Developing Automated Communicable Disease Reporting:

Two Pragmatic Technological Solutions

Kathryn Como-Sabetti, Asa Schmidt, Dede Ouren,

Kathleen Steinmann, Matt Muscha,

Richard Danila

Minnesota Department of Health, HealthPartners Inc., Hennepin County Medical Center

Minnesota Communicable Disease Reporting Rule

• MN statute requires all licensed healthcare providers and laboratorians to report specific communicable disease

• 78 pathogens/syndromes are reportable– 18 immediately reportable by phone– 60 reportable within 1 working day

• Over 25,000 reportable communicable diseases received in 2010

Minnesota Communicable Disease Reporting Rule, cont.

• Centralized communicable disease reporting – Case investigation may be performed by local

public health depending on pathogen and jurisdiction

• Minnesota is part of the Emerging Infection Program – Increases the number of reportable diseases

and complexity of reporting

Communicable Disease Reporting Process – Non Urgent Reports

IP Identifies reportable disease IP Reviews Chart and Completes CRF

CRF Submitted to MDH(via fax, mail, phone or web)

CRF Submitted to MDH(via fax, mail, phone or web)

MDH receives CRF

MDH enters information from CRF into program database

MDH receives CRF

MDH Calls IP for additional Information (sometimes)

IP Reviews Chart for Additional Information

MDH Enters Case Into Program Database

Repeat multiple times per day

Background

• Communicable disease reporting rule changed in 2004– MN-APIC/IPs expressed concern about the burden of

increased reporting– MDH agreed to look into ways to decrease reporting

burden• Fall 2006; MN-APIC authored a letter to the

Commissioner of Health regarding the increasing burden of infectious disease reporting

• Difficult economic times force all agencies to “find efficiencies”

ADR vs ELR

• MDH has had a number of labs submitting communicable disease reports through electronic laboratory reporting (ELR).

• ELR had limited impact on disease reporting when ELR has very little case information.– IPs still required to either complete a case

report form

ADR vs ELR, cont.

• Automated disease reporting (ADR) includes demographic, contact, laboratory, and facility information– Combines ELR with information from the

patient’s electronic health record– Decreases the number of case reports

completed by IPs

Race (check all that apply):

American Indian/Alaskan Native Asian

Black/African American White

Native Hawaiian/Pacific Islander Unknown

Other:______________________________

Ethnicity:

Hispanic/Latino

Non-Hispanic/ Non-Latino

Unknown

Was the patient hospitalized? Yes No Unknown

Hospital name: _________________________________________________

Admit date: ____/____/____ Discharge date: ____/____/____

Died? Yes No Unknown If yes, date of death: ____/____/____

Specimen collection date: _____/_____/_____

Specimen source :______________________________________

Pregnant (if applicable): Yes No Unknown

IF YES, due date: _____/_____/_____

Revised 6/10

LABORATORY AND FACILITY INFORMATION

Institution/Clinic: ______________________________

City: _________________________________________

Ordering provider:_____________________________

Phone:_______________________________________

Primary care provider: _________________________

Phone:_______________________________________

Lab Name:_____________________________________

Phone:_________________________________________

MDH contact if additional information needed (choose at least one):

Reporter Primary care provider Ordering provider Lab

Other:_______________________________________________________

DOB:____/____/____ Age:_____ DaysMonths Years

Gender: Male Female Transgender Unknown

Medical record #: ___________________________________________

Preferred language: English Other:________________________

Country of birth: U.S. Other:______________ Unknown

Address:___________________________________________________

Unknown Homeless

City:______________________ State:____ Zip:_____

County:________________

Phone 1st:___________________ Phone 2nd:_____________________

Occupation:_______________ Parent/Guardian:_______________

Reporter

Name: _______________________________ Phone: _____________________

Name

Last: ___________________________ First: ______________ MI: _________

DEMOGRAPHIC INFORMATION

Disease Name: ________________________ Onset date:____/____/____ Report date:____/____/____

MINNESOTA DEPARTMENT OF HEALTH COMMUNICABLE DISEASE REPORTING FORM

Highlighted fields were identified as those in electronic medical records that could be pulled though an automated process.

Solution #1 - Background

• August 2007 RFA released by MDH for data mining systems to develop automated reporting to MDH – 2 awards approximately $24,000 each– No applications

• April 2009 RFA released by MDH for health systems to develop automated reporting to MDH– 1 award up to $92,000– Awarded to HealthPartners/Region’s Hospital

Grant Objectives

• Automate the pull of demographic information from an electronic medical record and send an electronic case reports to MDH– HealthPartners opted to automate the

identification of reportable diseases

• Develop a roadmap for other institutions to develop ADR

Solution #1 - Process

• Teams were formed at HealthPartners and MDH and included experts from the Laboratory, Epidemiology, Infection Prevention, and Information Technology (IT)– IT experts included: project management,

message format, message transport, translation, and laboratory information systems

• Kick off meeting • Monthly project conference calls

Solution #1 – Implementation

• 681 tags of laboratory test/result combinations identified reportable diseases

• Once tagged, case reports were generated using Clarity extracting from the patient’s medical record (EPIC)

1. Lab results in LIMS (sunquest) triggers the feed

2. Information is passed on to the HER (EPIC), for case information

3. HL7 message is created

4. Transfer of file to MDH

5. Upload of data into MEDSS

6. IP staff at regions have access to add additional information manually

Sunquest

EPIC

HL7

PHIN-MS

Rhapsody

Solution #1 – Implementation

TASKformat HL7 results from LIS to EHR system confirm the English Text Code tag interpretation confirm reportable flag confirm extracted data is formatted in the proper sequence HL7 format has data elements mapped into agreed locations confirm standard encrypted EDI transmission from RH to MDH data communication is functional

DEPARTMENTInfection Prevention

Microbiology

LIS

IT

Solution #2 - Background

• Hennepin County Medical Center (HCMC) contracted with Premier to implement SafetySurveillor for healthcare associated infection surveillance

• Included in the contract was a provision that SafetySurveillor would develop reports identifying reportable communicable diseases

Solution #2 - Process

• 4 reports were developed by HCMC and Premier to identify cases:– Communicable disease report to

identify cases by pathogen only– Communicable disease report to

identify cases by pathogen and specimen source

– Neonatal sepsis report (pathogen and patient DOB)

– Invasive MRSA report

Solution #2 – Process, cont.

• Paper reporting by healthcare providers for STDs continues with ADR reporting to audit– Process to identify treatment is not automated

but necessary for STD reports

• MDH approved message format– Message includes demographic, contact,

laboratory, hospitalization and provider information

Solution #2 – Process, cont.

• Team was not formed• Facility IP coordinated development of

SafetySurveillor reports• IP coordinated IT assistance as needed at

the facility

1. Reports run by HCMC staff in the Premier system

3. Flat file is created

4. Transfer of file to MDH

5. Upload of data into MEDSS

6. IP staff at HCMC have access to add additional information manually

Premier

.csv

PHIN-MS

Rhapsody

Solution #2 – Implementation

Current StatusSolution #1

• MDH receives files daily from HP– Implementation is going through a validation

step to confirm all data is correct• Upload into MEDSS will create new disease

events in the system– De-duplication will try to match to existing

persons and events.• Disease events will be listed on daily workflows

for epis (routing is based on disease)• IPs at HP are being trained on MEDSS

Current StatusSolution #2

• MDH receives files twice a week from HCMC– MDH staff time saved for reviewing

HCMC charts• Files are manually routed to disease

program staff• MEDSS team is currently working on

mapping the message into MEDSS• Approximate 20% of chlamydia and

gonorrhea was not reported by providers

Lessons learned

• ADR improved disease reporting at HCMC

• Manual process of running ADR reports resulted in reports not being sent daily

• ADR decreases the burden of infectious disease reporting on healthcare facility staff – Once in MEDSS we expect ADR will decrease

MDH staff time spent entering records

Lessons learned, cont.

• There is no standard. Rules for the what tests/results to send are unique– Early discussions about when to send data is

essential– Lab/IP staff provide the knowledge

• IT/Lab/IP/EPI partnership essential– Team approach lead to smoother

implementation

• IP provides clinical interpretation

Lessons learned, cont.

• Creating the ADR message was complicated without a standard to fall back on, we ended up modifying the HL7 message for ELR reporting

• Standardized coding of tests and results would make it easier to route to the correct program areas/epis

• When data is sent from one system to another information gets lost– Example: Coded test/results in LIMS were

passed on as text to the EHR system, forcing us to translate them back after we received it.

Lessons learned, cont.

• A practical focus made it possible– What data elements can we rely on? If we can’t

trust the data don’t try to get it if its complicated

– What is our goal? If we want things to be easier for the IPs and we manage to do an automated transfer of 80% of the cases, can’t they then do the rest manually if we give them the tools?

– If we maintain the process of ‘report immediately by telephone’ for the conditions that needs this we got our EPIs to be more confident in the process

Questions and Contact Information

• Asa Schmidt, Project Manager– Asa.schmidt@state.mn.us

• Kathryn Como-Sabetti, Epidemiologist– Kathy.como-sabetti@state.mn.us

651-201-5414