PH+Reporting+User+Story+-+Michigan+Disease+Surveillance+System+-+Public+Health+Communicable+Disease+Surveillance+System

include component="page" wikiName="siframework" page="PHRI Header" =User Story: Michigan Disease Surveillance System - Public Health Communicable Disease Surveillance System=

Contact Info:
Laura Rappleye (rappleyeL@michigan.gov, phone: 517.335.3692) -- HIT Specialist, Michigan Department of Community Health Kimberly Bachelder (Bachelderk1@michigan.gov, phone: 517.241.9532) -- HIT Business Analyst, Michigan Public Health Institute Edward F. Hartwick (HartwickE@michigan.gov, phone: 517.335.8475) -- MDSS & GIS Coordinator, Michigan Department of Community Health

Date Received:
11/18/2011

**1.2 User Story Narrative**
Physicians, clinical laboratories, primary and secondary schools, childcare centers, and camps are required to report the occurrence or suspected occurrence of any disease, condition or infection as identified in the Michigan Communicable Disease Rules. In addition, all other health care providers are authorized to report to local health authorities. Historically, public health communicable disease surveillance systems have been comprised of disparate paper-based systems, or data collection systems that utilized older technology. The reported data often lacked timeliness and completeness. These systems were not as robust, accurate, or as timely as they needed to be to reliably monitor for disease outbreaks, or newly emergent infectious diseases.

In Michigan, the Michigan Disease Surveillance System (MDSS) is used for reporting communicable diseases to the Michigan Department of Community Health and, in turn, to the local health jurisdictions, who participate in the system. The MDSS is a web-based system that allows for the electronic capture of disease data for the tracking and case management of communicable disease. MDSS fulfills the physician communicable disease reporting requirements and has the ability to receive HL7 laboratory report. For more information on the MDSS please visit the State of Michigan website at: @http://www.michigan.gov/mdss/.

To address these issues, the Centers for Disease Control and Prevention (CDC) has initiated efforts to standardize public health data sets and maximize their effectiveness. The Public Health Information Network (PHIN) promotes existing and emerging national standards for the sharing of public health information. These include: These standards and guidelines offer public health a new roadmap toward the development of a productive technical infrastructure. With these standards and guidelines, an integrated surveillance system to support public health will ultimately incorporate data from a variety of sources: emergency responders, pharmaceutical retailers, laboratories, hospitals, physicians, schools, and many other resources within the community.
 * 1.2.1 Goal**
 * 1) Security standards that address the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
 * 2) Standard electronic exporting of health data through Health Level 7 (HL7).
 * 3) The Public Health Logical Data Model.

Electronic laboratory results reporting (ELR) is a product of the laboratory information management systems (LIMS) that are in place in virtually all reporting facilities. Lab results are entered into the LIMS where results that would indicate that a reportable condition has been identified through laboratory means would be flagged to be sent to the proper reporting system, in Michigan, the MDSS. The LIMS would then export the lab result in a standard HL7 format and send it via secure transport to the MDSS where the lab result is either added to an existing case, or a new case is created for it. Ideally, this happens on a real-time basis, but should happen at least once every 24 hours if batch processed. This ensures proper reporting as most diseases in Michigan are required to be reported within 24 hours of identification.
 * 1.2.2 Description of Data Reporting Events, Actors and Triggers**

To help facilitate a laboratory transition to ELR, Michigan has created electronic reporting guidelines and standards made them available online (@http://www.michiganhealthit.org/meaningful_use/ELR%20MDSS%20Guide%20V3_Nov%202011.pdf). These guides contain information as to what messaging and coding standards Michigan uses, which standards can be accepted, what information is required to be sent, and instructions on how to setup secure transport of the messages.

In 2010, Michigan had nearly 160,000 case referrals into the MDSS, approximately 31% of which were referrals made by electronic lab submissions. This represents an increase of about 5% in the proportion of case referrals made to MDSS by electronic reporting compared to 2009. The case referrals that are reported into MDSS are compared against a master patient index and, if similar enough to existing entries, become candidates for deduplication. Deduplication takes place for both the patient information and the case reports in order to ensure that cases are not over-reported.

After de-duplication, they are automatically assigned to the proper jurisdiction based on the reported address for the case. Local health authorities then perform follow-up on the case based upon the information presented in the referral. Case follow-up varies by the disease condition, but may include aspects such as interviewing the patient and the patient's physician, obtaining additional medical records and laboratory testing results, and providing appropriate infection control and prevention measures. Local health departments use these cases to monitor the incidence of reportable diseases in their jurisdiction and to track disease prevention efforts. Case reports are reviewed at both the local and state levels for completeness and for disease trends.

To assist health care providers and other institutions in reporting, the Michigan Department of Community Health has prepared separate reporting lists for physicians, clinical laboratories, schools, childcare centers, and camps to provide a quick reference guide of reportable conditions, disease or infections. In addition, Michigan health care professionals and laboratories are also authorized to report any condition, disease, or infection judged by them to indicate that the health of the public is threatened.
 * 1.2.3 Data**

A report must contain the following information:
 * 1) The patient's full name
 * 2) The patient's residential address, including street, city, village or township, county, and ZIP Code.
 * 3) The patient's telephone number
 * 4) The patient's date of birth (or age) and sex
 * 5) The name of the disease, infection, or condition reported and date of onset if known
 * 6) The specific laboratory test (if tested), date performed, where performed, and results
 * 7) The name and address of the reporting facility

Rules, regulations, and a list of notifiable diseases required for reporting in Michigan can be found in the Health Care Professional’s Guide to Disease Reporting in Michigan (@http://www.michigan.gov/documents/hlth_care_prof_guide_167371_7.pdf)

Currently, Michigan accepts ELR messages in HL7 versions 2.3.1, 2.3.z or 2.5.1. The messages are received via direct PHINMS connection between the sender and MDCH. Michigan is currently in the process of implementing an HIE model through which HL7 messages will be sent from the provider to MDCH. The following diagram depicts the current HIE environment in Michigan. Reportable Disease messages will follow this data flow using State, National, and Meaningful Use standards:
 * 1.2.4 Other information**


 * Figure 1: Meaningful Use Public Health Reporting Data Flow**

After the cases are reviewed by state and local health authroities and marked in the system as completed, they are compared against nationwide reporting rules. Those cases that are considered reportable at the national level are exported weekly from the MDSS and sent to CDC via electroinc messaging in an HL7 file (TB, Varciella or Generic messaging guides) or by manual upload (all other national notifable diseases).

The Michigan Health Information Network (MiHIN) is the state of Michigan's initiative to improve health care quality, cost, efficiency, and patient safety through electronic exchange of health information. The MiHIN is a joint effort among MDCH, the Michigan Department of Information Technology and Budget (DTMB), and a broad group of stakeholders from across the state of Michigan.
 * 1.3 Stakeholder Commitment**

The MiHIN is essential to ensuring that Michigan's health care providers can utilize Electronic Health Records or EHRs in a meaningful way that allows for a patient's health information to be available when they need it most - at the point of care. The MiHIN is fundamentally the infrastructure that mobilizes existing electronic health information in a manner that allows healthcare providers to access and exchange it regardless of individual technology choices.

The first phase of MiHIN will enable real time submission of notifiable lab results from electronic health records to the Michigan Disease Surveillance System through the State of Michigan Health Information Exchange (SoM HIE). The goal of SoM HIE is to enable interoperability among the Department of Community Health’s internal health information systems and its external partners, improving the health care quality, efficiency and coordination of Michigan citizens. The purpose of SoM HIE is to streamline the internal data flow between MDCH health information systems and external partners.

Laura Rappleye HIT Specialist Michigan Department of Community Health Phone: 517.335.3692 E-mail: RappleyeL@michigan.gov
 * 1.4 Contact Information**

Kimberly Bachelder HIT Business Analyst Michigan Public Health Institute Phone: 517.241.9532 E-mail: Bachelderk1@michigan.gov

Edward F. Hartwick MDSS & GIS Coordinator Michigan Department of Community Health Phone: 517.335.8475 Email: HartwickE@michigan.gov

Supporting Files:

 * **Description** || **File** ||
 * This document contains the initial draft user story submission. || [[file:Initial Draft Submission - MDSS PH Communicable Disease Surveillance System - November 18 2011.pdf]] ||  ||

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