Developing Automated Communicable Disease Reporting: Two Pragmatic Technological Solutions Kathryn...
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Transcript of Developing Automated Communicable Disease Reporting: Two Pragmatic Technological Solutions Kathryn...
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– [email protected]
• Kathryn Como-Sabetti, Epidemiologist– [email protected]
651-201-5414