Dixon Brian

Traditionally, public health agencies (PHAs) wait for hospital, laboratory or clinic staff to initiate case reports. However, this passive approach is burdensome for reporters and produces incomplete and delayed reports, which can hinder assessment of disease in the community and potentially delay recognition of patterns and outbreaks. Modern surveillance practice is shifting toward greater use of electronically transmitted disease information. The adoption of electronic health record (EHR) systems and health information exchange (HIE) among clinical organizations and systems, driven by policies such as the meaningful use™ program, is creating an information infrastructure that public health organizations can take advantage of to improve surveillance practice.

Objective: To enhance the process by which outpatient providers report surveillance case information to public health authorities following a laboratory-confirmed diagnosis of a reportable disease.

Administrative data refers to data generated during the processes of health care. These data are a rich source of patient health information, including diagnoses and problem lists, laboratory and diagnostic tests, and medications. Established standards are used to code each data into the appropriate coding systems. The International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9-CM and ICD-10-CM) codes are the coding standard for diagnoses and have been frequently used to identify cases for the creation of cohorts in examining care delivery, screening, prevalence, and risk factors. However, while some studies have assessed the validity and reliability of ICD-CM codes to identify various conditions such as cerebral palsy and rheumatoid arthritis3,4, the evidence for using ICD codes to accurately identify sexually transmitted infection (STI) cases is largely unexamined. The purpose of this study is to review the extant literature for evidence on the validity of ICD codes for identifying cases of chlamydia, gonorrhea, and syphilis. Our findings will inform efforts to improve the use of administrative data for STI-related health service and surveillance researches.

Objective: The purpose of this study is to review the extant literature for evidence on the validity of ICD-9-CM and -10-CM codes for the purpose of identifying cases of chlamydia, gonorrhea, and syphilis.

Electronic laboratory reporting (ELR) was demonstrated just over a decade ago to be an effective method to improve the timeliness of reporting as well as the number of reports submitted to public health agencies. The quality of data (inc. completeness) in information systems across all industries and organizations is often poor, and anecdotal reports in the surveillance literature suggest that ELR may not improve the completeness of the data in the submitted reports.

Objective 

To examine the completeness of data submitted from clinical information systems to public health agencies as notifiable disease reports.

Completeness of public health information is essential for the accurate assessment of community health progress and disease surveillance. Yet challenges persist with respect to the level of completeness that public health agencies receive in reports submitted by health care providers. Missing and incomplete data can jeopardize information reliability and quality resulting in inaccurate disease evaluation and management (1). Additionally, incomplete data can prolong the time required for disease investigators to complete their work on a reported case. Thus, it is important to determine where the scarcity of information is coming from to recognize the characteristics of provider reporting.

Objective

To examine the completeness of data elements required for notifiable disease surveillance from official, provider-based reports submitted to a local health department.

Disease surveillance is a core public health (PH) function. To manage and adjudicate cases of suspected notifiable disease, PH workers gather data elements about persons, clinical care, and providers from various clinical sources, including providers, laboratories, among others. Current processes often yield incomplete and untimely reporting across different diseases requiring time-consuming follow-up by PH to get needed information [1,2]. To improve the completeness and timeliness of case reporting, health departments have explored accessing EHR systems, which are increasingly available. We examine whether providing PH with EHR access to gather notifiable disease case information affects data completeness.

Objective

To assess the effect of electronic health record (EHR) system access on notifiable disease case data completeness.

The importance transmitting clinical information to public health for disease surveillance is well-documented. Conventional reporting processes require health care providers to complete paper-based notifiable condition reports which are transmitted by fax and mail to public health agencies. These processes result in incomplete reports, inconsistencies in reporting frequencies among different diseases and reporting delays as well as time-consuming follow-up by public health to get needed information. One strategy to address these issues is to electronically pre-populate report forms with available clinical, lab and patient data to streamline reporting workflows, increase data completeness and, ultimately, provide access to more timely and accurate surveillance data for public health organizations. Prior to implementing an intervention that includes using pre-populated forms, we conducted interviews in clinical and public health settings to identify the barriers and facilitators to adopting and utilizing the forms and their potential impact on workflow and perceived burden. These interviews are a component of a larger mixed methods evaluation that will triangulate pre- and post-intervention quantitative data quality measures with qualitative results.

Objective

Introduction of new health information technologies can produce unanticipated consequences on existing user behaviors, workflow, etc. Prior to implementing a public health reporting intervention, we conducted a series of interviews regarding workflow and perceptions of task burden with respect to notifiable condition reporting.