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Systems and Projects

NC DETECT

The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) is North Carolina’s statewide syndromic surveillance system. CCHI works under contract to the North Carolina Division of Public Health to deliver a flexible, responsive public health surveillance tool that provides near real-time analysis of statewide emergency department data, EMS data from the North Carolina EMS Data System, urgent care clinic data, death certificate data, and data from North Carolina Poison Control. NC DETECT is used daily by public health practitioners at the local and state level as well as providers to track and respond to issues ranging from COVID-19 and Monkeypox to prescription drug overdoses and firearm injuries. In addition, CCHI staff and affiliated faculty collaborate on a variety of research and quality improvement projects with many different investigators using data from NC DETECT.

NC Division of Public Health Meaningful Use Registration of Intent and Onboarding Tracking Site

CCHI designed, developed and maintains NC DPH’s Meaningful Use (MU) Registration of Intent site http://ncdphmeaningfuluse.org. This site allows providers to register intent to participate in public health programs, a MU requirement. The site also facilitates efficient tracking of providers through the onboarding process of submitting data to the North Carolina Central Cancer Registry, Electronic Laboratory Reporting and the North Carolina Immunization Registry.

Prescription Drug Overdose and Other Injury (PDO+)

Since 2016, CCHI has collaborated with the Injury and Violence Prevention Branch (IVPB) of the NC Division of Public Health on efforts to expand surveillance and descriptive epidemiology projects using emergency department visit and EMS data, with a particular focus on drug overdoses.  This work includes developing new reports and fact sheets addressing injury and violence topics, which support the use of NC DETECT across the state for injury and violence surveillance and response activities.  In addition, training and dissemination activities are an important part of these efforts, with particular focus on local public health practitioners in North Carolina. Topics covered by this work include opioid and other drug overdoses, suicide and self-harm, falls, traumatic brain injury, transportation related injury, firearm related injury, animal bites, and others.

North Carolina Firearm-Related Surveillance Through Emergency Rooms (NC-FASTER)

CCHI has partnered with the Injury and Violence Prevention Branch (IVPB) of the NC Division of Public Health since 2020 to develop and implement surveillance methods for identifying non-fatal firearm injury through emergency department visit and EMS encounter data.  This work includes collaboration with the CDC and partners across the state to evaluate surveillance case definitions, improve data quality, and share state, regional and local data with those addressing firearm injury prevention.  As part of NC-FASTER, firearm injury deaths in the North Carolina Violent Death Reporting System (NC-VDRS) have been linked to emergency department visits in the year prior to death to identify potential prevention opportunities.

EMT-P

The Emergency Medical Text Processor (EMT-P) is a software system that cleans emergency department chief complaint (CC) text (e.g., chst pn, CP, c/p, chest pai, chert pain, chest/abd pain, chest discomfort) in order to extract standard terms (e.g., chest pain). The system addresses acronyms, abbreviations, misspellings, various uses of punctuation, coordinate constructions, and other patterns of natural language in order to maximize extraction of standard terms. The standard terms are then available for primary and secondary uses such as clinical care, research, administrative tracking, and public health and bioterrorism surveillance.

EMT-P was developed by Dr. Debbie Travers and colleagues at the University of North Carolina at Chapel Hill. The system is available as open source software (http://www.ibridgenetwork.org/unc/emergency-medical-text-processor-version-2-3). EMT-P includes a controller program written in Java, text processing modules written in Perl, and a database populated with data from the Unified Medical Language System ®.

Completed CCHI Projects

North Carolina Crash Injury Surveillance System (NC-CISS)

CCHI partnered with the Injury and Violence Prevention Branch of the NC Division of Public Health, the UNC Injury Prevention Research Center, and the UNC Highway Safety Research Center on the development of the North Carolina Crash Injury Surveillance System (NC-CISS). The project was funded through a federal grant from the Centers for Disease Control and Prevention. The Project Team built on prior strategic planning activities and an existing network of motor vehicle crash injury stakeholders to successfully link crash data with emergency department visit and death certificate data. The NC-CISS provides data to local, state, and federal partners in transportation, planning, and public health, including through the NC Transportation & Public Health Data Dashboard.

Strategic Planning for Motor Vehicle Crash and Injury Data Linkage

The ability to integrate safety information from a variety of sources in North Carolina has the potential to improve safety analysis, inform subsequent policy and program decisions, and support communications with the public and with transportation decision makers. CCHI worked with the NC Governor’s Highway Safety Program (GHSP) and the NC Traffic Records Coordinating Committee (TRCC) towards a goal of evaluating the need for, and feasibility of, a statewide injury surveillance system in its 2017 Traffic Safety Information Systems Plan. One specific identified objective for this goal was to conduct a demonstration project that links injury surveillance data with crash data. Working with collaborators in the UNC Injury Prevention Research Center and Highway Safety Research Center, CCHI staff successfully demonstrated the ability to integrate crash and health data and use them to address questions of interest to stakeholders.

Data Documentation for Motor Vehicle Crash Injury Data Integration

Data documentation was identified as a major limiting factor to moving forward with data linkage efforts in NC, making planning for successful data linkage between data sources challenging.  The 2017 NC Traffic Records Assessment found a lack of data documentation available for key data sources and the NHTSA GO Team assigned to work with NC on developing an implementation plan for data linkage included a recognition of this lack of data documentation and endorsement of efforts to create the necessary data documentation to better inform data linkage efforts. CCHI worked to create standardized data documentation for all the key data sources necessary for crash and health outcomes data linkage in NC and make this information available online.

NC SPICE Healthcare Acquired Infection Survey Portal

The purpose of this contract was to expand North Carolina’s existing Healthcare Acquired Infection (HAI) prevention capacity by addressing gaps in infection control assessment and training, prevention guidance targeted to all healthcare facilities, and more robust healthcare readiness for high consequence emerging disease threats (including Ebola).  CCHI developed a data driven Web-based HAI Prevention Capability application, functioning as both a registration system and an infection control tracking and management system, to facilitate survey assessments of healthcare facilities across North Carolina to determine infection control capacity by identifying and addressing gaps, developing and maintaining

Surveillance Quality Improvement Project (SQI)

The Surveillance Quality Improvement Project (SQI) is a collaboration among CCHI, the UNC Injury Prevention Research Center (IPRC), and the Injury and Violence Prevention Branch of the NC DPH.  This project addresses data quality issues related to emergency department visit data used for injury surveillance at both the state and national level.  Work includes engaging and collaborating with hospitals and professional medical coders to audit existing coding practices and identify and improve coding problems.  The NC project also collaborates with other states to address nationally relevant surveillance quality issues.  View Publications and Presentations of the NC Surveillance Quality Improvement Project.

Motor vehicle crash injuries in Wake County, NC

Exploring available data sources and potential data linkages. Draft description: The project will describe Motor Vehicle Traffic Crash (MVTC) injury in Wake County using several different data sources. Exploratory efforts to link the data sources will be conducted. Recommendations will be made for future work to link MVTC injury data sources.

Adapting Natural Language Processing Tools for Biosurveillance

This study developed and tested a new system for pre-processing and syndromic classification of emergency department records with triage notes.  The system, Emergency Medical Text Classifier (EMT-C) is based on the vector space model and employs a pseudo-relevance feedback mechanism to process free text ED triage notes and extract standard terms for syndromic surveillance. The system was tested for classification of acute gastrointestinal infectious disease outbreaks and found to improve performance.  Manuscripts about EMT-C have been submitted for publication.
Funded by: National Library of Medicine, NIH
PI:  Debbie Travers, PhD

Gillings Innovation Lab (GIL)

CCHI faculty and staff participated in a Gillings Innovation Lab focusing on the integration and use of existing healthcare data to provide a better understanding of the distribution of diseases and their causes.  David Richardson, PhD, Assistant Professor of Epidemiology in the UNC Gillings School of Global Public Health, was the PI for this study.  The partnerships and collaborations founded in the GIL continue to generate projects and papers and the CCHI actively participates in this ongoing GIL work.

NC PERRC Research Project #2: Public Health Surveillance Systems Research

Dr. Anna Waller was co-PI along with Dr. Pia MacDonald, former Director of the NC Center for Public Health Preparedness, on this CDC-funded cooperative agreement, which was part of the North Carolina Preparedness and Emergency Response Research Center (NC PERRC).  The project systematically assessed the strengths, weaknesses and areas for improvement of NC DETECT and the North Carolina Electronic Disease Surveillance System (NC EDSS), including research on each system to examine system capacity, processes, outputs and outcomes. Emphasis was on assessment of user needs for surveillance, the characteristics of early and late adopters of electronic surveillance systems, and the connections of NC DETECT with NC EDSS and with other preparedness activities in NC. The results of these investigations yielded recommendations for interventions to ensure the utility, use and sustainability of these systems; these recommendations were disseminated and implemented with the assistance of key partnering practitioners.
Funded by:  CDC
PI:  Anna Waller, CCHI, Department of Emergency Medicine

BioSense Evaluation Cooperative Agreement

This study comprised a collaboration between the Research Triangle Institute (RTI) and CCHI to conduct biosurveillance evaluations in support of the CDC BioSense Initiative.  RTI conducted case studies at several different sites around the US to describe the operational components and functioning of a public health system’s response to a public health threat, and to assess the impact of biosurveillance on the timeliness of detection and response and its role within the public health system.  CCHI’s role in this cooperative agreement was to assess the quality of the data obtained through a biosurveillance system, by conducting data validity audits.  These audits compared data in source systems to the data found in biosurveillance systems.
Funded by:  CDC
PI:  Anna Waller, CCHI, Department of Emergency Medicine

BioSense-funded Research Project On Syndrome Definitions

This study comprised a collaboration between the Research Triangle Institute and CCHI to conduct research in support of the CDC BioSense Initiative. Rapid detection of disease outbreaks rests on a foundation of accurate classification of patient symptoms early in the course of their illness. The overarching objective of this research was to define, test, validate, and standardize methodology for optimizing syndrome definitions designed for the early detection of disease outbreaks of public health importance using emergency department data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT).
Funded by:  CDC
PI:  Matthew Scholer, CCHI, Department of Emergency Medicine

Evaluation of the Emergency Severity Index for Pediatric Triage

The goals of this project were to perform reliability and validity testing of ESI v.4 triage system in the pediatric population and to revise the ESI v.4 in order to produce a standardized method for stratification of pediatric patients, differentiating high acuity children from less sick children who can wait for limited resources in the Emergency Department (ED).  Our study was a multi-center, 7 site, prospective evaluation of ESI v.4 and implementation of a revised ESI for pediatric triage.  We conducted a three year process of validation, refinement, and then, repeat validation of the ESI.
Funded by:  HRSA, Maternal and Child Health Bureau (via EMSC))
PI:  Anna Waller, CCHI, Department of Emergency Medicine

Other CCHI Collaborations

  • Emergency Department – EMS Data Linkage
    Funded by CDC
    PI: Scott Proescholdbell, NC DPH

 

  • Use of Emergency Care Among Criminal Justice Involved Population
    Funded by NIH
    PI: David Rosen, Department of Medicine, Infectious Disease Division

 

  • NC Violent Death Reporting System
    Funded by CDC
    PI: Scott Proescholdbell, NC DPH

 

  • NC BRACE Project
    Funded by CDC
    PI: Lauren Thie, NC DPH

 

  • Planning a community network to prevent child maltreatment in Wake County.
    Funded by John Rex Endowment.
    PI: Meghan Shanahan, IPRC, UNC.

 

  • Wake County Childhood Injury Profile.
    Funded by John Rex Endowment.
    PI: Carolyn Crump, Health Solutions, UNC School of Public Health.

 

  • Outcomes of Prehospital care for Myocardial Infarction using linked EMS-ED Data.
    Funded by UNC School of Nursing.
    PI: Jessica Zegre-Hemsey, School of Nursing.

 

  • Comparing EMS Primary Impression with ED Diagnosis: An Analysis of Patient Outcomes.
    PI: Tony Fernandez.

 

  • Evaluation of a community-based initiative to prevent opioid overdoses.
    PI:  Chris Ringwalt, UNC IPRC.

 

  • Climate Change Impacts of Air Pollution on Morbidity in Vulnerable Populations across the Life Stages in 2050:  Translation to Local Health Preparedness
    Funded by:  Carolinas Integrated Sciences and Assessments, University of South Carolina
    PI:  Karin Yeatts, Department of Epidemiology

 

  • Pediatric Field Triage for EMS
    Funded by:  HRSA, Maternal and Child Health Bureau (via EMSC)
    PI:  Jane Brice, Department of Emergency Medicine

 

  • EMS Field Triage
    Funded by:  National Highway Traffic Safety Administration
    PI:  Jane Brice, Department of Emergency Medicine

 

  • Emergency Department Utilization by Oncology Patients
    Funded by:  NC TraCS Institute
    PI:  Deb Meyer, School of Nursing