Electronic medical record Support for Public health (ESP): Automated Detection and Reporting of Statutory Notifiable Diseases to Public Health Authorities

Clinician initiated reporting of notifiable conditions is often delayed, incomplete, and lacking in detail. We report on the deployment of Electronic medical record Support for Public health (ESP), a system we have created to automatically screen electronic medical record (EMR) systems for evidence of reportable diseases, to securely transmit disease reports to health authorities, and to respond to queries from health departments for clinical details about laboratory detected cases. ESP consists of software that constructs and analyzes a temporary database that is regularly populated with comprehensive codified encounter data from a medical practice's EMR system. The ESP database resides within the host medical practice's firewall, configured on either a central workstation to service large multi-site, multi-physician practices or as a software module running alongside a small practice's EMR system on a personal computer. The encounter data sent to ESP includes patient demographics, diagnostic codes, laboratory test results, vital signs, and medication prescriptions. ESP regularly analyzes its database for evidence of notifiable diseases. When a case is found, the server initiates a secure Health Level 7 message to the health department. The server is also able to respond to queries from the health department for demographic data, treatment information, and pregnancy status on cases independently reported by electronic laboratory systems. ESP is designed to be compatible with any EMR system with export capability: it facilitates translation of proprietary local codes into standardized nomenclatures, shifts the analytical burden of disease identification from the host electronic medical record system to the ESP database, and is built from open source software. The system is currently being piloted in Harvard Vanguard Medical Associates, a multi-physician practice serving 350,000 patients in eastern Massachusetts. Disease detection algorithms are proving to be robust and accurate when tested on historical data. In summary, ESP is a secure, unobtrusive, flexible, and portable method for bidirectional communication between EMR systems and health departments. It is currently being used to automate the reporting of notifiable conditions but has promise to support additional public health objectives in the future.