Review
Validity of electronic surveillance systems: a systematic review

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Summary

Electronic surveillance that utilises information held in databases is more efficient than conventional infection surveillance methods. Validity is not well-defined, however. We systematically reviewed studies comparing the utility of electronic and conventional surveillance methods. Publications were identified using Medline (1980–2007) and bibliographic review. The sensitivity and specificity of electronic compared with conventional surveillance was reported. Twenty-four studies were included. Six studies reported that nosocomial infections could be detected utilising microbiology data alone with good overall sensitivity (range: 63–91%) and excellent specificity (range: 87 to >99%). Two studies used three laboratory-based algorithms for the detection of infection outbreaks yielding variable utility measures (sensitivity, range: 43–91%; specificity, range: 67–86%). Seven studies using only administrative data including discharge coding (International Classification of Diseases, 9th edn, Clinical Modification) and pharmacy data claimed databases had good sensitivity (range: 59–96%) and excellent specificity (range: 95 to >99%) in detecting nosocomial infections. Six studies combined both laboratory and administrative data for a range of infections, and overall had higher sensitivity (range: 71–94%) but lower specificity (range: 47 to >99%) than with use of either alone. Three studies evaluated community-acquired infections with variable results. Electronic surveillance has moderate to excellent utility compared with conventional methods for nosocomial infections. Future studies are needed to refine electronic algorithms further, especially with community-onset infections.

Introduction

Surveillance is defined as the ongoing, systematic collection of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health.1 Surveillance is a major part of hospital infection control programmes, and infection control practitioners devote more time to this activity than any other task.2 Traditionally infection surveillance is conducted through passive reporting systems such as with notifiable diseases, or by individual case identification and clinical review such as with hospital-based infection prevention and control programmes.3, 4 Automated or electronic surveillance of infectious diseases is the process of obtaining information from inter-related electronic databases for identifying infection distributions within a particular setting.5 With increasing use and availability of electronic patient data within healthcare institutions and in community settings, the potential for automated surveillance has been increasingly realised.4, 6, 7 Since these electronic data are usually routinely collected for other primary purposes, electronic surveillance systems may be developed and implemented with a potentially minimal incremental expense.

As a result of uncertainty surrounding its validity, electronic surveillance has not been widely adopted. Traditional, labour-intensive, manual infection surveillance methods remain the principal means of surveillance in most jurisdictions. Our objective was to systematically identify and appraise the published literature assessing the validity of electronic surveillance systems compared with conventional surveillance techniques.

Section snippets

Search strategies

A methodical search was conducted to identify published literature comparing the utility of routine, electronic or automated surveillance systems with conventional surveillance systems for infectious diseases. Both electronic and manual searches were used, the latter by scanning bibliographies of all evaluated articles and the author's files. No language restriction was used. The US National Library of Medicine's PubMed service was used to search Medline for relevant electronic articles

Results

A total of 2421 references were initially identified. Twenty-four fulfilled the predetermined inclusion criteria and were included in analysis. The flow of studies and reasons for exclusion are displayed in Figure 1. Table I, Table II, Table III, Table IV summarise each article included in this review. Most (21; 87%) of the included studies focused on nosocomial infections including surgical site infections (SSIs),9, 10, 11, 12, 13 central venous catheter (CVC)-related infections,4, 14, 15

Discussion

In this report we identify and summarise the published literature evaluating the utility of electronic surveillance systems. The body of literature on this topic is small and we only identified 24 studies that compared electronic with conventional surveillance. While several of the studies were focused on nosocomial infections, the populations and methodologies were heterogeneous. We therefore did not attempt to summarise their results using formal quantitative statistics. Based on included

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