PH+Reporting+User+Story+-+Minnesota+DOH+-+Communicable+Diseases+(ASTHO)

include component="page" wikiName="siframework" page="PHRI Header" =User Story: Minnesota Dept of Health - Communicable Disease Reporting (ASTHO)=

Contact Info:
Kathryn Como-Sabetti (kathy.como-sabetti@state.mn.us, phone: 651.201.5485) -- Infectious Disease Epidemiology, Prevention and Control Section, Minnesota Department of Health Asa Schmit (asa.schmit@state.mn.us, phone: 651.201.5023) -- Minnesota Electronic Disease Surveillance System, Minnesota Department of Health

Date Received:
11/16/2011

**1.2 User Story Narrative **
Minnesota Department of Health (MDH) requires reporting of specified communicable diseases from healthcare providers, clinical and reference laboratories, medical examiners, and veterinarians. A subset of reportable diseases is reportable immediately by phone but the majority of pathogens/syndromes are reportable within one working day. Communicable disease reporting can be a time consuming process including the identification of reportable diseases, chart review (often to obtain patient contact and demographic information), completing case report forms and sending information to MDH. Once received by MDH, MDH staff must review the case report form and enter data into the Minnesota Electronic Disease Surveillance System (MEDSS).

**1.2.1 Goal **
The goal of the project was to develop automated disease reporting (ADR) in Minnesota by using technology to develop a system that would automate the identification of reportable communicable diseases from a combination of laboratory tests and results, the pull of data elements needed for communicable disease reporting from the patient’s electronic health record (EHR), and provide for the secure transmission of the report into MEDSS.

**1.2.2 Description of Data Reporting Events, Actors, and Triggers **
Many reportable communicable diseases are defined as a pathogen identified by laboratory methods and may only be reportable if identified as an infection at a specific site. For this reason, healthcare facility and reference laboratories are often the first to identify communicable diseases. There is also an additional subset of reportable communicable diseases that are clinically identified syndromes. In Minnesota, communicable disease reporting is often designated as the role of the infection preventionist (IP) to report for the entire facility or healthcare system. Communicable disease reporting includes basic information about the patient (demographics and contact information), provider (name, phone number and facility), laboratory (pathogen information and name and phone number of facility) and in certain situations treatment information (primarily for sexually transmitted diseases). All of this information resides in the patients electronic health record (EHR) and is generally available. And contact information is especially important because disease investigations generally require an interview with the patient or his/her proxy, contact information for the patient is vital for follow-up.

The burden and frequency of communicable disease report varies greatly on the size and population served of the facility, some facilities report infrequently (less than 20 cases per year) whereas others report thousands of cases to MDH each year. At the start of the ADR project, most facilities reported through abstracting information onto paper case report forms and either mailing or faxing information to MDH, some facilities reported through a web portal that required the IP to enter the data onto a website.

MEDSS is currently in the final stages of implementation at MDH. Prior to MEDSS, communicable disease reports were parsed out to disease-specific program areas and entered by MDH staff into disease-specific databases. With the initiation of MEDSS, disease reports are entered into one main person-centric system with disease-specific modules or events. Data in MEDSS can be access, as appropriate, by MDH and local public health staff.

ADR was implemented in one health system in Minnesota. To accomplish this task the health system identified 681 “tags” of laboratory test/result combinations identifying reportable conditions. Once tagged, case reports are automatically completed using data from the patient’s EHR. Reports were generated and transmitted daily electronically to MDH via a secure data transmission. IPs are able to view and update reports sent to MDH in MEDSS.

**1.2.3 Data **
The following data elements are included in our ADR transmission


 * **Data element ** || **Comment/more info ** ||
 * Sending facility name (name, ID, ID type) || ID is usually CLIA, but can be others as well. ||
 * Date message was generated from sending system ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Patient ID || <span style="font-family: 'Arial','sans-serif';">ID in the EHR ||
 * <span style="font-family: 'Arial','sans-serif';">Patient Name ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Alias ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Mothers maiden name ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Date of birth ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Birth order ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Patients Sex/Gender || <span style="font-family: 'Arial','sans-serif';">This information is coded using PHIN-VADS code system - Administrative sex (HL7) (its probably translated to this before sent to us) ||
 * <span style="font-family: 'Arial','sans-serif';">Patient address ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Patient address, county ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Patients phone number ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Patient Race || <span style="font-family: 'Arial','sans-serif';">This information is coded using our own standard – it’s translated to our codes by the facility before sent. ||
 * <span style="font-family: 'Arial','sans-serif';">Patients ethnicity || <span style="font-family: 'Arial','sans-serif';">This is coded and extracted by the facility from their race field. ||
 * <span style="font-family: 'Arial','sans-serif';">Patients primary language ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Patients marital status ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Pregnancy indicator (if the patient is pregnant) ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Patients death indicator ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Patients death date ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Emergency contact ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Emergency contact phone number ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Emergency contact address ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Attending provider name and phone number ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Hospitalization indicator || <span style="font-family: 'Arial','sans-serif';">Yes or No if the patient was hospitalized ||
 * <span style="font-family: 'Arial','sans-serif';">Hospitalization Admission date ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Hospitalization Discharge date ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Diagnosis name and STD specific diagnosis information ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test ordering provider name ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test ordering ID# ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test ordering provider location || <span style="font-family: 'Arial','sans-serif';">This field is used to identify the affiliation of the ordering provider ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test ordering provider call back phone# ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test ordering facility name ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test ordering facility address ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test ordering facility phone# ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test accession# (or specimen#) ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test specimen collection date ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test specimen source ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test name and code || <span style="font-family: 'Arial','sans-serif';">We do get some LOINC codes for the tests ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test result name and code || <span style="font-family: 'Arial','sans-serif';">We get local codes ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test result units ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test reference range ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test abnormal flags ||  ||
 * <span style="font-family: 'Arial','sans-serif';">Lab test result status ||  ||

<span style="font-family: 'Arial','sans-serif';">The files are sent in a modified HL7 2.5.1 message using the HL7 2.5.1 ELR reporting to public health message as a template. We added segments to the HL7 2.5.1 message for information not currently included in the ELR message (such as pregnancy indicator, admission date, diagnosis, and hospitalization status).

**<span style="font-family: 'Arial','sans-serif';">1.2.4. Other Information **
<span style="font-family: 'Arial','sans-serif';">The files from our ADR senders are sent using PHIN-MS or a sFTP transfer. We were planning on passing the messages through a HIE, however we decided not to do that initially. For the senders we currently have MDH is translating all incoming messages to our standard codes where applicable.

**<span style="font-family: 'Arial','sans-serif';">1.3 Stakeholder Commitment **
<span style="font-family: 'Arial','sans-serif';">MDH awarded a one-time grant of $83,500 to HealthPartners/Region’s Hospital develop ADR using their existing electronic health record (EHR) and laboratory information system (LIS). HealthPartners/Region’s Hospital was required to share their experience, process, and coding with MDH and other institutions. A multi-disciplinary team was formed including information technology (IT), LIS, microbiology, and IP staff from Facility A, and IT and epidemiology staff from MDH. Grant funds were used to support HealthPartners/Region’s staff time in development and for vendor contracts.

Supporting Files:

 * **Description** || **File** ||
 * This document contains the initial draft user story submission. || [[file:Initial Draft Submission - MDH Communicable Disease Reporting (ASTHO) User Story - November 16 2011.docx]] ||

Comments:
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