{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T11:15:53Z","timestamp":1783077353634,"version":"3.54.6"},"reference-count":24,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T00:00:00Z","timestamp":1689897600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100021045","name":"Massachusetts Department of Public Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100021045","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Syndromic surveillance can help identify the onset, location, affected populations, and trends in infectious diseases quickly and efficiently. We developed an electronic medical record\u2013based surveillance algorithm for COVID-19\u2013like illness (CLI) and assessed its performance in 5 Massachusetts medical practice groups compared with statewide counts of confirmed cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>Using data from February 2020 through November 2022, the CLI algorithm was implemented in sites that provide ambulatory and inpatient care for about 25% of the state. The initial algorithm for CLI was modeled on influenza-like illness: an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code for COVID-19 and an ICD-10-CM diagnosis code suggesting severe lower respiratory tract infection or \u22651 ICD-10-CM diagnosis code for upper or lower respiratory tract infection plus fever. We generated weekly counts of CLI cases and patients with \u22651 clinical encounter and visually compared trends with those of statewide laboratory-confirmed cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The initial algorithm tracked well with the spring 2020 wave of COVID-19, but the components that required fever did not clearly detect the November 2020\u2013January 2021 surge and identified &lt;1% of weekly encounters as CLI. We revised the algorithm by adding more mild symptoms and removing the fever requirement; this revision improved alignment with statewide confirmed cases through spring 2022 and increased the proportion of encounters identified as CLI to about 2% to 6% weekly. Alignment between CLI trends and confirmed COVID-19 case counts diverged again in fall 2022, likely because of decreased COVID-19 testing and increases in other respiratory viruses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Practice Implications:<\/jats:title>\n                    <jats:p>Our work highlights the importance of using a broad definition for COVID-19 syndromic surveillance and the need for surveillance systems that are flexible and adaptable to changing trends and patterns in disease or care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00333549231186574","type":"journal-article","created":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T04:22:32Z","timestamp":1689913352000},"page":"756-762","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Syndromic Surveillance for COVID-19, Massachusetts, February 2020\u2013November 2022: The Impact of Fever and Severity on Algorithm Performance"],"prefix":"10.1177","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7090-2761","authenticated-orcid":false,"given":"Noelle M.","family":"Cocoros","sequence":"first","affiliation":[{"name":"Harvard Pilgrim Health Care Institute, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah J.","family":"Willis","sequence":"additional","affiliation":[{"name":"Harvard Pilgrim Health Care Institute, Boston, MA, USA"},{"name":"Now with Pfizer, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Eberhardt","sequence":"additional","affiliation":[{"name":"Commonwealth Informatics, Waltham, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Morrison","sequence":"additional","affiliation":[{"name":"Massachusetts Department of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liisa M.","family":"Randall","sequence":"additional","affiliation":[{"name":"Massachusetts Department of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"DeMaria","sequence":"additional","affiliation":[{"name":"Massachusetts Department of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine M.","family":"Brown","sequence":"additional","affiliation":[{"name":"Massachusetts Department of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence C.","family":"Madoff","sequence":"additional","affiliation":[{"name":"Massachusetts Department of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bob","family":"Zambarano","sequence":"additional","affiliation":[{"name":"Commonwealth Informatics, Waltham, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selsebil","family":"Sljivo","sequence":"additional","affiliation":[{"name":"Harvard Pilgrim Health Care Institute, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kshema","family":"Nagavedu","sequence":"additional","affiliation":[{"name":"Harvard Pilgrim Health Care Institute, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Klompas","sequence":"additional","affiliation":[{"name":"Harvard Pilgrim Health Care Institute, Boston, MA, USA"},{"name":"Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,7,21]]},"reference":[{"key":"bibr1-00333549231186574","unstructured":"Centers for Disease Control and Prevention. 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