Leveraging electronic data to expand infection detection beyond traditional settings and definitions (Part II/III)

The rich and complex electronic health record presents promise for expanding infection detection beyond currently covered settings of care. Here, we review the "how to" of leveraging electronic data sources to expand surveillance to settings of care and infections that have not been the traditional purview of the National Healthcare Safety Network (NHSN), including a discussion of creation of objective and reproducible infection surveillance definitions. In pursuit of a 'fully automated' system, we also examine the promises and pitfalls of leveraging unstructured, free-text data to support infection prevention activities and emerging technological advances that will likely affect the practice of automated infection surveillance. Finally, barriers to achieving a completely 'automated' infection detection system and challenges with intra- and interfacility reliability and missing data are discussed.