Layout 1 ISDS Annual Conference Proceedings 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution- Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ISDS 2012 Conference Abstracts Novel Emergency Department High Utilizer Surveillance In New Hampshire David J. Swenson*1, Cole Zanetti2, Elizabeth R. Daly1 and Jose T. Montero1 1State of NH, Concord, NH, USA; 2NH Dartmouth Family Medicine Residency, Concord, NH, USA Objective To develop a manageable surveillance methodology to detect Emergency Department (ED) patients with the highest healthcare uti- lization, and monitor their targeted treatment improvement and med- ical health cost reductions over time for overall improvements in statewide health. Introduction Researchers have demonstrated benefits to identifying and devel- oping interventions for patients that frequently seek healthcare serv- ices in the ED. The New Yorker Magazine, recently published an article titled The Hot Spotters, summarizing work being done in the United States to lower medical costs by giving the neediest patients better healthcare (1). In Camden, NJ, Physician Jeffrey Brenner closed his regular practice to focus on Hot Spotter patients (directing resources and brainpower to help their improvement) and measured a 40% reduction in hospital inpatient and ED visits and a 56% med- ical cost reduction for the first 36 Hot Spotters. A 2008 NH Office of Medicaid Business and Policy (OMBP) outpatient Medicaid ED fre- quency visit study was conducted, which cited that frequent ED users were more likely to have higher costs and rates of illness or disease than all Medicaid members (2). It was noted that increased prevention and wellness could reduce frequent ED use and increase cost savings (5% of the NH Medicaid population contributed to approximately 38% of ED costs). The NH Division of Public Health Services initi- ated a pilot project to examine NH Emergency Department (ED) sur- veillance data to identify high utilizer patients and realize improved health benefits and medical cost reductions. Methods This pilot focused first on identifying 2010 ED high utilizers in one hospital. A high utilizer was defined as a patient with 9 or more ED visits (top 10%) and were identified using Medical Record Num- ber followed by sorting number of visits in descending order. Visit di- agnosis codes were identified for the top 10% of high utilizers, along with the date of admission, resident town, age, and gender. Finally, the top 10% over utilizers were mapped, identifying the total number of utilzers in each town. We overlaid this information on a map of NH’s social vulnerability index to provide comparative data. Plans for future expansion include: Creating a GIS system that trends data over 10 years; Identifying ED high utilizers by location (visits by town, number of diagnosis codes per visit, date of visits, and sum- mative data); and Creating hospital and total state-wide breakdown of highest utilizers, most common state-wide diagnosis for ED high uti- lizers, and specific data from each hospital in relation to state-wide social vulnerability index data. Results Over 56,000 ED visits at one pilot hospital were analyzed target- ing 2,005 high utilizer visits for 158 patients. Identification by loca- tion, age, gender and ICD-9-CM diagnosis coding was determined for each ED over utilizer. Mapping of the high utilizers showed that 142 of the 158 patients resided in the city where the hospital was lo- cated. The most frequent diagnosis codes for the top 10% ED high utilizers included mental health, substance abuse, and chronic dis- ease conditions (such as diabetes mellitus). Conclusions This pilot project provides a manageable approach for identifying ED high utilizers for both health improvement and cost reduction sur- veillance efficiencies, and is a model for other surveillance manage- ment monitoring applications. Potentially, 2.1 million dollars per year could be saved, if each over utilizer used the ED one less time (2). Keywords Surveillance; Informatics; Chronic Disease References 1. The Hot Spotters, Can we lower medical costs by giving the neediest patients better care? Gawande A, The New Yorker, Medical Report, January 24, 2011. 2. Office Of Medicaid Business And Policy, NH Comprehensive Health Care Information System (CHIS). Frequent Outpatient Emergency Department Use by New Hampshire Medicaid Members (An Evalu- ation of Prevalence, Diagnoses, Utilization, and Payments). Concord; October 2008. *David J. Swenson E-mail: dswenson@dhhs.state.nh.us Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e191, 2013