Use of Electronic Data for the Surveillance of Antimicrobial Resistance

The Navy’s EpiData Center (EDC) receives restructured Health Level 7 (HL7) microbiology data through a secure daily feed from Executive Information Decision Support (EIDS).  HL7 messages sent via the Military Health System (MHS) Composite Health Care System (CHCS) are received daily and require a database administrator (DBA) to transfer the large volume of compressed data to a storage area on the secure server. The compressed raw data are backed up to disk for disaster recovery efforts.  Before the data are uploaded to the database, they are validated for anomalies, such as missing or skewed data.

 Incoming MHS HL7 data present challenges due to the inclusion of non-standard laboratory test names and results, inconsistent date formats and field lengths, null values and duplicate records.  These data require extensive processing in SQL or SAS to restructure them for analysis with standard tools.  Methodology has been developed by EDC programmers and epidemiologists to utilize these data for infectious disease surveillance and case finding.

 HL7 Microbiology data have been successfully restructured for analysis and imported into WHONET©, a standard, WHO developed, tool that rapidly generates detailed antibiogram reports.  Restructuring rules developed in SAS were recreated in SQL for efficiency and automation purposes.  Reports generated using WHONET© will be utilized by clinical staff to guide empirical therapy.  This is the first methodology to provide timely analysis of antibiotic resistance in the military population.

 Utility of the MHS HL7 microbiology data for public health surveillance purposes depends on proper infrastructure and resources for the set up, storage and retrieval of data.  Restructured data can be utilized for the generation of detailed reports to support clinical and public health decisions.