Chief Complaint and Triage Notes in the Emergency Department Patient Record
When you go to the emergency room, the triage nurse asks why you are there. The chief complaint data element of your patient record briefly records the major problem. The triage note provides more detail, including symptoms, events (such as a fall or accident), and other potentially relevant information. The North Carolina Disease Event Tracking and Epidemiologic Collection Tool, NC DETECT, uses information from these data elements for public health surveillance. Extracting useful information  from the clinical notes of the patient record for surveillance and other purposes is an ongoing challenge.

• Chief Complaint (2003 - 2008)
  In a series of projects, Debbie Travers, UNC School of Nursing, who developed the Emergency Medical Text Processor (EMT-P), Anna Waller, PI of NC DETECT, Judith Tintinalli, both of UNC Department of Emergency Medicine, and I have analyzed the form and content of chief complaints, with the eventual goal of developing a standardized vocabulary. Towards Vocabulary Control for Chief Complaint: A National Symposium , held October 18, 2006, resulted in a white paper (Haas et al., 2008) outlining specific recommendations for achieving this goal. Other related papers are listed on my CV.
• Travers, D. A. & Haas, S. W. (2003). Using nurses’ natural language entries to build a concept-oriented terminology for patients’ chief complaints in the emergency department. Journal of Biomedical Informatics, 36(4-5), 260-270.
• Travers, D. A. & Haas, S. W. (2004). Evaluation of Emergency Medical Text Processor, a system for cleaning chief complaint text data. Academic Emergency Medicine, 11(11), 1170-1176.
  Haas, S. W. & Travers, D. A. (2004). Issues in the development of a thesaurus for patients’ chief complaints in the hospital emergency department. Proceedings of the 2004 Annual Meeting of the American Society for Information Science and Technology, 411-417.
• Haas, S. W., Travers, D. A., Tintinalli, J. E., Pollock, D., Waller, A., Barthell, E., et al. (2008). Towards Vocabulary Control for Chief Complaint. Academic Emergency Medicine, 15(5), 476-482.


• Interpretation of Temporal Expressions in Triage Notes (2007 - present)
  The triage note tells the story of what happened before you came to the emergency department. Time plays an important role in the story: How long have you had the rash? When was the accident? Which started first, the cough or the fever? In this project, we are studying how time is expressed in the triage note, with the goal of developing rules extract temporal expressions and place the associated events on a timeline. Other related papers are listed on my CV.
• Irvine, A. K., Haas, S. W., & Sullivan, T. (2008) TN-TIES: A system for extracting temporal information from Emergency Department triage notes. Proceedings of the American Medical Informatics Association.
  Sullivan, T., Irvine, A., & Haas, S. W. (2008). It's all relative: Usage of relative temporal expressions in triage notes. Proceedings of the 2008 Annual Meeting of the American Society for Information Science and Technology.


• Adapting Natural Language Processing Tools for Biosurveillance (2009 - present)
  The goal of this project is to incorporate information from the triage note into syndrome classification algorithms. The challenge is identifying relevant concepts in the triage note regardless of how they are expressed. For example, presence of fever may be indicated by a measured temperature, or the phrase skin feels hot to touch. We are developing the Emergency Medical Text Classifier (EMT-C) to improve classification of patient records into syndromes such as Gastro-Intestinal Severe or Respiratory Illness. Other related papers are listed on my CV.
• Mahalingam, D., Mostafa, J., Travers, D., Haas, SW, Waller, A. (2012). Automated Syndrome Classification using Early Phase Emergency Department Data. ACM SIGHIT International Health Informatics Symposium (poster).
• Mahalingam, D., Medlin, R., Travers, D., Haas, SW. (2011). Temporal Information Extractor: Identifying Symptom Onset Date from Emergency Department Notes. AMIA 2011 Annual Symposium.
• Travers, D., Haas, S. W., Waller, A., Crouch, J., Mostafa, J., Schwartz, T. (2010). Identifying evidence of fever in emergency department text. AMIA 2010 Annual Symposium, November 13-17, 2010, Washington, D.C. (poster)
• Haas, S. W., Travers, D., Mahalingam, D., Crouch, J., Mostafa, J., Waller, A. (2010). Burning up: Finding fever expressions in triage notes. Proceedings of the 2010 Annual Meeting of the American Society for Information Science and Technology., October 22-27, 2010, Pittsburgh, PA. (poster)

North Carolina Preparedness and Emergency Response Research Center (NC PERRC) (2008 - present)
Edward Baker, Director of the NC Institute for Public Health, PI. The North Carolina Preparedness and Emergency Response Research Center is one of seven centers at schools of public health funded by the Centers for Disease Control and Prevention (CDC) to strengthen and improve public health preparedness capacity through systems and services research. NCPERRC focuses on North Carolina public health systems and capabilities to develop and maintain sustainable preparedness and response systems. I am working on the Surveillance project, Anna Waller and Pia MacDonald , co-PIs. The goal of the surveillance project is to systematically assess the performance of timely, electronic public health surveillance systems in North Carolina and, based on the assessments, develop, implement and analyze interventions for system performance improvement. My focus is on studying the workflows and lines of communications of public health surveillance personnel.

• Samoff, E., Waller, A., Fleischauer, A, Ising, A., Davis, M. K., Park, M., Haas, S. W., DiBiase, L., MacDonald, P. (2012). Integration of syndromic surveillance data into public health practice at state and local levels in North Carolina. Public Health Reports, 127(3), 310-317.