PH+Reporting+User+Story+-+Oregon+Health+Authority+Mandated+Disease+Reporting

include component="page" wikiName="siframework" page="PHRI Header" =User Story: Oregon Health Authority - Mandated Disease Reporting=

Contact Info:
Steven K. Modesitt, RN, MPH (steve.k.modesitt@state.or.us, phone: 971.673.1293) -- Oregon Health Authority, Office of Health Information Technology

Date Received:
11/17/2011

This user story describes automated case reporting of diseases or conditions to public health authorities by licensed health care practititioners from Electronic Health Records (EHRs) to the improve timeliness and the ability to facilitate bi-directional exchange of information between healthcare providers and public health.
 * 1.1 ****Introduction **

Oregon law requires health care providers and clinical laboratories to report cases of certain diseases and conditions of public health importance to public health authorities: []). Public health authorities review and compile these reports to assess trends in disease occurrence the impact on populations. Often public health staff will investigate to prevent additional cases.

//Sometime in the near future… //Mr. Smith has come to visit Dr. Jones today. Mr. Smith visited Dr. Jones a couple of days ago for persistent abdominal pain. Mr. Smith was also curious about a recent change in the color of his stool. After examining Mr. Smith, noticing a yellow tinge to his eyes, and suspecting hepatitis, Dr. Jones decided to send Mr. Smith to the laboratory to have blood drawn to measure the serum levels of alanine aminotransferase, aspartate aminotransferase and bilirubin, and to test for viral hepatitis. Today, Dr. Jones and Mr. Smith are reviewing together the results of these tests on the computer terminal that displays test results automatically uploaded from the laboratory by Dr. Jones’ brand new electronic medical record software. (Dr. Jones is feeling good because she knows that now more than ever, no one will ever be able to keep up with her.) Unfortunately, Mr. Smith is not feeling so chipper. He remains nauseated and yellow. And, Dr. Jones has just told him that he has hepatitis C.
 * 1.2 ****User Story Narrative: Sean Schafer MD and Stephen Ladd-Wilson MS **

Wait, what’s that? A malfunction in Dr. Jones new medical record software so soon? Nope. This is just the first opportunity Dr. Jones has had to see and use a fancy new widget built into her electronic medical record application. Working closely with public health colleagues, the vendor that installed and maintains Dr. Jones medical record application has designed an algorithm that recognizes Dr. Jones indication of the diagnostic code for acute hepatitis C, a condition reportable to public health, and presents Dr. Jones with an option to make an instantaneous public health case report by a simple click of a button authorizing the report. This electronic report will effect a secure, standards-based (CDA, CCD) electronic transmission that includes important supplementary clinical and laboratory data, e.g. liver function test results, to the appropriate public health authority. — Oregon law requires Dr. Jones to report cases of acute hepatitis C anyway, and this simplifies many times over the usual runaround of filling out the reporting form, finding the fax number, yada yada— and the case will be automatically bundled in a format that is friendly to her heroic public health colleagues’database and shippedusing the secure, health information exchange. Everybody wins.

But wait, there’s more! Dr. Jones notes that, if she chooses, at the cost of little additional aggravation, she can go home feeling even prouder of her critical role in the public health system. Within the window that offers her the choice to make a public health case report, the interface explains that she could help public health by asking Mr. Smith about 25 additional questions and checking off the response boxes before closing the window. For hepatitis C, these questions are a little awkward—//Have you used injection drugs? Were you ever been incarcerated? Sexual contacts? etc —//

//Sometime in the slightly less near but equally imminent future… //Ms. White, the hepatitis epidemiologist in Mr. Smith’s county of residence, turns on her computer and logs in to the statewide integrated disease reporting database. //What’s this? A new case of acute hepatitis C reported by Dr. Jones? How did this get here? I certainly didn’t enter it. Oh wait…that’s right. Dr. Jones is one of the doctors with the electronic medical record capable of automatic electronic reporting. Cool. She even asked the public health questions!// Ms. White reviews Mr. Smith’s clinical care summary and rests assured that all the appropriate follow-up has been done for this case of acute hepatitis C. She then links the Mr. Smith’s clinical care summary to the electronic laboratory report that was already imported into the database several days earlier. As soon as Ms. White approved the report, an HL7 Case notification message (de-identified data) was generated from the integrated database and automatically and securely sent to CDC using PHIN-MS or Direct.

The mission of the Oregon Health Authority, Public Health Division is to protect, preserve and promote the health of all the people of Oregon.
 * 1.2.1 ****Goal **

The overall goal of Oregon’s public health acute and communicable disease programs is to reduce morbidity and mortality from preventable diseases and conditions, prevent epidemics and implement control measures to stop the spread of disease.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">1. An electronic health record application in place in a health care setting:
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">1.2.2 ****<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Description of Data Reporting Events, Actors and Triggers **
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Automatically identifies cases of diseases required by Oregon law to be reported to public health authority;
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Compiles information necessary for fulfilling reporting responsibility from the clinical record;
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Enables the provider to obtain and transmit history, risk and epidemiologic data to accompany the case report;
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Securely electronically transmits public health case report data securely to the public health authority; and
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Receives bi-directional message validation and public health evidence-based recommendations.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">2. Oregon’s integrated public health disease reporting database automatically uploads case reports transmitted from electronic medical record applications and initiates further investigation if needed.


 * <span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 16px;">Exchange of clinical and epidemiological data from a provider EHR to Public Health for a Acute Hepatitis C Communicable Disease Case Report **
 * **<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Step # ** || **<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Actor ** || **<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Event/Description ** || **<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Inputs ** || **<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Outputs ** ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">1 || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Provider || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Enters diagnosis into EHR system for Patient A || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">START || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Diagnosis for a ‘reportable condition’ ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">2 || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Provider EHR System || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Generates Case Report form from the EHR System || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Patient clinical/ lab results associated with diagnosis/condition || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Reportable Condition-specific case report form ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">3 || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Provider || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Enters history/risk detail into case report form || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">History/risk data recorded on EHR-generated report form || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Completed case report form for reportable condition ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">4 || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Provider EHR System || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Sends public health case report message to state public health || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Completed case report form and state public health message address || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">CDA message file sent ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">5 || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Public Health System || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Receives case report message from provider EHR and routes to appropriate public health staff || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Electronic case report form received and parsed to public health program staff || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">CDA message file saved ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">6 || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Public Health System || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Generates message acknowledgement || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Electronic message with recommendations sent to provider || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">CDA message file sent ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">7 || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Provider EHR System || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Receives verification that case report was received by public health || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Message received verification || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Notice to provider that report received and public health recommendations ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">8 || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Provider || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">View message verification || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">View || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">END ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">7 || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Provider EHR System || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Receives verification that case report was received by public health || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Message received verification || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Notice to provider that report received and public health recommendations ||
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">8 || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Provider || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">View message verification || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">View || <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">END ||

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Health Care Providers: Physicians and other licensed health care practitioners, and their staff and associates who diagnose, treat and record clinical illness. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Public Health Staff: Personnel who receive EHR-generated reports using a communicable database already in place. Public Health staff will review the reports, validate them and investigate if needed. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">EHR developers and programmers who will create filters to select reportable cases. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Inanimate actors: EHR software that will use filters to recognize suspected cases of reportable disease. Compile information necessary for reporting and make a secure electronic report. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Public Health Staff: will work with laboratories, EHR vendors and developers and providers or health care facilities to define standards for content such as: Race/Ethnicity, Procedure Codes, Diagnosis Codes, Observations and Definitions for Clinical Findings
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Actors **<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">:

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">The Acute Hepatitis C case report form can be found at; __ [] __
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">1.2.3 ****<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Data **

Supporting Files:

 * **Description** || **File** ||
 * This document contains the initial draft user story submission. || [[file:Initial Draft Submission - Oregon Health Authority Mandated Disease Reporting - November 17 2011.docx]] ||  ||

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