FEATURE
installments over ten years. And a joint
statement from APHL, the Council of State
and Territorial Epidemiologists (CSTE),
Healthcare Information and Management
Systems Society (HIMSS), and National
Association for Public Health Statistics
and Information Systems (NAPHSIS)
highlights six areas where this investment
is urgently needed:
• Enhancing the security and analytical
capabilities of the National Notifiable
Disease Surveillance System (NNDSS),
which collects data to inform outbreak
response and to create a snapshot of
health in the US.
All you have to do is read
[CDC’s] Morbidity and Mortality
Weekly Report and you’ll see that
there’re lots of reports—robust,
scientifically sound, public health
reports—but they rely on data from
two, three or even five years ago.
And that’s not quick enough.”
Michael Iademarco, MD, MPH
• Expanding and simplifying electronic
case reporting (eCR) from clinicians to
public health agencies to enable timely
interventions to prevent the spread of
“notifiable” diseases and conditions—
so-called because clinicians are legally
required to notify health authorities
about these infectious diseases and
conditions of public health concern.
(About 75 nationally notifiable diseases
and conditions are tracked by NNDSS.
Additionally, each state maintains its
own list of state notifiable diseases
and conditions, which may also be
reportable to the patient’s local health
agency.)
• Enhancing syndromic surveillance
to provide near real-time data on
hospital emergency department visits
for ongoing monitoring of community
health threats, such as opioid
overdoses.
• Enabling secure, interoperable,
real-time reporting and exchange
of electronic vital records system
data—i.e., birth outcomes and causes
of death—to inform public health
activities, such congenital syphilis
prevention programs.
• Strengthening laboratory information
management systems (LIMS),
without which laboratories cannot
electronically report data to health
authorities and healthcare providers.
• Developing a public health data
science workforce able to maximize
the security and utility of public health
data, such as the reams of information
generated by technologies like whole
genome sequencing.
10
LAB MATTERS Fall 2019
“Why can’t that data flow
intelligently?”
One area that has received much
attention of late is eCR. Historically, case
reporting has relied on a physician or
nurse recognizing a notifiable disease,
such as tuberculosis or measles,
extracting patient data from paper files,
and then filling out a form and faxing,
mailing or e-mailing the form to health
authorities at the federal, state and/or
local levels. At the receiving end, public
health personnel had to manually enter
the data into their notifiable disease
databases and follow up with providers
to secure missing information—a tedious
process with room for error.
Needless to say, many notifiable diseases
have been significantly underreported.
Today, with 96% of hospitals and 78% of
physicians using electronic health records
(EHRs) for their patients, Iademarco asked,
“Why can’t that data flow intelligently to
the health departments that need it to
take action?”
The federal Digital Bridge initiative aims
to jumpstart that electronic data flow,
beginning with a handful of core notifiable
conditions—chlamydia, gonorrhea,
pertussis, Salmonella infection, Zika virus
and hepatitis C (an optional add-on)—
in seven jurisdictions taking part in a
CDC-funded pilot project. Iademarco
said, “It’s not just about counting cases,
but getting useful information about the
cases. ... With interoperable systems,
you’re able to focus on data quality.”
Shan He, PhD, a senior medical
informaticist at Utah’s largest healthcare
system, is among those implementing
the project at ground level. Her employer,
Intermountain Healthcare, operates 24
hospitals and over 160 clinics in Utah,
plus a hospital in Idaho.
She said, “The goal of eCR compared
with electronic laboratory reporting
[which conveys laboratory test results]
is to provide all that additional clinical
information, including symptoms and
even some treatment initiated by the
providers,” to reduce the burden on
public health case investigators and
Intermountain staff.
PublicHealthLabs
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