dashboard" format that was used to communicate community syndromic health trends to hospitals, Emergency Departments, and other providers using a secure Internet technology.

The detection of monkeypox in humans in the Western Hemisphere.

Background: During May and June 2003, an outbreak of febrile illness with vesiculopustular eruptions occurred among persons in the midwestern United States who had had contact with ill pet prairie dogs obtained through a common distributor. Zoonotic transmission of a bacterial or viral pathogen was suspected.

Methods: We reviewed medical records, conducted interviews and examinations, and collected blood and tissue samples for analysis from 11 patients and one prairie dog.

Assuring community emergency care capacity with collaborative Internet tools: the Milwaukee experience.

Hospital overcrowding and diversion of ambulances from emergency departments are being recognized as increasing problems in the health care system. This article, a descriptive narrative, examines the various factors contributing to the problem and describes how collaborative approaches to public health issues can be applied. It describes Milwaukee's experience with a collaborative approach.

Heat wave morbidity and mortality, Milwaukee, Wis, 1999 vs 1995: an improved response?

Objectives: This study examined whether differences in heat alone, as opposed to public health interventions or other factors, accounted for the reduction in heat-related deaths and paramedic emergency medical service (EMS) runs between 1995 and 1999 during 2 heat waves occurring in Milwaukee, Wis.

Methods: Two previously described prediction models were adapted to compare expected and observed heat-related morbidity and mortality in 1999 based on the city's 1995 experience.

Results: Both models showed that heat-related deaths and EMS runs in 1999 were at least 49% lower than levels predicted by the 1995 relation between heat and heat-related deaths or EMS runs.

Wisconsin, July 1999 heat wave: an epidemiologic assessment.

Objective: To assess the characteristics of heat-related deaths in Wisconsin during the summer of 1999.

Methods: Review of death certificates indicating heat as an underlying or contributing cause of death.

Results: Heat-related illness led to 21 deaths during the summer of 1999 in Wisconsin.