The NBS: Digital Public Health Reporting A Brief History 2010 1997 January, 1997 1 st ELR...
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Transcript of The NBS: Digital Public Health Reporting A Brief History 2010 1997 January, 1997 1 st ELR...
The NBS: Digital Public Health Reporting
A Brief History
2010
1997
January, 19971st ELR Information Public Health Meeting January, 1999
2nd ELR Information for Public Health Meeting
October, 1999NEDSS Launched March, 2000
Construction of NBS Begins
January, 2003NBS Launched into Production
May, 2006Public Health ASP Offering Launched December, 2006
16th State in Production with NBS
May, 2010Ability to build disease modules at the state
February, 2005NBS User Group Launched
The NBS continually evolves to meet the challenges of public health surveillance.The NBS continually evolves to meet the challenges of public health surveillance.
The NBS: Digital Public Health Reporting
Utilization in the United States
NBS is implemented in 16 states and is used by over 1,000 public health practitionersNBS is implemented in 16 states and is used by over 1,000 public health practitioners
The NBS: Digital Public Health ReportingThe NBS: Digital Public Health Reporting and H1N1 Flu
At the Intersection of Policies, Standards and Technologies
The NBS: Digital Public Health Reporting
An Agent for Change in Public Health Surveillance
1997 2010Paper-Based Web-Based
‘Data Islands’ and ‘One-Off’ Solutions
Integrated and Interoperable
Manual Entry Electronic Messaging
Centralized Data Entry and Access
Distributed Data Entry and Access
Home Grown Standards-Based
The NBS has facilitated the movement from paper to digital surveillance.The NBS has facilitated the movement from paper to digital surveillance.
The NBS: Digital Public Health Reporting
Addressing Public Health Issues
The NBS: Digital Public Health Reporting and H1N1 Flu
The NBS: Digital Public Health ReportingThe NBS: Digital Public Health Reporting and H1N1 Flu
“Real World” Usage
TX: Responding to H1N1
SC: Empowering Providers
AL: Bidirectional Avenues of Collaboration
ID: Efficiency Through ELR
VA: Analysis/Visualization
The NBS: Digital Public Health Reporting
What We Now Know About H1N1
Source: Centers for Disease Control and Prevention
TX: Responding to H1N1
The NBS: Digital Public Health Reporting
Standards Based Surveillance
• Let’s Go Back to April 2009
– What will be the “source of truth” for data related to H1N1?
– At what level are we going to track the disease?
– What questions need to be captured?
– How are we going to analyze our data?
– How will we notify CDC of disease occurrence?
– How can we share our work with other public health departments?
TX: Responding to H1N1
The NBS: Digital Public Health Reporting
Responding to H1N1
• Identify: Early recognition that the “swine flu” emerging in Texas was actually Novel Influenza A
• Collect: Immediate need was to develop a mechanism to capture data
• Disseminate: Share information based on analysis of data collected using data warehouse
• Adapt: Adjust surveillance based on disease trends and public health outcomes
• Control: Surveillance to document the existence and potential for development of severe sequelae
TX: Responding to H1N1
The NBS: Digital Public Health Reporting
Before Electronic Laboratory Reporting
• Workload: Labor intensive and prone to error
• Timeliness: Reporting delays; dependency on fax, mail and phone
• Accountability: “Lost in bottom of the drawer”
• Completeness: Difficult to analyze the completeness of reporting
ID: Efficiency Through ELR
The NBS: Digital Public Health Reporting
NBS > Point of Care Reporting to Public Health
Public Health Data Repository
Integrated Data Repository
Electronic Laboratory Reporting to Public Health:
1. Salmonella is detected in a specimen submitted for a patient with symptoms of a Foodborne illness
2. County public health practitioner receives the electronic laboratory report and begins an investigation
3. State public health practitioner analyzes received ELRs NEDSS Base
System
Laboratory
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31
SecurePortal
Laboratory Information System
Analysis
ID: Efficiency Through ELR
The NBS: Digital Public Health Reporting
0
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Jan
Feb
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May Ju
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Aug
Sep Oct
Nov
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Feb
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May Ju
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Aug
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Dec Ja
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Feb
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Month and Year ELR Received
Nu
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s R
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Progress with ELR
Between 1/2007 and 6/2010, the number of lab reports received via ELR increased from ~22/month to ~500/month.
Between 1/2007 and 6/2010, the number of lab reports received via ELR increased from ~22/month to ~500/month.
2008
9/07Mayo
5/08ARUP
4/08Quest
11/08St. Lukes
2007 2009
5/09IBL
H1N1 results
Time period 7/09 – 10/10, includes H1N1 results from Idaho Bureau of Laboratories
ID: Efficiency Through ELR
2010
<2007LabCorp
3/10Interpath
The NBS: Digital Public Health Reporting
Percentage of reportable disease lab reports received via ELR, 2007–2009*
*Does not include STDs
3% ELR
97% Non- ELR 25% ELR
75% Non- ELR
40% ELR
60% Non- ELR
~1,000 lab reports
~1,200 lab reports (20%
increase)
ID: Efficiency Through ELR
Increased ELR between 2007 and 2009 led to a 40% statewide reduction in data entry time (from 195 hrs/yr to 120 hrs/yr) = more time for prevention and control activities.
Increased ELR between 2007 and 2009 led to a 40% statewide reduction in data entry time (from 195 hrs/yr to 120 hrs/yr) = more time for prevention and control activities.
Efficiency Through ELR
The NBS: Digital Public Health Reporting
Improvements in Timelines and Completeness
• Timeliness.
– Since implementation of the NBS and ELR, disease reporting timeliness has increased• Example: Elapsed time between PHD receiving reports and reporting to the state has
decreased from 5.0 days (95% C.I., 3.6-6.3) to 3.4 days (95% C.I., 2.7-4.8)
• Completeness
– Completeness varies by public health jurisdiction, but the percentage of required fields completed in the NBS in 2009 was between 88% and 100%:• 99.8% basic demographic fields (e.g., age, sex)
• 98.7% onset and diagnosis date
• Race and ethnicity are least likely to be complete (67%)
ID: Efficiency Through ELR
The NBS: Digital Public Health Reporting
Bidirectional Avenues of Collaboration
State Health Department
Local Health Departments
• Resource intensive processing of morbidity/laboratory reports
• Lost Investigations• Limited local staff development
• Limited feedback on investigations• Lack of analytic capabilities• Inability to monitor disease trends
Paper Business Process = Disconnected
AL: Bidirectional Avenues of Collaboration
The NBS: Digital Public Health Reporting
Bidirectional Avenues of Collaboration
• Electronic receipt of laboratory and morbidity reports
• Timely investigations and interventions
• Real-time, electronic feedback to field staff • Continual feedback on investigations
• On demand analysis capabilities• Access to multi-year data sets for trend
analysis
Digital Business Process = Connected
Local Health Departments
State Health Department
AL: Bidirectional Avenues of Collaboration
The NBS: Digital Public Health Reporting
Bidirectional Avenues of Collaboration
Paper-Based Digital
Prepare
Paper files received at state level Electronic or paper files received
Files manually sorted/saved according to jurisdiction.
ELR process consumes, translates, and loads messages into the NBS
Sorted files prepared to be sent to local jurisdiction with investigation form.
Paper files keyed in by State
Review
Files sent to jurisdiction by mail Messages appear in the dashboard accessible according to user’s permissions
Indicate records needing follow-up and begin investigation
Records reviewed within NBS, electronically stamping records not needing further follow-up
Respond
Investigation completed and mailed to State and state manually enter records into data silo
Create Investigation. Once completed, create a notification to state for review.
Weekly flat files transmitted to CDC State level electronically reviews investigations for transmission to CDC
AL: Bidirectional Avenues of Collaboration
The NBS: Digital Public Health Reporting
Paper Based Approach to Disease Reporting
SC: Empowering Providers
The NBS: Digital Public Health Reporting
NBS > Point of Care Reporting to Public Health
National Center for
Public Health Data Repository
Business Process
Provider to Public Health:
1. Infection Control Nurse at a hospital enters a patient’s lab report directly in the NBS to alert public health to a positive finding for Tuberculosis
2. Public health practitioner receives the laboratory report within their dashboard and follows up with the Infection Control Nurse for additional information
3. Upon investigation, CDC is electronically notified of a confirmed case of Tuberculosis
NEDSS Base System
Provider
Interoperability
2
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SecurePortal
Interoperability
SC: Empowering Providers
The NBS: Digital Public Health Reporting
Empowering Providers
SC: Empowering Providers
GA
NC
Examples of Provider Based Disease Reporting
SC
NBS facilitates private – public joint surveillance.NBS facilitates private – public joint surveillance.
Provider Site
The NBS: Digital Public Health Reporting VA: Analysis/Visualization
Centralized database and analytic tools enhance use of reportable disease data
• All health departments have a database for analysis
• Data is available for analysis sooner because it is in the database sooner
• Working from the same database results in consistent and reliable statistics
• Opportunity for more integrated analysis
• Information is used in decision making when it is readily available
• Once a report is developed it can be shared by all users (and across states)
• Users collaborate to find solutions and build skills
The NBS: Digital Public Health Reporting VA: Analysis/Visualization
You mean you want to be able to use the data?• Easy-to-use queries encourage non-epidemiologists to run reports• Datamarts support queries and analysis by power users
– Disease specific datamarts provide access to all relevant fields– Data from multiple ODS tables are combined, including administrative data – “Flattened” data structures simplify use – Data transformations simplify analysis – Exportable files support analysis through other tools (Aberration detection, geospacial
mapping, SAS, Logi-XML)• Reports prioritize action
– Identify cases needing investigation when many reports are received – Identify potential clusters from review of linelists
• Evaluation of workflow improves use of resources • Analysis to evaluate data quality and completeness
– improve surveillance strategies – support data improvement – ensure appropriate interpretation
• Incorporation of legacy data in a datamart to support historical analysis
The NBS: Digital Public Health Reporting VA: Analysis/Visualization
We collect data to guide public health action We need robust tools to analyze and visualize the data
• Need more access to disease-specific data
• Need more capacity for graphic presentation of data
• Need more capacity for ad-hoc analysis by users
• Need more ability to incorporate statistical calculations, including rates
Do we build the capacity in NBS or
build interfaces with other tools and applications?