PH+Reporting+User+Story+-+Florida+Dept+of+Health+-+Enteric+Disease+Reporting

include component="page" wikiName="siframework" page="PHRI Header" =User Story: Florida Department of Health - Enteric Disease Reporting=

Contact Info:
Janet Hamilton

Date Received:
11/22/2011


 * 1.2 User Story Narrative **


 * 1.2.1 Goal **

Public health surveillance information is used to assess public health status, identify public health emergencies, guide public health policy and strategies, and evaluate programs and interventions. Specifically, the Florida Department of Health Bureau of Epidemiology (BOE) conducts surveillance on more than 100 reportable diseases and conditions of public health importance for the purpose of rapid case finding and implementation of control measures to prevent secondary cases of illness, and contributes to national surveillance via weekly reporting of nationally notifiable diseases to the Centers for Disease Control and Prevention (CDC). Case identification is a passive system, based on information received from healthcare providers and laboratories, as required by state law.

Historically, reportable disease case and laboratory reports have gone directly to county health departments (CHD). CHD epidemiologists then gather additional information and report the case in Merlin, Florida’s secure web-based disease reporting and epidemiologic analysis system. Currently, some CHDs have access to EHR data that can be entered into Merlin, but Merlin does not directly accept EHR data. Over 60% of Florida’s total reportable laboratory result volume is received electronically by BOE and consumed by Merlin, significantly reducing the amount of data manually entered into Merlin.

This User Story is focused on automation of enteric disease reports. Around 10,000 enteric disease cases are reported every year in Florida. The electronic submission of initial reports of enteric diseases to BOE will ensure that healthcare comply with reporting requirements, while reducing the burden on the provider and increasing the timeliness, completeness, and accuracy of reporting.


 * 1.2.2 Description of Data Reporting Events, Actors and Triggers **


 * Reportable enteric disease dat **a are collected by healthcare providers, laboratories, and CHD epidemiologists. People become sick with reportable enteric diseases everyday. When a patient has symptoms of enteric disease and seeks medical evaluation, a healthcare provider will assess the patient. The healthcare provider documents demographics, medical history, and current signs and symptoms. The healthcare provider may also order laboratory tests. The provider collects a specimen patient from a to submit a specimen to the laboratory. The laboratory receives basic demographic data from the healthcare provider, performs the requested laboratory test, and then submits positive results to both the healthcare provider and their local CHD. Information reported by laboratories includes: patient’s demographics; type of diagnostic tests; and type, site, and collection date of specimen. Once the healthcare provider receives a positive laboratory result for a reportable disease, the healthcare provider reports the following to the CHD: patient’s demographics; type of diagnostic tests; type, site, and collection date of specimen; treatment given; and other necessary epidemiological information.

Currently, CHD users create a “case” in Merlin for each reportable disease that is reported, which includes information about the patient and the disease. Currently, it is unknown how completely these data are captured in EHRs and Merlin is not able to consume any EHR data. Physician reports are almost exclusively manual-based, either faxed or reported by phone to the CHD. The CHDs then manually enter the relevant data into Merlin.

Laboratory results are also created in Merlin. Laboratory results can be independent of cases, but can also be associated with (or “attached to”) a case. When a paper-based laboratory result is received, information on the patient and the laboratory test and results are manually entered into Merlin by CHD. The Merlin laboratory result can then be attached to a case, if appropriate. Over 60% of Florida’s total reportable laboratory results are electronic laboratory results (ELRs). ELRs are consumed by Merlin and sent to Merlin’s CHD-specific ELR task lists, where counties can view, process, save ELRs, and attach ELRs to cases, if appropriate. ELRs have increased completeness for some demographic and laboratory elements, but decreased for others, compared to manually entered laboratory results (see Table 1).

Table 1. Percentage of Laboratory Results Missing Selected Demographic and Laboratory Test Information by Method of System Receipt, Florida, 2005-2010

|| || Hand Entered Laboratory Results
 * Electronic Laboratory Results  ||
 * ^  ||||  % of results with missing or unknown values   ||
 * Demographics ||
 * Gender ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">0.12%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">0.54%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Race ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">7.66%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">10.27%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Ethnicity ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">8.45%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">11.69%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">First Name ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">0.01%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">0.00%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Last Name ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">0.00%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">0.00%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Home Phone ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">19.66%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">23.25%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Laboratory Test ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Accession Number ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">45.95%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">0.00%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Test Type ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">42.49%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">26.60%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Specimen Type ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">7.13%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">15.94%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Specimen Collection Date ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">3.52%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">9.61%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Specimen Received Date ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">43.99%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1.39%   ||

<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">With approximately 10,000 enteric diseases reported each year, reports are received every business day. Healthcare providers and non-ELR laboratories report cases and laboratory results as they are identified. Most laboratories participating in electronic laboratory reporting send files to BOE once a day.

<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Once a CHD has entered a required set of basic elements into Merlin, the CHD submits the case to BOE. BOE participates in national surveillance by sending CDC a file once a week with all the cases that have been submitted to BOE that are nationally notifiable. CHDs and BOE are able to run analysis on all cases that have been created in Merlin, which helps identify outbreaks and monitor trends. Data summaries of the Merlin-required elements for enteric diseases are created monthly and presented to state-level epidemiologists.


 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1.2.3 Data **

<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Appendix I includes data elements collected in Merlin for enteric diseases, as well the possible sources. Please note that this should be integrated with the work of the national Case Reporting Standardization Working Group. Many data elements can come from multiple sources. For data collected via ELR, Florida accepts all HL7 versions. State guidance requests version HL7 2.3.1, but 2.5.1 is used by some laboratories to meet Meaningful Use requirements. Florida uses interface engines and is capable of accepting all versions of HL7.


 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1.2.4 Other information **

<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Florida is a large state, with more than 18.5 million residents. Every year, approximately 10,000 enteric disease cases are reported in Florida (see Table 2). Enteric diseases account for a significant proportion of all reportable diseases in Florida, and decreasing the time spent reporting each case would significantly decrease the workload for CHDs.

<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Table 2. Number and Rate (per 100,000 Population) of Enteric Diseases Cases Compared to Number and Rate (per 100,000 Population) of All Reportable Disease Cases (excluding HIV/AIDS, STDs, and TB) Reported in Florida for 2007-2010


 * **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Disease ** ||||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2010 **  ||||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2009 **  ||||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2008 **  ||||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2007 **  ||
 * ^  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Total **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Rate **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Total **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Rate **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Total **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Rate **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Total **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Rate **  ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Campylobacteriosis || <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,225   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">6.5   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,112   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">5.8   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,081   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">5.7   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,037   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">5.5   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Cryptosporidiosis || <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">410   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2.2   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">497   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2.6   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">537   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2.8   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">727   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">3.9   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Giardiasis || <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2,147   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">11.4   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,890   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">9.9   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,430   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">7.6   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,239   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">6.6   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Salmonellosis || <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">6,217   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">32.9   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">6,736   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">35.2   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">5,176   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">27.4   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">5,054   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">26.9   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Shigellosis || <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,244   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">6.6   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">457   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2.4   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">751   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">4.0   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2,170   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">11.6   ||
 * **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Enteric Total ** || **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">11,243 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">59.5 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">10,692 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">55.9 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">8,975 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">47.5 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">10,227 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">54.5 **  ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">All reportable diseases (excluding HIV/AIDS, STDs, and TB) || <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">46,615   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">257.6   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">50,447   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">275.9   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">44,976   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">252.5   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">45,059   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">254.3   ||
 * **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">% of all reportable diseases (excluding HIV/AIDS, STDs, and TB) due to enteric diseases ** || **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">24% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">23% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">21% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">20% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">20% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">19% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">23% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">21% **  ||


 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1.3 Stakeholder Commitment **

<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Many stakeholders around the country that are interested in pursuing standardization for case reporting for enteric and other reportable diseases and conditions. All 50 states and territories will benefit from this activity.

Supporting Files:

 * **Description** || **File** ||
 * This document contains the initial draft user story submission. || [[file:Initial Draft Submission - FL DOH Enteric Disease Reporting - November 22 2011.docx]] ||  ||

Comments:
Please comment on this User Story using the "Discussion" tab at the top of the screen. <span style="display: block; height: 1px; left: -40px; overflow: hidden; position: absolute; top: -25px; width: 1px;"> <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Public health surveillance information is used to assess public health status, identify public health emergencies, guide public health policy and strategies, and evaluate programs and interventions. Specifically, the Florida Department of Health Bureau of Epidemiology (BOE) conducts surveillance on more than 100 reportable diseases and conditions of public health importance for the purpose of rapid case finding and implementation of control measures to prevent secondary cases of illness, and contributes to national surveillance via weekly reporting of nationally notifiable diseases to the Centers for Disease Control and Prevention (CDC). Case identification is a passive system, based on information received from healthcare providers and laboratories, as required by state law. <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Historically, reportable disease case and laboratory reports have gone directly to county health departments (CHD). CHD epidemiologists then gather additional information and report the case in Merlin, Florida’s secure web-based disease reporting and epidemiologic analysis system. Currently, some CHDs have access to EHR data that can be entered into Merlin, but Merlin does not directly accept EHR data. Over 60% of Florida’s total reportable laboratory result volume is received electronically by BOE and consumed by Merlin, significantly reducing the amount of data manually entered into Merlin. <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">This User Story is focused on automation of enteric disease reports. Around 10,000 enteric disease cases are reported every year in Florida. The electronic submission of initial reports of enteric diseases to BOE will ensure that healthcare comply with reporting requirements, while reducing the burden on the provider and increasing the timeliness, completeness, and accuracy of reporting. <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Currently, CHD users create a “case” in Merlin for each reportable disease that is reported, which includes information about the patient and the disease. Currently, it is unknown how completely these data are captured in EHRs and Merlin is not able to consume any EHR data. Physician reports are almost exclusively manual-based, either faxed or reported by phone to the CHD. The CHDs then manually enter the relevant data into Merlin. <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Laboratory results are also created in Merlin. Laboratory results can be independent of cases, but can also be associated with (or “attached to”) a case. When a paper-based laboratory result is received, information on the patient and the laboratory test and results are manually entered into Merlin by CHD. The Merlin laboratory result can then be attached to a case, if appropriate. Over 60% of Florida’s total reportable laboratory results are electronic laboratory results (ELRs). ELRs are consumed by Merlin and sent to Merlin’s CHD-specific ELR task lists, where counties can view, process, save ELRs, and attach ELRs to cases, if appropriate. ELRs have increased completeness for some demographic and laboratory elements, but decreased for others, compared to manually entered laboratory results (see Table 1). <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Table 1. Percentage of Laboratory Results Missing Selected Demographic and Laboratory Test Information by Method of System Receipt, Florida, 2005-2010 || || <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Hand Entered Laboratory Results <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">With approximately 10,000 enteric diseases reported each year, reports are received every business day. Healthcare providers and non-ELR laboratories report cases and laboratory results as they are identified. Most laboratories participating in electronic laboratory reporting send files to BOE once a day. <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Once a CHD has entered a required set of basic elements into Merlin, the CHD submits the case to BOE. BOE participates in national surveillance by sending CDC a file once a week with all the cases that have been submitted to BOE that are nationally notifiable. CHDs and BOE are able to run analysis on all cases that have been created in Merlin, which helps identify outbreaks and monitor trends. Data summaries of the Merlin-required elements for enteric diseases are created monthly and presented to state-level epidemiologists. <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Appendix I includes data elements collected in Merlin for enteric diseases, as well the possible sources. Please note that this should be integrated with the work of the national Case Reporting Standardization Working Group. Many data elements can come from multiple sources. For data collected via ELR, Florida accepts all HL7 versions. State guidance requests version HL7 2.3.1, but 2.5.1 is used by some laboratories to meet Meaningful Use requirements. Florida uses interface engines and is capable of accepting all versions of HL7. <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Florida is a large state, with more than 18.5 million residents. Every year, approximately 10,000 enteric disease cases are reported in Florida (see Table 2). Enteric diseases account for a significant proportion of all reportable diseases in Florida, and decreasing the time spent reporting each case would significantly decrease the workload for CHDs. <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Table 2. Number and Rate (per 100,000 Population) of Enteric Diseases Cases Compared to Number and Rate (per 100,000 Population) of All Reportable Disease Cases (excluding HIV/AIDS, STDs, and TB) Reported in Florida for 2007-2010 <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Many stakeholders around the country that are interested in pursuing standardization for case reporting for enteric and other reportable diseases and conditions. All 50 states and territories will benefit from this activity.
 * <span style="font-family: "Arial","sans-serif"; font-size: 14.0pt;">1.2 User Story Narrative **
 * <span style="font-family: "Arial","sans-serif"; font-size: 14.0pt;">1.2.1 Goal **
 * <span style="font-family: "Arial","sans-serif"; font-size: 14.0pt;">1.2.2 Description of Data Reporting Events, Actors and Triggers **
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Reportable enteric disease dat **<span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">a are collected by healthcare providers, laboratories, and CHD epidemiologists. People become sick with reportable enteric diseases everyday. When a patient has symptoms of enteric disease and seeks medical evaluation, a healthcare provider will assess the patient. The healthcare provider documents demographics, medical history, and current signs and symptoms. The healthcare provider may also order laboratory tests. The provider collects a specimen patient from a to submit a specimen to the laboratory. The laboratory receives basic demographic data from the healthcare provider, performs the requested laboratory test, and then submits positive results to both the healthcare provider and their local CHD. Information reported by laboratories includes: patient’s demographics; type of diagnostic tests; and type, site, and collection date of specimen. Once the healthcare provider receives a positive laboratory result for a reportable disease, the healthcare provider reports the following to the CHD: patient’s demographics; type of diagnostic tests; type, site, and collection date of specimen; treatment given; and other necessary epidemiological information.
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Electronic Laboratory Results  ||
 * ^  ||||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">% of results with missing or unknown values   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Demographics ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Gender ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">0.12%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">0.54%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Race ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">7.66%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">10.27%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Ethnicity ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">8.45%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">11.69%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">First Name ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">0.01%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">0.00%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Last Name ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">0.00%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">0.00%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Home Phone ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">19.66%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">23.25%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Laboratory Test ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Accession Number ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">45.95%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">0.00%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Test Type ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">42.49%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">26.60%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Specimen Type ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">7.13%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">15.94%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Specimen Collection Date ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">3.52%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">9.61%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Specimen Received Date ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">43.99%   ||  <span style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">1.39%   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 14.0pt;">1.2.3 Data **
 * <span style="font-family: "Arial","sans-serif"; font-size: 14.0pt;">1.2.4 Other information **
 * **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Disease ** ||||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2010 **  ||||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2009 **  ||||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2008 **  ||||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2007 **  ||
 * ^  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Total **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Rate **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Total **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Rate **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Total **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Rate **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Total **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Rate **  ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Campylobacteriosis || <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,225   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">6.5   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,112   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">5.8   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,081   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">5.7   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,037   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">5.5   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Cryptosporidiosis || <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">410   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2.2   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">497   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2.6   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">537   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2.8   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">727   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">3.9   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Giardiasis || <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2,147   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">11.4   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,890   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">9.9   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,430   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">7.6   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,239   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">6.6   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Salmonellosis || <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">6,217   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">32.9   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">6,736   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">35.2   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">5,176   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">27.4   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">5,054   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">26.9   ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Shigellosis || <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">1,244   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">6.6   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">457   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2.4   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">751   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">4.0   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">2,170   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">11.6   ||
 * **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Enteric Total ** || **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">11,243 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">59.5 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">10,692 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">55.9 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">8,975 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">47.5 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">10,227 **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">54.5 **  ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">All reportable diseases (excluding HIV/AIDS, STDs, and TB) || <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">46,615   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">257.6   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">50,447   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">275.9   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">44,976   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">252.5   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">45,059   ||  <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">254.3   ||
 * **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">% of all reportable diseases (excluding HIV/AIDS, STDs, and TB) due to enteric diseases ** || **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">24% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">23% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">21% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">20% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">20% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">19% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">23% **  ||  **<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">21% **  ||
 * <span style="font-family: "Arial","sans-serif"; font-size: 14.0pt;">1.3 Stakeholder Commitment **

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