Notifiable condition reporting practices: implications for public health agency participation in a health information exchange

Abstract Background The future of notifiable condition reporting in the United States is undergoing a transformation with the increasing development of Health Information Exchanges which support electronic data-sharing and -transfer networks and the wider adoption of electronic laboratory reporting. Communicable disease report forms originating in clinics are an important source of surveillance data for public health agencies. However, problems of poor data quality and delayed submission of reports to public health agencies are common. In addition, studies of barriers and facilitators to reporting have assumed that the primary reporter is the treating physician, although the extent to which a provider is involved in the reporting workflow is unclear. We sought to better understand the barriers to and burden of notifiable condition reporting from the perspectives of the three primary groups involved in reporting workflow: providers, clinic staff who bear the principal responsibility for reporting, and the public health workers who receive and process reports from clinics. In addition, we sought to situate these findings within the context of the future of notifiable disease reporting and the potential impacts of electronic lab and medical records on the surveillance system. Methods Seven ambulatory care clinics and 3 public health agencies that are part of a Health Information Exchange in the state of Indiana, USA, participated in the study. Data were obtained from a survey of clinic physicians (N = 29), interviews with clinic reporters (N = 11), and interviews with public health workers (N = 9). Survey data were summarized descriptively and interview transcripts underwent qualitative analysis. Results In both clinics and public health agencies, the laboratory report initiates reporting workflow. Provider involvement with reporting primarily revolves around ordering medications to treat a condition confirmed by the lab result. In clinics, reporting is typically the responsibility of clinic reporters who vary in frequency of reporting. We found an association between frequency of reporting, reporting knowledge and perceptions of reporting burden. In both clinics and public health agencies, interruptions and delays in reporting workflow are encountered due to inaccurate or missing information and impact reporting timeliness, data quality and report completeness. Both providers and clinic reporters lack clarity regarding how data submitted by their reports are used by public health agencies. It is possible that the value of reporting may be diminished when those responsible do not perceive receiving benefit in return. This may account for the low awareness of or recollection of public health communications with clinics that we observed. Despite the high likelihood that public health advisories and guidance are based, in part, on data submitted by clinics, a direct concordance may not be recognized. Conclusions Unlike most studies of notifiable condition reporting, this study included the clinic reporters who bear primary responsibility for completing and submitting reports to public health agencies. A primary barrier to this reporting is timely and easy access to data. It is possible that expanded adoption of electronic health record and laboratory reporting systems will improve access to this data and reduce reporting the burden. However, a complete reliance on automatic electronic extraction of data requires caution and necessitates continued interfacing with clinic reporters for the foreseeable future—particularly for notifiable conditions that are high-impact, uncommon, prone to false positive readings by labs, or are hard to verify. An important finding of this study is the association between frequency of reporting, reporting knowledge and perceptions of reporting burden. Increased automation could result in even lower reporting knowledge and familiarity with reporting requirements which could actually increase reporters’ perception of notifiable condition reporting as burdensome. Another finding was of uncertainty regarding how data sent to public health agencies is used or provides clinical benefit. A strong recommendation generated by these findings is that, given their central role in reporting, clinic reporters are a significant target audience for public health outreach and education that aims to alleviate perceived reporting burden and improve reporting knowledge. In particular, communicating the benefits of public health’s use of the data may reduce a perceived lack of information reciprocity between clinical and public health organizations

Site-based decision-making: the preceptions of parents, teachers, and administrators in an elementary school in Texas

While researchers studied site-based decision-making (SBDM) in depth in the 1990’s, mostly from the perspective of its effects on student achievement (Hopkins, Munumer, 1999; Bauer & Bogotch, 1997, Bell, 1996)), a dearth of the studies were quantitative in nature, often comparing student groups’ performance on a pretest and post test (Leithwood & Menzies, 1998). Results indicate that SBDM does not significantly affect student achievement (Schuttloffel, (2000; Dempster, 1999; Wohlstetter, 1993; White, 1989); however, few research studies focus on stakeholders’ beliefs about SBDM (Reyes, Scribner & Scribner, 1999; Hoetger, 1998; Griffin, 1995; Ovando, 1994; Wagstaff & Reyes, 1993). In this narrative case study, the researcher discerns successful, unsuccessful, and missing SBDM implementation strategies through stakeholders’ stories about their experiences on an elementary school SBDM committee in a central Texas district. The literature review includes the historical context of early reforms, a description of localized control, and anticipated SBDM outcomes. The researcher explains theoretical frames and conflicting research findings including the benefits and pitfalls. Two research questions frame the study: (1) What are the experiences of stakeholders involved with SBDM that illustrate the workable, unworkable, and needed implementation strategies? (2) What themes emerge from stakeholders’ stories that can further inform policy makers and educational leaders about SBDM implementation strategies that are workable and needed? The study represents each stake holder-group’s narrative; teachers, parents, and administrators. The district was selected based on its extensive SBDM experience and recognized district performance rating. The school was selected based on its three-year improved performance and Dr. Horn’s five-year tenure. The data included the review: (1) of minutes from SBDM meetings, (2) field notes from observations of SBDM meetings, (3) of transcripts from individual interviews with SBDM members and non-members, and (4) a focus group interview with the campus SBDM committee. Through the emergent themes from their stories, the stakeholders’ perceptions expand the extant knowledge about and contribute to the practice of SBDM. Policy makers and educational leaders gain information to further inform the implementation of SBDM.Educational Administratio

Movements of Transient Coyotes, Canis latrans, in Urbanized Eastern Massachusetts

I document the movements of five transient (or nomadic) eastern Coyotes (Canis latrans) in heavily urbanized eastern Massachusetts. Linear movements from capture location to end location varied from 23.0 to 100.5 km and averaged 63.8 ± 52.0 km for two females and 38.7 ± 17.2 km for three males (t = 0.657, df = 1.15, P = 0.618). Transients ranged in age between 1-2 yr old. There was no relationship between Coyote body weight and dispersal distances (r = 0.389, P = 0.518). Coyotes travel long distances even in human-dominated areas, allowing transients to find vacant territories. Because of the ability of Coyotes to colonize and recolonize areas, I recommend that Coyote management efforts focus more on educating the public about actual Coyote behavior and their life history needs than on killing them

As One Who From a Volume Reads: A Study of the Long Narrative Poem in Nineteenth-Century America

Though overlooked and largely unread today, the long narrative poem was a distinct genre available to nineteenth-century American poets. Thematically and formally diverse, the long narrative poem represents a form that poets experimented with and modified, and it accounted for some of the most successful poetry publications in the nineteenth-century United States. Drawing on contemporary theories of form and situating these poems within their literary-historical context, I discuss how our reading practices might be shaped by a greater attentiveness to the long narrative poem. My analysis will focus upon a small set of poems from across the nineteenth century, centering on works by Lucy Larcom and Henry Wadsworth Longfellow. More than mere recovery, this project aims to illuminate a tradition in which poets ambitiously melded genres, claimed poetry’s place to shape public discourse, and thought deeply about the reading practices available to their audience. Along the way, I consider how the dominant critical categories in the study of poetry have occluded these poems, and what these poems might offer in terms renewing or revitalizing our analytical tools and concepts

Evaluation of an OPNET Model for Unmanned Aerial Vehicle Networks

The concept of Unmanned Aerial Vehicles (UAVs) was first used as early as the American Civil War, when the North and the South unsuccessfully attempted to launch balloons with explosive devices. Since the American Civil War, the UAV concept has been used in all subsequent military operations. Over the last few years, there has been an explosion in the use of UAVs in military operations, as well as civilian and commercial applications. UAV Mobile Ad Hoc Networks (MANETs) are fast becoming essential to conducting Network-Centric Warfare (NCW). As of October 2006, coalition UAVs, exclusive of hand-launched systems, had flown almost 400,000 flight hours in support of Operations Enduring Freedom and Iraqi Freedom [1]. This study develops a verified network model that emulates UAV network behavior during flight, using a leading simulation tool. A flexible modeling and simulation environment is developed to test proposed technologies against realistic mission scenarios. The simulation model evaluation is performed and findings documented. These simulations are designed to understand the characteristics and essential performance parameters of the delivered model. A statistical analysis is performed to explain results obtained, and identify potential performance irregularities. A systemic approach is taken during the preparation and execution simulation phases to avoid producing misleading results

Is the Neuraminidase Inhibitor Tamiflu Effective in the Treatment of Influenza?

Influenza is a disease that has caused the deaths of tens of millions people in the last century alone. The influenza neuraminidase protein is essential in the mechanism infection. It enables the virus to leave the infected cell and proliferate. Antiviral neuraminidase inhibitor drugs can be used for treatment. The drug Tamiflu is the standard of care for both treatment and prophylaxis of influenza. The Cochrane reports of 2009 and 2014 conclude that evidence is lacking to support this. Numerous bodies disagree. Cochrane also question the accuracy and credibility of many studies and agencies in support of Tamiflu. This paper explores the issues

French Optical Telegraphy, 1793-1855: Hardware, Software, Administration

The relatively stable contribution of technological change to aggregate growth masks technological trajectories which are, at the sectoral level, often highly discontinuous. For decades, even centuries, the capabilities used to produce a particular good or service may continue essentially unchanged or with relatively minor evolutionary modifications. Sometimes without much warning a breakthrough innovation will create a new technological paradigm, along with an accompanying gale of creative destruction, which is then followed by a period of consolidation within a maturing framework