1.  A comparison of the completeness and timeliness of automated electronic laboratory reporting and spontaneous reporting of notifiable conditions

Author(s): Overhage JM, Grannis S, McDonald CJ

Source: Am J Public Health 2008 Feb;98(2):344-50.

Summary: 

This paper examined whether automated electronic laboratory reporting (ELR) of notifiable diseases results in information being delivered to public health departments more completely and quickly than spontaneous, paper-based reporting. We used data from a local public health department, hospital infection control departments, and a community-wide health information exchange to identify all potential cases of notifiable conditions that occurred in Marion County, Indiana, during the first quarter of 2001. We compared traditional spontaneous reporting to the health department with automated ELR through the health information exchange. After reports obtained using the different methods had been matched, there were 4785 unique reports for 53 different conditions during the study period. Chlamydia was the most common condition, followed by hepatitis B, hepatitis C, and gonorrhea. Automated ELR identified 4.4 times as many cases as traditional spontaneous methods and identified those cases 7.9 days earlier than spontaneous reporting, improving the completeness and timeliness of disease surveillance to enhance public health awareness and reporting efficiency.

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2.  PHSkb: a knowledgebase to support notifiable disease surveillance

Author(s): Doyle TJ, Ma H, Groseclose SL, Hopkins RS

Source: BMC Med Inform Decis Mak 2005 Aug 16;5((NULL)):27.

Summary: 

Notifiable disease surveillance (NDS) in the United States is predominantly a passive process, often limited by poor timeliness and low sensitivity. Interoperable tools are needed to interact seamlessly with existing clinical and laboratory data to improve NDS. The Public Health Surveillance Knowledgebase (PHSkbâ„¢) is designed to provide quick, easy access to domain knowledge regarding notifiable diseases and conditions. Data regarding the diseases were collected via a comprehensive review of state health department websites and integrated to support the National Notifiable Diseases Surveillance System (NNDSS). Domain concepts were harmonized, wherever possible, to existing vocabulary standards. The knowledgebase can be used: 1) as the basis for a controlled vocabulary of reportable conditions needed for data aggregation in public health surveillance systems; 2) to provide queriable domain knowledge for public health surveillance partners; 3) to facilitate automated case detection and surveillance decision support as a reusable component in surveillance information systems. The PHSkb provides an extensible, interoperable system architecture component to support NDS.

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3.  A Model for Expanded Public Health Reporting in the Context of HIPAA

Author(s): Sengupta S, Calman NS, Hripcsak G

Source: J Am Med Inform Assoc 2008 Sep-Oct;15(5):569-74.

Summary: 

The advent of electronic medical records and health information exchange raise the possibility of expanding public health reporting to detect a broad range of clinical conditions and of monitoring the health of the public on a broad scale. Expanding public health reporting may require patient anonymity, matching records, re-identifying cases, and recording patient characteristics for localization. The privacy regulations under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) provide several mechanisms for public health surveillance, including using laws and regulations, public health activities, de-identification, research waivers, and limited data sets, and in addition, surveillance may be distributed with aggregate reporting. The appropriateness of these approaches varies with the definition of what data may be included, the requirements of the minimum necessary standard, the accounting of disclosures, and the feasibility of the approach. Different combinations and implementations of the approaches will likely be developed in the future.

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4.  SurvNet@RKI--a multistate electronic reporting system for communicable diseases

Author(s): Faensen D, Claus H, Benzler J, Ammon A, Pfoch T, Breuer T, Krause G

Source: Euro Surveill 2006 (NULL);11(4):100-3.

Summary: 

In 2001, Germany implemented a new electronic reporting system for surveillance of notifiable infectious diseases (SurvNet@RKI). The system is currently being used in all 431 local health departments (LHD), the 16 state health departments (SHD) and the Robert Koch-Institut (RKI), the national agency for infectious disease epidemiology. The database is designed as a distributed, dynamic database, with an integrated version management system that documents deletion, undeletion, completion and correction of cases. RKI makes the system available to all LHDs and SHDs free of charge, receiving an average of 300,000 case reports and 6240 outbreak reports per year. A public web-based query interface, SurvStat@RKI, assures extensive and timely publication of the data. During the 5 years that SurvNet@RKI has been running in all LHDs and SHDs in Germany it has coped well with a complex federal structure which makes this system particularly attractive to multinational surveillance networks. The system is currently being migrated to Microsoft C#/.NET and transport formats in XML.

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5.  An intervention to improve notifiable disease reporting using ambulatory clinics

Author(s): Trepka MJ, Zhang G, Leguen F

Source: Epidemiol Infect 2009 Jan;137(1):22-9.

Summary: 

Strong notifiable disease surveillance systems are essential for disease control. We sought to determine if a brief informational session between clinic and health department employees followed by reminder faxes and a newsletter would improve reporting rates and timeliness in a notifiable disease surveillance system. Ambulatory clinics were randomized to an intervention group which received the informational session, a faxed reporting reminder and newsletter, or to a control group. Among intervention and control clinics, there were improvements in the number of cases reported and the timeliness of reporting. However, there were no statistically significant changes in either group. Despite improved communication between the health department and clinics, this intervention did not significantly improve the level or the timeliness of reporting. Other types of interventions should be considered to improve reporting, such as simplifying the reporting process or shortening the list of reportable diseases for ambulatory clinics.

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6.  Automated detection and reporting of notifiable diseases using electronic medical records versus passive surveillance--massachusetts, June 2006-July 2007

Author(s): Centers for Disease Control and Prevention (CDC)

Source: MMWR Morb Mortal Wkly Rep 2008 Apr 11;57(14):373-6.

Summary: 

Electronic medical record (EMR) systems have the potential to improve reporting of notifiable diseases beyond either traditional clinician-initiated or automated laboratory-based reporting systems, including disease surveillance that is timelier, complete, and clinically detailed. This report summarizes findings from a pilot EMR-based electronic surveillance system in Massachusetts called the Electronic Support for Public Health (ESP), which documented increases of 39% in reported chlamydia and 53% in reported gonorrhea for the period June 2006–July 2007, compared with the existing passive surveillance system.  All ESP case reports included patient treatment information and pregnancy status. In contrast, passive surveillance reports included pregnancy status for 5% of cases and treatment information for 88% of cases. ESP reported 81 cases of pregnancy in females with chlamydia or gonorrhea that were not noted on passive surveillance reports. Passive surveillance reports had a 5% rate of transcription errors, compared with no errors in ESP reports.

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7.  Effect of electronic laboratory reporting on the burden of lyme disease surveillance--New Jersey, 2001-2006

Author(s): Centers for Disease Control and Prevention (CDC)

Source: MMWR Morb Mortal Wkly Rep 2008 Jan 18;57(2):42-5.

Summary: 

Lyme disease (LD) is a vector-borne illness caused by the spirochete Borrelia burgdorferi and transmitted in the United States by blacklegged ticks (Ixodes spp.). In 2002, New Jersey expanded its paper-based laboratory reporting system to include electronic laboratory reporting (ELR) for all laboratory-reportable diseases. ELR represented 51% of reports received during 2001–2006, but only 29% were confirmed upon investigation. With the introduction of ELR in 2002, all incoming electronic reports were placed automatically on this list, substantially enlarging this list and placing a greater demand on local health department personnel. As a result of this investigation, New Jersey is modifying its LD surveillance system to reduce the surveillance burden. These results illustrate difficulties associated with ELR reporting of LD in New Jersey, especially the use of resources needed to address other public health problems. Other states with similar difficulties might need to reevaluate the resources used to confirm electronically reported LD and other notifiable diseases.

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8.  Electronic laboratory reporting: barriers, solutions and findings

Author(s): Overhage JM, Suico J, McDonald CJ

Source: J Public Health Manag Pract 2001 Nov;7(6):60-6.

Summary: 

Public health traditionally has relied on laboratory and hospital staff, physicians, and other relevant sources to take the initiative to provide data to health departments, where public health officials analyze and interpret the information as it comes in. Electronic laboratory reporting can improve surveillance for notifiable conditions. Building on standards for message structure and content, we have implemented an electronic laboratory reporting system by building on the infrastructure created for the Indiana Network for Patient Care (INPC). The system has proven reliable in delivering results and scalable to multiple laboratories over 36 months of use. In April 2000, the system identified over 1,000 cases of notifiable conditions from the laboratories at four different laboratories. Our experience in developing the system has highlighted the need for improved compliance with HL7 result message formats by the laboratory information systems and more structured reporting of results for tests such as microbiology including consistent use of the abnormal flag.

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9.  Electronic laboratory reporting for the infectious diseases physician and clinical microbiologist

Author(s): Wurtz R, Cameron BJ

Source: Clin Infect Dis 2005 Jun 1;40(11):1638-43.

Summary: 

One important benefit of electronic health information is the improved interface between infectious diseases practice and public health. Electronic communicable disease reporting (CDR), given its legal mandate and clear public health importance, is a significant early step in the sifting and pooling of health data for purposes beyond patient care and billing. Over the next 5-10 years, almost all CDR will move to the Internet. There are several ways that infectious diseases physicians, infection control professionals, and laboratory microbiologists will participate in electronic CDR, including web-based case reporting and ELR, the direct, automated messaging of communicable disease reports from clinical lab information management systems to the appropriate public health jurisdiction's information system. ELR has the potential to make a large impact on the timeliness and the completeness of communicable disease reporting, but it does not replace the clinician's responsibility to submit a case report with important demographic and epidemiologic information.

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10.  Electronic reporting improves timeliness and completeness of infectious disease notification, The Netherlands, 2003

Author(s): Ward M, Brandsema P, van Straten E, Bosman A

Source: Euro Surveill 2005 Jan;10(1):27-30.

Summary: 

In 2002, the internet based reporting system OSIRIS in the Netherlands fully replaced the paper-based reporting system. The objectives of OSIRIS were to improve timeliness and completeness of surveillance data on infectious diseases reported from regional to national level. We compared the timeliness of infectious diseases reported by the conventional system in 2001 with those reported by OSIRIS in 2003. Two distinct types of delay were compared: (1) total delay: defined as time between sympton onset and reporting at national level and (2) central delay: defined as time between regional and national reporting. Except for cases of malaria, the total delay, from symptom onset to national reporting, was significantly reduced, with OSIRIS records containing more complete information than conventional records. In total, in 2003, 92.3% of data field examined were complete compared with 81.3% in 2001. This study documents the benefits of electronic reporting of infectious disease surveillance data in terms of improved timeliness and completeness.

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11.  Electronic Support for Public Health: validated case finding and reporting for notifiable diseases using electronic medical data

Author(s): Lazarus R, Klompas M, Campion FX, McNabb SJ, Hou X, Daniel J, Haney G, DeMaria A, Lenert L, Platt R

Source: J Am Med Inform Assoc 2009 Jan-Feb;16(1):18-24.

Summary: 

Health care providers are legally obliged to report cases of specified diseases to public health authorities, but existing manual, provider-initiated reporting systems generally result in incomplete, error-prone, and tardy information flow. Here, we describe the Electronic Support for Public Health (ESP) application, a robust, automated, secure, portable public health detection and messaging system for cases of notifiable diseases. The ESP application applies disease specific logic to any complete source of electronic medical data in a fully automated process, and supports an optional case management workflow system for case notification control. All relevant clinical, laboratory and demographic details are securely transferred to the local health authority as an HL7 message. The ESP application has operated continuously in production mode since January 2007, applying rigorously validated case identification logic to ambulatory EMR data from more than 600,000 patients. Source code for this highly interoperable application is freely available under an approved opensource license at http://esphealth.org.

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12.  Evaluation of reporting timeliness of public health surveillance systems for infectious diseases

Author(s): Jajosky RA, Groseclose SL

Source: BMC Public Health 2004 Jul;4((NULL)):29.

Summary: 

Timeliness is a key performance measure of public health surveillance systems. The National Notifiable Diseases Surveillance System (NNDSS) data was evaluated to determine if it could support timely notification and state response to multistate outbreaks. When timeliness of NNDSS data was evaluated, the median national reporting delay, based on date of disease onset, ranged from 12 days for meningococcal disease to 40 days for pertussis. Diseases with the longer incubation periods tended to have a higher percentage of cases reported within its incubation period. Our analysis of NNDSS reporting timeliness indicated that among the conditions evaluated (except for acute hepatitis A infection), the long reporting lag and the variability across states limits the usefulness of NNDSS data and aberration detection analysis of those data for identification of and timely response to multistate outbreaks. A more standardized approach for evaluating and describing surveillance system timeliness should be considered. Further evaluation of the factors that contribute to NNDSS reporting timeliness is warranted.

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13.  Evaluation of the timeliness and completeness of a Web-based notifiable disease reporting system by a local health department

Author(s): Vogt RL, Spittle R, Cronquist A, Patnaik JL

Source: J Public Health Manag Pract 2006 Nov-Dec;12(6):540-4.

Summary: 

This article evaluates the completeness and timeliness of the Colorado Electronic Disease Reporting System, a statewide system for local health departments to conduct surveillance evaluations to identify areas of improvement. Reports received by Colorado were categorized as either Tri-County Health Department (TCHD) reports or reports for the rest of Colorado. Report completeness and timeliness were compared followed up by TCHD for both datasets. Six of 12 selected data fields were 95% or more complete for both datasets. 24-hour notifiable diseases were reported a median of 2.0 days for reports in the TCHD dataset and a median of 3.0 days for reports in the rest of Colorado, with seven-day notifiable diseases at a median of 4.0 days for both datasets. Both Colorado datasets were found to be relatively complete and timely. Improved data collection by interviewers will help better determine demographic information of reported cases and timeliness of reports.

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14.  How does HIPAA affect public health reporting?

Author(s): Campos-Outcalt D

Source: J Fam Pract 2004 Sep;53(9):701-4.

Summary: 

Since the Health Insurance Portability and Accountability Act (HIPAA) privacy rule was put into effect in April 2003, healthcare providers have sometimes been confused about what information they can legally disclose to public health agencies. The HIPAA is intended to protect the public from unauthorized access to, use of, and disclosure of individually identifiable health information. Specifically excluded from the requirement for individual authorization are disclosures for public health activities, as long as the agency to which the information is provided is legally authorized to collect and receive the information.  A clear understanding of permissible disclosure will enable family physicians to continue their important role of providing individual patient information for the critical activities of disease surveillance, outbreak investigation, monitoring causes of death and birth complications, assuring health care services, conducting public health research, and formulating health policy. Several scenarios are provided, demonstrating the appropriate response regarding HIPAA and whether unauthorized disclosure is permitted.

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15.  Impact of electronic laboratory reporting on hepatitis A surveillance in New York City

Author(s): Moore KM, Reddy V, Kapell D, Balter S

Source: J Public Health Manag Pract 2008 Sep-Oct;14(5):437-41.

Summary: 

The New York City Department of Health and Mental Hygiene (DOHMH) coordinates the administration of timely postexposure prophylaxis (PEP) to contacts of hepatitis A cases, making prompt disease reporting especially valuable. Electronic laboratory reporting (ELR) has shown to improve timeliness of infectious disease reporting, and this paper aims to: (1) quantify the increase in the proportion of hepatitis A reports received electronically, (2) assess how implementation of ELR affected the reporting time of hepatitis A, and (3) assess how changes in reporting time impacted the ability to offer timely prophylaxis to contacts. From 2000-2006, the proportion of hepatitis A reports received via ELR increased during the study period to 35 percent, reporting time improved with a median decrease of 17 days, and DOHMH administered PEP to 299 individuals, a fourfold increase. Increased utilization of ELR provides timely disease data to health departments and can have a remarkable impact on public health surveillance and response.

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16.  The effect of message type on physician compliance with disease reporting requirements

Author(s): Brissette I, Gelberg KH, Grey AJ

Source: Public Health Rep 2006 Nov-Dec;121(6):703-9.

Summary: 

Despite the existence of mandatory reporting laws, the underreporting of disease conditions to public health authorities is widespread. This article describes an evaluation of the effects of using different appeals to promote complete and timely reporting to the New York State Occupational Lung Disease Registry (NYS OLDR). Three-hundred sixty-eight physicians who had not reported patients were randomly assigned to receive correspondence emphasizing either the legal obligation to report, the public health benefits of reporting, or both. Physicians receiving correspondence describing the legal obligation to report were more likely to report patients than those receiving only the benefit message, while those receiving correspondence describing the public health benefits of reporting submitted more complete reports than those receiving only the obligation message. To maximize physician reporting, it is important for public health agencies to emphasize both the legal and public health basis for reporting conditions in correspondence to physicians.

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17.  Using natural language processing to improve accuracy of automated notifiable disease reporting

Author(s): Friedlin J, Grannis S, Overhage JM

Source: AMIA Annu Symp Proc 2008 Nov 6;(NULL)((NULL)):207-11.

Summary: 

The reporting of notifiable diseases by health care providers is currently inadequate. We examined whether using a natural language processing (NLP) system results in improved accuracy and completeness of automated electronic laboratory reporting (ELR) of notifiable conditions. We used data from a community-wide health information exchange that has automated ELR functionality. We focused on methicillin-resistant Staphylococcus Aureus (MRSA), a reportable infection found in unstructured, free-text culture result reports, using the Regenstrief Extraction tool (REX) for this work. REX processed 64,554 reports that mentioned MRSA and we compared its output to a gold standard (human review). REX correctly identified 39,491(99.96%) of the 39,508 reports positive for MRSA, and committed only 74 false positive errors. It achieved high sensitivity, specificity, positive predicted value and F-measure. REX identified over two times as many MRSA positive reports as the ELR system without NLP. Using NLP can improve the reporting completeness and accuracy of automated ELR.