Integration of FHIR to Facilitate Electronic Case Reporting: Results from a Pilot Study

Current approaches to gathering sexually transmitted infection (STI) case information for surveillance efforts are inefficient and lead to underreporting of disease burden. Electronic health information systems offer an opportunity to improve how STI case information can be gathered and reported to public health authorities. To test the feasibility of a standards-based application designed to automate STI case information collection and reporting, we conducted a pilot study where electronic laboratory messages triggered a FHIR-based application to query a patient’s electronic health record for details needed for an electronic case report (eCR). Out of 214 cases observed during a one week period, 181 (84.6%) could be successfully confirmed automatically using the FHIR-based application. Data quality and information representation challenges were identified that will require collaborative efforts to improve the structure of electronic clinical messages as well as the robustness of the FHIR application

Antibiotic resistance information exchanges : interim guidance

Antibiotic resistance (AR) is a major clinical and public health threat with potential to unravel more than half a century of human health advances offered by modern medical care. Unfortunately, modern healthcare delivery is notably contributory to the spread of antibiotic-resistant organisms, as patients who have become colonized with resistant organisms often receive care across multiple healthcare settings (e.g., ambulatory care, acute care hospitals (ACHs), and various long-term care (LTC) settings, including long-term acute care hospitals (LTACHs) and skilled nursing facilities (SNFs)).Although the threat of antibiotic-resistant organism transmission from a colonized patient to physically proximate patients remains for the duration of colonization, the lack of information sharing between healthcare facilities often results in the colonized status of a patient being unknown to a receiving or admitting facility. When this occurs, the appropriate infection control precautions are less likely to be used from the start of patient care, which increases the likelihood that resistant organisms will spread to other patients.The need for improved AR situational awareness is a major challenge to the U.S. Centers for Disease Control and Prevention\u2019s (CDC\u2019s) strategy to contain the most threatening forms of resistance and the genes responsible for such phenotypes. To fulfill their central role in implementing the CDC\u2019s containment strategy, some state health departments have developed systems (Multidrug-Resistant Organism (MDRO) Registries or MDRO Alert Systems, referred to herein as AR Information Exchanges (ARIEs)) that track patients previously colonized or infected with specific MDROs and then alert healthcare providers when these patients are admitted to a facility. The term AR Information Exchange emphasizes the importance of multidirectional information flow amongst healthcare facilities and public health authorities, as opposed to unidirectional data collection and storage.This interim guidance is intended for operational use by individuals and organizations responsible for developing or enhancing an ARIE; however, it does not constitute legal advice. Public health agencies should follow applicable laws, statues, and/or regulations when developing ARIEs with questions about directed to the entity\u2019s legal counsel.CS 324851-AARIE-Interim-Guidance-508.pdf20211158

Doctor of Philosophy

dissertationPublic health reporting is an important source of information for public health investigation and surveillance, which are necessary for the prevention and control of disease. There are two important problems with the current public health reporting process in the United States: (a) the reporting specifications are unstructured and are communicated with reporting facilities using nonstandard public health department Web sites and (b) most reporting facilities transmit reports to public health entities using manual and paper-based processes. Our research focuses on the development and evaluation of new strategies to improve the public health reporting process by addressing these problems. To improve the communication of public health reporting specifications by public health authorities, we: (a) examined the business process of a laboratory complying with the reporting requirements, (b) evaluated public health department Websites to understand the problems faced by reporting facilities while accessing the reporting specifications, (c) identified the content requirements of a knowledge management system for public health reporting specifications, (d) designed the representation of the public health reporting specifications, and (e) evaluated the content and design using a prototype web-based query system for public health reporting specifications. To improve the transmission of case reports from healthcare facilities to public health entities, we: (a) described public health workflow associated with the management of case reports, (b) identified the content of a case report to meet the needs of public health authorities, (c) modeled the case report using Health Level Seven (HL7) v2.5.1, and (d) evaluated the electronic case reports by comparing the timeliness, completeness of information content, and the completeness of the electronic reporting process with the paper-based reporting processes. We demonstrated a model for public health reporting specifications using a prototype web-based query system. The evaluation conducted with users from laboratories, healthcare facilities, and public health entities showed that the proposed model met most of the users' needs and requirements. We also identified variation in the reporting specifications, some of which could be standardized to improve reporting compliance. We implemented HL7 v2.5.1 case reports from Intermountain Healthcare hospitals to the Utah Department of Health. The electronic reports transmitted from the Intermountain hospitals were more timely (median delay: 2 days) than the paper reports sent from other clinical facilities (median delay: 3.5 days) but less timely than the paper reports from Intermountain laboratories (median: 1 day). However, the evaluation of the completeness of data elements needed for public health triage prior to investigation showed that electronic case reports from Intermountain hospitals included more complete information than paper reports from Intermountain laboratories. Even though the paper reports from Intermountain laboratories were more timely, the incomplete reports may delay investigation. There are informatics opportunities and public health needs to improve both electronic laboratory reporting and electronic case reporting

Leveraging EHRs and HIEs for Hepatitis C Surveillance, Prevention and Management:

This presentation for the National Alliance of State and Territorial AIDS Directors explores the ways public health departments can use electronic health record (EHR) or health information (HIE) exchange data for Hepatitis C surveillance, prevention and management

Addressing gaps in public health reporting of race and ethnicity data for COVID-19 : findings & recommendations among 45 state & local health departments

Public health data reveal that the COVID-19 pandemic disproportionately affects people from racial and ethnic minority groups. Public health\u2019s ability to identify and address such health inequities relies on the collection and reporting of complete and accurate race and ethnicity data for COVID-19; however, gaps in the public health reporting of these critical data have been observed at both the local and national level. Reporting to public health agencies occurs through a variety of reporting pathways, including case surveillance, laboratory reporting, syndromic surveillance, and immunization surveillance. It is necessary to explore the systemic factors contributing to the gaps in race and ethnicity data for COVID-19 \u2013 including where in the reporting stream these factors arise \u2013 in order to implement targeted, effectual, and well-resourced solutions that ultimately promote health equity for all.The Council of State and Territorial Epidemiologists (CSTE) conducted an assessment to identify the factors that are impacting the completeness and quality of race and ethnicity data for COVID-19 at public health agencies, as well as the solutions that may help mitigate these limiting factors.This summary report was supported in part by the Centers for Disease Control and Prevention, cooperative agreement #NU38OT000297. Its contents are solely the responsibility of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.Publication date from document properties.RaceEthnicityData_FINAL.pdf2022cooperative agreement #NU38OT0002971136

Learning from the Crowd in Terminology Mapping: The LOINC Experience

National policies in the United States require the use of standard terminology for data exchange between clinical information systems. However, most electronic health record systems continue to use local and idiosyncratic ways of representing clinical observations. To improve mappings between local terms and standard vocabularies, we sought to make existing mappings (wisdom) from healt care organizations (the Crowd) available to individuals engaged in mapping processes. We developed new functionality to display counts of local terms and organizations that had previously mapped to a given Logical Observation Identifiers Names and Codes (LOINC) code. Further, we enabled users to view the details of those mappings, including local term names and the organizations that create the mappings. Users also would have the capacity to contribute their local mappings to a shared mapping repository. In this article, we describe the new functionality and its availability to implementers who desire resources to make mapping more efficient and effective

Clinical laboratory COVID-19 response call : May 11, 2020

CDC\u2019s Division of Laboratory Systems (DLS) convenes regular calls with clinical laboratories to discuss the nation\u2019s clinical laboratory response to coronavirus disease (COVID-19). These Clinical Laboratory COVID-19 Response Calls take place every other Monday at 3:00 PM EDT.covid-19-response-calls/05_11_2020_slides.pdf2020889

How to report COVID-19 laboratory data

Updated Mar. 4, 2022The public health response to COVID-19 depends on comprehensive laboratory testing data. These data will contribute to understanding COVID-19\u2019s impact and testing coverage and can contribute to the identification of supply chain issues for reagents and other materials. The information below outlines reporting requirements for laboratories.The Coronavirus Aid, Relief, and Economic Security (CARES) Act and its June 4 implementation guidanceexternal icon require every CLIA certified COVID-19 testing site to report every diagnostic and screening test result (both positive and negative results) performed to detect SARS-CoV-2 or to diagnose a possible case of COVID-19 (e.g., molecular, antigen, antibody) to the appropriate state or local public health department, based on the individual\u2019s residence. Laboratories that currently report directly to CDC should continue sending these data to CDC.Who must report -- What to report -- Using Standard Terminology -- Assistance with Electronic Reporting -- FAQs.20221104

Evaluation of the System Attributes of Timeliness and Completeness of the West Virginia Electronic Disease Surveillance System\u27 NationalEDSS Based System

Despite technological advances in public health informatics, the evaluation of infectious disease surveillance systems data remains incomplete. In this study, a thorough evaluation was performed of the West Virginia Electronic Disease Surveillance System (WVEDSS, 2007-2010) and the West Virginia Electronic Disease Surveillance System NationalEDSS -Based System (WVEDSS-NBS; March 2012 - March 2014) for Category II infectious diseases in West Virginia. The purpose was to identify key areas in the surveillance system process from disease diagnosis to disease prevention that need improvement. Grounded in the diffusion of innovation theory, a quasi-experimental, interrupted, time-series design was used to evaluate the 2 data sets. Research questions examined differences in mean reporting time, the 24-hour standard, and comparison of complete fields (DOB, gender etc.) of the data sets using independent samples t tests. The study found (a) that the mean reporting times were shorter for WVEDSS compared to WVEDSS-NBS (p \u3c .05) for all vaccine-preventable infectious diseases (VPID) in Category II except for mumps; (b) that the 24-hour standard was not met for WVEDSS compared to WVEDSS-NBS (p \u3c .05) for all VPID in Category II except for mumps, and (c) that most fields were complete for WVEDSS compared to WVEDSS-NBS (p \u3c .05) for all VPID in Category II except for meningococcal disease. Healthcare professionals in the state can use the results of this research to improve the system attributes of timeliness and completeness. Implications for positive social change included improved access to public health data to better understand health disparities, which, in turn could reduce morbidity and mortality within the population