FEATURE
Additionally, with eCR, reports for some
diseases may be triggered solely by
symptoms before laboratory results
are available. Pertussis, for example, is
reportable in Utah based on the classic
disease presentation: coughing for at least
two weeks, sleep apnea and patient age
under two years old.
In such cases, said Jason Barnes, a
senior health informaticist at the Utah
Department of Health and He’s Digital
Bridge partner, “we’re just relying on
the providers to report and hope they
remember.” However, since the start of
automated eCR, he said, “already we can
tell that case reporting for pertussis has
increased.”
AIMS
Timely, accurate data is important,
Barnes said, “because if we have a
misunderstanding of the [pertussis]
disease burden for the state, we won’t be
allocating the appropriate resources for
public education and vaccinations.” Other
pilot conditions might trigger mosquito
abatement (Zika virus), food safety
investigations (salmonellosis) or contact
tracing (chlamydia and gonorrhea, both of
which are reportable in Utah based on a
test request alone).
The challenge now, said Iademarco, is
to scale up from five or six notifiable
conditions to 75, from seven pilot projects
to the nation and—the biggest challenge—
“for all states to [electronically] connect to
their healthcare facilities.”
From an informatics standpoint, eCR
depends on 1) identifying reportable
events, 2) identifying appropriate report
recipients and 3) validating, translating
and transmitting data messages, as
necessary, so they flow seamlessly from
EHRs to public health databases. Rather
than create an informatics infrastructure
from scratch, Intermountain is using
the APHL Informatics Messaging Service
(AIMS)—a cloud-based system that is
infinitely scalable and fully compliant
with the Health Insurance Portability
and Accountability Act and Federal
Information Security Modernization Act.
Dari Shirazi, APHL’s health IT manager,
said “The knowledge and skill of the
AIMS team is unparalleled in the [health
IT] industry. I like to say, ‘AIMS was
built by public health professionals for
PublicHealthLabs
@APHL
public health professionals.’” A distinct
advantage of the APHL platform is that
it can reconfigure messages from one
transport protocol to another. “You can
use whatever you use,” said Shirazi. “So
it’s easy for all our partners.”
Among other things, the platform is
being used to transmit data on biothreat
agents and influenza directly to CDC
and to house data on antibiotic resistant
bacteria, rabies and emerging infections
“so CDC can create customized reports
and export the data in any format they
want.” AIMS software also analyzes select
data in the cloud; for example, assessing
flu data for vaccine likeness, genetic
novelty and other characteristics.
Intermountain Healthcare employs AIMS
for decision support and routing services:
“Software on AIMS determines if a case is
reportable in Utah and, if so, sends data
to the state,” said He. During a two-month
evaluation period early this year, AIMS
reviewed 26,000 Intermountain electronic
case reports and routed about 18,000
to the Utah Department of Health. The
healthcare system plans to add additional
AIMS functionality to enable eCR outside
APHL.org
of Utah, based on the patient’s state
of residence and that state’s reporting
requirements.
He said, “AIMS reduces technical
complexity from the reporter’s side
and keeps track of all those cross-
jurisdictional reporting rules. We just need
to send to AIMS and we’re done.”
Another private sector source of public
health data is Quest Diagnostics, a clinical
laboratory with service sites across the US,
including at select Safeway and Walmart
stores. Oriel Hewlett, a senior software
engineer for the company, said Quest has
been using AIMS for about three years
and, during that time, has sent millions of
electronic laboratory messages to health
agencies nationwide. Quest relies on AIMS
to “maintain that working relationship
with each jurisdiction” and eliminate the
need to reconfigure notifiable disease
messages for each recipient, some of
whom receive only one or a few messages
every year or two.
Said Hewlett, “AIMS is a vital part of our
solution.”
Fall 2019 LAB MATTERS
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