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Volume 30, Number 7—July 2024
Research

Electronic Health Record Data for Lyme Disease Surveillance, Massachusetts, USA, 2017–2018

Kshema Nagavedu, Karen Eberhardt, Sarah Willis, Monica Morrison, Aileen Ochoa, Susan Soliva, Sarah Scotland, Noelle M. Cocoros, Myfanwy Callahan, Liisa M. Randall, Catherine M. Brown, and Michael KlompasComments to Author 
Author affiliations: Harvard Medical School and Pilgrim Health Care Institute, Boston, Massachusetts, USA (K. Nagavedu, S. Willis, A. Ochoa, N.M. Cocoros, M. Klompas); Massachusetts Department of Public Health, Boston (K. Nagavedu, M. Morrison, S. Soliva, S. Scotland, L.M. Randall, C.M. Brown); Commonwealth Informatics, Waltham, Massachusetts, USA (K. Eberhardt); Atrius Health, Boston (M. Callahan); Brigham and Women’s Hospital, Boston (M. Klompas)

Main Article

Table 2

Summary performance rates for algorithm components and combinations calculated by summing the pertinent strata in study of electronic medical records for Lyme disease, Massachusetts, 2017–2018*

Strata used Algorithm components Charts reviewed/ flagged
 No. Lyme disease cases†
 Summary performance
PPV, % 
(95% CI)‡ No. projected Lyme disease cases§ Sensitivity, % (95% CI)#
Site 1 Site 2 C P S
1, 2, 4, 6, 8, 10
 ICD code
 54/180
 66/198
42
 12
 9
52.5 (43.6–61.4)
 198.5
 86.6 (69.8–100)
3–10
 Positive EIA
 54/78
 77/148
20
 23
 33
58.0 (49.5–66.4)
 131.1
 57.2 (46.7–68.8)
2, 6, 10
 ICD code and antibiotics
 30/84
 42/138
38
 8
 4
69.4 (58.6–79.8)
 154.2
 67.3 (54.8–81.7)
5, 6, 9, 10
 Positive EIA and antibiotics
 27/51
 39/60
17
 14
 11
63.6 (51.9–75.0)
 70.6
 30.8 (24.4–38.2)
5, 6, 7–10
 (Positive EIA and antibiotics) or positive WB
 42/66
 57/80
20
 23
 32
75.8 (67.1–83.9)
 110.6
 48.3 (40.2–56.5)
2, 6, 7–10 (ICD and antibiotics) or positive WB 57/114 65/167 42 26 32 82.0 (74.9–88.5) 230.3 100 (86.2–100)

*Strata and algorithms are defined in Table 1. ABX, antibiotics; C, confirmed; EIA, enzyme immunoassay; ICD, International Classification of Diseases, 10th Revision, Clinical Modification; P, probable; PPV, positive predictive value; S, suspected; WB, Western blot. †Based on criteria from the Council of State and Territorial Epidemiologists and Centers for Disease Control and Prevention. ‡PPV value for each stratum was calculated by summing up the total number of confirmed, probable, and suspected cases for the stratum and then dividing by the total number of charts reviewed for the stratum. §The total number of projected Lyme disease cases for each stratum was calculated by multiplying the total number of charts flagged in the stratum by the positive predictive value for the stratum. #Sensitivity was calculated as the total number of projected Lyme disease cases for the criteria of interest divided by the total number of projected Lyme disease cases for the entire population. The total number of projected Lyme disease cases for the entire population is 229.1, which is the sum of the projected Lyme disease cases from each of the 10 unique strata in the top half of the table using unrounded numbers.

Main Article

Page created: June 05, 2024
Page updated: June 22, 2024
Page reviewed: June 22, 2024
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