Development of an electronic public health case report using HL7 v2.5 to meet public health needs

Rajeev, Deepthi; Staes, Catherine J.; Evans, R. Scott; Mottice, Susan; Rolfs, Robert T.; Samore, Matthew H.; Whitney, Jon; Kurzban, Richard; Huff, Stanley M.

doi:10.1197/jamia.m3299

Cited by 29 publications

(28 citation statements)

References 15 publications

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“…The Centers for Disease Control and Prevention found increased rates of disease reporting and increased accuracy when reporting is electronically automated via their software system, Electronic Support for Public Health, which is designed to communicate with and perform automated data queries on providers' electronic medical records 21. While use of this model is creeping into the health system for reporting to public health authorities,22 universal hospital electronic medical record implementation and full connectivity with such reporting systems is many years from fruition. In addition to its practical use for reporting CDAD in our current health system, our work easily transitions into automated reporting within an electronically integrated health system once achieved.…”

Section: Discussionmentioning

confidence: 99%

Toxin assay is more reliable than ICD‐9 data and less time‐consuming than chart review for public reporting of Clostridium difficile hospital case rates

Welker

Bertumen

2011

Journal of Hospital Medicine

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OBJECTIVE: Clostridium difficile–associated disease (CDAD) is common and has a 6.1% mortality. Governmental agencies have recommended surveillance, but reporting increases health care costs. We sought to identify a reliable method of reporting CDAD that will not significantly increase health care costs. METHODS: Patients were identified via database query for International Statistical Classification of Diseases and Related Health Problems, 9th Edition (ICD‐9) codes and C. difficile toxin positivity. All identified patients underwent a chart review, which was used to determine the accuracy of the database query methods. Methods of determining whether CDAD was acquired at the reporting institution were studied, and time required to perform each method was measured. RESULTS: The toxin assay reported 96.1% (369/384) of cases and had a positive predictive value of 100%. No difference was found in comparison of the toxin assay case rate of 15.7 per 1000 discharged patients to the rate of 16.3 identified by chart review (P = 0.440; 95% confidence interval [CI], 14.1–17.4), whereas the ICD‐9 method was found to be significantly different by reporting 116.1% (446/384) of cases for a case rate of 19.0 per 1000 discharges (P = 0.001; 95% CI, 17.3–20.8). The time for data extraction via the toxin assay method required only 842 minutes, while the chart review method consumed 21,899 minutes. CONCLUSION: A positive C. difficile toxin assay accurately reports the institutional incidence of disease and is more reliable than ICD‐9 query. This process can be instituted at a fraction of the cost of the standard chart review, and enables governmental agencies to inexpensively add CDAD to their list of reportable diseases. Journal of Hospital Medicine 2011; © 2011 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

Toxin assay is more reliable than ICD‐9 data and less time‐consuming than chart review for public reporting of Clostridium difficile hospital case rates

Welker

Bertumen

2011

Journal of Hospital Medicine

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“…The overarching goal of eCR is to create a standard electronic infrastructure in order to allow information to flow from clinical electronic health records (EHR) to public health. 32,33 However, substantial work must still be done to attain the required interoperability to make this process operational and widely used.…”

Section: Author Manuscriptmentioning

confidence: 99%

Health Care Provider Knowledge and Attitudes Regarding Reporting Diseases and Events to Public Health Authorities in Tennessee

Fill

Murphree

Pettit

2017

Journal of Public Health Management and Practice

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Context In the United States (U.S.), state laws require healthcare providers to report specific diseases and events to public health authorities, a fundamental facet of disease surveillance. However, reporting by providers is often inconsistent, infrequent and delayed. Objective To examine knowledge, attitudes, and practices regarding and understand current barriers to provider disease reporting. Design A cross-sectional study was conducted via an anonymous, standardized electronic survey. Setting The survey was conducted at Vanderbilt University Medical Center, a large, tertiary academic medical center in Nashville, Tennessee. Participants Healthcare providers in four specialties (internal medicine, pediatrics, obstetrics-gynecology and emergency medicine). Main Outcome Measure(s) Knowledge of and attitudes regarding provider reporting of diseases to public health authorities in Tennessee. Results The majority of providers acknowledged they cared for patients with reportable diseases (362/435, 83.2%) and believed that it was their responsibility to report to public health authorities (429/436, 98.4%); however less than half had ever reported a case (206/436, 47.2%). The median percent correct on the knowledge assessment of Tennessee reportable diseases and conditions was 81.3% (Interquartile Range [IQR] 68.8–87.5). Providers cited a lack of knowledge of which diseases are reportable (186/429, 43.3%) and the logistics of reporting (153/429, 35.7%) as the primary barriers for compliance. Conclusions Most providers acknowledged they cared for patients with reportable diseases and believed they had an obligation to report to public health authorities. However, a lack of knowledge about reporting was frequently described as a limitation to report effectively. Many knowledge deficits were significantly greater among residents than other providers. The policy and practice implications of these findings include a demonstrated need for education of providers about disease reporting as well as development of more convenient reporting mechanisms. Fundamental knowledge of reportable disease requirements and procedures is critical for participation in the broader public health system.

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“…Subsequent studies have assessed the role of intermediaries such as Health Information Exchanges (HIE) [9][10][11] to facilitate ELR and reported better completeness of data with HIE support. Presently, studies have begun to focus on provider reporting of notifiable diseases [12,13], as moving to electronic case notification [14][15][16] along with ELR will be great progress to support overall public health disease surveillance. Challenges in adoption and use of recommended codes [17][18][19] and need for an informatics savvy workforce [20] were identified as some of the issues in the move towards ELR [21].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Data Exchange Process for Interoperability and Impact on Electronic Laboratory Reporting Quality to a State Public Health Agency

Rajamani

Kayser

Emerson

et al. 2018

OJPHI

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BackgroundPast and present national initiatives advocate for electronic exchange of health data and emphasize interoperability. The critical role of public health in the context of disease surveillance was recognized with recommendations for electronic laboratory reporting (ELR). Many public health agencies have seen a trend towards centralization of information technology services which adds another layer of complexity to interoperability efforts.ObjectivesThe study objective was to understand the process of data exchange and its impact on the quality of data being transmitted in the context of electronic laboratory reporting to public health. This was conducted in context of Minnesota Electronic Disease Surveillance System (MEDSS), the public health information system for supporting infectious disease surveillance in Minnesota. Data Quality (DQ) dimensions by Strong et al., was chosen as the guiding framework for evaluation.MethodsThe process of assessing data exchange for electronic lab reporting and its impact was a mixed methods approach with qualitative data obtained through expert discussions and quantitative data obtained from queries of the MEDSS system. Interviews were conducted in an open-ended format from November 2017 through February 2018. Based on these discussions, two high level categories of data exchange process which could impact data quality were identified: onboarding for electronic lab reporting and internal data exchange routing. This in turn comprised of ten critical steps and its impact on quality of data was identified through expert input. This was followed by analysis of data in MEDSS by various criteria identified by the informatics team.ResultsAll DQ metrics (Intrinsic DQ, Contextual DQ, Representational DQ, and Accessibility DQ) were impacted in the data exchange process with varying influence on DQ dimensions. Some errors such as improper mapping in electronic health records (EHRs) and laboratory information systems had a cascading effect and can pass through technical filters and go undetected till use of data by epidemiologists. Some DQ dimensions such as accuracy, relevancy, value-added data and interpretability are more dependent on users at either end of the data exchange spectrum, the relevant clinical groups and the public health program professionals. The study revealed that data quality is dynamic and on-going oversight is a combined effort by MEDSS Informatics team and review by technical and public health program professionals.ConclusionWith increasing electronic reporting to public health, there is a need to understand the current processes for electronic exchange and their impact on quality of data. This study focused on electronic laboratory reporting to public health and analyzed both onboarding and internal data exchange processes. Insights gathered from this research can be applied to other public health reporting currently (e.g. immunizations) and will be valuable in planning for electronic case reporting in near future.

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Development of an electronic public health case report using HL7 v2.5 to meet public health needs

Cited by 29 publications

References 15 publications

Toxin assay is more reliable than ICD‐9 data and less time‐consuming than chart review for public reporting of Clostridium difficile hospital case rates

Toxin assay is more reliable than ICD‐9 data and less time‐consuming than chart review for public reporting of Clostridium difficile hospital case rates

Health Care Provider Knowledge and Attitudes Regarding Reporting Diseases and Events to Public Health Authorities in Tennessee

Evaluation of Data Exchange Process for Interoperability and Impact on Electronic Laboratory Reporting Quality to a State Public Health Agency

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