PH+Reporting+User+Story+-+Public+Health+Case+Reporting

include component="page" wikiName="siframework" page="PHRI Header" =User Story: Public Health Case Reporting=

Contact Info:
John Abellera, MPH (jla7@cdc.gov, phone: 404.498.6684) -- Division of Notifiable Diseases and Healthcare Information (proposed), CDC Hwa-Gan Chang, PhD (hgc04@health.state.ny.us) -- Director, Statistical Unit, Division of Epidemiology, New York State Department of Health Kathleen Gallagher, D.Sc (kxg7@cdc.gov) --Division of Notifiable Diseases and Healthcare Information (proposed), CDC

Date Received:
11/18/2011

Currently, public health case reporting from providers is paper-based, labor intensive and slow and can result in state reportable conditions not being reported to local and state public health departments. There is a lack of documentation about EHR systems and their ability to support case reporting. These are one of the many challenges in fully implementing public health case reporting, specifically due to technical challenges in enabling interoperability.
 * 1.1** **Introduction**

The significance of an EHR that supports a broad spectrum of public health “event of interest” reporting must be better articulated beyond the existing use case developed by the American Health Information Community (AHIC). The value added is identifying policy, resources, tools, and best practices used to enhance transactions between EHRs and public health systems.

Standardizing data collection methods and content has become increasingly important as information exchange systems have advanced and proliferated and more entities desire to share information. Within and across organizations possible benefits of data sharing include increased efficiency in performing core functions, support of continuous quality improvement (CQI) efforts, monitoring achievement of organizational goals, and improved outcomes. [1] Sharing data significantly underscores the need for standardization.
 * 1.2** **User Story Narrative**

In the arena of public health, the need for data sharing occurs at multiple levels. Data sharing can occur within a health department or between: local health departments, local and state health departments, state health departments, health providers and health departments, state health departments and the Centers for Disease Control and Prevention (CDC), and the United States and other countries. The ability to share data meaningfully, however, depends critically on the existence of a common, clearly defined set of data elements that are collected accurately and completely across jurisdictions. Recent efforts have focused on sharing data between health care and public health entities. [2]

The focus of case reporting for this use story is primarily focused, but not limited to, infectious diseases which are legally reportable to public health agencies. This includes high volume reports for conditions such as Sexually Transmitted Diseases (STDs), viral hepatitis, and HIV infection. In one specific user story, using perinatal hepatitis B surveillance and investigation as an example, highlights the need for standardized data elements/vocabulary and the interactions with an electronic medical record system, laboratory information management systems, state/local electronic disease surveillance system, and immunization registry.

Jane Doe, a female of child bearing age, visits the hospital for her annual gynecological check up. Dr. Elizabeth James examines Jane Doe and notices jaundice. Dr. James orders a hepatitis panel, which turns out to be positive for hepatitis B surface antigen. The result is sent to Dr. James and, as required, is reported to local/state public health department. Upon receipt of the report, the state public health official, Joe Black, registers the information into its jurisdiction’s electronic disease surveillance system. The case is assigned to Robert Smith, a local public health investigator, and he queries a local health information exchange to gather clinical data on the patient and finds that the patient has given birth in the recent past. Mr. Smith then queries the state Immunization registry which finds no evidence that the infant had received hepatitis B vaccine. The child is found to be infected with Hepatitis B, and Mr. Smith sends information over to the case management system for follow-up. Case data are sent back to the surveillance system for reporting, eliminating duplicate data entry. Furthermore, the population health data, as appropriate, is sent to the physician aid in clinical decision support.

The goal is to provide public health trading partners with guidance and the necessary tools to enable electronic reporting and exchange of standards-based case report data. The support of the following activities will help to contribute this goal:
 * 1.2.1** **Goal**
 * 1) Maintain common core data elements across jurisdictions for reportable diseases
 * 2) Harmonize disease specific data elements
 * 3) Maintain and distribute reportable conditions mapping table, case identification and report criteria
 * 4) Identify, develop and maintain implementation guide

Data reporting events, actors, and triggers are defined in the attached ONC use case on public health and adverse event reporting.
 * 1.2.2** **Description of data reporting events, actors, and triggers**

See Appendix A - Common Core Data Elements Recommendations by the Council of State and Territorial Epidemiologists (CSTE) and CDC Case Report Standardization Workgroup (CRSWg)
 * 1.2.3** **Data**

Attached for reference is a copy of the balloted HL7 implementation guide for public health case reporting in Clinical Document Architecture. This is an illustrative example of the use of standardize data elements recommended by the CRSWg and the application of standard terminology and vocabulary.
 * 1.2.4** **Other information**

The Division of Notifiable Diseases Surveillance and Healthcare Information (DNDHI) leads the integration of statistical, epidemiologic, and informatics methods for public health surveillance and evaluation using electronic health care data sources to support federal, state, and local stakeholders. In addition, this division leads and supports state and local notifiable diseases surveillance systems - monitoring diseases that are reportable under state laws and aggregating these data for use by CDC programs. DNDHI will continue to work with public health stakeholders, including CSTE/CDC’s Case Report Standardization Workgroup.
 * Stakeholder Commitment**

The CRSWg was formed in 2007 to promote the standardization of public health case reporting and the advancement of electronic case reporting. The CRSWg is a collaborative workgroup of CDC’s Office of Surveillance, Epidemiology, and Laboratory Services (OSELS) Division of Notifiable Diseases and Healthcare Information and the CSTE that includes members from CDC, academia, and state and local public health settings, who have expertise in the areas of epidemiology, data modeling, and terminology. The CRSWg will continue to work with its members, standard development organizations, and communities of practice to provide recommendations to CSTE and CDC in the promulgation of standards-based electronic case reporting. Workgroup members are listed in Appendix B.

John P. Abellera, MPH Division of Notifiable Diseases and Healthcare Information (Proposed) Centers for Disease Control and Prevention 404-498-6684 jla7@cdc.gov
 * Contact Information**

Hwa-Gan Chang, PhD Director, Statistical Unit Division of Epidemiology New York State Department of Health hgc04@health.state.ny.u

Kathleen Gallagher, D.Sc. Division of Notifiable Diseases and Healthcare Information (Proposed)Centers for Disease Control and Prevention Kxg7@cdc.gov


 * References** (in order of citation)
 * 1) Transforming Healthcare through Secondary Use of Health Data. PricewaterhouseCoopers. []. (accessed October 2009).
 * 2) Public Health Case Reporting Detailed Use Case. Office of the National Coordinator for Health Information Technology. March 21, 2008. []. (accessed January 2010).

Supporting Files:

 * **Description** || **File** ||
 * This document contains the initial draft user story submission. || [[file:Initial Draft Submission - Public Health Case Reporting - November 18 2011.docx]] ||  ||
 * Appendix A - Common Core Data Elements Recommendations || [[file:Appendix A - PH Case Reporting - Common Core Data Elements Recommendations.docx]] ||  ||
 * Appendix B - Case Report Standardization Workgroup Members || [[file:Appendix B - PH Case Reporting - Case Report Standardization WG members.docx]] ||  ||

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