Detection System for Automated Disease Reporting Evaluated
A collaborative team including the Massachusetts Department of Public Health, Harvard Pilgrim Health Care, Atrius Health, and the Department of Ambulatory Care and Prevention at Harvard Medical School created a new system, the Electronic Support for Public Health (ESP). The system was designed to support capture of information to foster compliance with requirements for disease notifications and was described in the Morbidity and Mortality Weekly Report (MMWR), published by the CDC.
The ESP system was designed with an open architecture to support compatibility with most electronic medical record systems (EMRs). Information from patient visits to see clinicians was transferred to the ESP server on a daily basis, which simplifies analysis. Data was regularly evaluated for the presence of four different notifiable diseases: pelvic inflammatory disease, acute hepatitis A, chlamydia, and gonorrhea.
Reports were automatically generated with the ESP tool. This was compared to standard reporting completed by clinicians independently. The advantage of using EMRs is that all information required for reporting of notifiable diseases is already contained within the record flagged. This tool may function as a tool that can provide actionable, notifiable disease surveillance in a more complete, timely, and clinically detailed manner.
Reporting rates with the two different methods were essentially similar; though there was one chlamydia case that was not detected with ESP. The reports, however, completed with ESP were more complete and more often included treatment information and pregnancy status among female patients.
The investigation was secondary to the burden associated with completing surveillance activities and the shortcomings noted with use of electronic laboratory reporting. Improvements in reporting can inform public health spending by identifying high priority cases that may require additional intervention.
There are still limitations in the ESP system from a public health perspective, however. Data required to complete extensive epidemiologic investigation is generally not collected in EMRs. Nevertheless, decreased burden for clinical staff has clear benefits. Broad use of a system, such as described above, requires more widespread use of EMRs.
April 14, 2008 Related topics: Infectious Diseases, New Technology & Innovation, Trends, Partnerships & Consortia, Diagnostic