PH+Reporting+User+Story+-+Communicable+Disease+Case+Reporting

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Contact Info:
Alla Fridman (afridman@phdsc.org) -- PHDSC/APHL/CSTE Project Manager

Date Received:
11/18/2011

Whenever a patient is being worked up for a condition (disease) that is mandated to be reported or of interest to the Public Health department, the doctor/hospital (provider) should be able to report the suspected, probable or confirmed diagnosis of the disease to the Public Health department. Whenever a provider diagnoses the disease, he/she should be able to record the disease in the Electronic Health Record System (EHR-S). The provider’s EHR-S should be able to automatically pre-populate a Public Health Report provided by the Public Health program. Depending on the conditions (disease), the Report may include laboratory results data. The provider should be able to review the Report, enter additional data on the form and submit the Report electronically to the public health program information system.
 * 1.1 Introduction **
 * 1.2 User Story Narrative **

The goal of a communicable disease public health program is to assure timely identification of communicable disease cases to protect the public within a jurisdiction from the spread of diseases. Communicable disease reporting, monitoring morbidity and mortality occurs on a daily basis. Communicable diseases are a major cause of mortality and morbidity in emergencies, and particularly in complex emergencies, where real time communication and coordination across clinical and public health entities is crucial to provide services and resources to population in need. The main causes of morbidity and mortality in emergencies are diarrheal diseases and acute respiratory infections, measles, epidemic meningococcal disease, tuberculosis, relapsing fever and typhus.[1]
 * 1.2.1 Goal **

The case identification is based on the information received from healthcare providers (clinician and laboratories) via laboratory reports and case reports.

This User Story is focused on automation of submission of initial reports of communicable diseases required by law from hospital and ambulatory Electronic Health Record Systems (EHR-S) (case reports) and Laboratory Information Management Systems (LIMS) (laboratory reports) to local or state Public Health Information Systems (PH-IS).

The electronic submission of initial reports of communicable diseases to a public health agency will reduce the burden on the healthcare provider in complying with the mandate to report communicable diseases to the public health department. For the public health agency, it will help increase timeliness, completeness and correctness of the reporting information needed to support public health preparedness interventions.

//Business Actors (stakeholders) include //
 * 1.2.2 Description of Data Reporting Events, Actors/Role and Triggers **
 * Provider (clinician)
 * Patient
 * Laboratory Staff
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Public Health Program Staff

//<span style="color: #000000; font-family: 'Arial','sans-serif';">Technical Actors (information systems) include //
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Electronic Health Records System (EHR)
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Laboratory Information Management System (LIMS)
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Public Health Information System (PH-IS)
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Health Information Exchange (HIE)

<span style="color: #000000; font-family: 'Arial','sans-serif';">Please note that S&I Framework Initiatives use term “Role” in addition to term” Actor”. We recommend to the PH Reporting Initiative Definition Workgroup to work on defining the term “Actor/Role”

<span style="color: #000000; font-family: 'Arial','sans-serif';">The following is the flow of events that trigger public health reporting:

__<span style="color: #000000; font-family: 'Arial','sans-serif';">Reporting Probable Diagnosis __
 * 1) <span style="color: #000000; font-family: 'Arial','sans-serif';">A Person (patient) visits Provider with the symptoms indicating communicable disease, e.g. fever, diarrhea. Visit data are recorded in the EHR-S.
 * 2) <span style="color: #000000; font-family: 'Arial','sans-serif';">EHR-S pre-populates the Initial Public Health Report form and sends Notification to Provider to review the Form.
 * 3) <span style="color: #000000; font-family: 'Arial','sans-serif';">Provider reviews the Form, enters additional information as needed, and authorizes the submission of the Report to PH-IS directly or via HIE.
 * 4) <span style="color: #000000; font-family: 'Arial','sans-serif';">PH-IS Staff receives Notification about the New Public Health Report. Public Health Practitioners opens the Report.
 * 5) <span style="color: #000000; font-family: 'Arial','sans-serif';">PH-IS sends back to EHR-S or HIE the acknowledgement of receipt of the Report

__<span style="color: #000000; font-family: 'Arial','sans-serif';">Reporting Suspected or Confirmed Diagnosis __
 * 1) <span style="color: #000000; font-family: 'Arial','sans-serif';">A Person (patient) visits Provider with the symptoms indicating communicable disease, e.g. fever, diarrhea. Visit data are recorded in the EHR-S.
 * 2) <span style="color: #000000; font-family: 'Arial','sans-serif';">Provider orders laboratory test(s). Test order(s) are recorded in the EHR-S.
 * 3) <span style="color: #000000; font-family: 'Arial','sans-serif';">Specimen(s) are collected by Nurse and sent to the Laboratory. Laboratory conducts test(s) and records test result(s) in LIMS.
 * 4) <span style="color: #000000; font-family: 'Arial','sans-serif';">LIMS sends data to EHR-S directly or via HIE.
 * 5) <span style="color: #000000; font-family: 'Arial','sans-serif';">Provider receives and reviews test results, makes confirmatory diagnosis and records data in the EHR-S.
 * 6) <span style="color: #000000; font-family: 'Arial','sans-serif';">EHR-S decision support engine detects that the diagnosis has to be reported to PH agency program.
 * 7) <span style="color: #000000; font-family: 'Arial','sans-serif';">EHR-S pre-populates the Initial Public Health Report form and sends Notification to Provider to review the Form.
 * 8) <span style="color: #000000; font-family: 'Arial','sans-serif';">Provider reviews the Form, enters additional information as needed, and authorizes the submission of the Report to PH-IS directly or via HIE.
 * 9) <span style="color: #000000; font-family: 'Arial','sans-serif';">PH-IS Staff receives Notification about the New Public Health Report. Public Health Practitioners opens the Report.
 * 10) <span style="color: #000000; font-family: 'Arial','sans-serif';">PH-IS sends back to EHR-S or HIE the acknowledgement of receipt of the Report

<span style="color: #000000; font-family: 'Arial','sans-serif';">The data is transmitted follows the requirements set forth by a local/state health department for communicable disease reporting. Appendix 1 contains data elements for Public Health Laboratory and Case Report<span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 14.6667px;">[2] developed by the CDC Public Health Case Report Standardization Workgroup.
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">1.2.3 Data **


 * <span style="color: #000000; font-family: 'Arial','sans-serif';">1.2.4 Other Information **
 * 1) <span style="font-family: 'Arial','sans-serif';">LOINC, SNOMED, ICD-9/ICD-10, UCUM, PHIN-VADS, CDC RCMT
 * 2) <span style="font-family: 'Arial','sans-serif';">HL7 Version 2.x messaging standards and implementation guides
 * 3) <span style="font-family: 'Arial','sans-serif';">HL7 Clinical Document Architecture (CDA) Release 2 standard
 * 4) <span style="font-family: 'Arial','sans-serif';">IHE Information Technology Infrastructure (ITI) Technical Framework Standards
 * 5) <span style="font-family: 'Arial','sans-serif';">IHE Laboratory Technical Framework Standards
 * 6) <span style="font-family: 'Arial','sans-serif';">IHE Quality, Research and Public Health (QRPH)Technical Framework Standards
 * 7) <span style="font-family: 'Arial','sans-serif';">HITSP Public Health Case Reporting Interoperability Specification (IS 11)<span style="font-family: 'Arial','sans-serif'; font-size: 14.6667px;">[3]
 * 8) <span style="font-family: 'Arial','sans-serif';">HITSP EHR Laboratory Result Reporting Interoperability Specification (IS 01)<span style="font-family: 'Arial','sans-serif'; font-size: 14.6667px;">[4]
 * 9) <span style="font-family: 'Arial','sans-serif';">S&I Framework Laboratory Result Interchange Implementation Guide
 * 10) <span style="font-family: 'Arial','sans-serif';">NPI Validation – NPICheckDigit and check digit

<span style="color: #000000; font-family: 'Arial','sans-serif';">Clinical Document Architecture (CDA) Laboratory reports and Case reports templates<span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 14.6667px;">[5] to support this User Story has been developed under the PHDSC-APHL-CSTE joint project supported through the CDC Cooperative Agreement for the following communicable diseases (URL: <span style="font-family: 'Arial','sans-serif';"> [|https://wiki.phdsc.org/index.php/PH-Lab] ):
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Antrax
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Tularemia
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Hepatitis B
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Tuberculesis
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Influenza

<span style="color: #000000; font-family: 'Arial','sans-serif';">A sample CCD document that can be transmitted from a hospital EHR to a public health department via the ATLAS EHR Gateway (our project partner) can be found at URL: <span style="font-family: 'Arial','sans-serif';"> [|https://wiki.phdsc.org/index.php/PH-Lab].

<span style="font-family: 'Arial','sans-serif';">By February 2011, the PHDSC-APHL-CSTE project team will develop CDA templates for laboratory reports and case reports for additional 10 communicable diseases, e.g. Hospital Acquired Infections (HAI),<span style="font-family: 'Arial','sans-serif'; font-size: 14.6667px;">[6] salmonella, and others selected by the PHDSC-APHL-CSTE project team in consultations with CDC.

<span style="color: #000000; font-family: 'Arial','sans-serif';">Standard harmonization activities under this User Story will be supported by the PHDSC-APHL-CSTE project. Our team includes EHR and PH vendors, PHDSC members, who have been participating in the national HIT standardization activities under HITSP, S&I Framework LRI Initiative and IHE. With the support from CDC we anticipate conducting a pilot test of this User Story data exchanges in two state pilot sites in May 2012.
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">1.3 Stakeholder Commitment **

<span style="color: #000000; font-family: 'Arial','sans-serif';">Participating organization supporting this User Story includes (in alphabetical order):
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Atlas Public Health - PH IS vendor
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Centers for Disease Control and Prevention, Office for Surveillance, Epidemiology and Laboratory Services (OSELS)
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Delaware State Health Department
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">IBM Research
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">Public Health Data Standards Consortium

<span style="color: #000000; font-family: 'Arial','sans-serif';">Alla Fridman, PHDSC-APHL-CSTE Project Manager at afridman@phdsc.org.
 * <span style="color: #000000; font-family: 'Arial','sans-serif';">1.4 Contact Information **

References: <span style="font-family: 'Calibri','sans-serif'; font-size: 13.3333px;">[1] World Health Organization (WHO). Communicable disease control in emergencies. A field manual Edited by M.A. Connolly. URL: @http://www.who.int/infectious-disease-news/IDdocs/whocds200527/ISBN_9241546166.pdf <span style="font-family: 'Calibri','sans-serif'; font-size: 13.3333px;">[2] ONC S&I Framework. The data elements used for case reporting and ELR - harmonized with syndromic surveillance and cancer URL:<span style="font-family: 'Calibri','sans-serif'; font-size: 14.6667px;">http://wiki.siframework.org/file/view/Common%20Core%20Data%20Elements_%2BSyndromicImmunizationand%20Cancer.docx <span style="font-family: 'Calibri','sans-serif'; font-size: 13.3333px;">[3] Public Health Case Reporting Interoperability Specification (IS 11). URL: @http://www.hitsp.org/InteroperabilitySet_Details.aspx?MasterIS=true&InteroperabilityId=364&PrefixAlpha=1&APrefix=IS&PrefixNumeric=11 <span style="font-family: 'Calibri','sans-serif'; font-size: 13.3333px;">[4] HITSP EHR Laboratory Result Reporting Interoperability Specification (IS 01). URL: @http://www.hitsp.org/InteroperabilitySet_Details.aspx?MasterIS=true&InteroperabilityId=44&PrefixAlpha=1&APrefix=IS&PrefixNumeric=01 <span style="font-family: 'Calibri','sans-serif'; font-size: 13.3333px;">[5] HL7 Pubic Health Case Reporting Implementation Guide. Release 1: URL;[] <span style="font-family: 'Calibri','sans-serif'; font-size: 13.3333px;">[6] HL7 Hospital Acquired Infections (HAI) Implementation Guide. DSTU: URL:[]

Supporting Files:

 * **Description** || **File** ||
 * This document contains the initial draft user story submission. || [[file:Initial Draft Submission - Communicable Disease Case Reporting - November 18 2011.docx]] ||  ||
 * Appendix 1 - Common Core Data Elements for Case Reporting and Laboratory Result Reporting || [[file:Appendix 1 - Communicable Disease Case Reporting - Common Core Data Elements.docx]] ||  ||

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