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Editorial Comment: Increased Missing Data Affects Burden Estimates

Image of MSMR Logo 800 x 480. The Medical Surveillance Monthly Report is published monthly by the Armed Forces Health Surveillance Division

During the preparation of the MSMR’s annual burden of disease issue, Armed Forces Health Surveillance Division epidemiologists and the MSMR staff noted data patterns that indicate incomplete transfer or capture of certain routinely reported elements. As the Military Health System completes its transition to the new MHS GENESIS electronic health record, AFHSD is also in the process of completely transferring or mapping EHR data to the Defense Medical Surveillance System. As a result, some data elements typically reported in the annual MSMR burden issues may not be completely mapped at this time, including duty disposition status and ambulatory appointment type (in-person vs. virtual).

In addition to these data mapping aspects, 2022 was the first year DMSS data were housed and analyzed from the new MHS Information Platform. During this transition to the MIP, the number of records transmitted from MHS GENESIS to DMSS are being continually reviewed for completeness of data capture. While both hospitalization and ambulatory records are routinely updated after the end of each calendar year, data transfer completeness has not yet been fully assessed during the MIP transition. 

To bring our readership as much information as possible, and in a timely fashion, the MSMR staff has elected to mark much of the data in this issue as “provisional.” The MSMR may publish revised figures later this year, after data completeness issues have been fully investigated. While the effect of these missing data is most pronounced on the absolute value comparisons year-to-year, e.g., total number of encounters in 2022 versus 2021, the relative values and rank order of the major diagnostic categories are likely unaffected. Notably, the largest decline in ambulatory encounters was observed for ‘Z’ codes (other factors influencing health status and contact with health services).

While the primary purpose of any EHR is to document care during inpatient and outpatient encounters, extracts of these data are critical to public health surveillance efforts. These extracts are utilized to continuously expand the DMSS as a central repository of medical surveillance data for the U.S. Armed Forces. The AFHSD will continue to monitor data capture from MHS GENESIS to DMSS for quality and completeness and collaborate with health informatics experts within MHS to resolve any remaining data issues.

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Last Updated: August 03, 2023
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