Electronic Laboratory Data for Disease Surveillance in the Military

The Navy’s Epi Data Center (EDC) receives restructured Health Level 7 (HL7) laboratory data through a secure daily feed from Executive Information Decision Support (EIDS).  Laboratory data messages sent via the Military Health System (MHS) Composite Health Care System (CHCS) daily include microbiology, chemistry, anatomic pathology and pharmacy records.  Methodologies in place within the EDC for the utilization of these data for infectious disease surveillance capitalize upon the skills of database administrators, programmers and analysts.  Epidemiologists and other public health professionals are the consumers of the generated output; line lists, graphical representations of trend data and summary reports are regularly published utilizing these data.

Tasks related to these processes include data transfer of large volumes of compressed data, data back up to disk for disaster recovery efforts, data validation, and extensive data processing in SQL.  These steps lead to clean, restructured data suitable for analysis with standard epidemiological tools.  Additionally, EDC programmers have developed specialized methods to utilize these data for automated case finding, detailed tracking of influenza related tests and prescriptions, and reporting of trends in antibiotic resistance throughout the MHS beneficiary population.  Case finding and influenza methodologies have been leveraged for the rapid development of a daily report for the identification of presumptive H1N1 influenza cases early in the outbreak.

Utility of the MHS laboratory data for public health surveillance purposes depends on proper infrastructure and resources for the set up, storage and retrieval of data.  This infrastructure will be described, including details of the methods utilized in these processed, including SQL Server Agent jobs and SQL Server Integration Services (SSIS) packages for the generation, cleaning and validation of data and the automation of data transfer onto established directories.